February 27, 2013

Raising An Issue in Indian Psychology

A recent literature search threw up an interesting-looking paper; a randomised controlled trial (RCT) on the effect of yoga on gunas (personality) in healthy volunteers (free to read). I was surprised as I rarely come across academic papers on yoga, that too with explicit reference to 'gunas' in the title. . I couldn’t help noticing at the outset that the study appeared to have been carried out at the Department of Yoga Research, Swami Vivekananda Anusandhana Samsthana, a deemed-to-be yoga university. The study was also published in the International Journal of Yoga, which appears to be the university’s own journal publication. So there is plenty of scope for bias to creep in.

Despite that RCTs are the 'gold standard' of psychological research when done properly, the stated aims of this paper didn't exactly fill me with confidence. The study itself wasn't what interested me, but rather one of the tools that the researchers used to assess the participants' personalities. In psychology, personality is assessed using specific scales or questionnaires that have been designed to measure a particular construct, say, anxiety or depression. The Beck Depression Inventory is probably the best known and widely used example of a scale to measure depression, and you can find information about other scales at Wikipedia.

An important concept in the construction of such scales is known as construct validity, the ability of the scale to measure what it is supposed to measure. Using the BDI as an example, can it be that a set of questions is capable of measuring the presence and intensity of depression in a person? All other things being equal, the answer is that it is probably the most reliable tool we have for measuring depression at the moment and that it has been consistently used in a number of different medical fields. Much research has been done in the field of personality psychology in an attempt to construct a real-term workable scale with which to assess personality. Many scales exist, but generally speaking researchers have come to agree that personality can be defined in terms of the "Big 5" factors: Neuroticism, Extraversion, Agreeableness, Conscientiousness and Psychopathy, and that all of our personalities can be measured in different ratings of these. The Reliability of such scales is another important issue that also means something different to the popular sense of the word, and we'll get to that at some point.

For this study the research team wanted to analyse the effects of a yoga course on personality and self-esteem, and they measured these with Karunanidhi's Self-Esteem Inventory (1996) and, wait for it, the Gita Inventory of Personality (Das, 1991). According to this paper, the GIP (referred to as GIN within the paper) was to measure three dimensions of personality: Sattva, Rajas and Tamas.

There is reason to suspect that, at least in the case of the GIP, something mischievous is afoot in the name of psychology. The Gita referred to is of course the Bhagavad-Gita, a Hindu scripture (traditionally believed to be 5000 years old), and the three personality dimensions being assessed are described in the 14th chapter of the text. I'm aware of issues of sensitivity surrounding cross-cultural research in psychology, the importance of accepting cultural boundaries, and so on. If you were to rely on Wikipedia, cross-cultural psychiatry (or transcultural psychiatry) is that which is "concerned with the cultural and ethnic context of mental disorders and psychiatric services".

I have to wonder, though, are cases like this something that ought to be a concern or to be praised? On one hand we have here a different outlook on personality that is independent of Western-oriented psychology, but on the other we have to wonder about the appropriateness of assessing people's individual personality traits on the basis of definitions provided in an antiquated religious text. Psychological research is frequently slighted or condemned (depending on who you listen to) as being overly WEIRD - analysing and assessing people that are dominantly Western, Educated, Industrialised, Rich, and Democratic, and that is a fair criticism in context. In general, the field is crying out for fresh perspectives.

However, it remains unclear if ethnically contextual research from the other end of the spectrum will be able to provide new insight into the field of personality psychology if little to no effort is made to work collegially, and using similar standards of measurement with which to assess people and carry out much needed research.

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Deshpande S., Nagendra H.R. & Nagarathna R. (2009). A randomized control trial of the effect of yoga on Gunas (personality) and Self esteem in normal healthy volunteers., International Journal of Yoga, 2 (1) 13-21. PMID:

February 15, 2013

Before We Hear Of 'Neuropuncture' In The Commons

Late last month, it was announced that David Tredinnick MP had been appointed to the House of Commons Science and Technology Committee. The Times rightly described the collective gasp of despair and arms exasperatedly thrown in the air by British scientists in response to this news.

For Tredinnick is known to believe in and advocate for a variety of peculiar beliefs relating to superstition and alternative medicine. Namely, that biological mechanisms behind blood clotting - as well as pregnancy and hangovers - were dependent on the phase of the moon. He is also an avid believer in homeopathy and acupuncture, suggesting that they should be provided by the NHS in spite of extremely little evidence of medical efficacy.

In a recent Q&A he was provided the opportunity to clarify his position on these and other issues, but instead used the occasion to confirm his views defiantly. This part caught my eye; in response to what Tredinnick thinks the STC should look at:

"Looking at healthcare, one of the mysteries of Western medicine is acupuncture. And there’s a lot of criticism of it saying it doesn’t work. But I’ve used Chinese medicine for years, and I cannot work out why this isn’t more widely used in the health service. The same for herbal medicine, we need to get back to some natural remedies that have stood the tests of time."

Although he didn't specificy what for, presumably Tredinnick suggests that acupuncture may have some application for psychotherapeutic strategies and neurological conditions too? In which case, I need only point to James Coyne's two-part sparkling rebuttal to claims that acupuncture may have any special efficacy for mental health conditions such as depression. And as for the neuroscience (the more research-minded can enjoy this 2007 review), I recently acquired an online copy of Val Hopwood & Clare Donnellan's Acupuncture in Neurological Conditions (2010), and it's a very interesting read. Especially this amazingly revealing little tidbit listed as a 'key point' of Chapter 1:

"The concept of ‘neurology’ is a relatively modern one, with no real place in traditional Chinese medicine (TCM). This is only partly because there is no historical concept of the ‘brain’ in TCM physiology. There have been many schools of Chinese medicine: some included ideas that we would recognize as ‘neurology’, whereas others did not."

Y'know, when something this damning is admitted in the first chapter, it may be time to give up and put the book down and realise that you're not going to get very far with this. And if the House of Commons actually plan to consider these things, it can only be a colossal waste of time, energy and resources. What to speak of the possibility of garnering dubious expenses.

February 13, 2013

Terminator Vision: I Can Haz It?

You've all seen The Terminator film and it's sequels and, admit it, you loved them. Not just because of the creepy futurealistic storyline but because of the stunts, the camerawork, the casting, and the sheer action of it all. And, of course, the special effects. As an example of the best sci-fi films out there, the Terminator films franchise has grossed nearly $1.5 billion worldwide. Some of the iconic scenes in the movies related directly to the Terminator itself, that ice-cold stare as a mistaken victim was brutally gunned down in pursuit of the target. But what was it about that scary stare? Surely it was the gleaming infrared light in the robotic eyeball that was shielded most of the time by the humanlike exterior. That infrared light enabled the Terminator itself to view its own surroundings:

Composite image. Credits: odysseyart.net and Orion Pictures
 In the emerging field of neuroprosthetics, the most well-known examples of the technology are cochlear implants for the deaf and retinal implants for the blind. Generally speaking, they work by receiving auditory and visual signals and then transmit them to the relevant brain areas after being transformed into electrical impulses. Obviously, these tools are extremely useful in restoring hearing/vision functions to those who weren't born with them or who have lost them due to injury. In some cases, depending on the nature and extent of the absence/injury, it may be necessary to augment rather than restore the functions fully.

Now a new study by researchers at Duke University suggests that 'Terminator Vision' could one day be a reality for some, after successful experiments on rats found increased learning and perception skills when prosthetics were fitted into their brains. Eric Thomsen, Rafael Carra and Miguel Nicolelis trained a cohort of six rats on a simple visual discrimination task: Rats were placed in a circular chamber that had three reward ports. On each trial, a visible LED was activated in a particular port and rats who poked their noses in the correct port were rewarded with a drink of water. After three weeks of training, the rats managed to be 70% correct on average. They were then fitted with an infrared detector as well as implants into the whisker region of the S1 cortex, a touch-sensitive area of the parietal lobe which is largely responsible for spatial navigation.

Bearing in mind that rats are normally blind to infrared light (as are we), it would be worth putting them back into the chamber to see if they could perform the task as well as before. As for how it works: The IR detector transmits electrical impulses directly into the rats' S1 cortex if the rat moved towards the infrared light, which were increased as the rats moved closer or oriented their heads in the light's direction. And here's where it gets interesting: Not only did the rats perform better on the task as before by finding the infrared lights with greater accuracy, but other interesting behaviour was noticed too. Namely, "they learned to actively forage through the behaviour chamber, sweeping the IR sensor on their heads back and forth to sample their IR world".

