Making Sense of your
ICU
Vivid Dreams and Hallucinations
I
have written these notes principally for you, the patient, who had vivid dreams and/or hallucinations in Intensive Care
and maybe still after discharge from ICU, but it should be helpful also for your relatives and carers, and for your counsellor
if you decide to see one.
My background: In 2001, while working
in the NHS, I became interested in researching patients’ experience of ICU and set up a Psychological Aftercare Service
for ICU Patients at Croydon University Hospital. It was the first routine service of its kind in the UK. During the fifteen
years until my retirement from the NHS, I saw many hundreds of patients who had been ventilated on ICU. My particular
area of expertise is working with ICU Vivid Dreams and Hallucinations (commonly referred to as ‘delusional memories’)
and I have spoken on that subject at training days and conferences nationally and internationally. I have published articles
on patients’ experience of ICU.
My aim: to acknowledge and validate the vividness
of your experience; to reassure you by showing that it is normal; to try to help you make sense of those vivid dreams and
hallucinations; to help you understand the place they probably had in your survival.
If you are still
suffering distress from those vivid dreams many weeks after discharge from ICU and you are having trouble sleeping at night
because of them, my aim is to encourage you to get counselling (and show the counsellor those specialist notes), as this could
develop into what is known as ‘post-traumatic stress disorder’ . ICU patients are at high risk of
Post-Traumatic Stress Disorder (PTSD) (recent research has put it at 1 in 5). I have been contacted by people
who had had recurring terrifying nightmares for years, so the sooner you can make sense of them for yourself the better. For
in my professional experience making satisfactory sense of your ICU dreams is a factor in lessening the risk and symptoms
of PTSD.
A Brief Word for Relatives
For you, the relatives, the whole ICU experience
will have been a roller coaster of emotions, from pre-admission time to now while the patient is still in
recovery. If, on coming round, the patient’s first words were some weird story of a doctor trying to kill them, nurses
pushing drugs, harvesting organs or having sexual orgies, you may really have worried that your loved one had gone mad. Rest
assured, these dreams are quite normal and a part of the patient’s fight for survival. They usually last only a few
days after discharge, but can carry on for months or years if not dealt with; so treat these dreams with respect,
do not dismiss them and take the time to read this. It should make a difference to your loved one’s psychological
recovery.
ICU Vivid Dreams and Hallucinations
ICU vivid dreams and hallucinations are one of the major causes of distress for patients who have
been in ICU: they are so unbelievably vivid that it is often difficult to distinguish between them and reality. And
because they feel so real, if relatives or health professionals respond by laughing, it can feel quite confusing and
shaming. And then you and your relatives may worry that you may have gone mad... So I shall say once again: vivid dreams and
hallucinations are a normal occurrence in ICU.
For almost twenty years I have made intensive
care dreams my speciality. My work with many hundreds of patients who have been in ICU has taught me that they are
powerful experiences to which we need to pay due attention and honour by trying to make sense of them.
The good news is that because the vivid dreams of ICU are not like ordinary dreams, it is usually
not difficult to make sense of them with the help of someone who will listen to them with respect and follow the key points
and ways of working below. So if you do not have easy access to a psychotherapist or counsellor, you can still
try to make sense of them. If you are seeing a counsellor, psychotherapist, psychologist or psychiatrist, I would suggest
that you show them these notes, as ICU dreamwork differs from ordinary dream work.
Should you
feel that you have become panicky simply reading this, try the following: Feel your feet on the ground, maybe stand
up and feel the solid ground beneath you, notice what happens to your body and breath as you do so.
If you are with a friend, look into their eyes,
or hold their hand.
Try
putting first one hand on your heart, then both, notice whether one feels better than the other, how can you tell? And what
happens as you place one hand on your heart and one on your stomach?
If your breath is shallow, sigh or breathe out then take a deep breath
in.
You can try
stroking your arms, or any other of your usual ways of relaxing.
And remember those dangerous days are past, you are here to tell the
tale, you came through! Take a break before reading any further. If the thought of reading further makes you panicky again
even a few weeks after discharge, that may be a symptom of PTSD, report this to your GP.
You will
need the help of a trusted person to help you with this.
Key
points about ICU vivid dreams and hallucinations.
