Bruce Greyson
Near-Death Experiences and Attempted Suicide
11
clinical studies of NDEs published to date suggest a marked decrease
with deceased loved ones and suggestion of survival of bodily death,
should foster suicidal ideation (Kastenbaum, 1979). However, the few
in subsequent suicidal intent and behavior among those experiencing
NDEs. Systematic investigation of NDEs and suicide attempts may
provide a more sophisticated understanding of the role of one’s con
cept of death in self-destructive behavior.
Data on NDEs and Suicidal Ideation
Bruce Greyson, MD
University of Michigan Medical Center, Ann Arbor
ABSTRACT: Attempted suicide is correlated with an increase subsequent risk of com
mitted suicide. However, preliminary data and psychodynamic hypotheses suggest
that serious suicide attempts followed by transcendental near-death experiences
(NDEs) may decrease rather than increase subsequent overt suicide risk, despite the
NDEs’ apparent “romanticization” of death. Studies of NDEs and of their influence on
suicidal ideation are proposed which may yield greater understanding of self
destructive urges and new strategies of suicide prevention.
Studies of persons who have attempted suicide have reported sub
sequent committed suicide rates greater than 50 to 100 times that of
the general population (Pederson, Awad, and Kindler, 1973; Tuckman,
Youngman, and Kreizman, 1968). Furthermore, those suicide
attempters who come close to death have a higher subsequent suicide
rate than those who do not come close to death (Rosen, 1976). How
ever, recent reports of profound subjective events with transcendental
or mystical elements, the near-death experiences (NDEs) which some
persons experience on the threshold of death (Stevenson and Greyson,
1979; Greyson and Stevenson, 1980), suggest the possibility that some
nearly-completed suicide attempts may decrease rather than increase
the attempter’s subsequent suicidal ideation.
Shneidman (1971) hypothesized that “romanticized” notions of
death, ie, notions of death as other than an involuntary naughtment or
annihilation, tend to promote suicide. According to this hypothesis,
NDE reports, which tend to characterize the process of dying by posi
tive affect, by absence of anxiety or pain, and by a sense of reunion
The author wishes to thank Ian Stevenson, M.D., Russell Noyes, Jr., M.D., Kenneth
Ring, Ph.D., and James E. Alcock, Ph.D., for their helpful comments on this
manuscript.
Suicide and Life-Threatening Behauior, Vol. 11(1/, Spring 1981
10
0363-0234/81/1300·0010$00.95©1981 Human Sciences Press
Among the sample of NDE reporters described by Greyson and
Stevenson (1980), 20 claimed that the NDE made them feel more nega
tive toward suicide than they had felt previously, 18 acknowledged no
change in their attitude toward suicide, and none stated that the NDE
made them feel more positive toward suicide. These attitude changes
were not correlated with any experiences, expectations, or beliefs prior
to the NDE, with any demographic parameters, nor with the manifest
content of the NDE.
Ring (1980) reported that suicide attempters were less likely to
experience NDEs (eight NDE reports out of 24 patients interviewed)
than either accident victims or victims of illness (40 NDE reports out
of 78 patients interviewed). Suicide attempters tended to report ND Es
of shorter duration, including feelings of relief or peace, bodily detach
ment, and drifting in a void; they tended not to report what Ring des
cribed as later sequential stages of an NDE: impressions of experi
encing a tunnel, a light, reunion with deceased loved ones, or a realm of
preternatural beauty.
In a more recent report, the same investigative team found that
among 30 suicide attempters who came close to death, the incidence of
NDE recall was not significantly different from that among victims of
illness or accidents (Ring and Franklin, 1980). They further report that
those NDEs described by suicide attempters were not qualitatively
different from those reported by others, and that none was predomi
nantly unpleasant. Nevertheless, they noted that despite the positive
nature of these experiences, they appeared to promote a strongly anti
suicide orientation among those reporting them.
Rosen (1975) interviewed seven survivors of suicide attempt by
jumps from bridges, and found some features of NDEs in each one.
