Dreams at the End of Life

People who are nearing death are often visited by deceased relatives or friends in visions or dreams. They come to help those who are dying on their journey to a new place, whatever and wherever that is. I have sat with enough hospice clients in the dying process to learn that in general medical staff prefer to call these revelatory dreams “delirium” or “hallucinations,” and see them as unpleasant, or undesirable. These hallucinations are something to be avoided at all costs. Often very strong antipsychotic medications are offered to the patients, in the hope that the meds will wipe out these experiences from their conscious minds.

Dreams of people in the dying process do not necessarily show them their own death. Instead, they are often visited by deceased friends and loved ones to let them know they are loving them and awaiting them. Or they may be visited by others, even strangers, who may offer support and accompany them in painful moments. These imaginary people may be showing the dying person that they are not alone.  Sometimes a beloved pet or childhood friend or an early lover may appear to walk this path with them to peace and beauty. If there has been trauma for the dreamer around loved ones who have died, then the dreamer could be afraid or upset. By speaking the story/content of their dream to a witness, the trauma is sometimes released, and subsequent dream visions are more supportive, perhaps guiding the dreamer to a different reality.

I would prefer to cherish the dying process and welcome the visits from loved ones who have passed as a message that I am not alone. These precious visions might offer us guides to the underworld, a light in the encroaching darkness.

End-of-life dreams and visions have been documented through the ages, but there has often been a lack of understanding on the part of health care workers about their significance, said Dr. Christopher Kerr, chief medical officer at Hospice Buffalo. Kerr led a research team from the Palliative Care Institute in Cheektowaga, N.Y. in a long-term study on dreams and visions in the dying between January 2011 and July 2012. All participants were terminally ill and had no cognitive impairment.

Kerr’s research revealed the dramatic increase in frequency of dreams and visions and particularly in seeing the deceased as death neared.  He tells the story of one dying woman who talked and acted as if she were holding an infant in her arms. She called him by name: Danny. Her four children, who surrounded her bedside, were puzzled. They had no idea who “Danny” was. Then the patient’s sister arrived. She explained that the patient’s first child, Danny, had been stillborn. None of Danny’s siblings ever knew he existed.

I had the experience of sitting with a woman who was terrified of dying, and not happy in the nursing home. She spoke of frequent visions of a man with a gray hat who was smoking a pipe. She stated that he would sit at the end of her bed or come out of the closet and stand next to her bed and say nothing. She was sure this man was up to no good.  The nurses who tended to her gave her Haldol for these “hallucinations.” I asked her if she knew anyone in her life who wore a grey hat and smoked a pipe. She immediately responded that her older brother looked like this and that that she loved him, since he took care of her as a five-year-old after her mother died. When asked if he was still alive, she said he died 20 years ago in a fire.

Some aspects of the research conducted in Buffalo lead to an important distinction that could guide the directions for counselors and dream analysts working with people at the end of their lives: the difference between dreams/ visions and delirium (or hallucinations). Delirium is an altered state characterized by terrible anxiety, agitation or fearfulness, while the dreams/visions evoke “inner peace, acceptance and the sense of impending death,” the researchers wrote in their study, published in The Journal of Palliative Medicine in 2015.

These distinctions are critical, as medication of (dreams/visions) that are mistakenly perceived as delirium may prevent dying patient from having comforting experiences inherent to the dying process. This approach may further cause isolation, suffering, and impairment in the dying person’s ability to experience and communicate meaning at end of life, the study indicates. 

Pie Grant, director of Research for the Palliative Care Institute in Buffalo, NY states that understanding the differences proved important to caregivers and family members as well. Generally, family members are relieved to learn that dreams and visions in their dying relative is a part of the process, not a sign of mental illness. They no longer worry that their mother, father, other dying realities are losing their minds. 

In the dreams of dying patients, 60 percent of the dreams or visions were comforting; 19 were distressing and 21 percent were neither. Close to two-thirds of people found their dreams comforting, in contrast to only one fifth of the dying patients were found to be distressed by their dreams.

Perhaps the dreams that seem distressing for the dying patient are memories of traumatic events that were never spoken or processed by the patient. When a patient does speak the unspeakable about his/her dreams or memories they may have repressed, things may shift due to psychic release.

There is the possibility that in voicing their trauma(s) they may be more open to the support offered in dreams from deceased loved ones during one of the most difficult journeys we experience as humans. Such reframing could take place by discussing their dreams/visions with a dream analyst, working with clergy, or even talking with their palliative care doctor.

Finally, 99 percent of the dreamers in this research believed their dreams/visions to be real. As a person approaches the time of death, his or her dreams and visions might provide an anchor for where their actual consciousness may be unconsciously heading.