1. ICU
dreams reflect the situation that you found yourself in at the time and express your response to that situation,
which included fighting to survive. This is my belief derived from almost 20 years of experience of working
with ICU dreams.
2. As it was a life and death situation, most ICU dreams have life and death themes;
some are very obvious (‘my nurse was trying to kill me’), others less so (‘there was this line on the ground
and I knew I mustn’t cross it’, ‘they were asking me questions’).
3. While
each ICU dream tells a different story, they usually fall under ten main themes:
a) doctors and nurses are trying
to kill me/pushing drugs/selling body parts
b) trying to escape
c) being attacked/chased/kidnapped by frightening people, creatures
or aliens
d)
trying to overcome an obstacle
e) being in a coffin
f) being on a journey, in a train/boat/plane
g) finding myself in a safe haven
(another hospital, a church etc.); special inspiration
h) having superhuman / healing powers
i) sexual orgies
j) babies
being born on ICU/next door
Although ‘doctors and nurses are trying to kill me’ and
‘trying to escape’ are the most common themes, I did not list the above themes according to frequency. You may
notice that the first four themes describe threatening situations, culminating in death (‘being in a coffin’),
then moving (on a journey) towards greater safety (inspiration, healing powers) and life (sex and babies).
Your
own personal history and your ICU environment may well come into your ICU dreams, as they would in ordinary dreams:
so for instance, the nationality or ethnicity of your nurses commonly affects where your dream is taking place; someone with
a history of torture and interrogation may be reminded of their experience by the constant 24/7 light in ICU; the coronavirus
and lockdown may well find their way into your vivid dreams’ storyline, as may various family events, births, anniversaries
etc. These will colour your dreams but their main significance is still likely to come under one of the above dream
themes.
Working with ICU vivid dreams and hallucinations
Find the right person to help you
It is important you find a person whom you trust and who will take your
vivid dreams seriously. That person will need to be able to pay attention to the dream without teasing or expressing shock,
and they will need to listen out for a theme. Start telling them the story, if you become very upset, take some soothing time
out.
There are important advantages of doing this with another person:
As you were asleep or unconscious at the time, you
were living through your dream but could not articulate some of its most significant aspects to yourself: you could not take
a step back and consciously try to make sense of what was going on. And still now, as you are likely to be caught
up in the story, images and emotions of the vivid dreams while you tell them, you may find it difficult to take a step back
to describe in words, to verbally articulate, some elements and details of the dream . Yet these are often the most important
points and you need to hear them and process them mentally to make any sense.
Your trusted person’s tasks are to acknowledge your experience and clarify it by asking
five vital questions:
who else was involved?
what were they like?
what were they doing?
how
were you feeling ?
and crucially, what
were you trying to do?
A
few examples of working with vivid dreams and hallucinations
Sean, Marcia, Tony and Jem (not
their real names) gave me permission to use their vivid dreams to try to help others. Sean’s and Tony’s had been
a recurring dream in ICU, Marcia, Mat and Jem’s occurred only once and they each had the sense of this being a turning
point in their recovery.
Sean
What had started off as a vivid dream in ITU, carried on for Sean
as hallucinations after his
discharge
to the ward.
L: Do you feel you can tell me about your vivid dream and these hallucinations?
Sean: ‘I was lying there
and there were all these silly little figures on the ceiling.’ (cringes)
L. ‘Do you remember how you felt as you lay there?’
Sean: ‘I was shit scared.
They were coming at me’
L. ‘Those silly little figures?’
Sean: ‘Yes.’
L. ‘And what did they look like, could you describe them?’
Sean: ‘They
were like hooded grim reapers.’ (a traditional picture of Death)
L. Hooded grim reapers, no wonder you were shit scared! And what were
you trying to do?
Sean:
I was trying to fight them off.’
Until he was helped to articulate it differently, Sean
had thought of his experience of ICU as being a wimp, lying there in bed, terrified of ‘silly little creatures’
on the ceiling, while doctors and nurses were tending to him and making him better. By the end of our session, he came to
realise that those creatures were far from ‘silly’, he was terrified of them for a very good reason, and he himself
had had a role to play in his own recovery as he sought to fight them off.
