One aspect of survival of TBI that has not been discussed to any great extent in the literature is the degree to which survival following a serious injury may constitute an NDE. People who have been faced with an unavoidable outcome of death, but through some means have avoided this outcome, have reported NDEs (Stevenson & Greyson, 1979).
Each NDE is comprised of a set of unique and a set of common elements. The commonly described elements include: feeling "out" of the body, feeling of passing through a tunnel, entrance into an unearthly realm, meeting with other people or beings, seeing a light, and replaying of one's significant life events (Greyson & Stevenson, 1980). The experience is commonly reported to be profound and to have immense and life-changing effects (Parnia, Waller, Yeates, & Fenwick, 2001).
Numerous methodological difficulties surround the description of these events, including the lack of a standardized definition of the NDE phenomenon and agreement as to its exact nature (Kellehear, 1993); difficulties and inconsistencies associated with measurement and classification of the experience (Greyson, 1998); sampling of participants (Greyson, 2001); and the comprehensiveness of the possible data collection associated with the experience (Kelly, 2001).
Clearly the personality and beliefs of the individual who experiences an NDE significantly colour the nature of the experience and the way in which it is interpreted (Gabbard, Twemlow, & Jones, 1981). Similar to the experience of recalling dreams, distortions can quickly creep in and these are confounded and multiplied by retelling the story of the experience, quickly altering the original content (Gabbard et al., 1981). Various social psychological phenomena also apply to the description and interpretation of these experiences, including social desirability in shaping the recall of the event (Greyson et al., 1983), fear of rejection and ridicule, concerns regarding sanity, and the desire not to burden those around them (Hoffman, 1995).
Verifiability is also an important concern here. Owens, Cook, and Stevenson (1990) found that of the 58 patients they studied who reported NDEs, 30 of them (52%) were not near death at the time of their NDE and of these, 21 erroneously believed that that their death was imminent or had already occurred. Stevenson, Williams-Cook, and McClean-Rice (1989) reported a similar figure of 55% of their 107 NDE patients not close to death with some only having minor illnesses. It may well be that the expectation of dying rather than the actual risk of dying per se initiates the NDE, indicating the vulnerability of this effect to personal belief.
A further aspect of the NDE occurs when the individual in question survives the accident or event but a significant other involved does not. This situation, referred to as survivor guilt (McMillan, 1996), adds to the emotional burden of the surviving individual, possibly acting as a further focus for posttraumatic stress. McMillan (1996) noted that 4 individuals featured this symptom in the sample of 10 cases in whom PTSD had emerged following mild to severe closed head injuries. Two of these emerged because of NDEs in the accident (one in which the individual's child was involved in the accident and might have been killed, and the second in which passengers were injured while the individual was driving).
McMillan (1996) also noted that the patients reported a number of consistent themes relating to their distress: confrontation with death, realization of their own physical vulnerability, loss of control, and adjustment to the "amnesic gap" in their lives. McMillan raised the possibility of irrational survivor guilt. In a single case report of PTSD following a severe head injury, McMillan noted that the young woman in question, who had been a passenger in the vehicle driven by a friend, developed the irrational belief that she had somehow caused the accident or failed to prevent it.
While few TBI sufferers report NDEs, the issue is one that must at least be considered in the evaluation of the individual in the wake of what is clearly a life-threatening event, and the implications of this to that individual may have significant, long-term and life-changing effects (Martin & Kleiber, 2005).
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