Department of Psychology
University of the West of England
Bristol BS16 2JP
Published in Journal of Near Death Studies 1998,
Reproduced with permission of the publishers.
The role of anoxia in NDEs has been hotly debated.
Some argue that anoxia can induce NDEs; others that its effects are
quite different. Children suffering from reflex anoxic seizures (RAS)
have repeated brief cardiac arrests. A questionnaire about their experiences
was sent to members of the British RAS Support Group. 112 questionnaires
were completed and 7 children interviewed. Most recalled nothing from
their seizures but 24% reported some experience. A few were comparable
to NDEs, with tunnels, lights, and out-of-body experiences. The results
are reported and some cases described.
I wish to thank Mrs Trudie Lobban, co-ordinator
of the Reflex Anoxic Seizures Support Group, for her invaluable help
in sending out all the questionnaires and providing other useful information.
The possible role of cerebral anoxia in NDEs
has been appreciated since the early days of NDE research (Moody, 1977;
Osis and Haraldsson, 1977), and has been argued over ever since (Ring,
1980; Sabom, 1982; Morse, 1990).
On the one hand it is clear that anoxia plays
some role. The areas of the brain most closely associated with the organisation
of memory, such as the hippocampus and limbic system, are especially
sensitive to anoxia, as is the temporal lobe, whose stimulation is known
to give rise to memory flashbacks, floating and out-of-body sensations.
On the other hand, many NDErs are clearly not
suffering from cerebral anoxia at the time of their experience. There
has been much argument over one case in which blood gases were measured
at the time of an NDE and found to be normal (Sabom, 1982; Gliksman
and Kellehear, 1990) but in any case many NDEs are reported from people
who were suffering extreme shock or fear, or who expected to die but
were not suffering any immediate trauma. Clearly anoxia cannot be necessary
for an NDE.
I have argued that anoxia is just one of many
triggers which can induce cortical disinhibition - that is, a release
of the normal inhibition leading to excessive random firing of neurons.
Disinhibition is known to give rise to various kinds of hallucinations,
depending on which parts of the brain are involved (Siegel, 1980). My
suggestion is that all NDEs depend on cortical disinhibition, but this
can be caused by many different triggers - only one of which is anoxia
Part of the argument rests on whether anoxia
really does lead to NDE-like experiences. Some forms of anoxia, especially
the slow anoxia due to high altitude or slow poisoning with some gases
or with alcohol, produce states quite unlike NDEs. I have argued that
it is the faster onset anoxia which produces the necessary disinhibition
for an NDE-like experience to occur.
The most direct way to test this would be to
induce anoxia experimentally and ask the subject what it feels like.
This might be thought too dangerous and unethical, but in fact has been
done. Lempert, Bauer and Schmidt (1994) induced syncope (fainting due
to a sudden drop of blood pressure) in healthy adults by using hyperventilation
and Valsalva manoeuvre. This produced hallucinations similar to NDEs.
Also fighter pilots sometimes lose consciousness under very high gravitational
or acceleration forces and are trained in centrifuges to cope with it.
They sometimes report pleasant emotions and out-of-body experiences
but full-blown NDEs have not been reported (Whinnery, 1990). The present
research concerns another situation in which anoxia occurs repeatedly,
but is not life-threatening, that is reflex anoxic seizures (RAS).
RAS is most common in infants and young children
(and is also sometimes called white breath holding, vagal attack, Stephensons
Syndrome, blue breath holding or pallid infantile syncope). Children
suffering from RAS are often misdiagnosed as epileptic, and sometimes
given years of inappropriate and possibly damaging medication, although
the condition is now being increasingly recognised (Appleton, 1993;
A RAS is caused by a brief cardiac arrest which
results from excessive activation of the vagus nerve in response to
a sudden shock, pain or other surprise. RAS is most common in babies
and toddlers, and more common in girls (Stephenson, 1980). In a typical
episode the child suffers a shock. A few seconds later he or she will
stiffen, clench the jaw, possibly jerk once or twice and often become
deathly white. The eyes roll up into the head and there may be urinary
incontinence. Unconsciousness lasts for anything from a minute or two
to more than an hour. Sometimes the patient wakes briefly and then goes
into an unnaturally deep sleep for two or three hours.
There is no danger in RAS attacks themselves
and the child invariable recovers in due course. The only recommended
action is to put the patient into the recovery position and wait. However,
they are terrifying to watch and many parents and carers, quite naturally,
think their child is dead or dying. Some have tried resuscitation, which
can be dangerous. Management of the condition therefore mostly involves
reassuring the parents and teaching them how to care for the child during
an attack, rather than treating the child, although atropine is sometimes
used and a few children have been fitted with pacemakers.
In the media, RAS is often associated with
dying, in such headlines as "Mummy, Ive died again"
(Sunday Mirror, 24.4.94) and "The children who die
over five times a week" (Observer, 2.5.93), and descriptions of
"the boy who has died 300 times" (Grantham Journal,
26.11.93). Newspapers have reported cases of children seeing a bright
warm light, and having out-of-body experiences in which they can observe
the events from above. However, it is not known whether such experiences
are common in RAS sufferers and this study aimed to find out.
