Much of the research on end-of-life dreams and visions (ELDVs) comes out of hospice care. ELDVs occur in the weeks and months before death. The dying person has an experience that those around them don’t have. They can have especially vivid dreams, or a sensory experience while awake, called ‘visions’ in the literature, though the experience can involve sight, sound, smell, touch, or taste, or any combination of the senses.
While generally ELDVs are experienced by the person as positive, calming and meaningful, they can cause distress. In each ELDV, the person experiences themselves as present. It is very common to experience an encounter. In a dream, the person can experience the encounter in the location of the dream, while in a vision, the person can experience the encounter wherever they presently are. If they are in bed, it could occur at the bedside. If they are sitting in the garden, or in the dining room, the encounter could occur there.
The person might experience an encounter with a deceased family member, or with people from their past, such as their childhood teacher or neighbour, or their peers throughout their life, such as workmates or friends. The encounter can be with people unknown, or with wildlife. It is common to experience visitations from or to dream of beloved pets. The person might encounter transcendental figures in the form of glowing lights, angels or deities.
ELDVs can incorporate the experiences of travel. The person can dream or envision themselves packing their bags, undertaking travel, or arriving at a new place. The scene of an ELDV can also be significant for the experiencer. They might experience places from their life, or places from their imagining, including scenes of an afterlife.
Distressing ELDVs are similar in content and theme to positive ELDVs, but the person’s response is one of agitation, upset, or confusion. The person might experience or re-encounter a human or animal figure representing a conflictual relationship, such as a dog continually peeing on their bed, or perhaps a family member they’d prefer not to encounter. The non-human beings encountered in distressing ELDVs are not beatific or transcendental figures but ambiguous or malevolent figures. The person might ‘replay’ unpleasant or traumatic events from their past.
These ELDVs can incorporate themes of travel, too, but here the travel induces distress. The person might not want to take the trip, concerned to leave their family or their responsibility. They could feel too rushed or have misplaced their passport. Distress can be caused by a lack of interaction, for example, taking a train trip and being alone on the train. As with positive ELDVs, place is significant. The person can experience less positive places from their life or their imagining. Some can experience themselves in ‘the bad place’ of their tradition.
ELDVs are really very common. Between 50% and 83% of people will experience them at their end-of-life. The phenomenon is transcultural; it crosses cultures and belief systems, but the content of the ELDV will be influenced by culture and belief. One theory of ELDVs supposes that a person in great physical pain is more likely to experience an ELDV. Another theory supposes that the risk for distressing ELDVs is increased by a history of trauma, substance abuse, or mental ill health.
The examples of ELDVs presented below are adapted from published academic literature. They represent the experiences of real people as they are dying.
Example 1
“My father visited me last night. He said it’s time to come home.”
The father mentioned in this ELDV had died 30 years previously. Consider how the emotion induced by this ELDV could change depending on the person’s prior relationship with their father.
Example 2
“There were radiant beings in the corner of my room. Their light shone on my face. My father was there with my sister Veda.”
In this account from around 1926, the woman was dying from complications of childbirth. According to the author, the woman’s sister Veda had died three weeks earlier, but she was not told about this.
Example 3
“I was scared and confused… She had died six months back… How could she be sitting next to me and smiling at me?”
This person encountered someone known to them. The visitor was smiling and was no threat. Even so, the person experiencing the vision was distressed because they knew they were seeing something unusual.
Example 4
“When I woke up the devil was standing at the end of the bed. He was rubbing his hands in glee, so happy that he would be taking me to hell soon.”
“All my dead relatives were standing around the bed. I saw my brother, my parents, my ex-wife. They were standing in a ring around my bed, and they had their backs to me. I tried to talk to them, but they wouldn’t turn around. They wouldn’t even acknowledge me.”
These are the ELDVs of a 68-year-old man with a history of alcohol abuse. He was estranged from his family from the time his children were young. Staff had contacted the children; only one came to visit briefly. The man was raised Catholic, no longer identified as such, but clearly retained a belief in the bad place of his childhood tradition.
What do ELDVs do for the person having them? They can offer comfort and psychological or spiritual solace, reducing stress and alleviating feelings of isolation. They offer opportunities for life review and meaning making. Within ELDVs, a person can revisit the significant events or themes of their life. They provide a way for a person to ask what the meaning and purpose of their life was. ELDVs offer moments of connection and communication. They provide a psychological mechanism for the person to process or cope with their coming death.
Offering support to a person experiencing ELDVs helps them to die their best possible death. When encountering a person with ELDVs, allow them to share their dream or vision with you. Some people, aware that they are having an experience that others aren’t, can try to hide their experience. Here it could be appropriate to normalise the experience. This is also necessary for some family members who are challenged by seeing their loved one experiencing ELDVs.
Don’t dismiss ELDVs as ‘just’ delirium or hallucinations. In our time, the end of life is approached as a biomedical process, and we can forget that there is a person experiencing that biomedical process as their life. It might be that the experience does arise from a comorbid infection or illness, or that it is occurring within a delirium, or that it is an hallucination. Yet the person is having an experience, and that experience is potentially meaningful for them.
Every person is an expert on their own life; allow the person to determine the meaning of their ELDVs. Consider that the ELDVs could be an aspect of the person when they were small, or someone they knew along the way, or a symbol of their life’s greatest themes, or a way to work through unfinished business. Their response to the ELDVs might change from day to day. The meaning, significance, or purpose of the ELDVs might change from day to day. Our job as companions to the dying is to hold space for those changes, to offer a listening ear, and to support whatever it is the person themselves brings to their experience.
Bibliography
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