Coma and near death
Coma and Near Death work
[Our] experiences with people in coma touched me more than almost anything else in my life; being so close to people as they were going through these deep altered states, sometimes very near to death. I think I learned more about the essence of life and the essence of death from those experiences than anywhere else in my life; it was incredibly moving. Amy Mindell, 2007 IAPOP Conference Opening Address
On this page you will find tips for working with coma and near death situations, some remarkable and moving personal stories, and other references including research that suggests the importance of coma work. For more, see Arny's book Coma: The Dreambody Near Death and Amy’s Coma: A Healing Journey.
Coma Work: Arnold Mindell interviewed by Jeffrey Mishlove, 1992.
Process-oriented coma and near-death work follows reduced, vegetative, and comatose states using basic Processwork methods: Notice and track the momentary and evolving situation. Such work may involve attention to very minute gestures and signals.
This 3 part interview occurred more than 20 years ago. Still, the essence, innovations, and hope shown in this interview with Arny are as important and new today as before. We need to re-think and learn more about how to connect deeply with people in vegetative and comatose states.
Thanks to Jeffrey Mishlove for his help with this interview.
Tips For Helpers And Family (NEAR DEATH AND COMA WORK: Questions Frequently Asked)
0. Value feelings, or meta-skills, as much as skills
There are no firm procedures and may never be any fixed rules in working with people. Everything is a process; it depends upon the moment, people, belief systems, and feedback processes. However some of the tips we provide below may be useful for those who ponder what to do in near death states. Follow them if they are useful, but please don’t use these statements as commandments. See Amy’s Coma, A Healing Journey and Arny’s Coma, Key to Awakening for more.
I. About Medications
At the appropriate time, when someone is nearing death, ask them if they prefer a lucid state (minimal drugs) in which they can track their experiences or a less-lucid state (more drugs). Left to themselves, the majority of people do not seem to use their lucidity in comatose or near coma-like states. This may be due in part to the lack of education about death and dying and the culture someone is living in. Giving more drugs –to make the “client” feel better– is a good idea. Remember that discovering the creativity trying to happen may enrich and facilitate the whole process. Hence there need be little conflict between using or not using medication; medications and awareness work together.
II. Effects of Lucidity
Everyone should know that as a general rule, the more complete the processes, the more restful and best for all.
For those “clients” choosing the lucid path, be absolutely precise as a helper and notice little tiny things and repeat them in one way or another.
IV. Wait and Notice
What you don’t t know, don’t t fill in with your everyday mind; wait for answers to happen. Only after positive feedback to what you have done, go on with what you are doing. Especially in comawork and in general, if the client asks you to play a part in their process, then you can or must use your own experiences as part of the overall process. You are needed as you are!
V. Agitation Just Before Death
To the surprise and terror of many helpers, clients near death seem to get agitated and try to fly or walk or even run from their bed. Helpful methods to work with this are to tell them you are going to fly or walk for them, and to ask them to “choreograph” you, if possible. Or, you can move their body or legs for them and ask them to imagine where they are going and what they are doing. Some folks tell you they are flying into the air, or reaching for the sun etc. (Actually helping someone out of bed is a very radical procedure and needs great care and expertise.)
VI. Respecting Death and dying is very important
Perhaps even more important however is respecting the process that is not necessarily time or space bound, here or there.
VII. About Attachment
If you are normal and attached and can’t t let go, then act that out, put on a little theater, show it to the other, and then you might be able to show letting go. Many feelings we have mirror submerged feelings the client has and is shy about showing.
VIII What to do Next?
Remember, you are the other. If your friend or client asked you to be there at the end, and you don’t know what to do, ask yourself what you would want in a given moment.
IX Special Situations. Young Children
When dealing with very young children, especially under the age of two, we have had good responses by playing very fast and/or very slow music and simultaneously, gently tapping on the feet in rhythm with the music. Depending upon the situation, half an hour, twice a day could be helpful.
X. What is Death?
The question often arises: “What is death?” In our experience, the answer depends upon the person. For some, it is a blissful altered state. For others it is meeting a departed loved one. For some it is a sense of the beauty of nature. And sometimes, near the end people say like the physicist Richard Feynman, “Not something you want to go through twice”.
