Palliative people’s dreams and dream-related perceptions and interpretations: A mixed-method nvestigation

Abstract

Dreams at end of life have always fascinated philosophical minds. Drawing on clinical anecdotes, a number of authors in the palliative field have argued that dreams of palliative care patients may contain common themes and personal meanings. Yet, despite major advances in general dream psychology, very little theoretical and empirical work has been done on end-of-life dreams or their subjective meanings. The main exception is represented by Jung and his followers who argued that dream content is essentially opposite to waking thought, compensating for maladaptive lapses of consciousness such as death denial. On the other hand, empirical investigations of dream content and its relationship with relaxed waking thought by cognitive and neurocognitive researchers do not support Jung’s theory. On the contrary, studies with individuals and groups (e.g. blind, divorced, bereaved or elderly people) have consistently found that dream content is predominantly continuous, whether literally or metaphorically, with the dreamers’ emotionally-salient waking concerns. The few existing dream studies on terminally-ill people were conducted mostly by psychodynamic therapists with single subjects or small groups. Although the results of these studies were interpreted by the authors in support of Jung’s ideas, their small samples, clinical focus and other methodological shortcomings raise concerns about their reliability. The main aim of this research was to systematically investigate prominent themes or patterns in the dreams of palliative people by combining qualitative and quantitative methods. The project comprised two successive studies where data was collected from palliative outpatients registered with six hospices in Auckland, New Zealand. The first study involved the thematic analysis of 90 post-illness and 16 pre-illness dreams collected from 13 participants through interviews and dream diaries. Themes across participants and recurring motifs in individual series were analysed. Data on the participants’ dream-related perceptions and interpretations were also collected and classified thematically. The second study involved the use of a well-validated coding system (Hall & Van de Castle, 1966) to content analyse 100 recent dreams from 100 participants. To investigate distinctive trends in the dreams of the participants, the gender norms derived from healthy adults (Hall & Van de Castle, 1966; Schneider & Domhoff, 1995) were used as a control group. In order to investigate the influence of gender, ethnicity (Māori and Pacific Island versus European and New Zealand European), and dream type (recurrent versus one-off) on dream content, comparisons between appropriately grouped participants were conducted. Data on participants’ dream-related perceptions and interpretations were also analysed, using the thematic categories established in the first study to examine their prevalence in a large sample. The two sets of results converged to a large extent. The most prominent themes in the participants’ dreams were greater appearances of family members, including deceased loved ones, and journey references. There was little overall aggression, but aggression and victimisation appeared to be overrepresented in recurrent dreams. The dreams of male participants contained more attempts to control the circumstances than the dreams of female participants. The dreams of Māori and Pacific Island participants featured more ‘positive’ (friendliness, good fortune, success) and ‘familiar’ (e.g. people, locations) elements compared to dreams of European participants. With regard to participants’ perceptions, most participants considered their post-illness dreams had changed in some way (i.e. more ‘vivid’, ‘bizarre’, or ‘negative’). With regard to interpretations, literal interpretations of dreams as transparent reflections of memories, current problems and worries or wishes for the future were the most common. Other categories included metaphoric, spiritual, and medical interpretations. There was a trend for female participants to interpret their dreams more often than male participants. Compared to European participants, Māori and Pacific Island participants gave more spiritual interpretations to their dreams, including those portraying deceased loved ones. There were also participants who did not attach any meaning to their dreams. The theoretical and clinical implications of the findings are discussed. The limitations of this research are considered, directions for future research being suggested.