On Dreams and Nightmares

Have you wondered why my patients have less nightmares and have dreams that increasingly become more and more real and present? No?  Oh dear, I had better explain.  What does it mean to dream?  It means that the limbic system is actively processing feelings as it does during the day when we are feeling something. Except at night it is going over feelings from the past and trying to integrate what? Not the dream: the feeling.  It may have been events from way back that were traumatic and could not be integrated at the time.  We were too young and fragile and perhaps non-verbal.  It is a mass of vague sensations and discomfort.  They bubble up when there is not too much external input and put pressure on the neo-cortex to do something with those feelings.  The cortex accommodates and provides images and thoughts.  The limbic system joins the cortex to mount a story to rationalize and  make the feeling coherent. This is what our therapy is about.  Dream processes lay bare the evolutionary path that we must follow in therapy; evolution in reverse.  We do not go straight to the emotional past; we anchor the patient in the present and focus her feelings in the present; from there the brain takes its own piste below.  Ideas, then go to meet their maker; they go to where the feeling is cemented in; where it began.  I dreamed for years about being chased by the Nazis and could not escape. The feeling? My father was unrelenting in his chastisement and would not let up.  He was always after me: sit up straight, don’t talk through your nose, why are you lying around and not doing something useful?  That dream disappeared with those felt feelings.

I could not escape the Nazis because I could not escape the feeling; someone was after me and trying to harm me.  It was never the Nazis; they were only a symbol for my feelings.  See, a symbol for my feelings; and that is how we develop dream symbols; same process.  I never knew it was my father because my system only knew the feelings, not the source.  Until I had a developed cortex I could not know what was wrong.  The feelings predated cognition and were properly registered limbically.  We must pay attention to that evolution when we do therapy:  feelings first, long before our ability to think.  In therapy feelings first, long before insights.  There is no defying evolution.

  So how do we explain this?  The imprints form a prism through which we see the world; they distort reality and give us symbolic dreams.  The first distortion is from our true feelings and then it moves up the neuraxis to the neo-cortex which joins the distortion with ideas.  Hence, “They are out to get me”.  But it is not that just because we dream that they are automatically distorted and symbolic. It is because repression holds back the pain and produces distortions; awake and asleep.  As we experience the imprinted pain and lift the gating force that keeps pain locked away there will be diminished  distortion awake and asleep.  Neurosis is systemic, not sleep determined. We carry it around always. It won’t let go.

Patients have more real dreams because they are more real;  they are less repressed and more open.

And of course we can spot where dreams come from.  First line dreams rarely have elaborate symbols; they are direct and short—“I am stuck in a washing machine and I can’t stop it.”  “I am in a  dark cave and cannot find a light to show me the way out.”  Pre-psychotics are awash in first-line pain and continue to have first-line dreams and frequent delusions.

Second line dreams are more intricate have a more coherent structure, contain some but not a lot of words, but they are more difficult to understand. “ I went to see my old teacher and tried to talk to him but I could not make him understand me.”  The real feeling was, “I could never get through to my parents and could not make them understand me.”

So more direct, non-symbolic dreams is a good index of a patient getting well.  We corroborate with vital signs, cortisol levels, behavior changes and a host of other measures. We get well systemically.