A dreamy personal heaven: One neurosurgeon’s dissection of another neurosurgeon’s claim of heavenly flight.

He was in a coma but never dead; hence my surprise when I saw the title of Dr. Eben Alexander’s book “Proof of Heaven: A Neurosurgeon’s Journey Into the Afterlife.” When one says afterlife, one means after life has ceased to exist completely; in other words, after a confirmed death. That makes Dr. Alexander’s dream-like experience of heavenly flight on the wing of a butterfly along with a beautiful blue-eyed girl during his coma a Near Death Experience (NDE) and not an afterlife experience. Anyone who recognizes the immense difference between a coma and death will find his book title inappropriate and misleading. Also, his claim of a scientist’s case for heaven makes one wonder about what definition and scientific method he used to prove such a supernatural entity. Unfortunately, I found neither a definition nor proof of heaven in the book. Instead, I came across generous reference to many more undefined and unverified supernatural entities like God, angels, guardian angels, souls, the spirit, miracles, the creator and divine alternate realms. I was perplexed by the rationale of using many more undefined and unverified supernatural entities to prove the existence of another such entity. As a neurosurgeon, trained at the University of Chicago and having practiced for almost twenty years, interested in understanding the phenomenon of NDE, I found many inconsistencies in Dr. Alexander’s book, but three aspects of his narrative were especially troubling.

First of all, one cannot simply claim that one’s superficial part of the brain, the neocortex, (which Dr. Alexander refers to as his human side) was “shut down and out” and consequently dead without performing an easily verifiable, objective test called an Electroencephalogram (EEG), which records the electrical activity of that part of brain. Secondly, in spite of the availability of 21st century neurosciences capable of explaining all components of NDE, why Dr. Alexander chose unverifiable, subjective faith and spirituality as a means to interpret his experience is confounding. Thirdly, his assertion that consciousness, as defined in the world of modern neuroscience, can exist independently outside of a brain, especially a dead one, is simply stunning!

Let me be clear that I do not take lightly the ordeal that Dr. Alexander went through. I have personally seen and empathize with the incredible suffering the comatose patients and their families endure. During those trying times, many heartbreaking but important decisions need to be made and are based on whether a patient is in a coma or has truly sustained brain death. The difference between those two is literally life and death. An EEG is one of the two components of a brain death study. The other component, Brain Stem Auditory Evoked Response (BAER), evaluates activity of a deeper part of the brain including the centers for respiratory as well as cardiac functions. Only when there is a flatline, electrical cerebral silence, can one confirm brain death. I did not see any mention of this test being done during the seven days he was in his coma. Even if it was done, it would have shown slowing, rather than absence, of electrical activity of the superficial part of his brain. Without brain death, labeling his experience as a journey into afterlife, rather than a NDE, is a fundamental flaw and is hard to accept from any true neuroscientist’s perspective.

Near Death Experiences are relatively common and have been experienced throughout history by people of different faiths and from different parts of the world. In this era of 21st century neuroscience research, it is not difficult to explain the components of NDE, many of which Dr. Alexander experienced. These include a tunnel of light, an intensely bright light, hazy beings, an out-of-body experience (OBE), the sensation of self hovering over and looking at one’s own body below (autoscopy), a sense of floating with no physical boundaries, life review, visitation by the deceased loved ones and also seeing deities of the religion that one is either born or converted into. All theses components can be naturally explained by the way the eyes and brain work.