A questionnaire was distributed to all members
of the British Reflex Anoxic Seizure Support Group. This is run by the
mother of an RAS sufferer for the support of other families with RAS
sufferers. The questionnaire was sent out to the approximately 400 members
with their regular newsletter starting with the December 1993 issue.
Questionnaire collection ended in June 1995. Questions concerned the
sufferers age, age at first attack and at diagnosis, and a series
of possible experiences thought to be relevant to anoxia.
Seven children, aged between 7 and 13 years,
were interviewed at a conference of the RAS support group in October
1994. The youngest was interviewed with her mother; the others on their
own, though their parents were at the conference. The questions followed
the structure of the questionnaire and then I added open-ended questions
about their experience of RAS attacks. Interviews were tape recorded
and later transcribed.
112 questionnaires were completed. A further
15 questionnaires were received well after the deadline and, though
they could not be included in the analysis, comments from some them
have been included where appropriate.
Only three of the children were old enough
to complete the questionnaire themselves. 93% were completed by the
childs mother and 4% by their father. 57% were female. The mean
age of the childs first attack was 16 months, though two reported
very early first attacks, one "at birth", the other at half
an hour after birth. The oldest reported first attack was at age 14.
The frequency of attacks was highly variable but many reported weekly
or even daily attacks.
An open ended question asked parents to describe
in as much detail as they could anything that their child has told them
about how he or she feels before, during or after an attack. 33% wrote
nothing. Many said their child was too young to say anything. Most of
the other comments concerned how the attacks appeared to the parents.
Several noted that their child became very clingy and wanted to be cuddled
for some time after an attack. Many slept for a long time afterwards,
waking up having apparently forgotten all about it. Some noted that
the child seemed to remember the cause of the attack - such as who bumped
them or what surprised them, but not the attack itself. A few parents
mentioned that the child looked terrified in the moments before passing
out. Some felt sick. Two noted that their children suffered from sleep
disturbances or night terrors after attacks.
Yes/no answers were requested concerning 12
possible experiences which have been reported in NDEs and other types
of anoxia. The percentages answering yes are shown in Table
1. Most people (76%) did not report any of the experiences. Among the
26 (24%) who did report them, the number of experiences ranged from
1 to 11.
Flashes of light
Smells or tastes
Other regular patterns
Sensations of floating or flying
Feeling as though they are leaving the body
Distortions of the body image
Visions of other places
Meetings with people (real or imaginary)
Memories of events from the past
Table 1. Percentage of reported experiences
during RAS (n = 112).
When additional descriptions were given, the
lights included a pink haze and blurred vision. A 7 year old girl reported
"spots of colours, red, blue, black and yellow, mostly black. Also
patterns" and enclosed a drawing of the coloured streaks.
Sounds included a fuzzy noise, a crackly noise,
echoes and high pitched screaming. A 25 year old woman who had her first
attack at age 14, said that she recalls nothing from the attacks but
hearing her own terrified scream on waking - only her husband says she
does not actually scream.
Only 5 respondents claimed to have felt as
though they were leaving the body and most did not elaborate. One mother
replied for her 6 year old daughter, but added that she also had RAS
as a child. "I used to lie in bed asleep and feel as though Id
left my body and floated to the ceiling. Id then wake up startled
to find myself still in the bed with no covers moved. This has always
baffled me but it hasnt happened since I was approx 14 years old".
Although 9 respondents reported meetings with
people, few made any further comment. One said that an imaginary person
visits. Another mentioned people from earlier in the childs life.
However, there were no descriptions of beings of light, of angels, of
deceased friends or pets, or of any of the beautiful and inspiring scenes
reported in some childhood NDEs (see e.g. Morse, 1980, Atwater, 1996).
The largest number of experiences (11) were
reported by Alan (not his real name), a 9 year-old boy who had his first
attack at age 2 and subsequent attacks daily or weekly. He was initially
diagnosed as epileptic and had many years of inappropriate medication
until he was finally diagnosed as having RAS and fitted with a pacemaker.
Both his parents recall having OBEs at school during illness or injury.
His mother has had several OBEs and two NDEs since childhood, one during
In discussion and correspondence with his mother
I learned that before an attack he feels dizzy with a throbbing head-ache
like being hit by a hammer. He then frequently goes into a dark tunnel
and is hurtled towards a light. On one recent occasion he was simply
walking from the bathroom when he found himself already in the tunnel
with the light coming towards him. The tunnel is clearly very frightening
and unpleasant and he dreads it, but the "white light is nice -
like a Christmas light".
He also reports distortions of his own body
image and of other people. For example, at the start of an attack "people
around me go into the distance". On waking the voices around him
are much louder. He says "When I come out of the horrid tunnel
everyone is much bigger and louder - I feel smaller than when I went
He reports hearing whistling sounds, seeing
patterns like snakeskin and seeing people from past periods in his life
- "Theyre on the other side of the wall" he added. He
also reports floating, and in response to the question "(has your
child ever reported....) feeling as though they are leaving the body",
he responded "definitely".
