It was appropriate that I read this book on a journey for a weekend meeting in Geneva of the steering group for our after death communications project –  a very significant book that I missed when it first came out. Some readers will already be familiar with the work of Sam Parnia and his AWARE Project, currently funded to the tune of $1.8 million by the Templeton Foundation and which he initiated some time ago with Peter Fenwick. Sam is a leading expert on cardiac arrest resuscitation, working as an assistant professor of critical care medicine at the State University of New York. It is interesting to learn that his own background includes the fact that his father suffered a devastating neurological disorder where his consciousness was largely absent for the last 17 years of his life – an emotive personal encounter that surely drives his passion to understand the nature of consciousness.

One of Sam’s central points is that cardiac arrest is in fact death (a global stroke), so it is misleading to talk about a near death experience and more precise to use the term actual death experience (ADE) since the former term is insufficiently precise (p. 178). Patients with cardiac arrest are actually dead, even though death as a whole is a process reversible up to a point, as Sam explains in describing the history and nature of resuscitation procedures. One of the most important of these procedures is cooling the body, which retards cell death and makes it much more likely that patients will recover without brain damage. However, progress in the field has been slow and even known effective procedures are far from universally applied.

Remarking on the scientific paradox that people experiencing ADEs have well-structured thought processes despite the brain being down, he likens interpretations of such experiences to the blind people and the elephant, with each explanation a partial view. He makes the critical point that the same areas in the brain are involved in both hallucinations and real experiences, so we cannot use a brain-based argument to differentiate them: ‘the activation of specific areas of the brain can’t determine the reality of an experience….no brain-based chemical change can define whether a sensation or feeling is real or not’ (pp. 156, 162). Moreover, if someone says they are depressed, we accept the report as real rather than thinking they are just imagining it. Sam also notes that reality is largely socially determined, including in science with its conventional boundaries.

The next chapter moves on to a discussion of brain, soul and consciousness, beginning with Plato and Aristotle and posing the essential question whether your brain creates mind and consciousness or if there is an entity separate from the brain that interacts with it. Here he could also have mentioned the Hebrew tradition often cited by theologians that the soul is fundamentally tied to the physical body, which contrasts with the Platonic view and is nearer to that of Aristotle. He also quotes Sir John Eccles, often neglected as a dualist by philosophers and psychologists, and here he could have added a reference to the pioneering work of William James in discussing the possibility that the brain may be more like a transmitter than an originator of consciousness. In any event, one can only strictly speak of neural correlates rather than causation.

One of the most interesting features of the book is the way that it contextualises experiences reported in cardiac arrest with other cases of long-term coma where consciousness is absent, but can suddenly reappear – Sam gives a number of fascinating case histories in this respect, including one where the patient recovers consciousness as a result of being administered a sleeping pill! Fascinatingly, a study where a control group and people in a vegetative state were both asked to imagine that they were playing tennis showed an activation in the motor cortex also in those in a vegetative state. Sam goes on to describe the AWARE study, comparing and analysing a number of experiences as well as noting the role of oxygen levels necessary for resuscitation –  a minimum of 30%. He gives a detailed account of a veridical ADE with verifiable detail, but also argues that we should distinguish between explicit and implicit memories – 38% of the sample had some kind of implicit awareness, but only 9% any explicit memories. The best cases support the Eccles view that the soul or consciousness may be a separate entity and continue to exist after death – this is backed up by survival research not mentioned here. The final chapter draws the threads together, both in terms of resuscitation and consciousness, using the analogy that he and his colleagues are in a similar situation to early gold and diamond prospectors in opening up a new field that may well require a new paradigm in neuroscience, as also argued in our Galileo Report. This is a thorough, incisive and important contribution to our understanding of cardiac arrest, resuscitation and the underlying nature of consciousness said as such should be widely read.
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