Dying and the Near-Death
Experience
Dusana Rybarova
Chapter 3
2007 Psyc 456
PTSD revisited
 Most clinicians agree that victims of PTSD should face the original
trauma to be able to cope with the debilitating effects of the disorder
 Exposure Therapy Helps PTSD Victims Overcome Trauma's
Debilitating Effects
– In the 1980’s, Dr. Terence M. Keane and his colleagues found that
exposure therapy was effective in treating the PTSD symptoms of
Vietnam War veterans. Exposure therapy, previously known as imaginal
flooding therapy, involves carefully exposing the patient to prolonged and
repeated imagined images of the trauma until the images no longer cause
severe anxiety. In Keane’s randomized clinical trial involving 24 Vietnam
veterans, Keane found that exposure therapy was effective in reducing
many of the veteran’s PTSD symptoms, including nightmares, flashbacks,
memory and concentration problems, and irritability.
http://www.psychologymatters.org/keane.html
 For more on efficacy of psychological treatments for PTSD check
– http://www.nimh.nih.gov/publicat/reliving.cfm
– http://www.ncptsd.va.gov/ncmain/ncdocs/fact_shts/fs_treatmentforptsd.html
Kubler-Ross’ Stage Model of Dying
 Pioneered research with the dying in 1960s
– Difficulty in access to dying patients hindered by
physicians
– Patients were usually surprised, amazed, and grateful;
relieved to share their last concerns and expressing
their feelings
– Interviewed 400 dying persons over a 10 year period
 Her work resulted in a book
– On Death and Dying (1969) usual stages of dying
Stages of dying according to
Kubler-Ross
 Shock/Denial
– Numbness, shock, withdrawal and cognitive denial
– Can take from few seconds to few months
– 1% of terminally ill people stay in that stage
 Anger
– Envy and resentment of those whose lives will continue
– Anger can be expressed towards everyone they
encounter in various forms such as complaints
– Important to see the dying person as a unique human
being engaged in the process of grieving rather than
somebody who is threatening or just a ‘patient’
Stages of dying according to
Kubler-Ross
 Bargaining
– Making promises (usually towards spiritual figures) in
exchange to more time to live
– It is natural and healthy way to cope with the reality of
approaching death
 Depression
– Acute depression, the dying regrets past failures and
mistakes that can not be corrected
– Grief about the lost time
– Recognition of approaching death
Stages of dying according to
Kubler-Ross
 Acceptance
– Without anger or depression
– ‘it’s my time now, and it’s all right’ without defeat or
disappointment
– In our culture the dying person is often drowsy,
withdrawn, drugged, and asleep much of the time
– Often does not like to engage in conversation
– But, it is important to show that others care through
physical presence
– The dying often realizes our connectedness to all
living/dying beings
Stages of dying according to KublerRoss – Advantages and Criticism
 Positive aspects
– Focus on humane treatment of the dying and their needs
– Encourages the caregivers to view the world through the
eyes of the dying
– Learning from the dying about ourselves, our values and
our own search for values
 Critique
– Lack of empirical support in scientific literature
– Restrictive nature of the stages
– Problem with the way it was applied by healthcare
professionals – annoyance if the dying people do not
move neatly through the expected stages
Pattison’s Phase Model
 Based on his book The Experience of Dying
(1977)
 Lists three phases of dying to assist clinical
practice – not meant to be viewed as
inevitable
– The acute phase
– The chronic living/dying phase
– Terminal phase
Pattison’s Phase Model
 The Acute Phase
– Corresponds to Kubler-Ross’ denial, anger, and
bargaining stages
– Rising anxiety can result in frozen fear – the
person can not function
– For caregivers
 Emphasizing reality issues connected to dying
 Providing emotional support throughout the process
Pattison’s Phase Model

The Chronic Living/Dying Phase
– Confrontation of fears surrounding dying and death
1. Fear of abandonment
- ranked as number one fear of the dying
- dying without loved ones
- may include fear of loneliness, fear of social death,
fear of loss of family and friends
2. Fear of loss of self control
- sense of dependency on others
- feeling ugly and unacceptable
- important to keep sense of power and authority over
day-to-day lives
Pattison’s Phase Model
3. Fear of suffering and pain
- 50% of dying patients in American hospitals report
moderate to sever pain during their final days
- helps to reframe attitudes to view the pain as part of
the disease process not punishment or abandonment
4. Fear of loss of personal identity
- loss of loved ones, body functions, consciousness,
and control over life as a threat to the self
- important to keep in touch and maintain contact with
work and community whenever possible
Pattison’s Phase Model
5. Fear of the Unknown
- questions about afterlife – spiritual crisis
in some cases
- what will happen to his/her family
6. Fear regression into Self
- facing the experience of entering ‘… into a
primordial sense of being where there is no
awareness of time or space or boundaries
between self and others..’ (Pattison, 1977:55)
-dying person may fight against the regression
resulting in so-called death-agonies
Pattison’s Phase Model
 Terminal phase
– Realizing that death is not going to go away
– Social death
 Physical separation from loved ones and community
– Psychological death
 Regress deep into self by way of various states of
consciousness (sleep, dream, coma)
– Biological death
 Vegetative stage – no intentional (purposeful) activity
– Physiological death
 Vital organs stop operating
Humanistic psychologists such as Maslow were first
to acknowledge higher needs - need for love, selffulfillment, aesthetic and spiritual needs
http://chiron.valdosta.edu/whuitt/col/regsys/maslow.html
Corr’s Task-based Coping Model
 Charles Corr (1992) – coping model of
active participation in living our dying
– Physical needs
 Communicating needs such as pain control, nutrition,
hydration, sleep pattern to family and medical staff
– Psychological needs
 Needs of psychological security, autonomy, richness
 As identified by caregivers healthy death was
associated with approaching death with seriousness
as well as humor, reviewing past, exploring afterlife,
discussing practicalities of dying with others etc.
