House & Psychology

By Ted Cascio

“Almost dying changes nothing. Dying changes everything.”

-House (Dying Changes Everything Season 5, Episode 1)

Compare that statement from Gregory House, M.D. with this one from Elisabeth Kubler-Ross, M.D., a well-regarded expert on the psychology of death and dying: “For those who seek to understand it, death is a highly creative force. The highest spiritual values of life can originate from the thought and study of death.” One can easily imagine the sort of bitter objection House would unleash upon hearing that remark.

Dissonant points of view like these underscore the current state of widespread ambivalence, apprehension, and uncertainty surrounding human death, the certain prospect of which continues to be a strange and frightening notion for most of us. Many people simply repress thoughts that center around kicking the bucket. In private reflections as much as in polite conversation, the topic is usually avoided altogether, unless it is forcefully brought to mind or mouth because somebody close to us has died or is threatening to die. Who really wants, as the dearly departed Elisabeth suggests, to voluntarily think about and study death, unless those efforts are limited to coming up with ways to avoid it?

It is disappointing that human culture as a whole has yet to make any truly significant advancements in terms of how we cope with thoughts of passing away. In fact, you could easily argue that we’ve regressed when you consider the bold and robust view that some ancient cultures such as the Vikings – for whom Valhalla was supposedly a tangible and unalloyed reward – are reputed to have had on the matter.

But surely even the Vikings could have benefitted from sound empirical research on this topic. Psychologists have studied the emotional role that death plays in our lives. How can we assume a more open and inquisitive attitude towards death, rather than a repressive one? Is House’s conjecture that “almost dying changes nothing” accurate?

We’ll begin with the latter question, because doing so will enable us to view the bigger death-related issues through the lens of research on the more specific subject of what are called Near-Death Experiences, or NDEs. I should mention before we begin that the role of religious coping is not on the menu here, even though it has been studied scientifically. In case you’re curious, the startling truth is that religious strategies for coping with death, ones that pre-suppose an afterlife, do not seem to instill the sort of confidence we wish they would: they don’t alleviate pre-death depression or anxiety (McClain-Jacobson et al., 2004). As House would declare with relish, piety does not bring peace.

What does bring peace? Here’s the trick: If you want to depart radically from convention – in particular from the all-too-common fear of death – it is helpful to experience a correspondingly radical life event. As we’ve already mentioned, finding Jesus does not make the grade. What appears to work really well for this purpose is undergoing the thing mentioned above, a near-death experience. NDEs are rare, often brief, and usually life-threatening occurrences that spawn the conviction, at least momentarily, that one’s demise is imminent and completely unavoidable.

Say you’re rock-climbing and your carabiner snaps, sending you into an extended free-fall that you fully anticipate will kill you. We can all picture that brief moment in which we would say to ourselves something like, “Uh-oh, this is bad…actually…yup, I’m gonna die.” But imagine that instead of landing on the hard ground or a bunch of rocks which, given the length of the descent, would kill you instantly, you miraculously land instead on a snow drift large enough to break your fall, thereby preserving your life. You stand up, feel around your body for damage, and conclude that – holy crap – you’re actually OK, your next thought being, “I shouldn’t be alive, but I am.”

It turns out that things like this happen; in fact, the preceding example is non-fictional. However, a NDE doesn’t have to be so dramatic: the slightly less entertaining episode of surviving a heart attack, where the injured party undergoes clinical death and then recovers from it, also potentially qualifies.

From momentary accidents to long-term health ailments, NDEs span a pretty wide set of possible circumstances. For this reason, they are more prevalent than you might expect. Estimates of the number of near death experiencers range from 4% to 15% of the population, depending on the stringency of the criteria used to define them.

One common element found in the wide variety of cases of near death experience is the profound subsequent effects they have on the lives of the people who have endured them. I can tell you right now that House is wrong; almost dying does not change nothing, as he claims; it appears on the contrary to change many centrally important things. What are these things?

First, there are dispositional changes. A consistent pattern of personality change has been identified whereby near-death experiencers exhibit a particular set of positive outcomes: increased compassion for others, a greater sense of purpose and meaning, improved self-esteem, and generally, a greater appreciation of life. These effects are marked; experiencers often feel like completely different people after their trauma, like they had been wasting their lives up to that point. Another common aftereffect is diminished fear of death, presumably because passing away becomes a more tangible and concrete possibility following direct experience with it; by this means death loses some of its sinister inscrutability. This reduced fear of death has been proposed by Kubler-Ross, among others, as a potential mechanism for the rest of the positive effects of NDEs.

Specifically, freedom from death-related anxiety seems to confer a welcome dose of levity to experiencer’s day-to-day lives. On average, experiencers may feel more lucky to be living than those who haven’t had such a close brush with oblivion. This sentiment was expressed in plainer language earlier, “I shouldn’t be alive, but I am.” This specific conviction seems to embody the unique outlook that experiencers find so easy to adopt following their fortunate extrication from the grim reaper’s icy embrace. It is categorically impossible for people who assume they are entitled to life to feel this sort of gratitude. The results of the scientific study of NDEs indicate that people so entitled suffer for this lack of appreciation frequently and profoundly.

In addition, these dispositional changes correspond with physical changes in the brain. Neuropsychological findings have uncovered links between NDEs and enduring patterns of brain activity. In general, experiencers exhibit heightened temporal lobe functioning, but in a fascinating twist this increased functioning is overwhelmingly located in the left temporal lobe (Britton & Bootzin, 2004), the part of the brain involved in, among other things, emotional stability. This is consistent with the lighthearted and even-keeled demeanor experiencers tend to adopt, and also with their greater appreciation of the small things, along with their improved ability to contextualize and render them meaningful.

On the other hand, negative effects have been documented. Experiencers sometimes have certain difficulties adjusting to normal, everyday life.  All-in-all, however, the consequences of NDEs are overwhelmingly positive, and they are striking. Whether we consider the positive or the (very limited) negative side of the story, there is no doubt that almost dying changes the remainder of one’s life a great deal.

The fact that House himself has had at least two close calls with death, once shot and then later electrocuted, suggests that he may have had a NDE somewhere in there. If so, research indicates that he’s being benefitted in certain ways, although he clearly doesn’t think or act like the typical person who has had a NDE. Despite that, we must conclude that any comprehensive analysis of House’s behavior should include the potential long-term psychological consequences of those incidents that have brought him to the brink and back.

Source Psychology Today

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Will Savage

Quantum Units Continuing Education provides online CEU training's to licensed professional mental health therapists, counselors, social workers and nurses. Our blog provides updates in the field of news and research related to mental health and substance abuse treatment.

2 thoughts on “House & Psychology”

  1. This was a excellent article – thanks for sharing it. Please consider joining a new linky over at called Monday Madness – It’s in support of bloggers who are involved in mental health/illness. I’d like it to grow steadily, to allow for a solid support community for those of us who could use it/who can help, to tackle stigma and enable awareness. Do pop by. Be great to have you with us. Shah .X

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