dissociation

Different parts

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This week has been calm at work. I haven’t had many client conversations, but one of them has been very much on my mind. Usually I don’t think too much about my clients between sessions, but when I get worried about a client it’s hard not to. The client has dissociative identify disorder, and one of the parts is suicidal. The part is young and doesn’t trust other humans, understandably so. Life has been unsafe and unpredictable, so the part has done what everyone would do in a similar situation: keeping its guard up. I asked this part if he is familiar with the people in my clients life today, and my client told me he knows about them, but he doesn’t connect with them emotionally. My client has been in therapy for many years, and even if things are somewhat better, my client still suffers every day. Nightmares, lack of sleep, daily dissociative episodes, and at the moment, a feeling of hopelessness.

I wonder, how can I help this part to recognize that his circumstances are different now? That he has people in his life who care and would be shattered if he disappeared for good? How can we work together on ways to regulate the intense pain he lives with everyday, when he has no experience with coping when things gets too much?

Found in translation

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I was in Budapest for five days. I attended a Hungarian wedding, and felt a bit isolated at first. Around me people were laughing, chatting in a language totally foreign to me. But then I met a British, wonderful man that managed to shift my perspective. That doesn’t happen everyday, especially not when you’re lost in translation, feeling like a bleep on the canvas of the universe.

We met after the wedding and he made my head spin. Being challenged in what you believe is unsettling, and for a moment there it felt like I was falling into a black hole. We talked about the universe giving you what you need, and also about space-time. The concept was somewhat familiar to me, but my head starts aching when I’m thinking about the mystery out there. I told him about particles being at two different spots at the same time, and he told a story about just that, but with humans: He was together with two friends, where one of them sat in the bed opposite him and the other friend. Suddenly this friend was in the bathroom at the other end, and they had not seen him walk over there. The friend who suddenly was at another space, did not understand he suddenly was there, too. I didn’t believe this story, so I will need verification from his friends, but it made me think about how little I know about this world. I recently read an article about consciousness where the author proposes a solution to the unfathomable mystery of our minds and souls. He compared ‘a common consciousness’ with dissociative identity disorder, where many personalities exists in the same body. He said that this might just answer the question related to how every human beings consciousness is completely unique: If consciousness exists all around us, even in other materials like plants, and it still can be unique for every creature, dissociative identity disorder might provide some answer to what scientists have struggled with for centuries.

Other than these discussions, I found a really good friend.

Am including some pictures from Budapest, a truly beautiful city.

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Stress Positions are Torture

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Reblogged from Ashana M. Thank you for sharing.

Stress Positions are Torture

Strappado at BuchenwaldSome days, my whole body hurts. Sometimes it’s just my legs that hurt. They hurt at the thighs most intensely, but also along the arches of my feet. I’ve described the sensation to my doctors as a burning sensation, the kind of pain you feel from muscular exhaustion.

There is no medical explanation for my pain. And yet there is.

Growing up, I was placed in what are euphemistically referred to as “stress positions”–positions in which a disproportionate amount of stress is place on a small number of muscles, at first causing discomfort and eventually leading to intense pain.

At Guantanamo, detainees are frequently subjected to stress positions during interrogation–“short-chaining” so that they are restrained in uncomfortable positions throughout the course of the interrogation. Seated detainees cannot sit up straight. Standing detainees cannot stand up. Enough of this, and you start finding yourself wanting to tell the interrogator whatever he wants to hear, just to get out of the short-chaining.

It is referred to as an “enhanced interrogation technique,” and justified as necessary for reasons of safety and security. But stress positions are a form of torture. And it is well-documented that torture is neither humane nor effective: the desire to end the torture motivates the victim to please the perpetrator, rather than to tell the truth.

Detainees are also placed in other stress positions as well, including what is sometimes referred to as strappado which places terrible stress on the shoulders, causing unbearable pain, dislocation, and sometimes nerve and ligament damage.

The most effective stress positions in torture are those that provide the prisoner with a choice of death or pain, or a choice of two kinds of pain. This causes the prisoner to falsely feel he is in control of the pain, and he will often unwittingly blame himself.

In my case, my father suspended me by the neck from the ceiling of the garage with my feet barely touching the ground, so that as long as I stood on tip-toes I could continue to breathe. If I relaxed my legs, I would asphyxiate.

