During World War I, American author Ernest Hemingway was wounded during fighting in Italy. Years later, he described the experience: “A big Austrian trench mortar bomb, of the type that used to be called ash cans, exploded in the darkness. I died then. I felt my soul or something coming right out of my body, like you’d pull a silk handkerchief out of a pocket by one corner. It flew around and then came back and went in again and I wasn’t dead anymore.”1
Sensing one’s consciousness ‘or something’ separating from and returning to one’s body during a close brush with death is a core feature of what we now call near-death experiences (NDEs). Other reported features include sensing movement, alterations in time, enhanced mental clarity and/or expanded spiritual awareness. Many report seeing a light or lights, experiencing a panoramic life review in which one relives life events, unitive consciousness in which one feels connected with a larger reality, and interacting with deceased loved ones or spiritual beings who often express unconditional love.
Approximately 20 percent of those who survive a life-threatening event report one or more features of an NDE. Though the origins of these experiences are a source of debate, it is clear, from decades of research, that they are usually profound, meaningful and real to those reporting them. An NDE has the power to permanently alter a person’s attitudes, values and worldview. Common aftereffects include diminished fear of death, increased spirituality, a heightened sense of life purpose and appreciation for others.
NDEs Are Common During Combat
Given that exposure to death is an inherent part of combat, it is logical to speculate that many Veterans have experienced an NDE. Research suggests that between 25 and 48 percent of combat Veterans have had an NDE; an estimate considerably higher than among the population in general.2,3
Despite potentially positive aftereffects, NDEs can be so at odds with conventional beliefs and assumptions about the world, that they can be disorienting, requiring time to become integrated. Some hesitate to share them for fear of being labeled as ‘crazy’ or having the experience dismissed as stress-induced hallucinations or the physiological effects of serious injury.
Unfortunately, many who share an NDE are met with ridicule, defensiveness or attempts to explain them away. This includes those who disclose them to professionals working in healthcare and psychological services.4 Dismissive or insensitive responses can shut down further attempts to seek assistance and support in processing and integrating these events, leaving the person experiencing them to feel stigmatized, betrayed, isolated and/or unsafe.
It is my clinical observation that fears of disclosing NDEs and pressures to remain silent are significant and commonplace among Veterans. In fact, many of the Veterans with whom I have worked experienced combat related NDEs and had never disclosed them until I specifically inquired about them in the context of a trusting therapeutic relationship.
Combat training and military culture can present barriers to talking about NDEs. Such training prizes tight control of emotions, mental discipline and focus, stoicism, unit cohesion and the ability to identify and respond to threats quickly. If one becomes mentally or emotionally distracted by an NDE while deployed and during combat, they and their fellow Soldiers might wind up dead.
As one Veteran put it, “Hell no I never told anyone. I knew they’d be sending me back to my unit. I was a twenty-two-year-old kid, trying to keep myself and my buddies alive. The last thing I needed was to get distracted by thinking about what had happened when I died.”
Retired Army Corporal Bill Vandenbush was wounded and experienced an NDE during the Vietnam War. According to him, “Vets don’t talk about it because they are afraid others will think they are crazy or weak. Veterans don’t want to come across as being weak. But it’s not weak, it’s not crazy. It happens and it’s important to connect with others who have experienced the same thing.”5
Moreover, combat NDEs may be negatively associated with post-traumatic stress, moral injury, traumatic bereavement or the debilitating impacts of life-altering injuries, such as traumatic brain injuries. Such associations may cause Veterans to avoid thinking about an NDE at all costs. In some cases, an NDE might even reinforce doubts about one’s mental fitness or serve as a painful trauma reminder.6
A study by Goza, Holden and Kinsey found that Veterans who experienced NDEs were less likely than non-Veterans to share them with healthcare providers. Compared with civilians who experienced NDEs, Veterans expressed ‘more fears of repercussions from disclosing their experiences, including loss of active duty status, unwanted or unnecessary treatment with medications, and (psychiatric) diagnoses.’7
The fact that Veterans appear to have higher incidence rates for NDEs and more potential barriers to sharing and processing them, has led the International Association for Near-Death Studies to conclude that: “Veterans who have had near-death experiences (NDEs) may experience a gap in healthcare. Most healthcare providers have little training in recognizing NDEs and frequently confuse it with post-traumatic stress disorder (PTSD) or mental illness. Therefore, Veteran ‘NDE’rs’ may be ignored, misdiagnosed, over-medicated, and provided costly, yet ineffective treatment.”8
The following case offers an illustration of the potential challenges Veterans who have experienced NDEs face, in addition to strategies for enhancing support and using NDEs as a source of psychological growth and healing.
