Practical Geriatrics: Psychiatry and Spirituality at the End of Life: A Case Report

Going Home is a series of meditation tapes designed for hospice patients. They were produced by the Monroe Institute in Faber, Virginia, and were created by Elizabeth Kubler-Ross, M.D. (8,9), Charles Tart, Ph.D., and Robert Monroe, the founder of the institute (10). The tapes guide the listener through meditation and trance exercises, using imagery that relates to near-death experiences, death, and the afterlife. The tapes use an open, permissive style, which allows patients to develop their own images. Also, the tapes do not promote or use specific images from any one religious group or system.

A sound technology called Hemi-Sync is used in the background of the tapes. For the Going Home tapes, Hemi-Sync uses soft sounds that are designed to gently entrain the brain wave frequencies—that is, to align the brain wave frequencies of the listener with those that are associated with certain states—meditative, trancelike, and dream. A number of studies have shown that both the brain wave signature, including the frequency of the predominant brain wave, and the state of consciousness can be affected by this technology (11,12,13,14). For example, when persons were exposed to Hemi-Sync sounds that were focused on a frequency of 16 cycles per second or higher, an electroencephalogram (EEG) spectrum revealed enhanced beta range activity and external arousal. Conversely, when persons were exposed to Hemi-Sync sounds that were focused on a frequency of eight cycles per second or lower, an EEG spectrum showed increased alpha and theta range activity and that the state of consciousness was similar to that of a meditative or trancelike state. These studies also indicated that this technology promotes the inter-hemisphere synchronization of brain waves, hence the name Hemi-Sync. Furthermore, preliminary work suggests that brain wave shifts may be more pronounced with appropriate tapes than with hypnosis or meditation alone (14).

During the next month Mr. X healed from his wounds and his depression improved. During this time he listened to the Going Home tapes. Members of the hospital administration believed that they were in a precarious situation, because they would be liable if Mr. X tried to commit suicide again. Although Mr. X had promised not to attempt suicide, the circumstances that led up to the suicide attempt still remained. The members of the hospital administration were reluctant to accept Mr. X's assurances, as were a number of local nursing homes, including the nursing home that was officially associated with the hospital. The consultant advised Mr. X's treatment team to involve the local hospice that was affiliated with the hospital. Unfortunately, this hospice had just entered a period of organizational turmoil. At a team meeting among hospice and hospital staff members that was called to address treatment and placement options for Mr. X, a hospice administrator stated, "This man must be taught a lesson. There are consequences for his actions." The hospice did not accept Mr. X. However, a nursing home near the hospital did accept Mr. X after he agreed to a "no suicide" contract. A nurse clinician from the hospital and I agreed to visit Mr. X in this new setting.

While Mr. X was in the nursing home, he continued to meditate with the help of the Going Home tapes and did some additional trance exercises with my help. Some of the exercises that I used were adapted from the conscious dreaming exercises of Moss (15) and the creative dreaming techniques of Garfield (16). Other exercises were adapted from Cerney's (17,18) work, which allows the person to work through grief by visualizing loved ones who have passed away. I also adapted techniques from Moen (19), who had, in turn, adapted techniques from the Monroe Institute. These exercises focused on dreamlike scenarios in which Mr. X encountered and talked with his late parents and other persons of emotional importance who had died. Some of the exercises that were used allowed Mr. X to explore spontaneous imageries of positive possible afterlife environments. It should be noted that these exercises do not depend on the existence or proof of an afterlife—although recent research on this subject is thought provoking (20)—but merely a person's interest in meditating on the subject. Mr. X reported satisfying meditative and trance experiences concerning dying, meeting his parents, and the afterlife. He reported a cessation of depression symptoms and satisfaction with his life at the nursing home. The nursing home, in turn, reported that Mr. X was active in physical therapy and program activities and that he was one of the most beloved members in the nursing home community. His twin brother visited multiple times from a nearby state, despite a severe illness of his own. Mr. X reported that the brothers achieved a sense of emotional closure. About four months after Mr. X was hospitalized, he experienced one day of increased weakness and died peacefully in his sleep.