I do have to disagree with Dr. Alexander’s claim that his NDE was unique and special, simply for the reason that the final common pathway of all such experiences is a lack of energy at the molecular level necessary for the neurons to function properly. That lack of energy can be induced by many etiologies including a deprivation of oxygen from respiratory or cardiac failure, stroke, infection of the coverings of the brain (meningitis) or the brain itself (cerebritis), which can be more devastating, as well as psychotropic drugs. Since the peripheral part of the retina is more vulnerable than the center, with decreased oxygen the peripheral vision is com- promised which explains the tunnel of light. With malfunctioning of the pupil that constricts in the presence of light, similar to the aperture of a camera, too much light impinges on the retina due to the pupils being widely dilated making one perceive intense and bright light. The lens in the eye that becomes more or less convex to focus sharply is also compromised, resulting in hazy images. Along with bright light some interpret these hazy beings as angels. Decreased activity of the right parietal cortex, responsible for three dimensional spatial orientation, makes one feel like floating without physical boundaries. When disruption of the adjacent Temporo-Parietal Junction (TPJ), which usually smoothly integrates the image of one’s self in their brain with surrounding three dimensional space, one feels like they have dissociated from their physical body (OBE) and are looking at their body (autoscopy) from above. Interestingly, some patients experience this during awake brain surgery when the TPJ is stimulated.

It is said that we must exhaust all natural explanations before attributing divine supernatural influence or intervention. I am afraid Dr. Alexander did not discuss all the possible natural neuroscience explanations for his NDE. His analysis was based on his understanding that, with the superficial part of his brain being shut down and out (unconfirmed), the deeper part of his brain alone could not handle the neuronal calculations necessary for the “ultra-real experience of a rich tapestry of orbs, wordless communication, music of Om, and timeless infinite universes.” But, such calculations occur quite frequently during sleep, when the neocortex is inhibited and is responsible for the elaborate experiences of dreams.

It is interesting to note that more than once Dr. Alexander describes his experience as dream-like but not quite. The difference between dreams and a NDE is not in the basis of anatomical structure and physiological function that are responsible for those experiences but in how one choses to interpret the recalled memory of the experience. One can have vivid and colorful dreams, during REM sleep, of flying high above the clouds on the wings of any kind of a bird or butterfly along with a beautiful blue-eyed blonde or brunette for that matter. During that time the frontal cortex that is necessary for critical thinking is shut off and the dreams can feel real. The amygdala, a part of the deeper reptilian limbic system that can be active during that period, imparts an emotional component to the dream. The hippocampus, responsible for memory, is also active and recalls the memory the next morning during a wakeful state. The awake frontal lobe interprets it as just a dream. In a NDE during a coma, a similar mechanism can still be active or disturbed and lay down a memory that can be recalled in vivid detail. The interpretation of that “remembered experience” can be based on either purely cerebral and academic inquiry, with application of available scientific methods and knowledge, or unscientific religious beliefs. The choice of choosing one method over the other may be influenced by one’s culture, knowledge as well as predilection for true scientific analysis or rationalization with spiritual attributes based on an emotional need for hope, solace and comfort.

“Indeed many believers in a life after death desperately hold these apparently inexplicable events, phenomena, and wonders before them. They listen to stories about these things, tell and retell them, and they are glad. They cherish their belief in these things, because their belief in these things liberates them from the oppressive transience of this mortal life, offering them the comforting prospect of eternal life after bodily death. So they do not critically analyze these events, phenomena and wonders, to discover whether they truly are signs indicating the reality of a life after death.” – Dr. G.M. Woerlee, Mortal Minds: The Biology of Near Death Experiences.

It is quite plausible, and even understandable, that Dr. Alexander’s decades of yearning for the love and acceptance of his biological parents was so deep rooted in his subconscious that the core theme of his experience was to feel like he was loved by an infinitely loving deity.

“A personal god was nothing more than an exalted father-figure: desire for such a deity sprang from infantile yearnings for a powerful, protective father, for justice and fairness and for life to go on forever. God is simply a projection of these desires, feared and worshipped by human beings out of an abiding sense of helplessness.”- Sigmund Freudd

A deeply personal and dramatized, with generous sprinkling of fantastically metaphoric religious and spiritual assertions interspersed with scientific jargon, story of Dr. Alexander’s experience may be inspirational to the faithful, the spiritual and the converted but cannot be considered an afterlife journey or proof of heaven. No amount of self-proclamation of being a scientist will substitute for rigorous and meticulous use of the scientific method. One can not conclude a subjec- tive faith-based narrative as a scientist’s case for evidence of anything, let alone a supernatural heaven. Even a great scientific mind like Einstein’s was not immune to an emotional need to believe in divinity. He committed a similar mistake when he initially disputed Heisenberg’s Uncertainty Principle by stating, “God does not play dice with the universe”, only to realize that he was wrong and was forced to accept Heisenberg’s theory later.

