Clinical Approaches to the Out-of-Body Experience

The author reviews aspects of the out-of-body experience (OBE) related to psychic experiences and personality traits, and describes a continuum of experiences of altered mind/body perception, from the prototypical OBE on the healthy end to schizophrenia and organic brain syndromes on the other end. The impact of the OBE on the individual's life is described, with suggestions for a psychoeducational approach to the clinical management of the patient with an OBE to allow maximum growth from the consciousnessexpanding effects of the experience. The out-of-body experience (OBE) has had a remarkably ambivalent relationship with parapsychology. Strictly speaking, the OBE, in its most common form, shows none of the esoterica usually subsumed under the rubric extrasensory perception or psychic phenomena but merely describes an unusual perception of the relationship between the subject's mind and his or her body. In the widely publicized researches of famous spiritualists and psychics such as Sylvan Muldoon and Hereward Carr ington (1969), Robert Monroe (1977), and many others, out-of-body "travel" is a term than has been used to describe very esoteric planes of reality. For theosophists, it is a psychic state fundamental to the mapping and chart ing of the astral plane and other Dr. Twemlow is in the private practice of psychiatry in Topeka, and is on the faculty of the Topeka Institute for Psychoanalysis, the Menninger Foundation, and is Clinical Associate Professor of Psychiatry at the University of Kansas School of Medicine in Kansas City and Wichita. Requests for reprints should be addressed to Dr. Twemlow at 5040 S.W. 28th Street, Topeka, KS 66614. Journal of Near-Death Studies, 8(1) Fall 1989 @ 1989 Human Sciences Press Z 9 30 JOURNAL OF NEAR-DEATH STUDIES realities. In this paper, I will consider the management of the experience as it presents to clinicians for t reatment . As will be seen from the previous research of Glen Gabbard and myself (Gabbard & Twemlow, 1984), we do not consider the OBE to be a disease state, but a normal experience usually requiring no specific clinical intervention beyond reassurance and education. The typical OBE is a pleasurable experience unlikely to present specifically to a clinician for t reatment . However, experience over the years with frequent consultations with psychiatrists, psychologists, and other clinicians indicates that sometimes OBEs appearing in the context of psychoanalysis or psychotherapy, or appearing spontaneously in patients undergoing t rea tment for other conditions, arouse the clinician's curiosity and strong urge to intervene. Unfortunately, the more medically oriented clinicians tend to wish to "treat" the out-of-body state, ra ther than allowing the individual to experience and profit from it. Because of this, there is value in considering differentiation of the OBE from pathological states. Even clinicians sympathetic to mystical and esoteric states can pathologize the OBE. Raymond Kennedy (1976) called the OBE a "selfinduced depersonalization experience"; although in his case report he indicates that he was personally studying Hindu mystical disciplines, he used a pathologizing depersonalization model to describe the OBE. Harvey Irwin (1985), in his book Flight of Mind, gave several other instances of the classification of an OBE as examples of autoscopy or depersonalization. D.H. Rawcliffe (1959) connected the experience with psychosis and hysteria, although our studies (Gabbard & Twemlow, 1984) contradicted that finding. Herbert Greenhouse (1975) related a case in which a psychiatrist agressively ordered an out-of-body experiencer into involuntary psychiatric examination on the basis of that experience alone! What Is an Out-of-Body Exper ience? In our previously reported questionnaire research of 339 out-of-body subjects (Twemlow, Gabbard, and Jones, 1982), we found the following profile description of an OBE: the experience occurs in a state of physical relaxation and mental calmness without emotional stress. The experience is pleasant and the subject typically feels calm, peaceful, and quiet. Occasionally, ecstatic experiences of joy may occur. Very unpleasant feelings are much less common, with the feeling of going crazy being rare. The subject is likely to find himself or herself in the same environment as the physical body, which he or she sees in an STUART W. TWEMLOW 31 inert state below the point of perception, which is spatially separate from the physical body. The subject usually notes that he or she has a '"new body" in a form similar to the physical body. The experience is vivid in quality, is more real than a dream, and has a profound influence on the individual's subsequent life according to self-report. Frequently, the subject may view the experience as spiritual in nature, and may be more likely to believe in life after death as a result of the experience. The individual has a fascination with the experience and would like to try it again, often describing it as one of the greatest events of his or her life. A prototypical OBE in composite form, of course, only describes a majority of experiences and not those extensive numbers of variations from this prototype. From a more theoretical and philosophical point of view then, our research enabled us to define the OBE as "an altered state of consciousness in which the subject feels that his mind or self-awareness is separated from his physical body and that sense of self-awareness is more vivid and more real than a dream" (Gabbard & Twemlow, 1984). This definition is quite similar to others reported in the field including those of Irwin (1985) and John Palmer (1978). OBE and Other Psychic Experiences Palmer (1978) stated that there is an association between the OBE and various psychic phenomena. He particularly referred to apparitional phenomena. In our study of 339 subjects, we found that 76% of the subjects felt they had experienced mental telepathy; 21% felt they had been healed by a psychic; 30% felt they had healed others by psychic means; 32% had seen a UFO; 67% had a precognitive dream; 59% felt they had communicated with an animal; and 51% felt they had had contact with a person after he or she had died. Additionally, 67% of the population claimed they had had blood relatives who experienced ESP and 29% had had blood relatives who had an OBE. These findings indicate an association of OBE and other psychic experiences, although the incidence of psychic experiences in the U.S. population is as yet undetermined but is likely to be significant. In a random sample of the population of Iceland, Erlendur Haraldsson, Asa Gudmundsdottir, Asthor Ragnarsson, Johann Loftsson, and Sigtryggur Jonsson (1977) found about 66% of the sample had had some form of ESP experience. That study is unique with regard to the representativeness of the sample. 32 JOURNAL OF NEAR-DEATH STUDIES