Though none reported panoramic memory or life review experiences,
most experienced a distortion in their sense of time, and all reported
feelings of tranquility, peacefulness, and transcendence of bodily
death. On follow-up, only one had repeated a suicide attempt, which
was not lethal. While this sample is necessarily small, the absence of
subs: quent mortality among those NDE reporters contrasts with the
12
Suicide and Life-Threatening Behavior
25 subsequent completed suicides, with a mean survival interval of
only 2.5 years, among 515 persons who had been restrained from
jumping off the same bridges (Seiden, 1968), some of whom might have
gone on to have a NDE if not restrained.
Buckman and Greyson (1977) described a patient with a pathological
grief reaction whose third near-fatal suicide attempt culminated in a
NDE in which he seemed to be reunited with deceased loved ones in a
transcendental realm. The patient then underwent a sudden and sus
tained personality change, with cessation of his self-destructive sui
cidal behavior and alcoholism.
Psychodynamic Hypotheses on NDEs and Suicidal Ideation
Prince and Savage (1966) described mystical states as one form of
regression in the service of the ego. The NDE may be a particular
example of such regression as a response to the threat of death, the fre
quently reported feelings of peace and contentment being a mani
festation of the denial of death. Clark (1966) and Horton (1976) have
reported dissipation of suicidal behavior following regression to sym
biotic or primary narcissistic states through mystical experiences. In
the patient described by Buckman and Greyson (1977), mentioned
above, renewal of the symbiotic attachment to his deceased mother
appeared to reverse a suicidal pathological grieving process. Grof and
Halifax (1978) reported therapeutic changes in suicidal patients fol
lowing psychedelic-induced “death-rebirth” experiences similar to
NDEs, in which feelings of isolation and alienation are replaced by a
sense of cosmic unity arid transcendence of the subject-object
dichotomy, reminiscent of the primal union with the mother.
In addition to gratifying symbiotic longings, regression to an
oceanic state may leave the patient with a primary sense of worth and
meaning not contingent upon external circumstances. As the suicide
attempter having a NDE experiences a sense of cosmic unity, he or she
of ten decathects unmet wordly goals and begins to view his or her
individual losses as irrelevant from a transpersonal perspective (Ring,
1980; Grof and Halifax, 1978). Greyson and Stevenson (1980) found
negative changes in attitude toward suicide after a NDE to be cor
related with attitude changes toward material possessions, sex or mar
riage, personal power or fame, family or friends, and the meaning of
life.
Another commonly reported feature of NDEs which may exert a sig
nificant therapeutic effect is the panoramic memory or “life review.”
This re-evaluation of the patient’s life may help to resolve and inte
grate old conflicts and to differentiate real from neurotic guilt, and
Bruce Greyson
13
may reduce suicidal ideation by providing a more favorable per
spective on one’s self-worth and position in life (Lewis and Butler,
1974; Grof and Halifax, 1978). Greyson and Stevenson (1980) reported
a significant correlation between the occurrence of the life review and
attitude changes following an NDE.
In patients for whom attempted suicide may be a form of sacrifice or
punishment, the ego-death experienced during a NDE, in which the
patient seems to survive despite the apparent cessation of ego func
tions, may serve as a sufficient substitute for the death of the self. This
“egocide” may be seen as a symbolic suicide, as a sacrifice of con
flictual ego parts, or as a compromise between the wish to live and the
wish to die (Rosen, 1976; Waltzer, 1968; Noyes, 1980). The suicidal
behavior of certain other patients may not be attempts to die but
rather attempts to transcend the ego, to escape from painful emotions
and sensations (Grof and Halifax, 1978); in other patients, suicidal
acts may be an attempt to confront death in order to renew or validate
one’s sense of being alive (Taylor, 1978; Noyes, in press). In either
circumstance, the transcendental NDE may satisfy cravings for ego
death and restore a sense of purpose to life.
Many patients attribute their disavowal of suicide to a strengthened
belief in post-mortem existence, as a result of their NDE (Ring, 1980;
Noyes, 1979; Noyes, 1980). Though this belief is a primary factor in the
romanticization of death, it appears to romanticize life as well: belief
that death is not cessation seems to enhance a sense of value or mean
ing of life. Conviction in the presence of an afterlife may also inhibit
suicide by enhancing one’s self-esteem and primary sense of worth.