Jonas: An Illustrative Case Study
During World War II, Jonas had served in the Air Force, flying bombing raids over Germany. At the time of his admission to Hospice services, he appeared to be coping well and was able to identify areas of meaning and life satisfaction, as well as demonstrating a good sense of humor.
As his illness progressed, however, he began having panic attacks and episodes of hyper-reactivity, including intense anger at seemingly small frustrations. He also began having nightmares about the war and an increasingly exaggerated startle response. These symptoms suggested post-traumatic stress disorder. Research has shown that stressors associated with aging and illness, such as physical symptoms, age-related losses, invasive medical care or diminished independence may trigger or intensify underlying posttraumatic stress.9,10 Such stressors can even result in delayed-onset PTSD.11,12,13
During a counseling session, I asked Jonas if he had ever been close to death during the war. When he nodded, I asked if he had experienced anything at that time that seemed hard to explain or that was at odds with conventional reality. He hesitated then asked why I wanted to know. After providing education about NDEs and after-death communications (ADC) in which a person has perceived communication from a deceased friend or loved one (which I have found to be common among combat Veterans), he stated that he actually did recall such an incident.
Jonas had been the bombardier for the crew of a B-17 bomber. They were flying in heavy anti-aircraft fire, the sky vibrating with explosions, flashes of fire, and planes being ‘blown to pieces’ in every direction. When an explosion shook his aircraft, he sustained a head injury. “I just blacked out and felt my spirit leave my body. The plane went one way and I went another.” He remembered moving toward a light, “just floating without trying to move or make any effort.” He was suffused with relief to be away from the war and found himself in the presence of “the most loving Being I’d ever met.”
With the Being’s encouragement, he looked through the same bombsight he had been using to destroy German cities. “When I looked down, I saw the sight trained on my hometown.” He recoiled at the thought of dropping bombs on friends and family. He searched for other targets, but every time he sighted one, it was always his hometown.
Watching from above, he saw images of his life and of loved ones rising up from the town. “Then it hit me,” he recalled, “every time I dropped bombs on a German city, I was bombing my hometown. We were all connected. It was the strangest feeling. It made me sad to think about what I’d been doing.” He recalled looking at the Being, afraid he was about to be punished. “But there was no judgment, just unconditional love.” At that moment, he was transported back into his body. Jonas had never shared the story. When I asked why, he offered several reasons: dismissing it as a hallucination; fear that his buddies would think he was crazy or could not ‘hack’ the stress of combat, fear that since the message of the Being was at odds with what he and his crew had to do. “It might have gotten us all killed if I thought about it too much.” By the time he returned from the war, he had ‘locked it all away.’
Jonas asked if I thought he was ‘nuts.’ I assured him I did not and offered reflections on the research literature and written accounts attesting to the frequency of NDEs, including during combat. I encouraged him to reflect on his NDE further, but he resisted. When I asked what was driving his hesitation, he said he was afraid that if he ‘took it too seriously’ he would “have to face how miserably I failed to stand up for the idea that we’re all connected.” He then shared some horrific details of what he had seen and done during the war and a belief that “I’ve got oceans of blood on my hands.”
I asked him to visualize himself once again with the Compassionate Being. After letting the visualization ‘sink in,’ I asked what he was feeling. Wiping away tears, he said he was feeling “a sense of being understood, being safe and loved.” He also felt the stirring of compassion for the ‘scared young kid’ he had been during the war.
Using a technique often utilized when exploring moral injury, I facilitated an imagined conversation between Jonas and this Being. I asked Jonas to express what was in his heart and to imagine what the Being’s response would be. Over our next few sessions, Jonas reflected more on his NDE. Though he continued to struggle with anxiety and hyper-reactivity, sharing and integrating the NDE spurred therapeutic changes. For example, he decided that his NDE was not an indication that he had cracked under pressure, perceiving it instead as “some kind of a gift from God.” The message of this gift, he believed, was universal acceptance of human imperfection and unconditional love. Jonas’s panic attacks and nightmares stopped. Any fear of death dissolved, and he expressed genuine curiosity about what ‘was on the other side.’ He even began sharing his NDE with loved ones, which enhanced his sense of relational safety and intimacy.
More importantly, his imagined conversations with the Being, along with strategies I taught him for settling his nervous system and engaging mindful self-compassion, significantly reduced feelings of shame, guilt, moral pain and anguish. This allowed him to safely begin to express previously undisclosed survivor guilt and grief for buddies who had been killed during the war. Grief he had “stuffed down my throat” decades earlier and never expressed.