Alans first OBE occurred when he was
two and fell down stairs. He recalls seeing himself lying on the floor
at the bottom of the stairs and going into a convulsion. Later he described
an OBE at school after a bump on the head "I saw the children standing
over me after I had one of my black-and-white dreams." His parents
describe his worst attack as the one that occurred while walking from
the bathroom. He had no pulse for at least a minute and a half and was
dark blue. Alan later reported that he had been watching them and his
sister from above as they leaned over him.
On one occasion he had an attack during a blood
test. This is confirmed by the ECG record which shows several seconds
without a heart beat at the time of the blood test. Alan later said
that he watched the doctor put in the needle, and the nurse move his
teddy. "I saw her lift my legs" he said.
As far as I know this is the only case of a
child having an OBE during a monitored cardiac arrest. However, it cannot
help resolve questions about the nature of that OBE. It is quite possible
either that something actually did leave the body and observe the scene
from above, or that the OBE was the brains reconstruction of events
from a birds eye view based on the sensations of the needle and
the sounds of activity around.
I should say that moving a teddy does not make
a lot of noise! Indeed Alans mother says "I dont recall
the nurse making a sound, either when moving Big Ted or
assisting the doctor. She literally grabbed the bear and cast him aside.
(He) slid across the polished floor and came to rest under the bed".
But I wish we had an independent record of what happened and of Alans
description of events. Without these this anecdote simply adds to the
many others which imply out-of-body vision but do not provide reliable
evidence for it.
Alan has since been fitted with a pacemaker
and is able to lead an active life and play sports. He says that his
deja-vu experiences have become less frequent. In a way he misses the
OBEs but does not miss the collapses, the dreaded tunnels or the black-and-white
7 children were interviewed informally at an
RAS conference. Angela (not her real name) was a 7 year-old girl interviewed
with her mother. She told me that normally she experienced nothing during
her "little sleeps". "You dont know anything for
that minute, youre just lying there for that minute not doing
anything, not moving, not breathing, not nothing... then I come like
wake up and then I start again." Interestingly, she said that sometimes
she did remember what it was like, and that it was nice (or lucky) to
remember. For example, on one occasion when she fell off the kitchen
work surface, she told her mother it was nice at the time, and later
explained it to me. "Its all quiet and silent and really
funny ... it stops you from being hurt." She added "Youre
not hurt when youre having it at all ... but you are when it stops
I asked Angela whether shed ever seen
a tunnel or any funny lights. She answered "Well, no, not really
... thats what Ive been told by Grandma when you die."
We went on to discuss what dying might be like and she added "But
you can never know if thats exactly what actually happens when
you really die, when you quite die, cos you dont know whats
down the tunnel, unless they wrote a letter ... but unless the angels
may have brought it." This conversation added to my impression
that many children have far deeper and more insightful thoughts about
death than adults give them credit for.
Some children described the feeling of being
aware of what was going on around them but being unable to speak or
communicate in any way. A 9-year old girl told me "When my Mummy
and Daddy talk to me when Im dead, I can hear them."
This is reminiscent not only of NDEs (in which
people are often frustrated by trying in vain to communicate with doctors
or nurses) but of OBEs occurring in many traditions and cultures (Blackmore,
1993). The same thing is also reported by pilots in high-gravity training.
One 13 year-old girl told me that everything begins by feeling "all
echoey and far away", then during the attack itself "Sometimes
I cant hear anything and other times I can. And when I cant
hear anything I get scared. And people have to hold my hand. "
When I asked her how they knew she was scared she explained the communication
system that she and her mother had developed. During attacks she can
only move her fingers. So she moves one finger to show she is scared,
another to show she is too cold, another for too hot and a fourth to
show she is about to wake up. She said that she can be out
for anything from 2 minutes to two and a half hours. I asked "When
its two and a half hours, does it seem like that long" "Longer"
The questionnaires and interviews provide a
general picture of what it is like to have RAS. While many of the children
were too young to describe their experiences, and even many older ones
remember little or nothing, those few who do remember report experiences
much like those associated with other types of anoxia and with NDEs,
that is, tunnels, lights, out-of-body experiences, distortions of body
image and of sounds and other people. However, they do not report very
positive emotions, meetings with beings of light, or the beautiful places
and scenes which are so frequently reported in NDEs.
Transformations of personality, and various
other after-effects of NDEs, are often reported in the literature but
it was not appropriate to investigate this here. Not only the childs
life, but the whole familys life, can be severely disrupted by
having RAS and therefore any effects of the experiences themselves could
not be separated out.
Within the limitations of this study, these
results show that transient, non-life-threatening anoxia can sometimes
induce NDE-like experiences, but these are not like typical NDEs in
all respects. I hope these results will add to our understanding of
the role of anoxia in NDEs.
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