Tuesday, February 2, 2016

Dreams of the Dying

A fascinating New York Times article about the dreams of people who are close to death brought to my attention a study of end of life dreams and visions carried out by clinicians at a Cheektowaga (a suburb of Buffalo) hospice and published in the Journal of Palliative Medicine.

The researchers systematically followed 66 hospice patients to ask them on a daily basis about dreams and visions. 87% reported having these experiences. The majority were comforting. The brief summaries cited in the article are moving.
28 days before his death, Barry (age 88) dreamt of driving somewhere unknown and was comforted by hearing his mother say, ‘‘It’s all right. You’re a good boy. I love you.’’ 
4 days before his death, Roger (age 73) dreamt about his best friend from childhood and saw him running out of the house with his glove and bat while laughing. They had shared a love of baseball throughout life. 
37 days before her death, Barbara (age 52) dreamt of her deceased father and brothers, hugging her and ‘‘welcoming her to the dead.’’ They seemed to be preparing to go somewhere but ‘‘they haven’t said’’ where.
The researchers conclude:
The results of this study suggest that a person’s fear of death often diminishes as a direct result of ELDVs, and what arises is a new insight into mortality. The emotional impact is so frequently positive, comforting, and paradoxically life affirming; the individual is physically dying, but their emotional and spiritual identity remains present as manifested by dreams/visions. In this way, ELDVs do not deny death, but in fact, transcend the dying experience, and present a therapeutic opportunity for clinicians to assist patients and their families in the transition from life to death, thereby providing comfort and closure.
But the researchers tell us that despite the commonness and value of such experiences, patients, families, and clinicians report being reluctant to openly discuss end of life dreams and visions for fear of ridicule and doubts concerning medical legitimacy. This is the downside of our hyper scientific approach to health care. Apart from the constraints of time that plague medical practice, young physicians I have worked with report that although dealing with spiritual/existential matters like end of life dreams and visions seems enormously valuable for both patients and physicians, they don't feel  they have developed the skills and depth of understanding that is required.

Years ago, when I taught medical students at the Howard University clinic in Washington, DC, many of our patients came from the rural South. I was impressed with how often they reported visions of a dead family member. As we listened to these experiences, it was clear that the patients were not hallucinating or experiencing psychosis. The exchanges they reported - like the dreams of the patients near death - were meaningful to them, and to us. And towards the end of his life, when I was visiting my three-times widowed father in Florida, he told me that he was expecting a "visit" from his own father, who came to him in dreams every year or two, in a way that gave comfort and joy.

The study I've summarized is potentially very influential. By making such personal experiences the focus of scientific study they bring what might be seen as solely the spiritual matters for pastors to deal with or psychopathology to be treated by psychiatrists within the orbit of what clinicians can listen to, work with, and learn from.

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