After

Declaration of interest I am a spiritual person. I didn't come into this book desperately seeking answers, or in need of comfort or certainty. You're never going to get that from any book, I'm afraid. I believe that we are not just our bodies, and that consciousness exists (at least partially) separately to the brain. I came into this book because I was interested in hearing the experiences of a healthcare and scientific professional, and how they experience / grapple with these questions. And to hear from people who had almost died. That sounds pretty cool.

Death, as we know, is the only inevitable thing in our life that isn't taxes. But people seem to spend a great deal more time and attention trying to cheat or bemoan taxes.

After: A Doctor Explores What Near-Death Experiences Reveal About Life and Beyond makes you think about death. Barely two pages pass where Greyson isn't telling us about a patient they saw who nearly died in some morbidly unique way. All throughout, Greyson approaches the subject of near death experiences (NDEs) as a practiced researcher and medical professional, and in doing so does what all good authors do: places their subject matter bang in the centre of something much larger. Death, living, almost dying, trauma, spirituality, and our relationships with ourselves, our families, and our mortality all come up. And while questions about the experience and impact of NDEs on someone's life comes relatively answered, these broader questions about how we live are left open.

At its core, however, it is a book about NDEs. So let's talk about that first.

Near death experiences are experiences that people have when they almost die. In some cases they do actually clinically die, but they eventually come back. The experiences themselves are vivid, and people who have them can tell them apart from dreams. Apparently they're not quite like anything else. The term NDE was coined 1975 with Raymond Moody's Life After Life, though reports of NDE-like events predate this. It has remained active grounds for research by people involved across neuroscience to philosophy and anthropology.

Current research suggests that some 10-15% of people who almost die experience NDEs. They are present across cultures, religious/spiritual beliefs, ages, and lifestyles. Greyson takes us through the building block questions like "what is an NDE?" and why they're worth studying. We get an overview of a few common characteristics: from the relatively innocuous change in time perception and clarity of thought, to seeing one's body from from outside your self, the "life review" (the addled phrase "my life flashed before my eyes"), and meeting and interacting with deceased people.

We are well-guided (though perhaps a little briefly) through the process of an NDE. From its immediate characteristics, to how it changes people in the weeks and years which follow. People who experience NDEs often live a different life after their experience, compared to those who almost died but did not have them. Sometimes they can cause conflict if the experience doesn't conform to somebody's pre-existing spiritual beliefs. In general, NDEs seem to be a force for good - leading people to live more patient and compassionate lives.

This is a well structured non-fiction book. Any aspiring non-fiction writer would do well to pay attention to Greyson's ability to plant the seeds of one question in one chapter, and then answer it promptly in the next. In some cases he points at something he's just said and them tells you he'll clarify it much later. You're never left wondering about things - Greyson has clearly guided many a novice down this garden path. This makes for an engaging read, one that you could burn through.

At times it is a little frustrating that the evidence seems to be "I met Jane who almost died, and here's what she reported… I met Alex who almost died and they said…". However, this does provide more personable that a table or chart might not. Still, it would have been nice to have a bit more formalisation.

In fact the entire book seems to work hard to directly avoid an academic tone. Rigour is very clearly cut off in favour of conversation and engagement. We get glimpses into the fact that Greyson obviously has a wealth of experience in dealing with NDEs and their consequences on others. However, I never got the sense that he had truly mastered the gnarlier corners of the field, or was attempting to push the shape of research forward from a collection of personal testimonies.

Depth is sacrificed for breadth in this book, even to the extent where I wonder if Greyson's success can be attributed more to the impact and consequences of his patients' experiences than to him as an individual or researcher. I get the sense he might give an excellent hour long seminar, or be lively company at a dinner party, but rather less that he fulfils the detail-oriented academic air. I suspect at least in part that this is because he has less literature to delve through, join together, or refute. He is a story teller, a founding father with a vision of a new nation. He is not a civil servant sorting through the minutia of allocating land and settling legal disputes.

At the same time, the only way that you'll get a sense for the actual experience of an NDE is if you hear them spoken about. You can hear "out of body experience" and not think about it too much. These are loaded, emotionally- or spiritually-charged terms, for me at least. Having three or four concrete examples, each with undeniably odd situations around them (like noticing the state of someone's attire while dead and having your eyes covered) does a better job at making you confront these experiences. I don't think the same could be achieved with the cool, polished marble of figures and numbers.

This becomes even more important when people talk about experiences which step past both our every-day lived experience, and the capacity of our language to communicate ideas.

It is here that we depart the actual topic of the book, and start talking about the meta aspects. It is here that Greyson is able to throw out half a dozen or observations about medical and scientific research, each fundamental to the way we conduct, review, and communicate research. In short - all very interesting ideas. Certainly they are not ideas to adopt wholesale. This won't be the book that topples the peer-reviewed, double blind study, but it's a step towards there.

The most interesting question this book raises isn't "what happens when we die?" it is "what is evidence?". Greyson works in the gate-kept, largely conforming and heterogeneous landscape of academic research. The focus for many practitioners is on getting enough published research out to justify their positions and move towards promotion and tenure. It is not in their interest, really, to rock the boat too heavily. It is a much wiser choice to make sure your research looks, broadly, as it is meant to look, which means it looks like everybody else's, and like everything that came before it.

This is not the most effective way to study every part of the human experience. If you hold NDE experience to the same standard as a vaccine trial (double-blind gold standard control), you will never get any data or information. From that stand point, NDEs simply do not exist.

With the prevailing attitude that NDEs do not exist, if you almost died (especially if you tried to take your own life), and you experienced going someplace else and meeting your deceased grandparents or parents, would you tell the doctors around you what happened? Nope, you'd probably stay quiet and maybe tell one other person in your life. Because NDEs do not exist, and there are no vehicles to get your NDE story outside of yourself.

You would be worried the doctors would think you crazy, or judge you, and not listen. There's a high chance they'd diagnose you with some kind of psychotic episode and maybe keep you in hospital longer. You would have gone through two very impactful events in your life (nearly dying, then having an NDE) and you will have no professional support to guide you through processing these and integrating them into your life.

The healthcare professionals made sure the mechanics of your body wouldn't fail, and then sent you off. This is not the gold standard, end-goal of medical care. The question of "what is data" is not just a philosophical one, it is one which impacts us and our healthcare system.

Greyson makes a very convincing case for a human- and experience-centric approach to research. Both in the design of experiments and the consideration of publication. There is no point in doing research if it cannot be effectively conducted, reviewed, and published. If the standards for conducting, reviewing, and publishing research remain narrow, then only some kinds of studies will be published. Or things will be studied with inappropriate methods, because they suit the medium (research) not the subject (NDEs).

Research should push our collective understanding forward, and medical research should (eventually) result in better care. To support people who have NDEs, regardless of what you think they actually are, you need to understand them. To understand them, you need to be flexible in how you collect data about them. We need peoples' testimonies and experiences to be treated as sacredly as though the were field observation or computational data.

Even if you don't care the slightest about the spiritual or moral implications of this book, read it. You might think it all poppycock, but it's a well told poppycock. Perhaps the strokes are too-broad and the author too American, but this is a good, accessible non-fiction book that raises more insightful points about our (the West's) approach to healthcare and wellbeing.