Read that again: They learned to incorporate their new IR vision relatively quickly into their normal sensory range as a type of "IR vision". And they did this by taking the time to re-orient themselves and make sense of their surroundings. They didn't immediately associate the new stimulation with the task but just assumed it was "something new" for them, scratching their faces in response to the electrical microstimulation. Isn't that awesome?!

It is possible that criticism of this study may cite 'training effects', that the rats had an idea of what to do in the experimental condition because of their previous training with the LED light. But this can be rebutted by how the rats learned to navigate their way with normally invisible infrared light purely by their movement and guidance, what to speak of more additional difficulty layers being added to the original task which were relatively aced by the rats (above 93%) in the IR condition.

In conclusion, the researchers felt that the rats learned to treat microstimulation as an external stimulus originating in the surrounding environment rather than within their body, which is an interesting finding that reflects the understanding of vision in humans too. Even though we have innate eyeballs that look 'out', vision occurs by light entering 'into' the eye. So even though the rats' brains were being stimulated in (correct) response to invisible infrared light, they appeared to act as if the light was shining at them in order to attract them. It was beyond the scope of this study, however, to determine if the rats thought of microstimulation as a separate sense, although the researchers suggest that a potential application of this technology could be in developing motor neuroprostheses - artificial(?) limbs that would be improved in terms of reaction times and accuracy because of the closed-loop bidirectional interaction that the technology can offer.

And of course, a plethora of possibilities that offer the curious possibility of sensory augmentation, the potential to expand sensory range to see forms of light that are normally invisible to human eyes. So it is entirely possible for Terminator Vision to emerge one day.

UPDATE Feb 13th: Coverage of this paper at Scientific American has fallen into the trap of describing the augmented vision as a "sixth sense", oddly proclaiming it as a seventh sense too. Minor but amusing errors.

UPDATE Feb 14th: Wow, now BBC coverage has also fallen into the "sixth sense" trap. Makes you wonder as to who has actually read the paper.

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Thomson E.E., Carra R. & Nicolelis M.A.L. (2013). Perceiving invisible light through a somatosensory cortical prosthesis, Nature Communications, 4 1482. DOI:

January 18, 2013

Primitive Physick - John Wesley

Christian theologian and cleric, John Wesley (1703-1791), who is credited with founding the Methodist denomination of Christianity, and due to whose teachings the Methodists were leading activists in the social issues of their day such as prison reform and abolitionism, is not necessarily someone we would expect to write a book detailing treatments for all sorts of medical ailments. But this is what he did in a relatively little-known work of his entitled Primitive Physick; Or An Easy And Natural Method of Curing Most Diseases

It is notable, however, that during his lifetime Wesley was considered a quack, both spiritually and medically (Madden, 2007). He led an itinerant lifestyle in order to preach as he never had his own church, and it is thought that the prevalence of disease as well as the prevalence and tendency of quacks who combined their treatments with theology were among the reasons behind writing this book.
 
According to Wesley, the word 'primitive' was akin to 'original' or 'early', and 'physic' was a general term for health care, especially “how to live in accordance with nature by proper diet and exercise, both to restore health and to retain it,” (Maddox, 2007). Taken together, Primitive Physick was a book that would be classed as holistic or alternative medicine today.

In Ingram's Patterns Of Madness In The Eighteenth Century: A Reader, it is noted that Wesley saw disease as a consequence of the Fall and thus regarded mankind as primarily responsible for its own sufferings. Wesley says as much in his preface:

"When man came first out of the hands of the Great Creator, clothed in body, as well as in soul, with immortality and incorruption, there was no place for physic, or the art of healing. As he knew no sin, he knew no pain, no sickness, weakness, or bodily disorder ... But since man rebelled against the Sovereign of heaven and earth, how entirely is the scene changed! ... The seeds of wickedness and pain, of sickness and death, are now lodged in our inmost substance; whence a thousand disorders continually spring, even without the aid of external violence."

Wesley covered the common illnesses of his day in alphabetical order; mental illnesses, curiously, are not distinguished from physical ailments, as in Wesley's view both are derived from man's first disobedience. They are thus stigmatised no more than other illnesses. 


What follows are Wesley's interesting and amusing remedies for various types of psychological conditions, especially the mania associated with rabies:
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44. An Hysteric Cholic.

164. Mrs. Watts, by using the cold bath two and twenty times in a month, was entirely cured of an hysteric cholic, fits, and convulsive motions, continual sweatings and vomiting, wandering pains in her limbs and head, with total loss of appetite.
165. In the fit, half a pint of water with a little wheat-flour in it, and a spoonful of vinegar.
166. Or of warm lemonade: tried.
167. Or, take 20, 30, or 40 drops of balsam of peru on fine sugar: if need be, take this twice or thrice a day:
168. Or, in extremity, boil three ounces of Burdock-seed in water, which give as a clyster:
169. Or, twenty drops of laudanum, in any proper clyster, which gives instant ease. 

45. A Nervous Cholic.

170. Use the cold-bath daily for three or four weeks.
171. Or, take quicksilver and acqua sulphurata daily for a month.

136. Hypochondriac and Hysteric Disorders.

426. Use cold bathing:
427. Or, take an ounce of quicksilver every morning, and ten drops of Elixir of Vitriol in the afternoon, in a glass of cold water.

151. Lunacy.

468. Give a decoction of agrimony four times a day:
469. Or, rub the head several times a day with vinegar, in which ground-ivy leaves have been infused:
470. Or, daily take an ounce of distilled vinegar:
471. Or, boil juice of ground-ivy with sweet oil and white wine into an ointment. Shave the head, anoint it therewith, and chafe it every other day for three weeks. Bruise also the leaves and bind them on the head, and give three spoonfuls of the juice warm every morning.
472. Or, be elecrified: tried.

152. Raging Madness.

473. Apply to the head, cloths dipt in cold water:
474. Or, set the patient with his head under a great water-fall, as long as his strength will bear: or, pour water on his head out of a tea-kettle:
475. Or, let him eat nothing but apples for a month:
476. Or, nothing but bread and milk: tried.


153. Bite of a Mad Dog.

477. Plunge into cold water daily for twenty days, and keep as long under as possible. This has cured, even after the hydrophobia was begun.
478. Or, mix ashes of trefoil with hog's-lard, and anoint the part as soon as possible. Repeat it twice or thrice at six hours distance. This has cured many: and particularly a dog bit on the nose by a mad dog.
479. Or, mix a pound of salt, with a quart of water. Squeeze, bathe, and wash the wound with this for an hour. Then bind some salt upon it for twelve hours.
N.B. The Author of this receipt was bit six times by mad dogs, and always cured himself by this means.
480. Or, mix powdered liver-wort, four drachms: black pepper, two drachms. Divide this into four parts, and take one in warm milk for four mornings, fasting. Dr. Mead affirms he never knew this to fail: but it has sometimes failed.
481. Or, take two or three spoonfuls of ribwort, morning and evening, as soon as possible after the bite. Repeat this for two or three changes of the moon. It has not been known to fail.
482. Immediately consult an honest physician.
 
References:

Ingram, Allan. Patterns of Madness In The Eighteenth Century: A Reader. Liverpool: Liverpool University Press, 1998.

Madden, Deborah. 'A Cheap, Safe and Natural Medicine': Religion, Medicine and Culture in John Wesley's Primitive Physic (Amsterdam/New York: Rodolpi, 2007).

Maddox, Randy.  “John Wesley on Holistic Health and Healing” in Methodist History, 46:1 (October 2007), 4-33.

January 5, 2013

Lead Astray

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A recent and interesting article at the investigative MotherJones magazine discusses links between crime rates and the prevalence of lead emissions, touting the latter as America's Real Criminal Element. A follow-up also noted interesting connections involving lead paint.

Kevin Drum does a good job of convincing readers that, rather than political measures being responsible for falling crime rates, the gradual decline of crack use or increased incarcerations, the rather counterintuitive proposal that said rates have dropped due to the gradual withdrawal of leaded petrol. According to Drum, there is a
"growing body of research linking lead exposure in small children with a whole raft of complications later in life, including lower IQ, hyperactivity, behavioral problems, and learning disabilities."
And among the more important neurologically relevant observations, Drum made special note of a PLOS study; Cecil et. al (2008) found that lead exposure had in fact contributed to reduced/decreased myelination. Myelination refers to the process by which neurons are surrounded by a layer or sheath of myelin, a type of fat that both insulates the neuron and allows for faster transmission and complex communications, and accounts for the composition of the brain's "white matter". Lead exposure was to be a factor in causing a degrading alteration in myelin organisation. In other words, less myelination leads to less co-ordination and slower connections as the neurons will not be communicating effectively.

