So then they roll me over on my back, and the examiner has a long needle in his hand. And I see the needle. And it’s bigger than any needle that I’ve ever seen.” So testifies Betty Hill, of her experience inside a flying saucer near Franconia Notch, New Hampshire, in 1961. Betty and her husband, Barney Hill, are the earliest known victims of alien abduction, and the 1966 bestseller The Interrupted Journey describes how they recalled the event under hypnosis. Their story includes nude medical exams and invasive probing—an alien abduction scenario many of us recognize from the TV shows and movies of the past 50 years.

But in 2008 a Columbia University psychoanalyst published “Alien Abduction: A Medical Hypothesis” which suggested that what is known as “accidental awareness under general anesthesia”—in which a patient awakens on the table during surgery—might lie behind stories of alien abduction. The analyst, David V. Forrest, noted the similarity of the classic alien abduction scenario—bug-eyed greenish humanoids surrounding the subject as she lies on an examining table under a bright light—to the operating room situation, where surgeons in scrubs and masks hover over the patient and enter her body with tools. Asked if being probed by aliens felt like his prior tonsillectomy, Barney Hill agreed: “Like that, but my eyes are closed, and I only have mental pictures. And I am not in pain. And I can feel a slight feeling. My groin feels cold.”

While in a hypnotic trance, Barney Hill told his psychiatrist, “I don’t want to be operated on.” He described a spacecraft lit by blue fluorescent light, which didn’t cast any shadows, as in a surgical suite. The aliens had oddly shaped heads with large craniums, and indistinct lips and nostrils; they were all foreheads and eyes. Though he was terrified, he felt sluggish. He was struck by the all-business, professional bedside manner of the alien “doctors,” and impressed by their determination to do whatever it was they meant to do.

He could have been describing the well-intentioned members of the Royal College of Anaesthetists, who have just released the largest collection of data on accidental awareness ever assembled. Awareness during general anesthesia first attracted interest in the late 1990s, when patient/activist Carol Weihrer publicized her own awareness experience. Awareness has since spawned support groups, Facebook pages, a horror movie, and an episode of Grey’s Anatomy, but is only now being generally recognized by the medical community. The Royal College notes that one purpose of the report is “to present an apology on behalf of the profession to all those patients who have hitherto been let down by a collective failure to understand or accept the condition.”

Of course, most patients who experience awareness never claim they were abducted by aliens—none of the hundreds of patients interviewed for the new report did—but the Royal College report documents the potential for lasting, perhaps permanent, psychological damage to afflicted patients. While half the patients in one survey experienced pain, two-thirds experienced helplessness and panic. Over 40 percent of the patients studied for the report experienced moderate to severe psychological harm, with some incapacitated by post-traumatic stress disorder.

One awareness patient describes a flashback: “It struck again days later as horrifying images and terror that rose from the depths of my being. I was once again in the grips of horror, again not comprehending, again trapped, again struggling to survive, yet wishing for death.” Alien abduction seems almost restful in comparison.

Assuming Barney Hill wasn’t actually brought aboard a spaceship that night in 1961, he may have experienced a flashback to his tonsillectomy. He was cold. His eyes were closed. He didn’t want to be operated on. Then he woke up under general anesthesia, to full-blown terror, surrounded by distorted beings, squinting in the blue light of the OR. Perhaps the pain and horror of awareness overwhelmed his mind, or maybe it was the anesthetic drugs, but somehow the experience disappeared from his working memory--until he and Betty came to believe they had crossed paths with an unidentified flying object on a dark and lonely New Hampshire road.

Alien abduction has been considered a fantasy, a hoax, and even to some, a fact; but it is now clear that it may also represent a recovered memory. Recovered memories are frequently astounding and implausible—if they were orderly and digestible, we would not have forgotten them. Most famously, recovered memory has been at the heart of controversial claims of childhood sexual abuse, satanic cults, and other disturbing and difficult-to-prove allegations by one family member against another. The difficulty of distinguishing between recovered memories and so-called false memories has troubled psychiatrists and patients alike. 

What can anesthesia awareness teach us about recovered memory? For one thing, the report discusses different types of memory, including “trauma memory.” Everyday memories are not terribly descriptive. Intense emotional states, such as those experienced during awareness, create memories that are rich in sensory detail and tend to burst out inappropriately, as in a flashback. Trauma memories are not encoded as logical narratives, but as globs of sensation. Thus a sensory experience—like seeing a hospital worker in scrubs—can cause an awareness survivor to feel overwhelmed with panic and to relive the sensation of paralysis she suffered through while anesthetized.

PTSD researchers have found that trauma memories are jumbled, and making sense of them can be compared to putting together a jigsaw puzzle.  Memories are recovered in bits and pieces.  When Barney Hill heard the playback of the tapes he had made while telling his story under hypnosis, he said “I felt so overwhelmed and relieved.  Now parts of my life that had been missing were added to it again.  Parts of my life were being put back together.”  The story of his abduction by aliens helped him create meaning out of a set of disjointed and mysterious sensations, and that was weight off his shoulders.  Similarly, the Royal College concluded that the awareness experience is less traumatic when patients understand what is happening, or receive an explanation after it has occurred.  Their report recommends that all hospitals develop protocols for helping patients with suspected or confirmed awareness.  As a poster advised on the website,  “I also found that having the experience validated by the doctors involved, was important to my recovery. . . but I can tell you this was difficult to get, as they did not want to admit to their mistake.”

There is another problem: a person can only report an awareness experience if she remembers it, which could take years or never happen at all.   Alien abduction may be one of the most dramatic sequelae of anesthesia awareness, but surely not the only one.  Hate jazz?  If you have ever had surgery, it may not just be your taste in music.  One awareness patient, formerly a jazz aficionado, developed a bizarre aversion to the style after an awareness experience.  It was not until years later that she recalled hearing a favorite jazz piece playing in the OR while awake during surgery. 

The report recommends a number of changes in anesthesia practice to minimize the impact of awareness; in particular the decreased use of neuromuscular blockade, which induces paralysis in the patient and may not always be necessary.  The Royal College suggests that patients be assessed post-operatively for awareness experiences, and offered explanation, reassurance, and counseling. 

That’s all very rational, well-meaning, and compassionate—human one might even say.  Perhaps in the future there will be fewer alien abductions.  But it seems more likely that now that they have invaded our bodies—and our culturefor over 50 years, aliens will never leave this planet for good.