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A near-death experience (NDE) is an experience reported by a person who nearly died, or who experienced clinical death and then revived. Some people argue it can be explained by hallucinations produced by the brain as it loses adequate blood supply and nutrients , while others state that such an explanation cannot account for all the evidence. The experience has become more common in recent times, especially since the development of cardiac resuscitation techniques. Popular interest in near-death experiences was sparked by Raymond Moody Jr's 1975 book Life after Life and the founding of the International Association for Near-death Studies (IANDS) in 1978. According to a Gallup poll approximately eight million Americans claim to have had a near-death experience. NDEs are among the phenomena studied in the field of parapsychology, psychology, psychiatry and hospital medicine.

Characteristics
The phenomenology of an NDE usually includes physiological, psychological and transcendental aspects. Typically the experience follows a distinct progression:

• 1.A sense of being dead.
• 2.An out-of-body experience. A sensation of floating above one's body and seeing the surrounding area.
• 3.Pleasant feelings, calmness. A sense of overwhelming love and peace.
• 4.A very unpleasant sound/noise is the first sensory impression to be noticed (R. Moody: Life after Life)
• 5.A sensation of moving upwards through a tunnel or narrow passageway.
• 6.Meeting deceased relatives or spiritual figures.
• 7.Encountering a being of light, or a light (possibly a religious or divine figure).
• 8.Being given a life review.
• 9.Reaching a border or boundary.
• 10.A feeling of being returned to the body, often accompanied by a reluctance.
• Some people have also experienced extremely distressing NDEs.

A 'core' near-death experience reflects — as intensity increases according to the Rasch scale — peace, joy and harmony, followed by insight and mystical or religious experiences. The most intense NDEs involve an awareness of things occurring in a different place or time, and some of these observations are said to have been evidential.

Research
Interest in the NDE was originally spurred by the research of such pioneers as Elisabeth Kübler-Ross, George Ritchie, and Raymond Moody Jr. Moody's book Life after Life, which was released in 1975, brought a great deal of attention to the topic of NDEs. This was soon followed by the establishment of the International Association for Near-death Studies (IANDS) founded in 1978 in order to meet the needs of early researchers and experiencers within this field of research. Today the association includes researchers, health care professionals, NDE-experiencers and people close to experiencers, as well as other interested people. One of its main goals is to promote responsible and multi-disciplinary investigation of near-death and similar experiences.
Later researchers, such as Bruce Greyson, Kenneth Ring and Michael Sabom, introduced the study of Near-death experiences to the academic setting. The medical community has been somewhat reluctant to address the phenomenon of NDE's and grant money for research has been scarce. However, although the research was not always welcomed by the general academic community, both Greyson and Ring made significant contributions in order to increase the respectability of Near-death research. Major contributions to the field include the construction of a Weighted Core Experience Index. in order to measure the depth of the Near-death experience, and the construction of the Near-death experience scale in order to differentiate between subjects that are more or less likely to have experienced a classical NDE. The NDE-scale also aims to differentiate between what the field claims are "true" NDE and syndromes or stress responses that are not related to a NDE. Greyson's NDE-scale was later found to fit the Rasch rating scale model.

Other contributors to the research on Near-death experiences come from the disciplines of medicine, psychology and psychiatry. Greyson (1997) has also brought attention to the near-death experience as a focus of clinical attention, while Morse et al. (1985; 1986) have investigated Near-death experiences in a pediatric population.

Neuro-biological factors in the experience have been investigated by researchers within the field of medical science and psychiatry (Mayank and Mukesh, 2004; Jansen, 1995; Thomas, 2004). Among the researchers and commentators who tend to emphasize a naturalistic and neurological base for the experience we find the British psychologist Susan Blackmore (1993), and founding publisher of Skeptic magazine, Michael Shermer (1998).

Among the scientific and academic journals that have published, or are regularly publishing new research on the subject of NDE's we find: Journal of Near-Death Studies, Journal of Nervous and Mental Disease, British Journal of Psychology, American Journal of Disease of Children, Resuscitation, The Lancet, Death Studies, and the Journal of Advanced Nursing.