Tony
Tony had been reliving his nightmare
ever since his discharge from ITU a few
days previously, and was very distressed. Like many other patients, Tony couldn’t see why ICU
patients should dream of trying to escape (which I told him was the most common theme), nor could he understand how his ICU
dream could reflect his ICU situation. What most upset Tony was that ‘line’.
L. A line?
Tony: A white line on the ground,
and you mustn’t cross it. Cries. And I’ve tried to get
round it...
L. And what would have happened if you’d gone over that line?
T.: crying, I don’t know,
if I went over it, it would mean my number’s up.
Tony replied as if that was
obvious and yet a moment earlier he could not understand what was so upsetting about that line! For until I had asked him
directly, his knowledge had not been explicit - he knew at some level that he had to avoid crossing that line, but had not
articulated the reason to himself.
Taking an active
role in one’s survival does do not necessarily involve fighting as in Sean’s dream, it can be trying to shout,
to escape (although both are of course impossible in ICU, especially while ventilated), to find a safe place (a church, a
plane transformed into a hi-tech hospital inside etc.), or even to answer questions:
Marcia
Marcia: There were people crowding
all around me
L.:
What sort of people? Did you know them?
Marcia: No
L.: And what was it like with these people crowding all around you?
Marcia: shudders It was scary
L.: What were these people doing?
Marcia: They were asking questions
L. What sort of questions?
Marcia: I don’t remember…
They were life and death sort of questions...
L: No wonder that was scary, all these people asking you life and death sort of questions...
Well,
you’re here today, you must have had the answers
Marcia: Yes, I did!
Even in ‘coffin’ dreams, it is worth
asking for clarification: the person may be trying to get out, which though it may sound spooky is an amazing example of fight
for survival.
Moving towards life
The last five themes show a progressively stronger movement away from
death: journeys by various means of transport (boat, train, plane - that often look like care centres inside), safe havens,
healing powers, inspirational dreams...
Jem recalled Blondie at her bedside singing
‘You can’t let this happen to a girl like you’, specially for her; it gave her, she said, a real boost.
And I could simply acknowledge how special that must have felt. No further clarification was necessary: the song’s words
said it all.
ICU and sex and baby
dreams
If
your ICU vivid dreams were about sex, you may feel embrassed at describing them - especially to partners, even if they are
about nurses having sexual orgies and babies. And it may not be necessary to clarify details, because the sex and baby dreams
are most clearly about survival: for clearly, even if the dreams are scary, sex and babies being born are powerful symbols
of a life force.
And
just remember that these sex dreams are not, in essence, about being 'oversexed' or disloyal, but about engaging with
life.
ICU vivid dreams: Moving from Panic
and Terror to Empowerment
I hope you can see how in each of the above examples
of dreamwork, the dreamer is helped to move from being caught up in the storyline, imagery and strong emotions of their vivid
dreams and/or hallucinations to gaining a sense of their own powerful attempts to fight for survival. In my professional
experience, making satisfactory sense of ICU dreams not only helps the dreamer move from fear to empowerment, but also seems
to help prevent the dreams from becoming intrusive and repetitive, which is distressing.
Of course there
will be some dreams that do not fall under any of the above themes and it may be difficult to make any sense of them. In such
cases it can be helpful to acknowledge what you went through in those dreams, what you might have been trying to do and assume
that your dream had some role in the life and death situation in which you found yourself in ICU. Sometime the only recollection
is a powerful image, such as a tree, and it is worth holding onto it and honouring it.
Summary
for the trusted helper:
Vivid dreams and hallucinations are a normal occurrence in ICU and shortly after
Acknowledge the experience, don’t make fun of it, don’t dismiss it
Remember that ICU vivid dreams usually have a fight for survival theme
Listen to the dream and ask for clarifications: who else was involved?what were they like?
what were they doing? how were you feeling ? what were you trying to do?
Highlight the fight for survival; Empower
Summary
for you, the patient:
Whether your ICU vivid dreams felt like terrifying nightmares or inspiring dreams at the time, they can become
an empowering testimony to your own fight for survival and your resourcefulness. What is more, they can help you give some
meaning to your ICU experience: you may not remember events or medical/nursing interventions that occurred in that ‘lost
time’ while you were in ICU, however these dreams and their significance can be integrated within the context of your
coronavirus journey and, if you wish, the story of your life.
Lewes, May
2020
