Pre-Death Dreams: Their Psychological and Spiritual Value

The recent edition of the New York Times' "Science Times" section featured an article on the research of Dr. Christopher Kerr at Hospice Buffalo in Cheektowaga, New York. Dr. Kerr's research has looked at the role of dreams in the end-of-life experiences of patients in palliative care. Written by Jan Hammond, the article points out that these kinds of dreams have long been known as significant moments in the approach of death, but doctors trained in mainstream Western medicine have had no preparation for dealing with such dreams:

"Doctors tend to give them [pre-death dreams] a wide berth because 'we don't know what the hell they are,' said Dr. Timothy E. Quill, an expert on palliative care medicine at the University of Rochester Medical Center. Some researchers have surmised that patients and doctors avoid reporting these phenomena for fear of ridicule."

The main study published in 2014 by Dr. Kerr and his colleagues looked at the end-of-life experiences of 59 people in a hospice inpatient unit, using semi-structured interviews to ask about their sleep and dream patterns. These are the results and conclusions reported in that study:

"Most participants reported experiencing at least one dream/vision. Almost half of the dreams/visions occurred while asleep, and nearly all patients indicated that they felt real. The most common dreams/visions included deceased friends/relatives and living friends/relatives. Dreams/visions featuring the deceased (friends, relatives, and animals/pets) were significantly more comforting than those of the living, living and deceased combined, and other people and experiences. As participants approached death, comforting dreams/visions of the deceased became more prevalent. ELDVs [end-of-life dreams and visions] are commonly experienced phenomena during the dying process, characterized by a consistent sense of realism and marked emotional significance. These dreams/visions may be a profound source of potential meaning and comfort for the dying, and therefore warrant clinical attention and further research."

I met Dr. Kerr a few years ago at a conference on palliative care, and I found him a delightful person and very focused researcher. He told me he had been influenced in his work by the 2006 book Dreaming Beyond Death: A Guide to Pre-Death Dreams and Visions, which I co-wrote with my mother Patricia M. Bulkley, a former Hospice Chaplain. In that book, based on my mother's many years working with hospice patients, we reached many of the same basic conclusions that Dr. Kerr and his team reached: 1) dreams and visions are very common at the end of life, 2) they tend to have a positive, emotionally reassuring quality, and 3) they often feature themes of journeys, guides (primarily those who have already died), and obstacles or challenges needing to be resolved.

Dr. Kerr and his colleagues, using a more formal research methodology, essentially replicated our findings from 2006. This confirmation of the basic patterns in pre-death dreams underscores the need for wider awareness of these important phenomena among palliative care workers and other mental health professionals.

The Science Times article touched on the potentially profound spiritual impact of these dreams, but only briefly, in recognition of the fact that, as Dr. Quill put it, "in this area, we physicians do not know what we are doing."

However, exploring that spiritual potential of pre-death dreams was exactly the goal of Dreaming Beyond Death. With both of us having graduate training in religious studies and theology, my mother and I looked closely at these kinds of dreams in the context of each individual's existential reaction to the approach of death. For some people that reaction took a religious form, and for other people it expressed itself in non-religious but still deeply meaningful language and images. This is how we put it in the introduction to the book:

"The final days of life can be a powerful opportunity to reflect on the story of one's life, particularly on issues and concerns that remain unresolved such as troubled family relationships, unfulfilled desires, long-suppressed frustrations, and fearful uncertainties about religion. Pre-death dreams and visions have a role to play in the integrative process of consciously and deliberately bringing life to a meaningful conclusion. In many cases this process involves an exploration of the person's image of God or, in a less formally religious sense, the person's sense of spiritual powers greater than the self. We have found that many dying people are surprised to find themselves struggling with an image of a harshly judgmental God, and in such situations a dream or vision often comes that can help to transform the person's sense of the divine, easing the guilt-ridden anxiety and bringing a new appreciation of God's presence in the world." (p.9)

Dr. Kerr's research shows that there is a huge opportunity here for medical professionals to work with religious and spiritual caregivers in the treatment of end-of-life patients. Simply asking a few questions about sleep and dreams can open up a wealth of deeply meaningful images, feelings, and memories that help the individual anticipate and prepare for the end of life. Whatever the ultimate source of these dreams, they unquestionably provide many dying people with emotional comfort and reassurance. Pre-death dreams are a kind of natural healing resource that hospice and palliative care practitioners should welcome in their patients and carefully study when they occur.