The same study used MRI-scanning to determine the effect of lead poisoning on the whole brain. Neuronal loss was found in various areas such as the cognitive and emotional areas of the anterior cingulate cortex, regions associated with "general intellectual and executive functioning, antisocial behaviors, and attention deficit hyperactivity disorder (ADHD)". Poor scores were found in physical movement tests too, but by far the largest and most serious finding related to a permanent reduction in grey matter, specifically in the medial part of the pre-frontal cortex. According to one of the researchers, Kim Cecil, lead poisoning affected precisely the brain areas "that make us most human", as the pre-frontal cortex is associated with the brain's executive functions; emotion regulation, impulse control, attention, verbal reasoning and mental flexibility.

These findings certainly deserve attention although, as Deborah Blum (Pulitzer Prize-winning journalist and science writer) noted in her response, the research has been covered before, both by Drum (Jan 2012) and other authors/publications, including the Washington Post back in 2007. What makes this article different is Drum's seeming enthusiasm to attribute up to 90% of crime to lead exposure and poisoning. As Blum notes,
"does it trump drugs, poverty, urban gang warfare, education, and other such issues to the point that they account for a bare ten percent of the crime statistics? That's a harder case to make, partly because as Drum himself notes correlation is not causation: the fact, for instance, that falling crime follows a pattern of falling lead exposure doesn't rule out many other influences."
Blum also brings a calming elucidation to the worrying neuroscientific findings as well, stating that, while it is true that lead exposure may lead to significant neurological deficits, it is much more complicated than as simply thought. For instance, reduced myelination can also be down to malnutrition and other environmental factors, and also that research into the situation hasn't yet produced any indication of a clear biological pathway through which exposure to lead can influence individuals to become antisocial and criminal.

As well as indicating other sources of lead that could cause concern, there is agreement that increasing evidence does point to lead as being a significant threat to health and that further research could increase the knowledge and evidence base through which solutions can be found.

If you have time, go take a look at Drum's article. Aside from the '90%' issue (that has since been corrected) it is littered with links to research, making it an edifying and extremely interesting read.

December 15, 2012

Seeing God In The Third Millenium

(1) Eben Alexander | (2) Sam Harris | (3) Sam Harris | (4) Oliver Sacks

Various responses to Eben Alexander's NDE account were published, but I have here collected those responses by esteemed neuroscientists and neurologists, who present an effective rebuttal of the account as well as question the validity of near-death experiences (NDEs) as a genuine medical and neurological phenomenon. We have seen Alexander's own account as well as two responses from Dr. Sam Harris, and now we will hear from Professor Oliver Sacks.
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by Oliver Sacks, Dec. 12, 2012.

How the brain creates out-of-body experiences and religious epiphanies.

There are many carefully documented accounts in the medical literature of intense, life-altering religious experience in epileptic seizures. Hallucinations of overwhelming intensity, sometimes accompanied by a sense of bliss and a strong feeling of the numinous, can occur especially with the so-called "ecstatic" seizures that may occur in temporal lobe epilepsy. Though such seizures may be brief, they can lead to a fundamental reorientation, a metanoia, in one's life. Fyodor Dostoevsky was prone to such seizures and described many of them, including this: 

"The air was filled with a big noise and I tried to move. I felt the heaven was going down upon the earth and that it engulfed me. I have really touched God. He came into me myself, yes God exists, I cried, and I don't remember anything else. You all, healthy people ... can't imagine the happiness which we epileptics feel during the second before our fit. ... I don't know if this felicity lasts for seconds, hours or months, but believe me, for all the joys that life may bring, I would not exchange this one."

A century later, Kenneth Dewhurst and A. W. Beard published a detailed report in the Journal of Neurology, Neurosurgery, and Psychiatry of a bus conductor who had a sudden feeling of elation while collecting fares. They wrote:  

"He was suddenly overcome with a feeling of bliss. He felt he was literally in Heaven. He collected the fares correctly, telling his passengers at the same time how pleased he was to be in Heaven. ... He remained in this state of exaltation, hearing divine and angelic voices, for two days. Afterwards he was able to recall these experiences and he continued to believe in their validity. [Three years later] following three seizures on three successive days, he became elated again. He stated that his mind had "cleared." ... During this episode he lost his faith."

He now no longer believed in heaven and hell, in an afterlife, or in the divinity of Christ. This second conversion -- to atheism -- carried the same excitement and revelatory quality as the original religious conversion.

More recently, Orrin Devinsky and his colleagues have been able to make video EEG recordings in patients who are having such seizures, and have observed an exact synchronization of the epiphany with a spike in epileptic activity in the temporal lobes (more commonly the right temporal lobe).

"I was flying forwards, bewildered. I looked around. I saw my own body on the ground. I said to myself, 'Oh shit, I'm dead.'"

Ecstatic seizures are rare -- they only occur in something like 1 or 2 percent of patients with temporal lobe epilepsy. But the last half century has seen an enormous increase in the prevalence of other states sometimes permeated by religious joy and awe, "heavenly" visions and voices, and, not infrequently, religious conversion or metanoia. Among these are out-of-body experiences (OBEs), which are more common now that more patients can be brought back to life from serious cardiac arrests and the like -- and much more elaborate and numinous experiences called near-death experiences (NDEs).

Both OBEs and NDEs, which occur in waking but often profoundly altered states of consciousness, cause hallucinations so vivid and compelling that those who experience them may deny the term hallucination, and insist on their reality. And the fact that there are marked similarities in individual descriptions is taken by some to indicate their objective "reality."

But the fundamental reason that hallucinations -- whatever their cause or modality -- seem so real is that they deploy the very same systems in the brain that actual perceptions do. When one hallucinates voices, the auditory pathways are activated; when one hallucinates a face, the fusiform face area, normally used to perceive and identify faces in the environment, is stimulated.

In OBEs, subjects feel that they have left their bodies -- they seem to be floating in midair, or in a corner of the room, looking down on their vacated bodies from a distance. The experience may be felt as blissful, terrifying, or neutral. But its extraordinary nature -- the apparent separation of "spirit" from body, imprints it indelibly on the mind and may be taken by some people as evidence of an immaterial soul -- proof that consciousness, personality, and identity can exist independently of the body and even survive bodily death.

Neurologically, OBEs are a form of bodily illusion arising from a temporary dissociation of visual and proprioceptive representations -- normally these are coordinated, so that one views the world, including one's body, from the perspective of one's own eyes, one's head. OBEs, as Henrik Ehrsson and his fellow researchers in Stockholm have elegantly shown, can be produced experimentally, by using simple equipment -- video goggles, mannequins, rubber arms, etc. -- to confuse one's visual input and one's proprioceptive input and create an uncanny sense of disembodiedness. 

"Hallucinations, whether revelatory or banal, are not of supernatural origin; they are part of the normal range of human consciousness and experience."

A number of medical conditions can lead to OBEs -- cardiac arrest or arrhythmias, or a sudden lowering of blood pressure or blood sugar, often combined with anxiety or illness. I know of some patients who have experienced OBEs during difficult childbirths, and others who have had them in association with narcolepsy or sleep paralysis. Fighter pilots subjected to high G-forces in flight (or sometimes in training centrifuges) have reported OBEs as well as much more elaborate states of consciousness that resemble the near-death experience.

The near-death experience usually goes through a sequence of characteristic stages. One seems to be moving effortlessly and blissfully along a dark corridor or tunnel towards a wonderful "living" light -- often interpreted as Heaven or the boundary between life and death. There may be a vision of friends and relatives welcoming one to the other side, and there may be a a rapid yet extremely detailed series of memories of one's life -- a lightning autobiography. The return to one's body may be abrupt, as when, for example, the beat is restored to an arrested heart. Or it may be more gradual, as when one emerges from a coma.