Finally, as a neurosurgeon who understands that consciousness is part of the mind and “mind is what brain does”, I was astonished by Dr. Alexander’s assertion that consciousness exists independently from a brain, especially after brain death, only to reenter the brain after wandering in a trans-earthly voyage through invisible and visible universes, visited by the deceased loved ones as well as angels and an infinitely loving deity, while music of Om was playing in the background. I could not believe what I read and had to read the chapter again to make sure that I didn’t misread his statement about independent consciousness. What he said is similar to saying that when a heart stops, the heartbeat leaves the heart and hovers around only to magically reenter the non-beating heart when a jolt of electricity from the defibrillator restarts the heart rhythm. It is akin to saying that a patient who becomes unconscious from low glucose in their blood (hypoglycemia) and wakes up with an intravenous solution of glucose, that consciousness leaves the unconscious brain only to enter the brain through the bottle containing the intravenous glucose solution. When the entire modern neuroscience community accepts that consciousness is a product of a functioning and living brain, and rejects a physical brain and immaterial mind dualism, it is disappointing to see a prominent neurosurgeon trained in a prestigious medical school proposing Cartesian mind-body dualism in this era of modern neuroscience.

Dr. Alexander became a changed man after his NDE. He feels the experience gave him a glimpse of the eternal life in the presence of “an infinitely loving deity” in heaven that awaits after his transient journey of earthly life ends and that everybody else should listen to his message. He also believes his experience had a divine purpose – to spread the word of love and compassion. It is not uncommon to have profound changes in people who have undergone a NDE that include meaningfulness, peace of mind, apathy, disinterest in material goods and a sense of the interconnectedness of us all. Such changes also occur as a consequence of meditation and decreased activity in the amygdala (which deals with emotions like anger), and changes in the left anterior cingulate gyrus which is considered by some researchers to be the center for love. Even though neuroanatomical and physiological explanations are available for all these changes, people may be unaware or uninterested in accepting that knowledge and instead chose to paint their experience with a divine, religious or spiritual brush to suit their personal and emotional needs.

Although I do not accept Dr. Alexander’s inference of his NDE as scientific proof for any of the supernatural claims, I applaud his realization that love is the most important thing in life. His decision to spend a considerable part of the rest of his life preaching love and compassion is a noble one. But then, one does not need to come close to death to realize that love matters the most. Humanism, a uniting philosophy without any dividing religious or spiritual connotation, has been professing a meaningful and purposeful life and oneness of humanity throughout history and all around the globe.

As a brain surgeon who deals with comas and brain death not infrequently, as well as being familiar with the brain science of a NDE, I am skeptical of many claims in this book. Carl Sagan, one of the pioneer American astronomers, said a few decades ago, “Extraordinary claims require extraordinary evidence.” With no concrete evidence provided, and the availability of alternate 21st century neurosciences as a natural explanation for his NDE, I have a hard time accepting Dr. Alexander’s personal faith-based claim of a journey into the afterlife or proof of a case for heaven. His story does not pass basic scientific scrutiny and should not be considered as extraordinary evidence for heaven.

But then what do I know! I am just a brain surgeon.

“And men ought to know that from nothing else but thence [from the brain] come joys, delights, laughter and sports, and sorrows, griefs, despondency, and lamentations. And by this, in an especial manner, we acquire wisdom and knowledge, and see and hear, and know what are foul and that are fair, what are bad and what are good, what are sweet, and what unsavory… And by the same organ we become mad and delirious, and fears and terrors assail us… All these things we endure from the brain, when it is not healthy… In these ways I am of the opinion that the brain exercises the greatest power in the man. This is the interpreter to us of those things which emanate from the air, when it [the brain] happens to be in a sound state.” – Hippocrates

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