Traum- und Wachvisionen am Lebensende
Abstract
Zusammenfassung: Traum- und Wachvisionen am Lebensende (TWVL) sind Transzendenzerfahrungen, die als visuelle, akustische oder sensorische Qualität wahrgenommen werden und häufig die Erscheinung von Angehörigen oder Freunden ebenso wie Wahrnehmungen von schönen Orten, Reisen, Lichterscheinungen oder Klängen beinhalten können. Diese Phänomene treten typischerweise Wochen bis Stunden vor dem Tod auf und werden überwiegend als tröstlich beschrieben. Obwohl Traum- und Wachvisionen am Lebensende häufig vorkommen – ca. 30–80% der Sterbenden berichten von visionärem Erleben am Lebensende – wird diesem Phänomen in der Medizin kaum Bedeutung zugeschrieben und häufig als pathologische Veränderung im Rahmen eines Delirs behandelt. Dieser Artikel versucht anhand der Literatur sowie klinischer Beobachtungen die Abgrenzung zwischen Delir, Traum und TWVL zu illustrieren und die therapeutische Relevanz dieser Phänomene in der Begleitung von sterbenden Menschen und ihren Angehörigen aufzuzeigen.
Abstract: End-of life dreams and visions (ELDVs) or so-called death bed phenomena are transcendent experiences at the end of life that can be visual, auditory and/or kinesthetic, and often include visions of (deceased) loved ones, close friends or perceptions of places, travels, bright lights, or music. ELDVs typically occur weeks to hours prior to death and may comfort the dying and prepare spiritually for the end of life. Such experiences are frequently reported by dying individuals, the prevalence varying between 30 and 80%, but in the clinical context ELDVs are usually neglected, but interpreted and treated as pathological changes in the brain that result in, and from, delirium. This article tries to enlighten the occurrence, the contents and meanings of ELDVs in dying persons as opposed to delirium and night dreams using findings from the literature and from clinical observations. Implications of these conclusions for palliative care and the therapeutic relevance of ELDVs when taking care of dying individuals and their loved ones will also be discussed.
Résumé: Les visions oniriques et éveillées en fin de vie sont des expériences de transcendance perçues comme des qualités visuelles, acoustiques ou sensorielles souvent inclusant l’apparition de proches ou d’amis, ainsi que des perceptions de beaux endroits, de voyages, de lumières ou de sons. Ces phénomènes se produisent généralement des semaines ou des heures avant la mort et sont principalement décrits comme réconfortants. Bien que les visions oniriques et éveillées soient fréquentes en fin de vie – environ 30 à 80% des personnes en fin de vie font état d’expériences visionnaires – la médecine n’accorde guère d’importance à ce phénomène et le traite souvent comme une modification pathologique dans le cadre d’un délire. Cet article tente d’illustrer, à l’aide de la littérature ainsi que d’observations cliniques, la délimitation entre un délire, un rêve et une vision oniriques en fin de vie et de montrer la pertinence thérapeutique de ces phénomènes dans l’accompagnement des personnes en fin de vie et de leurs proches.
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