The Death and Life of Dr. Sara Halprin, Nov. 10, 2006
We are sad to report that Dr. Sara Halprin died early this evening. At 6.30pm Portland Oregon time, November the 10th, our good friend, best author, wonderful teacher, exciting filmmaker, amazing colleague, creative therapist, inquiring student and spicy being, Sara Halprin has died. Thanks to Herb Long, her best friend and husband for being with her, helping to facilitate the following interaction. He did this in so many ways through the period of her 8 month illness and death. And thanks to Amy for having recorded the experiences below.
After her death, we dreamed she wanted to “be useful” to the public; and as a result, decided to publish her final words, as they included her interest in being of use to all.
One of her last (semi) verbal exchanges occurred while being with her as she tracked altered state experiences, finally becoming a magical bird. She called it “The Mallard”. We think she might like it if others knew of her experience, and her bird.
Here is a reportage of those experiences (as closely as we can remember.)
Herb: Arny, I’ll put the phone near Sara’s ear. Go ahead and speak, she will hear you.
Arny: Sara, so good to be with you, to hear your breath, your voice.
Sara: Yes. Perhaps I should get more therapy.
Arny: Why not. What would you do with your life if you could.
Sara: I want my life to be a useful one, for everyone.
Arny: The best way to make your life useful in the moment is to track your experiences, very few people are able to do that and give it to others.
Sara: (barely audible but mumbling, gasping a bit) O.K. I can’t breathe too well, my heart is racing. My hand is jittering, jittering.
Arny: Herb and Sara, perhaps Sara can try to sit up just a bit, not too much, that may ease the strain on your breathing and heart.
Sara: (Breathing easier) Ah, that is better.
Arny: Sara, make little hand motions that go with that jitter
Sara: Ohhhh, mmmm. Now I feel relaxed. (quietness..)
Arny: What do you notice now?
Sara: Ohhhh, the neck, Arny, it is moving, jittering, now I’m falling away, falling backwards, like nothing.. falling into empty space.
Arny: If you fell somewhere where would you like to fall?
Sara: I am falling into nothingness.
Arny: Sounds ok. You can choose where you’d like to go. That might be your best medicine.
Sara: (after a few seconds) I can make a choice as to where I want to go? Now I’m losing my senses, I’m free and floating.
Arny: Just feel that.
Sara: I don’t know, I’m disappointed.
Arny: If you âre disappointed, that means you know where you want to go and aren’t . Would you like to go into the arms of something taking care of you? The Seashore? Or to Mars?
Sara: Someplace I’m needed.
Arny: You are very much needed..
Sara: OK, I’m falling backwards again, falling out and I’m a nobody and there’s a bird, the water’s edge.
Arny: What kind of bird?
Sara: It’s a pigeon, no, it’s a duck, ahhh, it’s a mallard! It’s a mallard!
Arny: You’re needed as a duck floating on the water.
Arny: Would you like me to sing you a duck song?
Sara: Yes, please.
Arny: (In Swiss German Alli mini Entli schwimmed uf em See, schwimmed uf em Seeâ€. (translated approximately into English) All my little ducks, swimming on the lake, swimming on the lake, put their little heads in the water, and their little tails up high. That’s a Swiss children’s song. Did you like it?
Sara: Ohhhh YES!!
Arny: Well, you are a duck, a mallard at the water’s edge.
Sara: Ummmm. Yes! And it’s head is moving back and forth. It’s amazing.*
Arny: Enjoy being a mallard, it was so good being with you.
Sara: Oh yes! Good Bye.
Everyone is silent.
Herb: Thanks Arny, and good bye.
* Thinking back upon the experiences of this amazingly wonderful and lucid woman, we can say that what began as a hand-arm-body tremor, was from the inner viewpoint, apparently the beginning of the Mallard.
Natasha’s Last Performance
This picture of Natasha Docker was taken at her presentation of the story, ‘The Bird in the Fire’, Portland, Oregon June 2004. She completed that story January 1, 2005, ten days before she died. We wrote the following about her last process with us, because she wanted her work to be seen by others. We also wrote this up because some of the people closest to her at the time of her death, told us about how she moved back and forth between the left and right (life and death, see below) and that she died on the right side.