This is why my legs continue to hurt. My automatic response to stress is to create tension in my legs, as I unconsciously associate danger with a need to stand on tip-toe and to maintain tension in my legs.

There are two take-aways from this in my mind. One, the use of stress positions in American detention facilities needs to end completely. And, two, rehabilitation of torture victims must include the collaboration of medical professionals on mental health and physical issues, as they are inter-related. The torture survivor who feels physical pain is not merely reliving the pain in his own mind. He is sometimes feeling the affects of ongoing damage to nerves, joints, and tissues. At other times, he is unwittingly recreating it, by returning to positions that kept him alive.

Further reading:

Amnesty International. Torture and Accountability. http://www.amnesty.org/en/campaigns/counter-terror-with-justice/issues/torture-and-accountability

The Green Light. (2008, May) Vanity Fair. http://www.vanityfair.com/politics/features/2008/05/guantanamo200805

Reydt, P. (2004, 25 August). Former Detainees Detail Abuses at Guantanamo Bay. World Socialist Website. http://www.wsws.org/en/articles/2004/08/tipt-a25.html

The sound of being torn in two

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Unapologetic

You saw me on a television Setting fire to all the buildings Yeah I guess you saw me stealing But you’ve no idea what I’ve been needing Talk about when we were children Not the kinda kid that you believe in You saw me on a television Saw me on a television

But that’s just the half of it Yeah you saw the half of it This is the life I live And that’s just the half of it

You saw me on a television Hanging out my dirty linen You’re entitled to your own opinion Sit and shake your head at my decisions I guess the kinda songs that I’ve been singing Make it seem as if I’m always winning But you saw me on a television Yeah you saw on a television

But that’s just the half of it You saw the half of it, yeah This is the life I live And that’s just the half of it

Oh you know me, I’m the life of the party Beautiful people surround me Everybody falling in love Oh you know me, everybody knows that I’m crazy Sticks and stones, they never break me And I’m the type that don’t give a fuck

And that’s just the half of it You saw the half of it Yeah this the life I live And that’s just the half of it

Yeah you saw the half of it And this is the life I live You saw the half of it Only the half of it, hey, no…

You saw me on a television Saw me on a television

The philosophers and dissociation

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How we see the world, depend on our categories

Dissociation is a complex theory that is based on basic research and knowledge gathered from philosophers and theories from different disciplines. Sometimes we forget that everything we experience in the world, is a construct created by ourselves. I can give a little example of this from my personal experiences. Before I had my own car (a little opel corsa) I did often not “see” other cars as anything else than a vehicle who takes me from A to B. After I bought the car, I suddenly started to notice new things: I saw many other cars of the same type, and it almost seemed like the world was filled with little corsas. This does not mean that it was more Corsa`s there after I bought my car, just that I did not attend to the fact before. The “outer” world is still the same, but my world has suddenly changed.

My little corsa, before it "died"
My little opel corsa

 

Understanding in psychiatry

We also experience this in psychiatry. Where a doctor might see bipolar disorder, a psychiatrist might see the same symptoms as AD/HD, and therefore notice other things than the doctor might do. This will also shape how one tries to “treat” the same patient. Where one doctor might give them lithium for bipolar disorder, a psychiatrist who interpret it as AD/HD will maybe prescribe Ritalin. In fact, this happens all the time. Some patients have been given every diagnosis possible, but still not feel better. When I work, I feel that no matter if a person has bipolar disorder, AD/HD, dissociation they still need much of the same: The need to be whatever they are. I find one of psychoterapists main goal must be to help patients to live more in accordance with their impulses. In fact, many schizophrenic patients, still live with voices in their heads even on medicine, but they don`t feel bothered by it anymore. The same thing happens (hears voices), but since it is “okay” it doesn`t evoke a feeling of guilt and shame when it occurs.

