DREAMS, DEATH AND SPIRITUALITY
ALEJANDRO PARRA examines anomalous experiences reported by nurses concerning deathbed visions and near-death experiences, and argues that we should pay more attention to the dream life of patients approaching the end.
ALEJANDRO PARRA examines anomalous experiences reported by nurses concerning deathbed visions and near-death experiences, and argues that we should pay more attention to the dream life of patients approaching the end.
End-of-life experiences are of interest, both to the general public and to health professionals, because they help establish the importance of preparing for death. These phenomena have been described and categorised in several ways and are well documented, having been observed in different cultures throughout history.
People who are approaching the end of life often experience increasingly vivid and intense dreams. This observation is consistent with the idea that dreams and visions are intrinsic to the transition from life to death. Most research indicates that these experiences occur in close proximity to death, within an interval of hours, days, weeks or even months before it comes. Their content is variable, often involving previously deceased relatives and pets. They can be visual, auditory, and/or kinaesthetic experiences, with visions occurring during waking hours or in dreams. They may also contain references to travel, a sign of closeness to death.
Published studies of these experiences are based mainly on surveys or interviews with doctors or families of deceased persons. An inductive analysis in order to examine their content and subjective meaning has identified at least six categories: positive presences, preparations for farewell, seeing or communicating with the deceased, contacting waiting loved ones, stressful experiences, and resolving issues.
Nurses often hear about dreams based on these experiences. One nurse spoke of a resident in a nursing home whose dreams were an indicator of imminent death. “He said that he saw the animals he had had throughout his life... He felt that they were waiting for him.” The resident died that same week. Another nurse spoke of a patient’s son who woke her in the middle of the night to tell her he had dreamt that his mother was dying. He arrived at the nursing home at 4am and sat next to his mother until she died at 7 o’clock that morning. Without that dream, he would not have been present at the time of his mother’s death.
One nurse described a strange dream she had had of a resident whom she loved very much whose husband had died a year earlier; her health had deteriorated, and she was no longer able to walk. The nurse had gone home after attending her as part of the dying process. While in the bathroom, she had an image of the resident standing with her dead husband holding her arm, with a wonderful smile on her face: “She told me: ‘I can walk!’ It was weird, but very comforting.”
Dreams and visions of the end of life are sometimes described as phenomena associated with a strong spiritual connotation; however, even though these events are generally interpreted as religious experiences or encounters, they are emotionally significant even in the absence of such connotations. It seems clear that dreams and visions can be spiritually transformative, as patients describe deceased loved ones as messengers guiding them on their journey to death. Dreams and visions are a rich source of symbolic meaning; indeed, often they can be a message of hope and comfort, or can serve to improve family ties. There are studies which suggest that these experiences provide feelings of joy, serenity, happiness, hope, and wisdom to patients and offer greater control over their fate. In addition, they can help them put their pending affairs in order, and reconcile with their families before dying in peace.
TALKING TO NURSES
Despite the anecdotal evidence that dreams and visions are positive experiences, doctors and nurses who are not comfortable with end-of-life care have difficulty accepting them as inherent in the dying process.
As a result, in the clinical context, these experiences are frequently explained away as hallucinations with clear organic aetiology (i.e., sedatives, fever, or quasi-delusional or
It seems clear that dreams and visions can be spiritually transformative
confused states). Studies have shown that this lack of recognition isolates patients even more, making them fear ridicule and, therefore, feel uncomfortable when sharing these experiences with their doctors and nurses. Although there is abundant literature on the importance of deathbed experiences, many studies are based on interviews from secondary sources such as relatives, nurses, doctors, and other medical personnel.
Nurses, in fact, report dozens of unexplained experiences: visions in people about to die, near-death experiences, or patients who recover suddenly and completely from illnesses after a religious intervention. Nurses themselves have often had their own experiences in a hospital context, such as seeing apparitions, intuitively “knowing” the nature of a patient’s illness or when he or she will die, or having unexpected experiences in intensive care units, neonatology areas, or pediatric or neuropsychiatric services.
In my study of nurses, I received 443 questionnaires from nurses in Buenos Aires; they came from 39 hospitals, 20 sanatoria, 21 clinics, and seven homes for the elderly. The sample was divided into two groups based on the answers given by the nurses. Those who responded to at least one of the 13 questions of the survey were termed nurses who had had anomalous or paranormal experiences (n = 296, 67%), while a “control” group consisted of those nurses who indicated that they had not had any such experience (n = 147, 33%). Of the 443 nurses, 353 (80%) were women and 90 (20%) were men; the age range was from 19 to 69 years (mean = 39 years); the average time spent in the role was 10 years; 60 (13%) operated on the morning shift, 110 (25%) on the late shift, and 121 (27%) on the night shift. The main areas covered were the waiting room (140, 31%), the emergency room (72, 16%), Intensive Therapy (80, 18%), Neonatology (42, 9.5%), and other services (ambulances, medical clinic, oncology, paediatrics, among others, 75%).