From the feelings of sadness and amazement, we immediately wrote this almost unedited letter January 11, 2005, to everyone on our local process work string. Many in the community had loved Natasha.
Natasha’s living and dying process. Thanks to Peter Irving and everyone for having cared so lovingly, honored and followed, danced and wept with Natasha as she went through her amazing dance. She dreamed about going back to a “Dreamtime Mob”, and described that to us as the process work community of friends, as you, those who have been so close to her and around her. She would like you to be honored, and so we are thank you all from her and our hearts. Thank you again for your loving, feisty, tender caring. At the same time, we must remain awestruck by the life and death of Natasha.
Dear Natasha, crowded together with 15 other people in your hotel room that January the first, we recall the following. There you were, here with us in Yachats, when we saw you ten days ago. You blew us away. We remember your warm greeting, then entering your hotel room, seeing you curled up in your seat waiting for us.
Then we recall working with you. You said that your process was “between life and death”. We remember beginning to work with you. True to your courageous seer’s spirit, we recall being detached but at the same time attached and amazed by your amazing physical and mental clarity and “wellness,” how you wanted to work on what you called the “struggle between life and death. ” We said, “Which way is your process heading?” You moved your hands together first to the right side –that was death, and then slowly to the left side —that you said was life. Then we asked you to follow your process and see what happened next. We all sat and meditated with you. Then you said, “oh…drugs make me slide”. So we said, “slide, slide, and slide”. And slide you did, over to the left into life!
“OK”, we said, “let’s get into life”. You said, “YES! And what about my creative project to present my story in theater form about “Bird in the Fire”?”
OK we said, that is your next step…but then following your amazing energy, we noticed you move. So we said, let’s get up and forget this death thing for a moment and get on with the theater. And indeed, with immense vitality, you arose to your feet, got your crutch, and then began to direct all of us who were stuffed into that little hotel room. How awesome.
What a choreographer!! You had us all stand. What a scene. Amy became you, moving through the forest. Many others played the trees in the forest. Arny was to be the ally, warrior. Amy moved hesitantly (as you) through the trees, met the warrior. Then Amy took Heiko’s yellow crutch, which you said was the golden tree that was to guide Amy through her journey through the dark forest with the help of her tree of light.
It seemed like the theater piece was done, but no, you as the director got right up, marched over to where Amy was standing upright, at the edge of the forest facing the Pacific ocean more or less alone, and you took her “golden tree”(the yellow crutch) and continued marching on forwards into time with a kind of pride and beauty. Standing in the room, we all stood in back of you while you were in front of us facing the sea. It is not saying enough to say that some of us were stunned and touched by your immense ability at moving through time and space so courageously with your golden tree shining the way.
Well, you said you wanted to produce this show for the community and everyone. Peter Irving was so good as to video the latter part of this work. And so dearest Natasha, that is why we are now giving folks a bit of a preview of your show, that we may all see it at another point in space and time, whenever.
May your golden tree be forever shining the way, and may it help each and every one of us still bound to the gravity of the earth, stuck in occasional darkness, needing that light of yours moving through everything and anything.
Thank you thank you dear one. We all love you dearly, and some of us have no sense of your passing, but of your being even more present than ever before right with us in this moment, with your golden tree shining and pointing the way for us, wherever it may go with us. In some senses you are further than ever, and in another, closer then ever. There is no substitute for giving you a hug, and at the same time, there is.
Thank you for your gifts.
Love amy and arny
ACCIDENT, COMA AND RECOVERY : FROM THE INSIDE OUT
We are happy to publish this remarkable verbatim story from Mr. Matthias Turtenwald . His wonderful story includes his own inner and outer coma “realities”, and together with the report (see below) of his friend, Theresa Koon, gives hope to those worried about comatose states.
by MATTHIAS TURTENWALD, email: MTurtenwal@aol.com.
Accident 14 January. 1996
At the 14 January. 1996 I was alone at home with my three kids. In the afternoon we decided to go to a tower not far from us to see the sunset.
