‘Oh, it’s just that leopard again!’ End of Life Hallucinations
What will happen to you as you die? You might imagine a long illness, a car crash or a sudden heart attack. What you may not be expecting is for an elephant to walk nonchalantly past your hospital bed, or your long dead grandma to come by and hold your hand.
These visions, common to people nearing the end of their lives, are associated with peaceful deaths and often go under reported. There are many biomedical reasons why a person who is dying might be hallucinating. A ready culprit is the pain killer morphine. With morphine, the classic hallucination is of large animals and that’s useful, says palliative care expert, Doctor Kate Crossland,
‘if a patient tells you there is a leopard on the ward, it’s a good sign that you maybe need to change their pain medication around.’
There are many potential causes of end of life hallucinations; other palliative care drugs and conditions such as Alzheimer’s and dementia can be associated with visual hallucinations.
Hallucinations can also be visually derived — as with Charles Bonnet syndrome, in which those who have lost their sight may begin to ‘see things’. There is also a possibility that hallucinations can be caused by the natural oxygen depletion which occurs shortly before death. Yet another theory is that chemicals released from certain types of cancer may cause hallucination.
The upshot of all this says Doctor Crossland, is that we don’t always know why a patient might be hallucinating but what is more interesting than these biomedical explanations, is the cultural overlay — in other words, what are people getting out of these visions? What stories are they telling themselves about their impending deaths?
In western culture, when someone has just died its entirely normal to think you’ve seen them in a crowd or to talk to them at night and perhaps hear them talk back to you. These hallucinations are often very comforting and would not be treated with anti-psychotics in the same way that death bed visions often are. But end of life hallucinations can be similarly comforting. To see a loved one at the end of the bed or to feel an angelic presence often brings peace to patients. In African Caribbean culture, seeing someone who has already died is considered to be a sign that death is very imminent and within this culture deathbed visions are considered to be an entirely natural part of the dying process.
‘In a western biomedical setting we might treat [these hallucinations] when actually they are helpful to the patient.’ Explains Doctor Crossland, ‘it is important to find out how a patient feels about their hallucinations. If they are a source of comfort, it’s best not to treat them.’