Not infrequently, an OBE turns into an NDE -- as happened with Tony Cicoria, a surgeon who told me how he had been struck by lightning. He gave me a vivid account of what then followed, as I wrote in Musicophilia:

"I was flying forwards. Bewildered. I looked around. I saw my own body on the ground. I said to myself, 'Oh shit, I'm dead.' I saw people converging on the body. I saw a woman -- she had been standing waiting to use the phone right behind me -- position herself over my body, give it CPR. . . . I floated up the stairs -- my consciousness came with me. I saw my kids, had the realization that they would be okay. Then I was surrounded by a bluish-white light . . . an enormous feeling of well-being and peace. The highest and lowest points of my life raced by me . . . pure thought, pure ecstasy. I had the perception of accelerating, being drawn up . . . there was speed and direction. Then, as I was saying to myself, 'This is the most glorious feeling I have ever had' -- SLAM! I was back."

Dr. Cicoria had some memory problems for a month or so after this, but he was able to resume his practice as an orthopedic surgeon. Yet he was, as he put it, "a changed man." Previously he had no particular interest in music, but now he was seized by an overwhelming desire to listen to classical music, especially Chopin. He bought a piano and started to play obsessively and to compose. He was convinced that the entire episode -- being struck by lightning, having a transcendent vision, then being resuscitated and gifted so that he could bring music to the world, was part of a divine plan.

Cicoria has a Ph.D. in neuroscience, and he also felt that his sudden accession of spirituality and musicality must have gone with changes in his brain -- changes which we might be able to clarify, perhaps, with neuroimaging. He saw no contradiction between religion and neurology -- if God works on a man, or in a man, Cicoria felt, He would do so via the nervous system, via parts of the brain specialized, or potentially specializable, for spiritual feeling and belief.

Cicoria's reasonable and (one might say) scientific attitude to his own spiritual conversion is in marked contrast to that of another surgeon, Dr. Eben Alexander, who describes, in his recent book, Proof of Heaven: A Neurosurgeon's Journey into the Afterlife, a detailed and complex NDE which occurred while he spent seven days in a coma caused by meningitis. During his NDE, he writes, he passed through the bright light -- the boundary between life and death -- to find himself in an idyllic and beautiful meadow (which he realized was Heaven) where he met a beautiful but unknown woman who conveyed various messages to him telepathically. Advancing farther into the afterlife, he felt the ever-more-embracing presence of God. Following this experience, Alexander became something of an evangelist, wanting to spread the good news, that heaven really exists.

Alexander makes much of his experience as a neurosurgeon and an expert on the workings of the brain. He provides an appendix to his book detailing "Neuroscientific Hypotheses I considered to explain my experience" -- but all of these he dismisses as inapplicable in his own case because, he insists, his cerebral cortex was completely shut down during the coma, precluding the possibility of any conscious experience.

"To deny the possibility of any natural explanation for an NDE, as Dr. Alexander does, is more than unscientific -- it is antiscientific."

Yet his NDE was rich in visual and auditory detail, as many such hallucinations are. He is puzzled by this, since such sensory details are normally produced by the cortex. Nonetheless, his consciousness had journeyed into the blissful, ineffable realm of the afterlife--a journey which he felt lasted for most of the time he lay in coma. Thus, he proposes, his essential self, his "soul," did not need a cerebral cortex, or indeed any material basis whatever.

It is not so easy, however, to dismiss neurological processes. Dr. Alexander presents himself as emerging from his coma suddenly: "My eyes opened ... my brain ... had just kicked back to life." But one almost always emerges gradually from coma; there are intermediate stages of consciousness. It is in these transitional stages, where consciousness of a sort has returned, but not yet fully lucid consciousness, that NDEs tend to occur.

Alexander insists that his journey, which subjectively lasted for days, could not have occurred except while he was deep in coma. But we know from the experience of Tony Cicoria and many others, that a hallucinatory journey to the bright light and beyond, a full-blown NDE, can occur in 20 or 30 seconds, even though it seems to last much longer. Subjectively, during such a crisis, the very concept of time may seem variable or meaningless. The one most plausible hypothesis in Dr. Alexander's case, then, is that his NDE occurred not during his coma, but as he was surfacing from the coma and his cortex was returning to full function. It is curious that he does not allow this obvious and natural explanation, but instead insists on a supernatural one.

To deny the possibility of any natural explanation for an NDE, as Dr. Alexander does, is more than unscientific -- it is antiscientific. It precludes the scientific investigation of such states.

Kevin Nelson, a neurologist at the University of Kentucky, has studied the neural basis of NDEs and other forms of "deep" hallucinating for many decades. In 2011, he published a wise and careful book about his research, The Spiritual Doorway in the Brain: A Neurologist's Search for the God Experience.

Nelson feels that the "dark tunnel" described in most NDEs represents constriction of the visual fields due to compromised blood pressure in the eyes, and the "bright light" represents a flow of visual excitation from the brainstem, through visual relay stations, to the visual cortex (the so-called pons-geniculate-occipital or PGO pathway).

Simpler perceptual hallucinations -- of patterns, animals, people, landscapes, music, etc. -- as one may get in a variety of conditions (blindness, deafness, epilepsy, migraine, sensory deprivation, etc.) do not usually involve profound changes in consciousness, and while very startling, are nearly always recognized as hallucinations. It is different with the very complex hallucinations of ecstatic seizures or NDEs -- which are often taken to be veridical, truth-telling and often life-transforming revelations of a spiritual universe, and perhaps of a spiritual destiny or mission. 

"Even a single experience of God, imbued with the overwhelming force of actual perception, can be enough to sustain a lifetime of faith."

The tendency to spiritual feeling and religious belief lies deep in human nature and seems to have its own neurological basis, though it may be very strong in some people and less developed in others. For those who are religiously inclined, an NDE may seem to offer "proof of heaven," as Eben Alexander puts it.

Some religious people come to experience their proof of heaven by another route -- the route of prayer, as the anthropologist T. M. Luhrmann has explored in her book When God Talks Back. The very essence of divinity, of God, is immaterial. God cannot be seen, felt, or heard in the ordinary way. Luhrmann wondered how, in the face of this lack of evidence, God becomes a real, intimate presence in the lives of so many evangelicals and other people of faith. She joined an evangelical community as a participant-observer, immersing herself in particular in their disciplines of prayer and visualization -- imagining in ever-richer, more concrete detail the figures and events depicted in the Bible. Congregants, she writes:

"Practice seeing, hearing, smelling, and touching in the mind's eye. They give these imagined experiences the sensory vividness associated with the memories of real events. What they are able to imagine becomes more real to them."

Sooner or later, with this intensive practice, for some of the congregants, the mind may leap from imagination to hallucination, and the congregant hears God, sees God, feels God walking beside them. These yearned-for voices and visions have the reality of perception, and this is because they activate the perceptual systems of the brain, as all hallucinations do. These visions, voices, and feelings of "presence" are accompanied by intense emotion -- emotions of joy, peace, awe, revelation. Some evangelicals may have many such experiences; others only a single one -- but even a single experience of God, imbued with the overwhelming force of actual perception, can be enough to sustain a lifetime of faith. (For those who are not religiously inclined, such experiences may occur with meditation or intense concentration on an artistic or intellectual or emotional plane, whether this is falling in love or listening to Bach, observing the intricacies of a fern, or cracking a scientific problem.)

In the last decade or two, there has been increasingly active research in the field of "spiritual neurosciences." There are special difficulties in this research, for religious experiences cannot be summoned at will; they come, if at all, in their own time and way -- the religious would say in God's time and way. Nonetheless, researchers have been able to demonstrate physiological changes not only in pathological states like seizures, OBEs, and NDEs, but also in positive states like prayer and meditation. Typically these changes are quite widespread, involving not only primary sensory areas in the brain, but limbic (emotional) systems, hippocampal (memory) systems, and the prefrontal cortex, where intentionality and judgement reside.

Hallucinations, whether revelatory or banal, are not of supernatural origin; they are part of the normal range of human consciousness and experience. This is not to say that they cannot play a part in the spiritual life, or have great meaning for an individual. Yet while it is understandable that one might attribute value, ground beliefs, or construct narratives from them, hallucinations cannot provide evidence for the existence of any metaphysical beings or places. They provide evidence only of the brain's power to create them.

(1) Eben Alexander | (2) Sam Harris | (3) Sam Harris | (4) Oliver Sacks

Science on the Brink of Death

(1) Eben Alexander | (2) Sam Harris | (3) Sam Harris | (4) Oliver Sacks

Various responses to Eben Alexander's NDE account were published, but I have here collected those responses by esteemed neuroscientists and neurologists, who present an effective rebuttal of the account as well as question the validity of near-death experiences (NDEs) as a genuine medical and neurological phenomenon. We have seen Alexander's own account, now we will read the second of two responses from Dr. Sam Harris and one from Professor Oliver Sacks.
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by Sam Harris.

