DSM-IV Religious and Spiritual Problems

The NDE is a clearly identifiable psychological phenomenon that includes:

A characteristic temporal sequence of stages
peace and contentment
detachment from physical body
entering a transitional region of darkness
seeing a brilliant light
passing through the light into another realm of existence

A cluster of subjective components
strong positive affect
dissociation from the physical body
transcendental or mystical elements

The person often feels unconditionally accepted and forgiven by a loving source. Life review is also common, and the person returns with a mission or "vision," believing that there is still more to be done in this life.

Modern medical technology has resulted in many persons experiencing NDEs. Near-death experiences are reported by 35% of individuals who come close to death. Gallup Polls estimates that about 5% of the adult American population, approximately 13 million American adults, have had a NDE with at least some of the features described above, making it a clinically significant and pervasive phenomenon. (See The International Association for Near-Death Studies)

NDE and Psychopathology
In the proposal to the Task Force on DSM-IV for the new diagnostic category, Religious or Spiritual Problem, the NDE was used as an example of a spiritual problem that warrants clinical attention, but is not a mental disorder. The non-pathological nature of the NDE is documented by the growing literature on its after-effects — in particular, the positive attitude and value changes, the personality transformation, and spiritual development that often follow such an experience.

The typical near-death survivor emerges from his experience with a heightened sense of appreciation for life, determined to live life to the fullest. He has a sense of being reborn and a renewed sense of individual purpose in living. . .He is more reflective and seeks to learn more about this core experience. He feels himself to be a stronger, more self-confident person and adjusts more easily to the vicissitudes of life. The things that he values are love and service to others; material comforts are no longer so important. He becomes more compassionate toward others, more able to accept them unconditionally. He has achieved a sense of what is important in life and strives to live in accordance with his understanding of what matters. (Kenneth Ring, Heading Toward Omega: In Search of the Meaning of the Near-Death Experience p. 157-8)

Kenneth Ring, PhD has conducted studies on NDE on which this summary is based. His research found these changes occur within 5 years and are stable over time. (See After-effects of Near-death States for a review of the extensive research documenting psychological and physiological changes.)

Charles Tart, PhD posits that the experience of existing in some form that seems partially or fully independent of the physical body (as occurs in NDE and other altered states of consciousness) constitutes the most direct knowledge of survival an individual may have. While not the subject of this course, NDEs present profound challenges for the study of consciousness and reveal issues of deep significance for the life of the individual and for humankind in general.

Associated Clinical Problems
Despite generally positive outcomes, significant intrapsychic and interpersonal difficulties frequently arise in the wake of an NDE.

Intrapsychic problems associated with NDE include:

anger or depression related to losing the near-death state
difficulty reconciling the NDE with previous religious beliefs, values or lifestyle
becoming overly identified with the experience
the fear that the NDE might indicate mental instability

Interpersonal problems associated with NDE include:

difficulty reconciling attitudinal changes with the expectations of family and friends
a sense of isolation from those who have not had a similar experience;
a fear of ridicule or rejection from others
difficulty communicating the meaning and impact of the NDE
difficulty maintaining previous life roles that no longer carry the same significance
difficulty reconciling limited human relationships with the unconditional relationships experienced during the NDE
(Greyson B, The near-death experience as a focus of clinical attention)

Some NDEs become very distressing and meet the criteria for DSM-IV Adjustment Disorder. (Greyson B, Bush NE, Distressing near-death experiences)

In the immediate aftermath of an NDE, many individuals struggle with a fear of mental instability and/or a fear of rejection and ridicule by family and friends. One person reported, "I've lived with this thing [NDE] for three years and I haven't told anyone because I don't want them to put the straight jacket on me."Another found that, "After this happened to me [an NDE], and I tried to tell people, they just automatically labeled me as crazy" (Raymond Moody Life After Life: The Investigation of a Phenomenon — Survival of Bodily Death, p. 86). Many individuals did not discuss the NDE with friends or professionals for fear of being rejected, ridiculed, or regarded as psychotic or hysterical.

In addition, individuals who shared their experiences with professionals have often received negative reactions. Raymond Moody cited these examples: One woman stated, "I tried to tell my minister, but he told me I had been hallucinating, so I shut up" (p. 86). A surgical patient recounted that, "I tried to tell my nurses what had happened when I woke up, but they told me not to talk about it, that I was just imagining things" (p 87). Life After Life: The Investigation of a Phenomenon — Survival of Bodily Death,

Long term adjustment to a near-death experience can also present problems. Greyson [1] described such a case:

A 24 year-old graduate student in geology had a near-death experience during a near-drowning when he was 17. In the intervening 7 years, he experienced some unusual psychological phenomena that eventually prompted him to seek treatment. His NDE included a life review involving many events from his childhood along with several scenes that he could not recognize. After a few of these scenes came to pass exactly as they had appeared in his life review, he became concerned about some very painful scenes that had not yet happened and which he felt were destined to happen someday. He sought counseling for his anxiety about these seemingly inevitable events and his despair at losing control over his fate.

In this case, the client's psychological conflicts were not attributable to a mental disorder, but were rather a longer-term manifestation of the psychological upheaval surrounding his earlier NDE. The issue of the meaning of the patient's clairvoyance (seeing into the future) raised questions for the patient about his values ("losing control over his fate"), thus warranting a Religious or Spiritual Problem diagnosis.

Treatment
Spiritual experiences that occur during an NDE are often a prominent issue in therapy. Yet prior religious beliefs do not affect either the likelihood or the depth of the near-death experience.  An atheist is as likely to have a life-changing NDE as a devoutly religious person.

Fortunately, the many published scientific articles and first person accounts have resulted in greater sensitivity to these experiences. NDEs are recognized as fairly common occurrences in modern ICUs, as is the need to differentiate between NDEs and ICU psychoses (which do occur often as a side-effect of aggressive treatments) . With this increased awareness, ICUs are less likely to "treat" NDEs with antipsychotic medication. Bruce Greyson, MD, expects that this clinical problem will be given greater attention in the future:

The inclusion of this new diagnostic category in the DSM-IV permits differentiation of NDEs and similar experiences from mental disorders and may lead to research into more effective treatment strategies. (The near-death experience as a focus of clinical attention, p. 327)

Therapists working with persons who have had an NDE can utilize the interventions described in Lesson 6.

Case Examples
The International Association for Near-Death Studies site contains many case examples of NDEs, including one entitled My Spiritual Enlightenment.

WWW LIBRARY on Religion and Spirituality
The WWW Library on Spirituality and Religion contains summaries of scientific findings on the aftereffects of NDEs, religious beliefs concerning death and afterlife, and interpretations of NDEs by different religious groups. Also personal accounts and NDE organizations. 

References
1 Greyson, B. and Harris, B. (1987). Clinical approaches to the near-death experience, Journal of Near-Death Studies, 6(1), 41-52.

REQUIRED QUIZ ITEM 14 Medical Technology Which of the following types of spiritual problems is occurring more frequently due to advances in medical technology. a) UFO abduction b) Kundalini c) NDE d) Psychic Experiences Record your answer for later insertion into the Quiz.

 

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