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Since such inconvenient facts for a survivalist interpretation of NDEs could be repeated , I will mention just one other example. Taken literally, the deepest NDEs (e.g., ) seem to imply a communal afterlife subject to some form of governance. But if NDEs were glimpses of such an afterlife, we would expect to see some sort of pattern in the distribution of pleasant and distressing NDEs. For instance, we might anticipate predominantly altruistic or spiritual individuals fairly consistently reporting pleasant NDEs, while predominantly antisocial or profane individuals tend to report distressing ones. Alternatively, we might anticipate that all NDErs report by and large pleasant NDEs. Or there might be some other conceivable pattern consistent with afterlife governance. In fact, however, , and antisocial individuals seem no less likely than others to have pleasant NDEs. Instead, the character of one's NDE seems to be determined primarily by either "the person's mindset immediately prior to the experience" or "programming during childhood" (Rommer 196). On any model of a governed afterlife, this distribution appears to be entirely random and difficult to explain; but it is exactly what one would anticipate on a psychophysiological model of NDEs.
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If the mediator of out-of-body vision is an element that functions independently of the body, I find no reason why it should position itself only above the body; it seems reasonable to expect instances of observation of oneself from other positions to be no less frequent. For example, in the case of a person undergoing an OBE when sitting or standing or falling from a height, self-observation is possible from the front at eye-level or below it (Krishnan 23).
Plausible psychophysiological reasons for other correlations are not as easy to conjecture, but no less problematic for survivalist interpretations. For example, NDEs during cardiac arrest or while anesthetized are more likely to feature tunnel experiences and experiences of light (Drab 147; Owens, Cook, and Stevenson 1176; Twemlow and Gabbard 230; Twemlow, Gabbard, and Coyne 136), while NDEs resulting from the perception of imminent threats (e.g., in mountain-climbing accidents) in the absence of actual medical crises more often feature feelings of euphoria, thought speeding up, time slowing down, and life review (Noyes and Kletti 57-58; Stevenson and Cook 454). In one study, NDErs under the influence of drugs were also more likely than other NDErs to report an awareness of and communication with other beings, suggesting that drugs directly altered the content of their experiences (Twemlow and Gabbard 230). But if NDEs occur when consciousness is released from the confines of the brain, then altering brain chemistry ought not have an effect on NDE content. Though medical factors affecting a person's brain state would be expected to influence the course of a 'brain-free' experience, we nevertheless find medical influences on the content of OBEs and NDEs.
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In fact, the comments of NDErs themselves provide evidence that NDE accounts become more elaborate over time while NDErs' commitment to the reality of their experiences deepens. After 23 years of trying to determine the significance of her NDE, one woman commented: "It was real then. It is more real now" (Zaleski, "Otherworldly" 150). Another NDEr noted that what he understood and remembered about his NDE had grown over the years by relating the story to others (150). In one of the more reliable studies of NDE incidence and transformation, van Lommel and colleagues found that the transformations widely believed to occur after NDEs actually do occur, but that "this process of change after NDE tends to take several years to consolidate" (van Lommel et al. 2043). In other words, the transformative effect of NDEs on experients is not immediate, but gradual. This suggests that NDE transformations do not result from the NDE itself, but from reflecting on the meaning of the experience—that is, from the added layers of meaning and interpretation experients' place on their NDEs.
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About one or two in a thousand patients undergoing general anesthesia report some form of . That represents between 20,000 and 40,000 patients a year within the United States alone. A full 48% of these patients report auditory recollections postoperatively, while only 28% report feeling pain during the experience (JCAHO 10). Moreover, "higher incidences of awareness have been reported for caesarean section (0.4%), cardiac surgery (1.5%), and surgical treatment for trauma (11-43%)" (Bünning and Blanke 343). Such instances must at least give us pause about attributing Pam's intraoperative recollections to some form of out-of-body paranormal perception. Moreover, for decades sedative anesthetics such as nitrous oxide have been known to trigger OBEs.