One cannot travel far in spiritual circles without meeting people who are fascinated by the “near-death experience” (NDE). The phenomenon has been described as follows:

"Frequently recurring features include feelings of peace and joy; a sense of being out of one’s body and watching events going on around one’s body and, occasionally, at some distant physical location; a cessation of pain; seeing a dark tunnel or void; seeing an unusually bright light, sometimes experienced as a “Being of Light” that radiates love and may speak or otherwise communicate with the person; encountering other beings, often deceased persons whom the experiencer recognizes; experiencing a revival of memories or even a full life review, sometimes accompanied by feelings of judgment; seeing some “other realm,” often of great beauty; sensing a barrier or border beyond which the person cannot go; and returning to the body, often reluctantly."

- E.F. Kelly et al., Irreducible Mind: Toward a Psychology for the 21st Century. New York: Rowman and Littlefield, 2007, p. 372.

Such accounts have led many people to believe that consciousness must be independent of the brain. Unfortunately, these experiences vary across cultures, and no single feature is common to them all. One would think that if a nonphysical domain were truly being explored, some universal characteristics would stand out. Hindus and Christians would not substantially disagree—and one certainly wouldn’t expect the after-death state of South Indians to diverge from that of North Indians, as has been reported.⁠ It should also trouble NDE enthusiasts that only 10−20 percent of people who approach clinical death recall having any experience at all.⁠

However, the deepest problem with drawing sweeping conclusions from the NDE is that those who have had one and subsequently talked about it did not actually die. In fact, many appear to have been in no real danger of dying. And those who have reported leaving their bodies during a true medical emergency—after cardiac arrest, for instance—did not suffer the complete loss of brain activity. Even in cases where the brain is alleged to have shut down, its activity must return if the subject is to survive and describe the experience. In such cases, there is generally no way to establish that the NDE occurred while the brain was offline.

Many students of the NDE claim that certain people have left their bodies and perceived the commotion surrounding their near death—the efforts of hospital staff to resuscitate them, details of surgery, the behavior of family members, etc. Certain subjects even say that they have learned facts while traveling beyond their bodies that would otherwise have been impossible to know—for instance, a secret told by a dead relative, the truth of which was later confirmed. Of course, reports of this kind seem especially vulnerable to self-deception, if not conscious fraud. There is another problem, however: Even if true, such phenomena might suggest only that the human mind possesses powers of extrasensory perception (e.g. clairvoyance or telepathy). This would be a very important discovery, but it wouldn’t demonstrate the survival of death. Why? Because unless we could know that a subject’s brain was not functioning when these impressions were formed, the involvement of the brain must be presumed.⁠

What is needed to establish the mind’s independence from the brain is a case in which a person has an experience —of anything— without associated brain activity. From time to time, someone will claim that a specific NDE meets this criterion. One of the most celebrated cases in the literature involves a woman, Pam Reynolds, who underwent a procedure known as “hypothermic cardiac arrest,” in which her core body temperature was brought down to 60 degrees, her heart was stopped, and blood flow to her brain was suspended so that a large aneurysm in her basilar artery could be surgically repaired. Reynolds reports having had a classic NDE, complete with an awareness of the details of her surgery. Her story has several problems, however. The events in the world that Reynolds reports having perceived during her NDE occurred either before she was “clinically dead” or after blood circulation had been restored to her brain. In other words, despite the extraordinary details of the procedure, we have every reason to believe that Reynolds’s brain was functioning when she had her experiences. The case also wasn’t published until several years after it occurred, and its author, Dr. Michael Sabom, is a born-again Christian who had been working for decades to substantiate the otherworldly significance of the NDE. The possibility that experimenter bias, witness tampering, and false memories intruded into this best-of-all-recorded cases is excruciatingly obvious.

The latest NDE to receive wide acclaim was featured on the cover of Newsweek magazine. The great novelty of this case is that its subject, Dr. Eben Alexander, is a neurosurgeon who we might presume is competent to judge the scientific significance of his experience. His book on the subject, Proof of Heaven: A Neurosurgeon’s Journey into the Afterlife, has landed atop the New York Times paperback best-seller list. As it happens, it displaced one of the best-selling books of the past decade, Heaven Is for Real—which is yet another account of the afterlife, based on the near-death adventures of a 4-year-old boy. Unsurprisingly, the two books offer incompatible views of what life is like beyond the prison of the brain. (As colorful as his account is, Alexander neglects to tell us that Jesus rides a rainbow-colored horse or that the souls of dead children must still do homework in heaven.)

Having now read Alexander’s book, I can say that it is every bit as remarkable as his Newsweek cover article suggested it would be. Unfortunately, it is not remarkable in the way that its author believes. I find that my original criticism of Alexander’s thinking can stand without revision.1 However, as he provides further “proof” of heaven in his book, there is more to say about the man’s mischief here on earth. There is also a rumor circulating online that, after attacking Alexander from the safety of my blog, I have refused to debate him in public. This is untrue. I merely declined the privilege of appearing with him on a parapsychology podcast, in the company of an irritating and unscrupulous host. I would be happy to have a public discussion with Alexander, should it ever seem worth doing.

As I wrote in my original article, the enthusiastic reception that Alexander is now enjoying suggests a general confusion about the nature of scientific authority. And much of the criticism I’ve received for dismissing his account has predictably focused on what appear to be the man’s impeccable scientific credentials. Certain readers feel that I have moved the goalposts: You see, even the testimony of a Harvard neurosurgeon isn’t good enough for a dogmatic, materialistic, fundamentalist atheist like Harris! And many people found the invidious distinction between a “neurosurgeon” and a “neuroscientist” (drawn in a comment by Mark Cohen in my last article) to be somewhat flabbergasting.

When debating the validity of evidence and arguments, the point is never that one person’s credentials trump another’s. Credentials just offer a rough indication of what a person is likely to know—or should know. If Alexander were drawing reasonable scientific conclusions from his experience, he wouldn’t need to be a neuroscientist to be taken seriously; he could be a philosopher—or a coal miner. But he simply isn’t thinking like a scientist—and so not even a string of Nobel prizes would shield him from criticism.

However, there are general differences between neurosurgeons and neuroscientists that might explain some of Alexander’s errors. The distinction in expertise is very easy to see when viewed from the other side: If the average neuroscientist were handed a drill and a scalpel and told to operate on a living person’s brain, the result would be horrific. From a scientific point of view, Alexander’s performance has been no prettier. He has surely killed the patient (in fact, he may have helped kill Newsweek, which announced that it would no longer publish a print edition immediately after his article ran), but the man won’t stop drilling. Many of his errors are glaring but immaterial: In his book, for instance, he understates the number of neurons in the human brain by a factor of 10. But others are absolutely damning to his case. Whatever his qualifications on paper, Alexander’s evangelizing about his experience in coma is so devoid of intellectual sobriety, not to mention rigor, that I would see no reason to engage with it—apart from the fact that his book seems destined to be read and believed by millions of people.

There are two paths toward establishing the scientific significance of the NDE: The first would be to show that a person’s brain was dead or otherwise inactive during the time he had an experience (whether veridical or not). The second would be to demonstrate that the subject had acquired knowledge about the world that could be explained only by the mind’s being independent of the brain (but again, it is hard to see how this can be convincingly done in the presence of brain activity).

In his Newsweek article, Alexander sought to travel the first path. Hence, his entire account hinged on the assertion that his cortex was “completely shut down” while he was seeing angels in heaven. Unfortunately, the evidence he has offered in support of this claim—in the article, in a subsequent response to my criticism of it, in his book, and in multiple interviews—suggests that he doesn’t understand what would constitute compelling evidence of cortical inactivity. The proof he offers is either fallacious (CT scans do not detect brain activity) or irrelevant (it does not matter, even slightly, that his form of meningitis was “astronomically rare”)—and no combination of fallacy and irrelevancy adds up to sound science. The impediment to taking Alexander’s claims seriously can be simply stated: There is absolutely no reason to believe that his cerebral cortex was inactive at the time he had his experience of the afterlife. The fact that Alexander thinks he has demonstrated otherwise—by continually emphasizing how sick he was, the infrequency of E. coli meningitis, and the ugliness of his initial CT scan—suggests a deliberate disregard of the most plausible interpretation of his experience. It is far more likely that some of his cortex was functioning, despite the profundity of his illness, than that he is justified in making the following claim:

"My experience showed me that the death of the body and the brain are not the end of consciousness, that human experience continues beyond the grave. More important, it continues under the gaze of a God who loves and cares about each one of us, about where the universe itself and all the beings within it are ultimately going."