Corr’s Task-based Coping Model
– Social needs
 Sustaining and enhancing relationships that we value
 Finishing unfinished business
 Deciding who to spend the terminal phase of life with
– Spiritual needs
 Seeking source of spiritual nurturance and meaning
 Three principal spiritual tasks for the dying
– The need to find meaning in or the ultimate significance of
life
– The need to die an appropriate death (appropriate with
respect to our values, and spiritual beliefs)
– The need to transcend death (reassurance of immortality or
continuity of future generations)
Final moments
Sleep/Death analogies
 Regression into self (Pattison, 1977)
– The state of consciousness we experience just before
we fall to sleep each night, or just before we are awake
 Hypnagogic state of consciousness – altered state
of consciousness between wakefulness and sleep
 Greeks talk about similarities between death
(thanatos) and sleep (hypnos)
 Sogyal Rinpoche (1992:344)
‘The senses and grosser layers of consciousness
dissolve… Next, there is a dimension of consciousness
which is so subtle we are normally completely unaware
of its very existence…’
Near-death Experiences
 Near-death experience (NDEs)
– Individuals at the edge of permanent death are revived
 Raymond Moody (1975) pioneered work on NDE
 Survivors describe death as unpleasant at first, but
upon ‘letting go’ they report experiences of great
joy
– Travel through darkness, then trough a tunnel filled with
bright light;
– afterwards the mind emerges into the bright light, often
accompanied by beings of light;
– reports of ‘life reviews’
 Research shows that NDEs occur in other cultures
as well http://www.nderf.org/
Dimensions of the Near-Death
Experience
 Hyperalertness dimension
– Higher levels of attention
– Thoughts and images become sharper and
speeded up
– Visions become highly intense
 Depersonalization dimension
– Experience of lacking personal identity
– Sense of detachment
– Loss of ability to keep track of time
Dimensions of the Near-Death
Experience
 Out-of-body dimension
– Awareness of what is happening to the body with
accompanying feeling of being separate from it
– Floating above the body while others are trying to revive
it
– Viewing body as watching a movie, detachment
– NDE survivors reporting information they could not have
found out about through guesswork or prior knowledge
 Mystical dimension
– Transcendence, leaving earthly dimension
– Encounters with mystical beings or invisible spirits
– Harmony, revelation, unity, joy
The Death-as-Door Thesis
 The spiritual view
 Awakening of latent spiritual energy such as holy
spirit, vital winds, chi, tumo or kundalini which can
lead to the experience of enlightenment or
illumination
 Across spiritual traditions
– Death leading to resurrection and everlasting life
– Hindi – reincarnation
– Tibetan Buddhist – door into bardo (state in between, in
this case between death and future rebirth)
The Death-as-Wall Thesis
 The scientific view
 NDE as strong reactions of the nervoussystem enabling us to adapt to dangerous
circumstances
– Not everyone experiences NDEs or ‘dies’
blissful, accepting death
– The NDE can occur in situations not related to
death
– We hear reports of NDE only from the survivors
The near-death event as a major life
transition
 Impact of NDE on the survivors:
– Reduction in death anxiety
– Focus on here and now rather than preoccupation with
death
– Sense of relative invulnerability
– Strong belief in continued existence
– Significant shift towards spirituality
– Changes in values, priorities towards love and caring of
others
– New interests in caring aspects of human relationships