Originally, the survey was developed from an in-depth interview format of five freeresponse questions, which were presented to doctors and nurses within the hospital setting. The survey included 13 items of dichotomous responses (YES/NO), with a space for respondents to expand their answer to provide information about the
type of experience. The questions could also be subdivided into two types: (1) Nurses as recipients (auditors) of the experiences of their patients and/or colleagues (e.g., a near-death experience or an out-of-body experience, n = 177, 40%); and (2) Nurses as witnesses of anomalous or paranormal experiences (n = 266, 60%).
FIVE TYPES OF DEATHBED DREAMING
The dreams and visions under discussion can be divided into five categories:
(1) A comforting presence
(2) Preparing to depart
(3) Connecting with visitors
(4) Waiting loved ones
(5) Unresolved issues
A comforting presence
Some nurses related dreams and visions of the presence of living or deceased friends and relatives, as well as pets or other animals, particularly in children. These dreams and visions were a comfort to the patient. Many of the stories that emerged through my interviews with nurses in hospitals and nursing homes were particularly moving. For example, a patient often dreamed of her dead sister sitting next to her bed. She also dreamed that she herself was younger, that she had gone for a walk and done “the usual things” with her sister. She described these dreams as extremely comforting, because “I’m not going alone ... [my sister] is with me.”
“I knew we were going somewhere, but we did not know where”
Another patient told her nurse a dream where she encountered her deceased mother talking to her in a beautiful garden, “telling her that everything will be fine. It was very comforting for the patient, who told [her family] that she wanted to go back to sleep, because her mother would return.” Another patient, who had dreamed of deceased friends and relatives as well as living people, also said that everyone “was telling me that I would be fine, that there was nothing to fear.” Still another dreamed of his mother, who had died when he was a child: “The dream was so vivid that I could feel her perfume and hear her voice that calmed me. saying ‘I love you.’”
Preparing to depart
Some nurses and caregivers described dreams of patients who said they were preparing to go somewhere. An elderly patient in a care home described to his caregiver how he had seen his parents, grandparents, and old friends in his dreams: “I knew we were going somewhere, but we did not know where.” Another patient dreamed that she was driving through the city and had to get somewhere, but also did not know exactly where. A third patient dreamed of taking off on a plane with her living son. She could not describe where they were going, but she felt happy. She said that she and her son “were about” to leave. Although there were feelings of anguish because the dreamers felt “in a hurry, in general, the dying people found this experience to be a positive one, rather than painful because of the proximity of death.”
Connecting with visitors
Those in this category described the presence of other people in their dreams and visions as simply “being there” or “looking at them”, rather than relating to or interacting with them. For example, a hospital patient said that she had dreamed of her two aunts standing and watching her while she was reclining on the sofa, which made her feel happy and at peace. However, there were also cases where patients described themselves as interacting with these people in their dreams. One patient said that her husband and her dead sister had met her for breakfast; she also dreamed that she was playing cards with her dead friends. Another patient dreamed that her father and two brothers, all dead, had embraced her in silence and played with her; she then described how “they were welcoming her to death.” One patient recounted a dream in which he played with and caressed his dead dog. Another patient admitted to an Intensive Care Unit told her nurse that “the Virgin was at her side. The patient also said that the Virgin had come to look for her. Twenty minutes later, the patient died.” The nurse and other patients and relatives reportedly began to smell roses.
Waiting loved ones
Some patients dreamed about friends and relatives who had died previously as “waiting for them”. A woman dreamed of six of her already deceased family members in her room, holding a vigil; they were “waiting for her, and it was good to see them.” Three days before another woman died, she said she had experienced visions of being at the top of a staircase, with her dead husband “waiting for her” at the bottom of the stairs. Once again, the presence of these dead friends and relatives was mainly comforting. “In the hospital I had many patients who told me that someone was watching them, especially more masculine than feminine figures... And a few days later, the patients died,” reported one nurse from the emergency service.
In another hospital in the city of Córdoba, a patient confessed to her nurse upon returning from the operating room that she had seen herself on the table where they were operating, and that she had experienced a sense of peace. She had met a family member who was waiting for her; they talked, they laughed, and then she felt that she came back suddenly. She then asked to see the family member whom she had met, but later learned that, just at the time they were operating, that relative had died in a car accident. Other patients, who insisted that they were not ready to die, experienced anguish over the impression that the dead were “waiting” to accompany them because they sensed or were certain that their final hour was approaching.
