BACKGROUND: When some people come close to death, they report a profound experience of transcending the physical world that often leads to spiritual transformation. These "near-death experiences" (NDEs) are relevant to clinicians because they lead to changes in beliefs, attitudes, and values; they may be mistaken for psychopathological states, although producing different sequelae requiring different therapeutic approaches; and because they may enhance our understanding of consciousness. OBJECTIVES: This literature review examined the evidences regarding explanations proposed to explain NDEs, including expectation, birth memories, altered blood gases, toxic or metabolic hallucinations, and neurochemical and neuroanatomical models. METHODS: The literature on NDEs of the past 30 years was examined comprehensively, including medical, nursing, psychological, and sociological databases. RESULTS: NDEs typically produce positive changes in attitudes, beliefs, and values, but may also lead to interpersonal and intrapsychic problems. These problems have been compared to various mental disorders, but are distinguishable from them. Various therapeutic strategies have been proposed to help experiencers with problematic aftereffects, but have not been tested yet. CONCLUSIONS: The mystical consciousness and higher mental activity during NDEs, when the brain is severely impaired, challenge current models of brain/mind interaction and may occasionally lead to more complete models for the understanding of consciousness.
Near-death experience; spiritual transformation; differential diagnosis; psychotherapy; consciousness