 

The dissociation model as a tool in psychiatry

The haunted self by Nijenhuis

For me the dissociation-model has been meaningful in my work. I often see dissociation where others might see bipolar disorder or AD/HD. I am not against medicine, since I think it can be an important supplement IF the person taking them, believe it is necessary. Right now I am on a two-day course with Ellert Nijenhuis, who has written “the haunted self”. This book was one of the first dissociation books I read, and I immidiately found the theory meaningful. To sit here and actually hear him talk about his theories is very interesting. Right now he is talking about the background for the theory, and I will focus on some of those thoughts in the following paragraph

page10image160

Aristoteles

Aristoteles four causes as a background for understanding dissociation

  • A change or movement’s material cause is the aspect of the change or movement which is determined by the material which the moving or changing things are made of. For a table, that might be wood; for a statue, that might be bronze or marble. Where the organization IS
  • A change or movement’s formal cause is a change or movement caused by the arrangement, shape or appearance of the thing changing or moving. Aristotle says for example that the ratio 2:1, and number in general, is the cause of the octave. The structural dissociation of the personality, what we need to know about is there
  • A change or movement’s efficient or moving cause refers to things apart from the thing being changed or moved, which interact so as to be an agency of the change or movement. For example, the efficient cause of a table is a carpenter, or a person working as one, and according to Aristotle the efficient cause of a boy is a father. It needs to be organized
  • An event’s final cause is the aim or purpose being served by it. That for the sake of which a thing is what it is. For a seed, it might be an adult plant. For a sailboat, it might be sailing. For a ball at the top of a ramp, it might be coming to rest at the bottom. The most important, that explains the reason for the structural dissocation? The “I want” part. Spinoza: Everything that exist, wants to continue to exist. Why? We don`t know. It can be very frightening to think there is NO reason for living, and it can be easier to think that there must be something more, like a God. In the tv-show “All in the family” there is a episode where “Archie” sees God, as a negro Woman. He is shocked and in Awe. He says “I am sorry, I did not know that”. He did not really believe in God, but since he had no other way to regulate his feelings of uncertainty at that time, to keep his self-esteem alive, he sought something “outerwordly” that might give meaning.

  • Nietzche thoughts about consciousness and it`s relation to dissociation

Nietzche talked about our inner “needs”. One of those were the will to power. We have an inner need to control. He thought this underlying need was unconscious, that means that we did not always register that we had to feel in control. This is meaningful for every person who has at one time or another not understood WHY it is so important for them to not “loose” an argument. Have you ever experienced to have a argument with somebody you know, and finding yourself protesting against things you are not really against? Afterwards you might think: Why did I do that? I did not really mean to say those things. Why do we not want to be the first person that says “I`m sorry”, even when we as grown-ups see that it would be better to lay down the sword? In fact, this can sometimes lead to unneccessary powerstruggles in the outer world. The Cuba Crisis was one example of this. Being the first person to withdraw, left you vulnerable for attack. If it withdrawing first hadn`t been done by USA, the outcome might have been very different.

Neuroscience and dissociaiton

Panksepp, an neuroscientist interested in the unconscious mind, has studied the brain, and found that there are truly active areas in the brain, that we do not “register” in consciousness even if some other part of the brain has done so. The vagus nerve is the part of our nervous system that mediates the parasympathic and sympathic nerve-system. The ventral part of the vagus-nerve has become specialized in regulation social relationships. Those systems are complex, and will be written about elsewhere, but the point is that neuroscience can explain why we do certain things: Like defend ourselves. Normally we approach people close to us, but when a person has experiences trauma, confusion often develops, between the system that wants to approach (like our natural system would) and the system who wants to escape or “fight” to survive. To manage this confusion, a solution can be to dissociation these systems from each other. It keeps the conflict “away” so that the person can “appear normal (ANP: Apparent normal personality).


Nietzche
Nietzche

http://www.trauma-pages.com/a/nijenhuis-2004.php


 

The sound of the stranger in the mirror

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Shatter the myths of dissociation – a debilitating psychological condition that affects over 30 million people globally – with Dr. Marlene Steinberg, author of THE STRANGER IN THE MIRROR: DissociationThe Hidden Epidemic. Now, for the first time, professionals and lay readers alike can learn valuable guidelines for identifying, treating, recovering from, and ultimately understanding this often confusing condition involving feelings of disconnection from one’s self.

Dr. Steinberg is the originator of The Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D), the breakthrough diagnostic test that allows therapists worldwide to diagnose dissociative disorders based on rigorous scientific testing. She has also authored The Handbook for the Assessment of Dissociation: A Clinical Guide, a resource for therapists offering systematic guidelines for assessing dissociative symptoms and disorders.