Unresolved issues
Some patients also had dreams focused on their fears that they could no longer do the things they felt they needed to achieve in their lives. A young mother, for example, had anguished dreams about her responsibility to her children. These dreams consisted of preparing her children for school and other responsibilities. Another young mother experienced dreams relating to real-life worries about her debts and her children. A 58-year-old woman dreamt of relatives still living and concerns about whether her daughter would have a cell phone.
Meanings and messages
The visions and dreams of these patients are clear and vivid stories that describe significant life events in proximity to the time of death. They definitely appear to be different from hallucinations associated with delirium, in terms of the feelings they evoke (e.g., relief, comfort, anguish), as well as the clarity, detail, and organisation with which they are narrated. Patients with delirium or symptoms of confusion derived from organic or neurological disorders exhibit disorganised thinking and altered perceptions that can result in agitation, restlessness, and fear. Such delusions are fraught with negative emotions, not only for patients, but also for their families and caregivers or nurses. In contrast, the visions and dreams reported by these nurses had a very different effect. For the most part, they were a source of comfort for the patients, providing a sense of peace and, in some cases, a remarkable change in their behaviour and acceptance of death.
Erroneously diagnosing these experiences as having little value would be detrimental to the terminal patient’s
ability to communicate, reach closure, and experience meaning at the end of life. These experiences, which are largely personal and subjective, are associated with peaceful and tranquil deaths. The themes of the dreams or visions related to an “imminent journey” could symbolise the process of leaving this world in preparation for the “great journey” towards death. Although most patients did not see this preparation as a painful experience, some clearly had a sense of urgency related to the details of the travel plans – that is, the destination and how to reach it.
According to the patients, deceased relatives and friends played an important role in the dreams – standing by their beds, watching them, and interacting with them. There was not much dialogue; indeed, sometimes the visions were totally “silent; however, patients announced that their mere presence transmitted a message of comfort and tranquillity, intuitively or telepathically”. Other patients reported similar experiences with deceased relatives or “invisible companions, present for a purpose, namely, to escort them along the process or path and possibly help them move forward towards death”. Other similarities can be found in the literature, e.g. a messenger who guides the individual on the journey to death, or encounters with pets, friends, and relatives who await them.
MENTAL STATES OF THE DYING
Deathbed visions are found in the biographies of mystics and writers and in the literature of many cultures and times for example, the Tibetan Bardo ,the Pert Em Hru from Ancient Egypt, and the wood engravings of the Ars Morendi (The Art of Dying) of mediaeval Europe. Other such visions are related by the mystical English Christian writer Julian of Norwich (13421416), in her work Revelations of Divine Love, which represents the spiritual preparation of the soul for death and life in the hereafter. The anecdotal accounts of nurses and doctors today suggest that these experiences may involve a much broader spectrum of phenomena than just deathbed visions. They include the transition to and from other realities, coincidences around the moment of death, often based on the appearance of a relative or close friend not physically present at the time, and the need to deal with unresolved issues, such as reconciling with distant family members or putting one’s affairs in order before dying.
The pain felt by relatives at the time of a patient’s death is part of the experience. Even so, many people who have witnessed or experienced these phenomena as intensely significant to them have sometimes then dismissed them as insignificant or mere hallucinations. Today, many people die in hospitals – away from their homes – but, unfortunately, nurses do not have the time or the training to deal adequately with this important aspect of the dying process.
Some nurses in care homes offered very moving testimonies about elderly people who had never or almost never received visits from their children or grandchildren. Once they did, however, they would die shortly afterwards – sometimes within hours or even minutes. Similar effects followed telephone calls (either from the elderly person to his or her families, or from the relatives to the home where the elderly person was living), news of legacies from a business or an inheritance, or even being given much appreciated books. Other stories involved reconnecting with a spouse, dictating instructions or recommendations to relatives or friends, and, even more surprising, receiving visits from relatives from faraway places, with the result that, within a few minutes to hours following the encounter with the dying person – even surrounded by other significant people they ended with his or her death. A nurse recounted her experience accompanying a terminal patient in the hospital:
“The patient was a relatively young man whose condition had very much deteriorated. When I came to the room, he wanted me to leave – he rejected me. After we discussed his feelings, he accepted me, and we talked about his family. He told me that he had problems with his 20-year-old daughter, with whom he had ‘outstanding issues’, as well as with his mother, his sister, and his wife. Then I noticed that his body and face began to change, with his appearance improving
DECEASED RELATIVES AND FRIENDS PLAYED AN IMPORTANT ROLE IN THE DREAMS
remarkably. The night before he died, he told me he sensed an intense smell of flowers. He told me that a ‘shadow’ was trying to reach him, that someone had come looking for him. When he died, although his body was in bad shape, his face showed a great sense of calm and peace.”