As an afterlife experience
Some see the NDE as an afterlife experience. They believe that the NDE cannot be completely explained by physiological or psychological causes, and that consciousness can function independently of brain activity. Many NDE-accounts seem to include elements which, according to several theorists, can only be explained by an out-of-body consciousness. For example, in one account, a woman accurately described a surgical instrument she had not seen previously, as well as a conversation that occurred while she was under general anesthesia. In another account, from a proactive Dutch NDE study , a nurse removed the dentures of an unconscious heart attack victim, and was asked by him after his recovery to return them. It might be difficult to explain in conventional terms how an unconscious patient could later have recognized the nurse.
Dr. Michael Sabom reports a case about a woman who underwent surgery for an aneurysm. The woman reported an out-of-body experience that she claimed continued through a brief period of the absence of any EEG activity. If true, this would seem to challenge the belief by many that consciousness is situated entirely within the brain. A majority of individuals who experience an NDE see it as a verification of the existence of an afterlife. This includes those with agnostic/atheist inclinations before the experience. Many former atheists, such as the Reverend Howard Storm have adopted a more spiritual view after their NDEs. Howard Storm's NDE might also be characterized as a distressing near-death experience. The distressing aspects of some NDE's are discussed more closely by Greyson & Bush (1992).

As Greyson notes: "No one physiological or psychological model by itself explains all the common features of NDE. The paradoxical occurrence of heightened, lucid awareness and logical thought processes during a period of impaired cerebral perfusion raises particular perplexing questions for our current understanding of consciousness and its relation to brain function. A clear sensorium and complex perceptual processes during a period of apparent clinical death challenge the concept that consciousness is localized exclusively in the brain.

Research on NDEs occurring in the blind have also hinted that consciousness survives bodily death. Dr. Kenneth Ring notes in the book "Mindsight: Near-Death and Out-of-Body Experiences in the Blind" that up to 80% of his sample studied reported some visual awareness during their NDE or out of body experience.

In infrequent instances there is ambiguity between medical and spiritual facts. There exist reports about connections between deceased persons and persons who have had an NDE. Ken Mullens (1992;1995), who was clinically dead for more than 20 minutes, reported spiritual encounters in his life after his NDE. As he reported, deceased persons he communicated with were often unknown to him, but were connected to people he met at a later point. While such reports are discredited by skeptics, others maintain that they remain a mystery. Since they have no apparent medical or physical explanation they are said to belong to the interpretative and phenomenological dimension of the NDE, as investigated by the field of Near-death studies.

Spiritual and psychological after-effects
NDE's can also lead to long-lasting spiritual effects (as evidenced by the many studies which confirm the experience as having taken place during clinical death). The mathematician John Wren-Lewis (1985), after his NDE, felt himself in a more or less permanent state of equanimity, feeling contact with the void and with no separate existence from the whole.

NDE subjects often report long-term after-effects, and changes in worldview, such as increased interest in spirituality, greater appreciation for life, increased interest in the meaning of life, increased empathic understanding, decrease in fear of death, higher self-esteem, greater compassion for others, heightened sense of purpose and self-understanding, desire to learn, greater ecological sensitivity and planetary concern, a feeling of being more intuitive or psychic (Mauro, 1992; van Lommel et.al, 2001). Greyson (2003) notes that Near-death experiences are associated with enhanced purpose in life, appreciation of life and with reduced fear of death, but also with adverse effects, such as posttraumatic stress symptoms. Some subjects also report internal feelings of bodily energy and/or altered states of consciousness similar to those associated with the yogic concept of kundalini (Greyson, 2000).

Greyson (1983) developed The Near-Death Experience Scale in order to measure the after-effects of a near-death experience. Researchers have pointed out that the aftermath of the experience can be associated with both positive and healthy outcomes related to personality and appreciation for life, but also a spectrum of clinical problems in situations where the person has had difficulties with the experience (Orne, 1995). These difficulties are usually connected to the interpretation of the experience and the integration of it into everyday life. The near-death experience as a focus of clinical attention, and the inclusion of a new diagnostic category in the DSM-IV called "Religious or spiritual problem" (American Psychiatric Association, 1994 - Code V62.89), is discussed more closely by Greyson (1997) and Lukoff, Lu & Turner (1998).
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