MORE ABOUT THE BOOK

ABOUT DISSOCIATIVE DISORDERS
Are you among the millions of people who have suffered from dissociative symptoms, and they have caused you inner pain and interfered with work or relationships? You can learn more about whether your symptoms are nothing to worry about, or would benefit from professional help.

CONSUMER RESOURCES
If you or a member of your family suffers from dissociation, you can have access to professionals who are trained in the latest advances in diagnosing and treating dissociative disorders.

RESOURCES FOR PROFESSIONALS
If you are a mental health professional and want to gain specialized knowledge in the diagnosis of dissociation using The Structured Clinical Interview for Dissociative Disorders-Revised (SCID-D-R), become familiar with the resources that are available. 

CONTACTING DR. STEINBERG

  
      
Shatter the myths of dissociation – a debilitating psychological condition that affects over 30 million people globally – with Dr. Marlene Steinberg, author of THE STRANGER IN THE MIRROR: DissociationThe Hidden Epidemic. Now, for the first time, professionals and lay readers alike can learn valuable guidelines for identifying, treating, recovering from, and ultimately understanding this often confusing condition involving feelings of disconnection from one’s self.

Dr. Steinberg is the originator of The Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D), the breakthrough diagnostic test that allows therapists worldwide to diagnose dissociative disorders based on rigorous scientific testing. She has also authored The Handbook for the Assessment of Dissociation: A Clinical Guide, a resource for therapists offering systematic guidelines for assessing dissociative symptoms and disorders.


MORE ABOUT THE BOOK

ABOUT DISSOCIATIVE DISORDERS
Are you among the millions of people who have suffered from dissociative symptoms, and they have caused you inner pain and interfered with work or relationships? You can learn more about whether your symptoms are nothing to worry about, or would benefit from professional help.

CONSUMER RESOURCES
If you or a member of your family suffers from dissociation, you can have access to professionals who are trained in the latest advances in diagnosing and treating dissociative disorders.

RESOURCES FOR PROFESSIONALS
If you are a mental health professional and want to gain specialized knowledge in the diagnosis of dissociation using The Structured Clinical Interview for Dissociative Disorders-Revised (SCID-D-R), become familiar with the resources that are available. 

CONTACTING DR. STEINBERG

The psychology of money

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The Psychology of Money

prismAn important contribution that Jung made to understanding the personality was its tendency to dissociate, or split into parts.  He called these parts complexes, or splinter personalities.  On occasion, a person ‘falls into’ a complex and it takes over the personality for a time.  The inferiority complex is, by now, familiar in our cultural landscape and when in the grip of this, a person feels inadequate, incompetent, weak and lowly.  Even people who have objectively achieved excellence can still be prey to feeling inferior at times.

 

At the centre of a complex are some strong feelings, which are described as archetypal due to their intensity.  They are usually out of proportion to the event that has triggered them and can carry us away, into acting in ways that we might, in a different state of mind, not countenance.  Some familiar expressions capture this well: ‘I was beside myself with rage’; ‘I don’t know what came over me’; ‘it is not like me at all to…’  The ‘cure’ for complexes is for the heart of them to find expression and understanding in a safe place, which can be psychotherapy for some people.  They take quite a bit of unravelling which is why they are called complex.  If we think of small children and how intense their feelings are, it is easier for us to think of how normal it is to behave in unacceptable ways and to understand how we socialise children into our culture.  When these strong feelings are lived and accepted, they become humanised – no longer the province of the archetypal – and then they can become more integrated into the personality and put to good use.  If, however, the feelings are repressed (rather than understood and accepted)  because they are socially unacceptable, then they move into unconscious territory where they will erupt via a complex at a later stage.  Rage is not often helpful but in its attenuated state of assertiveness or healthy anger, then it is an important part of the psychic economy that can protect and stand up for us, giving us energy to do what needs to be done.