The caretaker of a nursing home told me about the following experience, where she heard the voice of her deceased father on her mother’s deathbed: “I took some time to take care of my mother at home, and, when she died, I had her in my arms. Also present was my brother and a niece. I clearly heard my father’s voice calling her right before she died. He had died 24 years earlier, so, of course, I was not thinking about him. It may have been in my subconscious, but I clearly heard his voice calling her by her name. It was incredible!”
Other common stories are those of “a patient in an unconscious state dying just when the relatives have gone out to take a break”; “relatives who call the hospice just when the patient is deteriorating or is leaving”; or “a patient’s dog who howls at the moment his hospitalised owner dies”. In general, these cases are interpreted as a final and comforting message from family members that seems to occur independently of previous beliefs or expectations, and is usually attributed to designs (divine or cosmic), synchronicity (from a Jungian perspective), “significant” or amazing coincidences, or even some form of extrasensory perception.
BREAKING THE TABOO
In my interviews, few doctors, nurses, or caregivers indicated that listening to these testimonies had affected their own spiritual or religious views; indeed, their private attitudes, based on their own experiences with patients, remained the same. But now they felt that, since the issue was a legitimate case for medical research, it was no longer taboo and could be discussed more openly. Almost all the nurses who experienced these events expressed their concern about the lack of education in these matters, adding that they expected these topics in general would become part of the academic curriculum and incorporated into teaching practice.
One nurse observed: “It is important that the nurses working in palliative care be prepared to face these incidents, because I feel that they are very common, and I think patients want to share them. They want to know if what they have experienced means something... They feel a certain sense of meaning in what is happening to them. I regret that nurses are not prepared to discuss these events with their patients. I think it is absolutely essential for nurses to be trained in this new speciality; if they do not have these skills, they should be given this opportunity.”
Recently in the United Kingdom, former nurse Penny Sartori carried out an extensive prospective study on near-death experiences.
Sartori, who worked as a palliative care nurse, took care of many patients who were close to death. In the Netherlands, between 2009 and 2011, nurse Ineke Koedam conducted interviews with 30 caregivers from three different hospices. This study included two in-depth interviews with nurses; they completed a questionnaire that analysed their experiences and observations in the last five years, and a second one a year later. Their results showed that the answers to the second questionnaire had not changed substantially since the first one.
Doctors in general, nurses, geriatricians, and workers in palliative care are responsible for the care of the dying and those who mourn them; however, the spiritual care of the dying and knowledge about these experiences still do not form part of education in palliative care.
FURTHER READING
D Bjarnason, “Nurse religiosity and end of life care”, Journal of Research in Nursing, 17(1), 7891, 2010.
P Fenwick, H Lovelace & S Brayne, “End of life experiences and implications for palliative care”, International Journal of Environmental Studies, 64, 315-323, 2007.
Ineke Koedam, In the Light of Death: Experiences on the Threshold Between Life and Death, White Crow Books, 2010.
Alejandro Parra, “Seeing and feeling ghosts: Absorption, fantasy proneness, and healthy schizotypy as predictors of crisis apparition experiences”, Journal of Parapsychology, 70, 357372, 2006.
Alejandro Parra, “Cognitive and emotional empathy in relation to five paranormal/anomalous experiences”, North American Journal of Psychology, 15, 405-412, 2013.
S Ruder, “Spirituality in nursing: Nurses’ perceptions about providing spiritual care”, Home Healthcare Now, 31(7), 356367, 2013.
✒ ALEJANDRO PARRA is a psychologist and psychotherapist in private practice. He teaches psychology at the Universidad Abierta Interamericana at Buenos Aires. For 15 years (1990-2004), he was editor of the Revista Argentina de Psicología Paranormal (Argentine Journal of Paranormal Psychology) and, since 2006, of the E-bulletin Psi. Since 1993, he has been President of the Institute of Paranormal Psychology (www.alipisi.com.ar). He is the former President of the Parapsychological Association (2011-2013), and is the author of 12 books, more than 300 articles in scholarly and popular magazines, as well as several chapters in books. His latest English-language book is The Last Farewell Embrace: spirituality, Near-Death Experiences, and Other Extraordinary Events Among Nurses (Nova Science, 2019).