The very fact that Alexander remembers his NDE suggests that the cortical and subcortical structures necessary for memory formation were active at the time. How else could he recall the experience?

It would not surprise me, in fact, if Alexander were to claim that his memories are stored outside his brain—presumably somewhere between Lynchburg, Virginia, and heaven. Given that he is committed to proving the mind’s nonphysical basis, he holds a peculiar view of the brain’s operation: 

"[The brain] is a reducing valve or filter, shifting the larger, nonphysical consciousness that we possess in the nonphysical worlds down into a more limited capacity for the duration of our mortal lives."

There are some obvious problems with this—which anyone disposed to think like a neuroscientist would see. If the brain merely serves to limit human experience and understanding, one would expect most forms of brain damage to unmask extraordinary scientific, artistic, and spiritual insights—and, provided that a person’s language centers could be spared, the graver the injury the better. A few hammer blows or a well-placed bullet should render a person of even the shallowest intellect a spiritual genius. Is this the world we are living in?2

In his book, Alexander also attempts to take the second path of proof—alleging that his NDE disclosed facts that could be explained only by the reality of life beyond the body. Most of these truths must be left to scientists of some future century to explore—for although his collision with the Mind of God seems to have fully slaked Alexander’s scientific curiosity, it apparently produced few insights that can be rendered in human speech. This puts the man in a difficult position as an educator:

"I saw the abundance of life throughout countless universes, including some whose intelligence was advanced far beyond that of humanity. I saw that there are countless higher dimensions, but that the only way to know these dimensions is to enter and experience them directly. They cannot be known, or understood, from lower dimensional space. Cause and effect exist in these higher realms, but outside our earthly conception of them. The world of time and space in which we move in this terrestrial realm is tightly and intricately meshed within these higher worlds…. The knowledge given to me was not “taught” in the way that a history lesson or math theorem would be. Insights happened directly, rather than needing to be coaxed and absorbed. Knowledge was stored without memorization, instantly and for good. It didn’t fade, like ordinary information does, and to this day I still possess all of it, much more clearly than I possess the information that I gained over all my years in school."

Alexander claims undiminished knowledge of all this, and yet the only specifics he can produce on the page are as vapid as any ever published. And I suspect it is no accident that they have a distinctly Christian flavor. Here, according to Alexander, are the deepest truths he brought back to our world:

"You are loved and cherished, dearly, forever. You have nothing to fear. There is nothing you can do wrong."

Not only will scientists be underwhelmed by these revelations, but Buddhists and students of Advaita Vedanta will find them astonishingly puerile. And the fact that Alexander returned from “the Core” of a loving cosmos only to piously assert the Christian line on evil and free will (“Evil was necessary because without it free will was impossible…”) renders the overall picture of his religious provincialism fairly indelible.

Happily, you do not need to read Alexander’s book to see him present what he considers the most compelling part of his case. You need only spend six minutes of your life in this world watching the following video:

Watch the video to the end. True, it will bring you six minutes closer to meeting your maker, but it will also teach you something about the limits of intellectual honesty. The footage shows Alexander responding to a question from Raymond Moody (the man who coined the term “near-death experience”). I am quite sure that I’ve never seen a scientist speak in a manner more suggestive of wishful thinking. If self-deception were an Olympic sport, this is how our most gifted athletes would appear when they were in peak condition.

It should also be clear that the knowledge of the afterlife that Alexander claims to possess depends upon some extraordinarily dubious methods of verification. While in his coma, he saw a beautiful girl riding beside him on the wing of a butterfly. We learn in his book that he developed his recollection of this experience over a period of months — writing, thinking about it, and mining it for new details. It would be hard to think of a better way to engineer a distortion of memory.

As you will know from watching the video, Alexander had a biological sister he never met, who died some years before his coma. Seeing her picture for the first time after his recovery, he judged this woman to be the girl who had joined him for the butterfly ride. He sought further confirmation of this by speaking with his biological family, from whom he learned that his dead sister had, indeed, always been “very loving.” QED.

As I said in my original response to his Newsweek article, I have spent much of my life studying and even seeking experiences of the kind Alexander describes. I haven’t contracted meningitis, thankfully, nor have I had an NDE, but I have experienced many phenomena that traditionally lead people to believe in the supernatural.

For instance, I once had an opportunity to study with the great Tibetan lama Dilgo Khyentse Rinpoche in Nepal. Before making the trip, I had a dream in which he seemed to give me teachings about the nature of the mind. This dream struck me as interesting for two reasons: (1) The teachings I received were novel, useful, and convergent with what I later understood to be true; and (2) I had never met Khyentse Rinpoche, nor was I aware of having seen a photograph of him. This preceded my access to the Internet by at least five years, so the belief that I had never seen his picture was more plausible than it would be now. I also recall that I had no easy way of finding a picture of him for the sake of comparison. But because I was about to meet the man himself, it seemed that I would be able to confirm whether it had really been him in my dream.

First, the teachings: The lama in my dream began by asking who I was. I responded by telling him my name. Apparently, this wasn’t the answer he was looking for.

“Who are you?” he said again. He was now staring fixedly into my eyes and pointing at my face with an outstretched finger. I did not know what to say.

“Who are you?” he said again, continuing to point.

“Who are you?” he said a final time, but here he suddenly shifted his gaze and pointing finger, as though he were now addressing someone just to my left. The effect was quite startling, because I knew (insofar as one can be said to know anything in a dream) that we were alone. The lama was obviously pointing to someone who wasn’t there, and I suddenly noticed what I would later come to consider an important truth about the nature of the mind: Subjectively speaking, there is only consciousness and its contents; there is no inner self who is conscious. The feeling of being the experiencer of your experience, rather than identical to the totality of experience, is an illusion. The lama in my dream seemed to dissect this very feeling of being a self and, for a brief moment, removed it from my mind. I awoke convinced that I had glimpsed something quite profound.

After traveling to Nepal and encountering the arresting figure of Khyentse Rinpoche instructing hundreds of monks from atop a brocade throne, I was struck by the sense that he really did resemble the man in my dream. Even more apparent, however, was the fact that I couldn’t know whether this impression was accurate. Clearly, it would have been more fun to believe that something magical had occurred and that I had been singled out for some sort of transpersonal initiation—but the allure of this belief suggested only that the bar for proof should be raised rather than lowered. And even though I had no formal scientific training at that point, I knew that human memory is unreliable under conditions of this kind. How much stock could I put in the feeling of familiarity? Was I accurately recalling the face of a man I had met in a dream, or was I engaged in a creative reconstruction of it? If nothing else, the experience of déjà vu proves that one’s sense of having experienced something previously can jump the tracks of genuine recollection. My travels in spiritual circles had also brought me into contact with many people who seemed all too eager to deceive themselves about experiences of this kind, and I did not wish to emulate them. Given these considerations, I did not believe that Khyentse Rinpoche had really appeared in my dream. And I certainly would never have been tempted to use this experience as conclusive proof of the supernatural.⁠

I invite the reader to compare this attitude to the one that Dr. Eben Alexander will likely exhibit before crowds of credulous people for the rest of his life. The structure of our experiences was similar—we were each given an opportunity to compare a face remembered from a dream/vision with a person (or photo) in the physical world. I realized that the task was hopeless. Alexander believes that he has made the greatest discovery in the history of science.

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1. Everything of substance in Alexander’s account hinges on his assertion that his cortex was shut down while he enjoyed a “hyper-real” experience of the afterlife. It seems, however, that it is easy for many readers to miss this. For instance, I’ve heard from several people who think that Alexander successfully ruled out the hypothesis that a spike in the neurotransmitter DMT could explain his NDE. But he did so only by observing that DMT would require a functioning cortex upon which to act, whereas his cortex “wasn’t available to be affected.” But no neurophysiological account of his experience could survive this treatment—because Alexander is asking us to stipulate that his cortex was functionally dead. As I have said, this is an incredible claim, rendered even less plausible by the fact that he does not appear to understand what sort of evidence would make it plausible.

2. The phrase “reducing valve” appears to come from Aldous Huxley in his Doors of Perception, but the idea that the brain is a filter (rather than the origin) of mind goes back at least as far as Henri Bergson and William James. Both Bergson and James suggested that the purpose of the brain might be to limit conscious experience to a range of perceptions and mental states compatible with survival in this world. When the barrier of the brain is breached—whether partially, through mystical experience, or fully, upon the death of the body—a wider range of conscious states and cosmic understandings become available.