 

Anna was born into a poor family where money was tight, but just as importantly, where there was also psychic moneyimpoverishment.  Her father spent too much of the family budget on nights down the pub and was not only emotionally unavailable to his family but when he was present, he would be rough, both verbally and physically.  Anna learnt to keep out of his way and to ‘swallow’ much of her resentment, trying her best to keep the peace and to help her mother.  When she found the capacity to come to therapy in her thirties, she would fall into her ‘money complex’.  She would become profoundly anxious that she was spending the entire family budget on herself (as her father had) and terrified that she would become dependent on the therapist (as father was dependent on alcohol) and at risk of falling apart if money ran out (which was mother’s fear for herself and the family).  The parallels between the family poverty and the current deprivation were played out with money as the currency for emotional expression.  A lot of attention was given to money transactions, including the payment of fees in the therapy, as they carried a great deal of feeling.  As links were made between the past and the present and Anna’s needs were attended to, slowly there was a shift and Anna became less anxious generally and less anxious about money in particular.  Whereas some people may need to learn to rein in their spending and become more prudent, for Anna it was the opposite and she learnt to let go a little, waste a little and to enjoy herself more.  She had plenty of resources as she was intelligent, capable, and in a good and emotionally nurturing relationship.  We began to use the symbolism of money to understand that she was rich in many ways and that her financial and emotional poverty were literally a ‘small’ part of her, that is belonging to her child self.

Escaping the safety net of silence

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Reblogged from Elle:

escaping the safety net of silence

http://media.washtimes.com/media/community/photos/blog/entries/2011/11/27/silence-640_s640x427.jpg?7

Silence was such a helpful skill to master.

To literally not let a word escape from these lips for at least one school year at the ages of 4-5 (don’t know how long it was exactly, only what was written in records that have been accessed). That is not normal, and it certainly wasn’tmanipulative (which is how an educational psychologist described it).

Fearing making a sound; if those little girls had spoken, it would have reinforced their shame for existing. That fear is held by so many of us, even now. “Shut up” “you always sound so stupid” “you never make sense” are just some of the many statements that are repeated, internally pretty much always.

But why should those little girls still be so frozen in silence? Why shouldn’t they cry their tears out loud? Why shouldn’t they tell? Why shouldn’t someone hear them?
Why are we all still so afraid of hearing our own voices? Why are we so afraid of anyone else hearing?

Silence can be safe, it can also be pretty dangerous and we need to stop holding onto silence so tightly.

*just writing this has triggered the “don’t ever tell” monologue.

Thank you for reading.

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The sound of swan song

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How much do you know about the brain? consisting of 100 billion neurons that each can connect to from 1000-10000 others, it hides the secrets of our being, and the path to enlightenment. The most fascinating feat of this grey-wrapped supercomputer, is how it can be influenced by the world around us. Lately, I have read an amazing book about dissociation where I found information about near-death experience. The author explained how”near-death” sound like certain experiences people have when they dissociate. And now I found even more information about the subject, on another blog. Enjoy!  

More information:

(The stranger in the mirror)

 The New York Times
  • The Washington Post
    A Flight of Mind, The Act of Dissociation Can Protect Children Emotionally From Trauma, but Repeated Use May Cause Lasting Harm

  • Yale Scientific
    The Shattered Self: Understanding Dissociative Disorders

  • Clinical Psychology News
    Are Dissociative Disorders Unusual or Ubiquitous?

  • Science News
    Interviews Unmask Multiple Personalities

  • Psychiatric Times
    Advances in Diagnosis and Treatment of Dissociation: The SCID-D in Clinical Practice
  • Many Voices
    Dissociation and Trauma: A Professor’s Perspective

The brain’s swan song: hyperactivity near death

TL;DR: Near-death experiences are ‘electrical surge in the dying brain? …But dude, what does it all mean?

Swan-Song-detail-2 copy

We often think of death as flipping a switch: one minute you’re there, next all lights go out. But this is a simple caricature of the dying process: sparks of activity still linger in the brains of those undergoing cardiac arrest, in whom both breath and heartbeat flutter and abruptly halt. Researchers have long thought that these sad, sparse bouts of activity characterize the brain’s descent into permanent unconsciousness. However, a new study suggests that the complete opposite – a surge of heightened connectivity – paradoxically marks the final step towards death. Although a long (and I mean LOOOONG!) stretch, the authors propose that the observation may partially underlie the enigmatic near-death experience(NDE).