I drove up there with my kids and we climbed the tower. The sunset was very beautiful.
When we went down again, my two older kids Stefan (11 years old) and Felix (9 years old) went first and
I went with the smallest son Franklin (5 years old). Approximately at the second level from top Franklin told me that he was scared about going on. Just to soothe him I lifted him into my arms. At this moment I slipped with my shoes and we toppled over the banister.
We both fell 28 feet and I hit my head on concrete. My son fell on my body. I was immediately in coma and I was brought in a university hospital at the same day. A neurosurgeon made the operation. The neurosurgeons thought that there is no chance for if, than only and me to survive as a vegetable.
It took 6 month until I went back into live. …
Consciousness in “Coma” goes unseen by Medical Professionals
Our challenge, everyone’s challenge is to statistically validate the subliminal connections we notice when speaking with people and noticing feedback, that is applying process oriented coma work to states of consciousness where people seem “not to be there.”
The following New Scientist article seems crucial to the potential for consciousness in coma, so we include it here full text, with thanks to New Scientist.
Doctors missing consciousness in vegetative patients, by Celeste Biever, New Scientist (July 2009) (Reproduced in full with thanks):
If there’s one thing worse than being in a coma, it’s people thinking you are in one when you aren’t. Yet a new comparison of methods for detecting consciousness suggests that around 40 per cent of people diagnosed as being in a vegetative state are in fact “minimally conscious”.
In the worst case scenario, such misdiagnoses could influence the decision to allow a patient to die, even though they have some vestiges of consciousness. But crucially it may deprive patients of treatments to make them more comfortable, more likely to recover, or to allow them to communicate with family, say researchers.
In a vegetative state (VS), reflexes are intact and the patient can breathe unaided, but there is no awareness. A minimally conscious state (MCS) is a sort of twilight zone, only recently recognised, in which people may feel some physical pain, experience some emotion, and communicate to some extent. However, because consciousness is intermittent and incomplete in MCS, it can be sometimes very difficult to tell the difference between the two.
In 2002 Joseph Giacino at the JFK Rehabilitation Institute in New Jersey and colleagues released the first diagnostic criteria for MCS. Then in 2004, Giacino released a revised coma recovery scale (CRS-R) – a series of behavioural tests based on criteria that can be used to distinguish between the two states.
To see if the revised scale improves diagnoses, Giacino and Caroline Schnakers of the Coma Science Group at the University of Liege in Belgium, with colleagues, spent two years using CRS-R to re-diagnose patients admitted to a network of Belgian intensive care units and neurology clinics with head injuries that resulted in some kind of disturbance to consciousness.
The clinics and units all used a “clinical consensus” agreed by a range of specialists to diagnose patients. Some of the specialists relied on qualitative, “bedside” observations to diagnose patients, others used older diagnostic tools, but none used the CRS-R – the only one designed specifically to distinguish between MCS and VS.
Of the 44 patients diagnosed as being in a vegetative state by the clinicians, the researchers diagnosed 18, or 41 per cent, as being in a MCS according to the CRS-R.
“We may have become much too comfortable about our ability to detect consciousness,” concludes Giacino. “I think it’s appropriate for there to be some level of alarm about this.”
Giacino concedes that, because there is no objective way to measure consciousness, he cannot exclude the possibility that the reason for the discrepancy is that the CRS-R is over-diagnosing MCS.
However, Schnakers argues that CRS-R should be more accurate because it specifies how many times each test must be repeated – and how many responses are needed to give an indication of consciousness.
This, she says, guards against missing awareness in someone who pops in and out of consciousness, or mistaking a reflexive response for a response based on consciousness. It should also control for “examiner bias”, where someone subjectively decides whether the patient is conscious or not, adds Giacino.
What’s more, the revised scale also makes use of some new insights. One sign of consciousness is whether someone follows the path of a moving object, known as “visual pursuit”. Many clinicians simply look at whether someone follows a moving pen or person, says Schnakers.
The CRS-R specifies the use of a mirror, which she argues may prompt a reaction in someone who is conscious, but who does not respond to a moving pen. “When you move an object, it is less powerful,” she says.