However, as I said above, if the brain were merely a filter, damaging it should reliably increase cognition. Some readers objected to this, suggesting that the brain could be a filter that functions like a radio—a receiver of conscious states, rather than a mere barrier to them. At first glance, this would appear to account for the deleterious effects of neurological injury and disease: If one smashes a radio with a hammer, it no longer functions properly.

There is problem with this metaphor, however: Those who employ it forget that we are the music, not the radio. If the brain is truly a receiver of conscious states, it should be impossible to diminish a person’s experience of the cosmos by damaging his brain. He may seem unconscious from the outside—like a broken radio—but, subjectively speaking, the music plays on.

This is not how the mind works. Specific reductions in brain activity might benefit people in certain ways, but there is no reason to think that the pervasive destruction of the cortex can leave the mind unaffected (much less improved). For instance, medications that reduce anxiety generally work by increasing the effect of the inhibitory neurotransmitter GABA, thereby diminishing neuronal activity in various parts of the brain. But the fact that dampening arousal in this way can make people feel better does not suggest that they would feel better still if they were drugged into a coma. Similarly, the psychedelic drug psilocybin seems to reduce activity in brain areas responsible self-representation. It would be unsurprising if this accounted for the experience of self-transcendence that is often associated with this drug. But this does not give us any reason to believe that turning off the brain entirely would yield increased awareness of spiritual realities.

If Alexander’s account is correct, strategically damaging the brain should be the most reliable method of personal empowerment and spiritual practice available to us. In almost every case, loss of brain should yield more mind. Surely there must be a way of enjoying the benefits of this brain-reduction therapy while maintaining an ability to function in the physical world. He’s the neurosurgeon: I wonder which regions of his brain Alexander would remove first.

(1) Eben Alexander | (2) Sam Harris | (3) Sam Harris | (4) Oliver Sacks 

This Must Be Heaven

(1) Eben Alexander | (2) Sam Harris | (3) Sam Harris | (4) Oliver Sacks

Various responses to Eben Alexander's NDE account were published, but I have here collected those responses by esteemed neuroscientists and neurologists, who present an effective rebuttal of the account as well as question the validity of near-death experiences (NDEs) as a genuine medical and neurological phenomenon. We have seen Alexander's own account, now we will read the first of two responses from Dr. Sam Harris and one from Professor Oliver Sacks.
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by Sam Harris

Once upon a time, a neurosurgeon named Eben Alexander contracted a bad case of bacterial meningitis and fell into a coma. While immobile in his hospital bed, he experienced visions of such intense beauty that they changed everything—not just for him, but for all of us, and for science as a whole. According to Newsweek, Alexander’s experience proves that consciousness is independent of the brain, that death is an illusion, and that an eternity of perfect splendor awaits us beyond the grave—complete with the usual angels, clouds, and departed relatives, but also butterflies and beautiful girls in peasant dress. Our current understanding of the mind “now lies broken at our feet”—for, as the doctor writes, “What happened to me destroyed it, and I intend to spend the rest of my life investigating the true nature of consciousness and making the fact that we are more, much more, than our physical brains as clear as I can, both to my fellow scientists and to people at large.”

Well, I intend to spend the rest of the morning sparing him the effort. Whether you read it online or hold the physical object in your hands, this issue of Newsweek is best viewed as an archaeological artifact that is certain to embarrass us in the eyes of future generations. Its existence surely says more about our time than the editors at the magazine meant to say—for the cover alone reveals the abasement and desperation of our journalism, the intellectual bankruptcy and resultant tenacity of faith-based religion, and our ubiquitous confusion about the nature of scientific authority. The article is the modern equivalent of a 14th-century woodcut depicting the work of alchemists, inquisitors, Crusaders, and fortune-tellers. I hope our descendants understand that at least some of us were blushing.

As many of you know, I am interested in “spiritual” experiences of the sort Alexander reports. Unlike many atheists, I don’t doubt the subjective phenomena themselves—that is, I don’t believe that everyone who claims to have seen an angel, or left his body in a trance, or become one with the universe, is lying or mentally ill. Indeed, I have had similar experiences myself in meditation, in lucid dreams (even while meditating in a lucid dream), and through the use of various psychedelics (in times gone by). I know that astonishing changes in the contents of consciousness are possible and can be psychologically transformative.

And, unlike many neuroscientists and philosophers, I remain agnostic on the question of how consciousness is related to the physical world. There are, of course, very good reasons to believe that it is an emergent property of brain activity, just as the rest of the human mind obviously is. But we know nothing about how such a miracle of emergence might occur. And if consciousness were, in fact, irreducible—or even separable from the brain in a way that would give comfort to Saint Augustine—my worldview would not be overturned. I know that we do not understand consciousness, and nothing that I think I know about the cosmos, or about the patent falsity of most religious beliefs, requires that I deny this. So, although I am an atheist who can be expected to be unforgiving of religious dogma, I am not reflexively hostile to claims of the sort Alexander has made. In principle, my mind is open. (It really is.)

But Alexander’s account is so bad—his reasoning so lazy and tendentious—that it would be beneath notice if not for the fact that it currently disgraces the cover of a major newsmagazine. Alexander is also releasing a book at the end of the month, Proof of Heaven: A Neurosurgeon’s Journey into the Afterlife, which seems destined to become an instant bestseller. As much as I would like to simply ignore the unfolding travesty, it would be derelict of me to do so.

But first things first: You really must read Alexander’s article.

I trust that doing so has given you cause to worry that the good doctor is just another casualty of American-style Christianity—for though he claims to have been a nonbeliever before his adventures in coma, he presents the following self-portrait:

"Although I considered myself a faithful Christian, I was so more in name than in actual belief. I didn’t begrudge those who wanted to believe that Jesus was more than simply a good man who had suffered at the hands of the world. I sympathized deeply with those who wanted to believe that there was a God somewhere out there who loved us unconditionally. In fact, I envied such people the security that those beliefs no doubt provided. But as a scientist, I simply knew better than to believe them myself."

What it means to be a “faithful Christian” without “actual belief” is not spelled out, but few nonbelievers will be surprised when our hero’s scientific skepticism proves no match for his religious conditioning. Most of us have been around this block often enough to know that many “former atheists”—like Francis Collins—spent so long on the brink of faith, and yearned for its emotional consolations with such vampiric intensity, that the slightest breeze would send them spinning into the abyss. For Collins, you may recall, all it took to establish the divinity of Jesus and the coming resurrection of the dead was the sight of a frozen waterfall. Alexander seems to have required a ride on a psychedelic butterfly. In either case, it’s not the perception of beauty we should begrudge but the utter absence of intellectual seriousness with which the author interprets it.

Everything—absolutely everything—in Alexander’s account rests on repeated assertions that his visions of heaven occurred while his cerebral cortex was “shut down,” “inactivated,” “completely shut down,” “totally offline,” and “stunned to complete inactivity.” The evidence he provides for this claim is not only inadequate—it suggests that he doesn’t know anything about the relevant brain science. Perhaps he has saved a more persuasive account for his book—though now that I’ve listened to an hour-long interview with him online, I very much doubt it. In his Newsweek article, Alexander asserts that the cessation of cortical activity was “clear from the severity and duration of my meningitis, and from the global cortical involvement documented by CT scans and neurological examinations.” To his editors, this presumably sounded like neuroscience.

The problem, however, is that “CT scans and neurological examinations” can’t determine neuronal inactivity—in the cortex or anywhere else. And Alexander makes no reference to functional data that might have been acquired by fMRI, PET, or EEG—nor does he seem to realize that only this sort of evidence could support his case. Obviously, the man’s cortex is functioning now—he has, after all, written a book—so whatever structural damage appeared on CT could not have been “global.” (Otherwise, he would be claiming that his entire cortex was destroyed and then grew back.) Coma is not associated with the complete cessation of cortical activity, in any case. And to my knowledge, almost no one thinks that consciousness is purely a matter of cortical activity. Alexander’s unwarranted assumptions are proliferating rather quickly. Why doesn’t he know these things? He is, after all, a neurosurgeon who survived a coma and now claims to be upending the scientific worldview on the basis of the fact that his cortex was totally quiescent at the precise moment he was enjoying the best day of his life in the company of angels. Even if his entire cortex had truly shut down (again, an incredible claim), how can he know that his visions didn’t occur in the minutes and hours during which its functions returned?

