Du « moi vif » des noyés à l’expérience de mort imminente : approche clinique d’une énigme médico-psychologique à partir d’un nouveau cas

Abstract

ObjectivesMedical and psychological nineteenth century literature included reports of strange subjective experiences from people who survived drowning. Instead of being traumatic, this life-threatening situation was sometimes experienced as a paradoxically positive moment, with an apparent acceleration of thoughts and a panoramic review of life. This experience was discussed by several famous figures of French psychology: Hyppolite Taine, Théodule Ribot, Charles Féré, Paul Sollier, Henri Piéron, Henri Bergson, Henri Wallon, etc. This topic was part of a larger discussion on the “exaltations” of thought and memory, and compared with dreams, experiences at the hour of death, and altered perceptions under psychoactive drugs (i.e., opium). In 1896, the French philosopher Victor Egger developped a psychological understanding of these experiences under the name of “live self”. His papers, first published and discussed in the Revue philosophique de la France et de l’Étranger, launched the recognition of what is now called near-death experiences (NDE). But there is subtle differences in the way this object was studied and understood when comparing it to current debates, divided between spiritualist and neuro-reductionist approaches. We explore what we could learn about this enigma when bringing together past and present literature. MethodsAfter a literature review of old French psycho-medical literature on the concept of “live self” and its sources, we analyzed a contemporary case collected through an elicitation interview. This case study is then discussed both through a clinical analysis, and in a comparison with current interpretations of NDE related to drowning. ResultsIn our case study, the subject fell in water and believed, during this short period of time, that it was the end of his life. Then he experienced pragmatic thoughts about how to rescue himself from this danger, prospective thoughts about how his death will be announced and received, and retrospective thoughts about important autobiographical memories. Furthermore, he ignored pain, developed automatic movements, focused his senses, and felt quiet and peaceful. All these aspects disappeared only seconds later when he realized he could easily swim. This experience had relatively few aftereffects on him, as he kept fearing death and did not endorse a belief in afterlife. This case both fits with patterns described in the old literature, and contradicted the “Moody syndrome” currently defining what is a typical NDE (for instance, no out-of-body experience in this case). The subject did not developed posttraumatic stress disorder or other symptoms relative to psychotrauma. This suggested that this experience may be adaptative and help to prevent the consequences of a confrontation with death. Comparison with experiences occurring in various circumstances show similar phenomenology and aftereffects. ConclusionsThe study of the “live self” of drowning survivors was once a interesting topic for psychology and medicine, but was latter lost sight, until its rediscovery under the umbrella term of “near-death experiences”. Testimonies of such experiences can still be collected and analyzed qualitatively and quantitatively. Psychological and neurological hypotheses about the triggers of such experiences let room for a psychodynamic approach in which the fright of annihilation activates a special psychosomatic circuit. This reaction may be adaptive both because it helps the person to practically save himself/herself from a life-threatening situation and because it may prevent, even long term, the clinical aftermath of such a potentially traumatic event.