The evolutionary origin of near-death experiences: a systematic investigation Costanza Peinkhofer, 1,2,† Charlotte Martial, 3,4,† Helena Cassol, 3 Steven Laureys 3,4 and Daniel Kondziella 1,5 † These authors contributed equally to this work. Near-death experiences are known from all parts of the world, various times and numerous cultural backgrounds. This universality suggests that near-death experiences may have a biological origin and purpose. Adhering to a preregistered protocol, we investigate the hypothesis that thanatosis, aka death-feigning, a last-resort defense mechanism in animals, is the evolutionary origin of near- death experiences. We first show that thanatosis is a highly preserved survival strategy occurring at all major nodes in a cladogram ranging from insects to humans. We then show that humans under attack by animal, human and ‘modern’ predators can experi- ence both thanatosis and near-death experiences, and we further show that the phenomenology and the effects of the two overlap. In summary, we build a line of evidence suggesting that thanatosis is the evolutionary foundation of near-death experiences and that their shared biological purpose is the benefit of survival. We propose that the acquisition of language enabled humans to trans- form these events from relatively stereotyped death-feigning under predatory attacks into the rich perceptions that form near-death experiences and extend to non-predatory situations. 1 Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen 2100, Denmark 2 Department of Psychiatry, Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen 2000, Denmark 3 Coma Science Group, GIGA-Consciousness, University of Lie `ge, Lie `ge 4000, Belgium 4 Centre du Cerveau 2 , University Hospital of Lie `ge, Lie `ge 4000, Belgium 5 Department of Clinical Medicine, University of Copenhagen, Copenhagen 2100, Denmark Correspondence to: Daniel Kondziella, MD, PhD, MSc, FEBN Department of Neurology, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark. E-mail: daniel_kondziella@yahoo.com Keywords: death; evolution; near-death experience; survival; tonic immobility Abbreviations: CSD ¼ cortical spreading depolarization; NDE ¼ near-death experience; NMDAR ¼ N-methyl-d-aspartate receptor; REM ¼ rapid eye movement Received March 22, 2021. Revised April 18, 2021. Accepted May 05, 2021. Advance Access publication June 22, 2021 V C The Author(s) (2021). Published by Oxford University Press on behalf of the Guarantors of Brain. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. B BR AIN COMMUNICATIONS AIN COMMUNICATIONS doi:10.1093/braincomms/fcab132 BRAIN COMMUNICATIONS 2021: Page 1 of 13 | 1 Downloaded from https://academic.oup.com/braincomms/article/3/3/fcab132/6307709 by Det Kongelige Bibliotek user on 07 July 2021