I confess that I found Alexander’s account so alarmingly unscientific that I began to worry that something had gone wrong with my own brain. So I sought the opinion of Mark Cohen, a pioneer in the field of neuroimaging who holds appointments in the Departments of Psychiatry & Biobehavioral Science, Neurology, Psychology, Radiological Science, and Bioengineering at UCLA. (He was also my thesis advisor.) Here is part of what he had to say:

"This poetic interpretation of his experience is not supported by evidence of any kind. As you correctly point out, coma does not equate to “inactivation of the cerebral cortex” or “higher-order brain functions totally offline” or “neurons of [my] cortex stunned into complete inactivity”. These describe brain death, a one hundred percent lethal condition. There are many excellent scholarly articles that discuss the definitions of coma. (For example: 1 & 2)

"We are not privy to his EEG records, but high alpha activity is common in coma. Also common is “flat” EEG. The EEG can appear flat even in the presence of high activity, when that activity is not synchronous. For example, the EEG flattens in regions involved in direct task processing. This phenomenon is known as event-related desynchronization (hundreds of references).

"As is obvious to you, this is truth by authority. Neurosurgeons, however, are rarely well-trained in brain function. Dr. Alexander cuts brains; he does not appear to study them. “There is no scientific explanation for the fact that while my body lay in coma, my mind—my conscious, inner self—was alive and well. While the neurons of my cortex were stunned to complete inactivity by the bacteria that had attacked them, my brain-free consciousness ...” True, science cannot explain brain-free consciousness. Of course, science cannot explain consciousness anyway. In this case, however, it would be parsimonious to reject the whole idea of consciousness in the absence of brain activity. Either his brain was active when he had these dreams, or they are a confabulation of whatever took place in his state of minimally conscious coma.

"There are many reports of people remembering dream-like states while in medical coma. They lack consistency, of course, but there is nothing particularly unique in Dr. Alexander’s unfortunate episode."

Okay, so it appears that my own cortex hasn’t completely shut down. In fact, there are further problems with Alexander’s account. Not only does he appear ignorant of the relevant science, but he doesn’t realize how many people have experienced visions similar to his while their brains were operational. In his online interview we learn about the kinds of conversations he’s now having with skeptics:

"I guess one could always argue, “Well, your brain was probably just barely able to ignite real consciousness and then it would flip back into a very diseased state,” which doesn’t make any sense to me. Especially because that hyper-real state is so indescribable and so crisp. It’s totally unlike any drug experience. A lot of people have come up to me and said, “Oh that sounds like a DMT experience,” or “That sounds like ketamine.” Not at all. That is not even in the right ballpark.

"Those things do not explain the kind of clarity, the rich interactivity, the layer upon layer of understanding and of lessons taught by deceased loved ones and spiritual beings."

“Not even in the right ballpark”? His experience sounds so much like a DMT trip that we are not only in the right ballpark, we are talking about the stitching on the same ball. Here is Alexander’s description of the afterlife:

"I was a speck on a beautiful butterfly wing; millions of other butterflies around us. We were flying through blooming flowers, blossoms on trees, and they were all coming out as we flew through them… [there were] waterfalls, pools of water, indescribable colors, and above there were these arcs of silver and gold light and beautiful hymns coming down from them. Indescribably gorgeous hymns. I later came to call them “angels,” those arcs of light in the sky. I think that word is probably fairly accurate….

"Then we went out of this universe. I remember just seeing everything receding and initially I felt as if my awareness was in an infinite black void. It was very comforting but I could feel the extent of the infinity and that it was, as you would expect, impossible to put into words. I was there with that Divine presence that was not anything that I could visibly see and describe, and with a brilliant orb of light….

"They said there were many things that they would show me, and they continued to do that. In fact, the whole higher-dimensional multiverse was this incredibly complex corrugated ball and all these lessons coming into me about it. Part of the lessons involved becoming all of what I was being shown. It was indescribable.

"But then I would find myself—and time out there I can say is totally different from what we call time. There was access from out there to any part of our space/time and that made it difficult to understand a lot of these memories because we always try to sequence things and put them in linear form and description. That just really doesn’t work."

Everything that Alexander describes here and in his Newsweek article, including the parts I have left out, has been reported by DMT users. The similarity is uncanny. Here is how the late Terence McKenna described the prototypical DMT trance:

"Under the influence of DMT, the world becomes an Arabian labyrinth, a palace, a more than possible Martian jewel, vast with motifs that flood the gaping mind with complex and wordless awe. Color and the sense of a reality-unlocking secret nearby pervade the experience. There is a sense of other times, and of one’s own infancy, and of wonder, wonder and more wonder. It is an audience with the alien nuncio. In the midst of this experience, apparently at the end of human history, guarding gates that seem surely to open on the howling maelstrom of the unspeakable emptiness between the stars, is the Aeon.

"The Aeon, as Heraclitus presciently observed, is a child at play with colored balls. Many diminutive beings are present there—the tykes, the self-transforming machine elves of hyperspace. Are they the children destined to be father to the man? One has the impression of entering into an ecology of souls that lies beyond the portals of what we naively call death. I do not know. Are they the synesthetic embodiment of ourselves as the Other, or of the Other as ourselves? Are they the elves lost to us since the fading of the magic light of childhood? Here is a tremendum barely to be told, an epiphany beyond our wildest dreams. Here is the realm of that which is stranger than we can suppose. Here is the mystery, alive, unscathed, still as new for us as when our ancestors lived it fifteen thousand summers ago. The tryptamine entities offer the gift of new language, they sing in pearly voices that rain down as colored petals and flow through the air like hot metal to become toys and such gifts as gods would give their children. The sense of emotional connection is terrifying and intense. The Mysteries revealed are real and if ever fully told will leave no stone upon another in the small world we have gone so ill in.

"This is not the mercurial world of the UFO, to be invoked from lonely hilltops; this is not the siren song of lost Atlantis wailing through the trailer courts of crack-crazed America. DMT is not one of our irrational illusions. I believe that what we experience in the presence of DMT is real news. It is a nearby dimension—frightening, transformative, and beyond our powers to imagine, and yet to be explored in the usual way. We must send fearless experts, whatever that may come to mean, to explore and to report on what they find. (Terence McKenna, Food of the Gods, pp. 258-259.)"

Alexander believes that his E. coli-addled brain could not have produced his visions because they were too “intense,” too “hyper-real,” too “beautiful,” too “interactive,” and too drenched in significance for even a healthy brain to conjure. He also appears to think that despite their timeless quality, his visions could not have arisen in the minutes or hours during which his cortex (which surely never went off) switched back on. He clearly knows nothing about what people with working brains experience under the influence of psychedelics. Nor does he know that visions of the sort that McKenna describes, although they may seem to last for ages, require only a brief span of biological time. Unlike LSD and other long-acting psychedelics, DMT alters consciousness for merely a few minutes. Alexander would have had more than enough time to experience a visionary ecstasy as he was coming out of his coma (whether his cortex was rebooting or not).

Does Alexander know that DMT already exists in the brain as a neurotransmitter? Did his brain experience a surge of DMT release during his coma? This is pure speculation, of course, but it is a far more credible hypothesis than that his cortex “shut down,” freeing his soul to travel to another dimension. As one of his correspondents has already informed him, similar experiences can be had with ketamine, which is a surgical anesthetic that is occasionally used to protect a traumatized brain. Did Alexander by any chance receive ketamine while in the hospital? Would he even think it relevant if he had? His assertion that psychedelics like DMT and ketamine “do not explain the kind of clarity, the rich interactivity, the layer upon layer of understanding” he experienced is perhaps the most amazing thing he has said since he returned from heaven. Such compounds are universally understood to do the job. And most scientists believe that the reliable effects of psychedelics indicate that the brain is at the very least involved in the production of visionary states of the sort Alexander is talking about.

Again, there is nothing to be said against Alexander’s experience. It sounds perfectly sublime. And such ecstasies do tell us something about how good a human mind can feel. The problem is that the conclusions Alexander has drawn from his experience—he continually reminds us, as a scientist—are based on some very obvious errors in reasoning and gaps in his understanding.

Let me suggest that, whether or not heaven exists, Alexander sounds precisely how a scientist should not sound when he doesn’t know what he is talking about. And his article is not the sort of thing that the editors of a once-important magazine should publish if they hope to reclaim some measure of respect for their battered brand.

(1) Eben Alexander | (2) Sam Harris | (3) Sam Harris | (4) Oliver Sacks