‘Death or survival’
So why do clinicians still use the qualitative assessment? “Their focus is more typically on death or survival” and on biological factors that need treatment, such as how long a patient needs to be in an intensive care unit, says John Whyte of the Moss Rehabilitation Research Institute in Philadelphia, Pennsylvania, who was not involved in the study. “For their purposes, the distinction [between MCS and VS] doesn’t matter much.”
For the patient and the family, the difference between MCS and VS can make a huge difference, though. Drug treatments, painkillers, physical therapies designed to stimulate the brain, as well as techniques for encouraging communication, are more likely to be given to someone in a MCS.
In some jurisdictions, whether food can be withdrawn may depend on whether or not they are in a VS, says Whyte. “It’s very important to be sure of the diagnosis,” says Schnakers.
Journal reference: BMC Neurology (DOI: 10.1186/1471-2377-9-35)
Near Death research
In a 2006 news report, 'Near death' has biological basis, researchers at the Neurology department of the University of Kentucky define near death experiences as a time during a life-threatening episode when someone experiences what they feel is an “out-of-body experience, unusual alertness or sees an intense light or feels a great sense of peace”. These researchers suggest that there is a biological basis for these experience, but wonder about its potential meaning. Professor Kevin Nelson says, “However, I hesitate to call it dreaming or dreaming while awake.”
We applaud the neurologist for his biological theory and for his saying, “the theory did not automatically rule out a spiritual dimension to near death experiences.’ We are also researching near death experiences. We are studying whether learning to “dream while awake” (See Arny’s book with that name) may possibly ameliorate or at least assist making such near death experiences a more integral and meaningful part of life (as well as the death experience). At this point, it seems to us that near death experiences are examples of what we call the “big U”, a central part of personal myths. In addition, we are researching the social impact and significance of such experiences. We have pondered the interconnections between the teachings of Carlos Castaneda’s shaman-teacher, don Juan Matus, and the teachings of near death experiences (NDEs). We are thinking about the NDE experienced by C.G. Jung and reported on in Chapter 11 of his “Memories Dreams and Reflections”. There he speaks of an NDE that occurred during a heart attack where he saw his life in a “snap shot”, part of a timeless “flow”, free of the “imprisonment” of life, space and time.
COMA AND THE IMPROBABLE THEATRE
We were pleased and thankful to have discovered the actor and director, Phelim McDermott, and his show, COMA by the Improbable Theatre Company. Some of the process work background he speaks of is related to the work of Arlene and J.C. Audergon of London.
COMA: KEY TO AWAKENING? (AUGUST 2012)
We thank Emmanuel Haddad a French journalist for interviewing us on comatose states for Global magazine, (a French online magazine working on issues such as ecology, geopolitics and social issues).
1) E. In general, waking up from a coma is more lived as a trauma or as a chance to begin a new life?
A+A. Dear Emmanuel This first questions of yours is a good question. The people we have worked with and known who have lived through comatose states do not show any one reaction such as “traumatic stress” or “chance for new life.” The reason might be that although coma is common, the origins of the comatose state are many.
(To see his story in the Global magazine, click here (French language requires subscription)
Coma and Dementia: Stan Tomandl and Tom Richards
We are enjoying reading the new and helpful books on Dementia, Coma and Eldership by Stan Tomandl and Tom Richards. See An Alzheimer’s Surprise Party and Eldership, A Celebration available from http://www.lulu.com/sentientcare. These books are both compassionate and practical.
ComaCare: Jan Webster in South Africa
We are touched by Jan Webster and her team’s “A Call to Consciousness, A four year report of ComaCare in South Africa.” We are thankful to hear from her that her work “reflects what you (A+A) have helped build”.
Research Into Altered States by Pierre Morin
We are happy to see Dr. Pierre Morin’s investigation connecting the philosophical, medical, and process oriented viewpoints around the meaning of consciousness and connection with people in altered and comatose states”.
Download his original article in German: Prozessorientierte Kommunikation mit Menschen in VerÃnderten BewusstseinszustÃnden und Koma Pierre Morin, MD, Ph.D.