As a clinician, I have worked with dozens of Veterans who have experienced NDE’s. An Iraq War Soldier, for example, was a caregiver for his dying father. In remembering back to his unit being ambushed, he recalled being wounded, leaving his body and looking down on the scene as medics worked to save him; then meeting a friend who had been killed in a mortar attack a few weeks earlier. “When I saw him, he looked good as new. The mortar had blown away half of his body, but he was whole again and smiling at me.” In the case of a Vietnam War chopper pilot, he reported feeling himself being pulled through a tunnel of light before experiencing a life review in which he witnessed “everything I’d ever done.”
Veteran Who Have had NDEs Deserve Better Support
It is commonplace for combat Veterans to experience NDEs.2,3,14 Unfortunately, there may be barriers to sharing these experiences and pressures to remain silent. Many medical and counseling professionals have no training in this area and may have biases that cause them to dismiss or misdiagnose those who report NDEs.4,7,15
It is time that all professionals working with Veterans learn about NDEs and take them seriously in order to provide more sensitive and effective care for those who have experienced them. When Veterans are able to share and process NDEs in a safe context, and to receive accurate, objective information on their features and incidence rates, this goes a long way toward helping them integrate experiences. These may then become sources of tremendous growth and resolution.
1. Atwater, P.M. H. Beyond the light: what isn’t being said about near death experience. 2009: Transpersonal Publishing.
Goza, T., Holden, J. and Kinsey, L. Combat near-death experiences: an exploratory study. Military Medicine. 2014, 179 (10), 1113-1118.
Hufford, D. Research results of a study of combat veteran NDEs. Paper presented at the annual conference of the International Association for Near-Death Studies. 2019, August, King of Prussia, PA.
Holden, J., Kinsey, L. and Moore, T. R. Disclosing near-death experiences to healthcare providers and nonprofessionals. Spirituality in Clinical Practice. 2014, 1(4), 278–287
Kime, P. Authors seek combat near death experience stories. Military Times. 2015, March 19.
Janssen, S. When doing counseling with survivors of trauma and near-death experiences. The Trauma and Mental Health Report. 2021, January.
Goza, T., Holden, J. and Kinsey, L. Combat near-death experiences: an exploratory study. Military Medicine. 2014, 179 (10), 1113-1118.
International Association for Near-Death Studies Website. Resources for closing the gap in medical care for NDERS. 2021, March 11.
Feldman, D. Stepwise psychosocial palliative care: a new approach to the treatment of posttraumatic stress disorder at the end of life. Journal of Social Work in End-of-Life and Palliative Care. 2017. 13(2-3),113-133.
Ganzel, B. Trauma-informed hospice and palliative care. The Gerontologist. 2018. 58(3), 409–419.
Aarts, P., den Velde, W., Falger, P., Hovens, J., De Groen, J. and Van Duijin, H. Late onset of posttraumatic stress disorder in aging resistance Veterans in the Netherlands. In Ruskin, P. E. and Talbott, J. A. (Eds.), Aging and Posttraumatic Stress Disorder. 1996, (pp. 56-76). Washington: DC: American Psychiatric Press.
Hyer, L., Summers, M., Braswell, L. and Boyd, S. Posttraumatic stress disorder: silent problem among older combat Veterans. Psychotherapy. 1995, 32, 348-364.
Ruzich, M., Looi, J. and Robertson, M. Delayed onset of posttraumatic stress disorder among male combat Veterans. American Journal of Geriatric Psychiatry, 2005, 123, 424-427.
Sullivan, R. Combat-related near-death experiences: A preliminary investigation. Anabiosis: Journal of Near Death Studies,1984, 4(2), 143-152.
Fenwick, P., Lovelace, H., & Brayne, S. Comfort for the dying: Five year retrospective and one year prospective studies of end of life experiences. Archives of Gerontology and Geriatrics, 51(2), 173-179.
ABOUT THE AUTHOR
Scott Janssen, MA, MSW, LCSW is a clinical social worker with the University of North Carolina Hospice. As a member of the National Hospice and Palliative Care Organization’s Trauma-Informed Care Work Group, he has written extensively about trauma-informed care of terminally ill patients, as well as caring for Veterans at the end of life. His articles on near-death experiences and related phenomena have appeared in Social Work Today, American Journal of Nursing, Journal of Near-Death Studies, and the Washington Post.
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