Noyes and Kletti (1976) reported that an NDE may enhance a
patient’s self-image based on his or her experience of having faced
death with serenity and acceptance. Grof and Halifax (1978) described
the mobilization and discharge of destructive energies during the
NDE. Both of these mechanisms may contribute to the reduction of
suicidal ideation following a NDE.
Finally, there is the possibility that for some suicide attempters, a
NDE may be such an unpleasant experience as to dispel any subse
quent death wishes. This does not appear to be the case for the major
ity of NDE reporters, however, as a reduced fear of death has been
repeatedly documented as a frequent and longlasting consequence
(Kalish, 1969; Noyes and Slymen, 1971; Sabom, 1978; Noyes, 1980),
and, among the sample of NDE reporters described by Greyson and
Stevenson (1980), negative attitude changes toward suicide following
the NDE were correlated with feelings of peacefulness or contentment
during the NDE (chi square = 3.88, df = 1; p < .05).
14
Suicide and Life-Threatening Behavior
Discussion
The frequency and nature of NDEs following attempted suicide, as
contrasted to those following other near-fatal situations, remains in
question. Ring (1980) has suggested that the lower rate of NDEs found
in some series among suicide attempters maybe an artifact of that pop
ulation’s increased incidence of intoxication during the near-death
situation and of mental illness, rather than a correlate of the suicide
attempt itself.
Since NDEs appear to reduce fear of death, it is striking that the
literature, meager though it is, contains few reports of suicidal intent
increasing or even persisting following an NDE. Beyond the proba
bility that not all investigators have explored this area routinely in all
interviews, it is possible that suicide attempters who persist in their
death wishes are less likely to discuss their experiences or intent with
an interviewer than are suicide attempters whose self-destructive
impulses are dissipated by the NDE.
If further study confirms the suicide-inhibiting influence of ND Es,
then the contrasts between NDEs and other transcendental, mystical,
or depersonalized states should be explored. For example, studies
documenting a high rate of depersonalization experiences prior to
attempted suicide (Bowles, 1972; ·Waltzer, 1968) include lack of affect
as an essential aspect of the deperso’nalized state; however, the inten
sified affect often accompanying depersonalization in a NDE may be a
critical influence on subsequent suicidal ideation. Many NDE
reporters spontaneously associate their disavowal of suicide with their
conviction in an afterlife as a result of their NDEs. Investigations of
the effect of depersonalized or transcendental states on suicidal idea
tion must take into account the patient’s understanding of and affec
tive response to such experiences.
In addition to intrapsychic elements of a NDE, the interpersonal
consequence of the experience following an attempted suicide may also
influence subsequent suicidal ideation. That is, suicide attempters who
do and do not report ND Es may differ in the treatment they receive, in
the resolution of their precipitating crises, or in the secondary gain
from their suicidal behavior, all of which may substantially modify
their subsequent suicide risk.
Further investigation is needed to document the influence of NDEs
on suicidal ideation. Mjnimally, the patients who do and do not report
NDEs should be identified for follow-up from an unselected cohort of
suicide attempters. Ideally, controls from the group who do not report
NDEs should be matched with NDE reporters in terms of physio
logical proximity to death, intoxication with alcohol or other drugs at
the time of the suicide attempt, and documented mental illness.
Bruce Greyson
15
Short-term follow-up should include degree of resolution of the crises
precipitating the suicide attempt, and subsequent secondary gain and
psychiatric treatment, as well as the persistence of suicidal ideation.
In those patients who report NDEs, the cognitive understanding of
and affective response to the experience should be explored, as well as
contrasts between the NDE and other transcendental or deper
sonalized states from the patients’ experience. Changes in attitudes
and beliefs not only about death, but also about the value and meaning
of life after the suicide attempt, may be explored among both NDE
reporters and non-reporters. Finally, long-term follow-up would be
useful to assess the persistence of attitudinal and behavioral changes;
suicidal and other self-destructive behavior should be monitored to
correct for reporting biases.
Such studies, if they confirm the suicide-inhibiting influence of
NDEs, may identify the relative contributions of the various psycho
dynamic mechanisms involved and the particular features of the
experience which exert this ef feet. A more sophisticated under
standing of the influence of one’s concept of death on suicidal ideation
may lead to more effective therapeutic approaches to suicide
prevention.
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