Reports of NDE are nothing new. The luckily revived few often re-emerge from “the other side” with realer-than-real stories of long tunnels, intensely vivid visions and meetings with those bygone. NDEs are treated by some as proof of an afterlife, or by others, the existence of a “mind” beyond the brain and body. Spiritual connotations aside, the biological underpinnings remain mysterious, although abnormal dopamine and glutamate transmission may be involved (and probably everything else – the brain IS dying!). Here, the authors turned the focus away from individual neurotransmitters, and instead asked: after the heart stops, what happens to the oscillating waves of neural activity in the brain?

Jimo Borjigin et al. 2013. Surge of neurophysiological coherence and connectivity in the dying brain. PNAS. doi: 10.1073/pnas.1308285110 

Researchers fitted 9 rats with electrodes to measure their brain waves – rhythmic brain activity generated by feedback connections between large numbers of neurons that differ in frequency. Alpha activity, for example, is often detected during relaxed wakefulness, while the faster theta activity is linked to cognitive processing. Gamma waves – the most recently discovered component – are particularly interesting to cognitive neuroscientists (and pseudo-science marketers) studying consciousness.

Why? The low gamma band, oscillating at 25-55Hz, has long been linked to visual consciousness, or the perception and awareness of visual stimulation. It seems to promote associative learning, and is also present during REM sleep (and slow wave sleep/deep sleep as well), which involves dreaming and complex visuals. Gamma bands also appear during transcendental mental states, as measured in Tibetan monks told to generate feelings of compassion as they meditated. Some even propose that gamma bands are behind the heightened sense of consciousness and bliss following a meditative bout. Sounds pretty magical, eh? As things goes, it’s also a tough band to measure with EEG – in fact,there are even skeptics who doubt its existence.

Screen Shot 2013-08-14 at 11.28.24 AM

Back to the study. After fitting rats with electrodes, researchers monitored changes in each brain wave component as the rats passed through three states: awake, under ketamine-induced anesthesia and after cardiac arrest. Unsurprisingly, after the loss of heartbeat and oxygen flow, the strength (“power”) of all brain wave frequencies measured tanked – except for low gamma bands, which spiked in power and became the dominant frequency in the spectrum as you can see above.

After cardiac arrest, gamma waves also showed higher levels of synchrony – that is, the neural activity in various brain regions became more “in tune”, even compared to an awake state. This high level of coherence between different brain regions is often associated with a highly “aroused” brain – that is, a state in which high levels of information processing may occur. Thus the authors concluded that the brain might exist in a hyper-conscious state for tens of seconds after the heart stops.

Sounds a bit too philosophical? I feel you. Where to start? First, the data really doesn’t tell us much. We already know that for a brief time following clinical death (which will most likely be redefined in the future), the brain remains active – so that’s nothing new. The increase in gamma wave power and synchrony is intriguing, especially since it appeared in all 9 rats (but really, just 9?), and the magnitude of the changes were large. But to link those changes to hyper-consciousness (what does that even mean?) and near-death experiences (NDEs) is going a step too far.

For one, there is absolutely no direct proof that gamma waves reflect NDEs. It has never been recorded in people there-and-back-again. While it’s true that high power gamma activity is often measured during conscious brain activity (and dreaming), its presence does not “lead to” conscious perception. Hence we can’t conclude, for example, that the rats were experiencing heightened awareness like NDEs – if they even have the ability to – because they show increased gamma oscillation. Along the same lines, higher gamma activity in the visual cortex does not necessarily mean there is more visual awareness and sensation. It may let you watch your life flash before your eyes, or it might just be a random quirk in the brain before all lights go out.

I’m not bashing research on consciousness. I just dislike interpretations that take data completely out of the realm of scientific discussion. I’d perk up if the authors repeated this experiment on people who have undergone cardiac arrest and experienced NDEs, and found the same pattern of changes in gamma waves. But even then it wouldn’t really tell us much. Now if only we had the ability to experimentally manipulate gamma (or any other) bands and “implant” an NDE in those still alive…

Note: I’d love for the EEG experts out there pitch in. How hard is it to measure and isolate gamma band from noise? What conclusions (if any) would you make out of this study?

ResearchBlogging.org
Borjigin J, Lee U, Liu T, Pal D, Huff S, Klarr D, Sloboda J, Hernandez J, Wang MM, & Mashour GA (2013). Surge of neurophysiological coherence and connectivity in the dying brain. Proceedings of the National Academy of Sciences of the United States of America PMID:23940340