The dreaming brain/mind, consciousness and psychosis

Several independent lines of research in neurobiology seem to support the phenomenologically-grounded view of the dreaming brain/mind as a useful model for psychosis. Hallucinatory phenomena and thought disorders found in psychosis share several peculiarities with dreaming, where internally generated, vivid sensorimotor imagery along with often heightened and incongruous emotion are paired with a decrease in ego functions which ultimately leads to a severe impairment in reality testing. Contemporary conceptualizations of severe mental disorders view psychosis as one psychopathological dimension that may be found across several diagnostic categories. Some experimental data have shown cognitive bizarreness to be equally elevated in dreams and in the waking cognition of acutely psychotic subjects and in patients treated with pro-dopaminergic drugs, independent of the underlying disorder. Further studies into the neurofunctional underpinnings of both conditions will help to clarify the use and validity of this model.     

Affect integration in dreams and dreaming

The processes by which dreaming aids in the ongoing integration of affects into the mind are approached here from complementary psychoanalytic and nonpsychoanalytic perspectives. One relevant notion is that the dream provides a psychological space wherein overwhelming, contradictory, or highly complex affects that under waking conditions are subject to dissociation, splitting, or disavowal may be brought together for observation by the dreaming ego. This process serves the need for psychological balance and equilibrium. A brief discussion of how the mind processes information during dreaming is followed by a consideration of four component aspects of the integrative process: the nature and use of the dream-space, the oscillating "me / not me" quality of the dream, the apparent reality of the dream, and the use of nonpathological projective identification in dreaming. Three clinical illustrations are offered and discussed.     

An empirical study of seriously disturbed suicidal patients

Aspects of unconscious processes in a group of seriously disturbed psychiatric patients are examined in an effort to predict near-lethal suicide attempts and explore psychoanalytic formulations of suicide. The Rorschach Inkblot Test, the most widely used projective measure in suicide research (Bongar 1991), was chosen for its potential to shed light on specific unconscious processes. Psychic states commonly associated with suicide were measured by psychoanalytic Rorschach analog scales and then subjected to a progression of statistical analyses in order to predict future occurrence and lethality of suicide attempts. On the basis of a priori hypotheses, the authors developed a suicide index comprising four psychoanalytic Rorschach signs that predicted, with considerable accuracy, which patients would later make near-lethal suicide attempts. The best predictors were unconscious processes indicative of penetrating affective overstimulation, disturbance in the capacity to maintain adequate ego boundaries, and depressive affective states characterized by a morbid preoccupation with death and inner decay. These findings provide empirical support for several well-known formulations of the unconscious motivations for suicide.     

Dreaming as a primordial state of the mind: The clinical relevance of structural faults in the body ego as revealed in dreaming1

Thetherapeuticactionofpsychoanalysis, attributedformanyyearstotheinterpretation of the repressed libido, has shifted its focus to object relationships. Some modern analysts maintain that the primary factor of psychic change is the new model of object relationship provided by analysis, and do not consider signifi cant the knowledge of episodes comprising implicit memories, whose irrecoverable nature is demonstrated by neuroscience. Nevertheless, the author proposes that the knowledge of specifi c archaic events, useless as their interpretation may be, offers a glimpse of the make‐up of the mind, contributing to the improvement of the empathy indispensable for inducing changes in the patient. Episodes linked to absolute narcissism, in the beginnings of the body ego, which do not appear either in associations or in transference, emerge in dreams. Neuroscience has made possible the understanding of aspects of dreaming capable of providing a glimpse of the genesis of the ego, whose development from the bodily phase of absolute narcissism to the psychic object phase can thus be traced. The unearthing of the genesis of primary structural faults in dreaming furnishes the analyst with an estimate of the possibilities for development of the ego, and this knowledge provides fi ne tuning capable of guiding the analyst's conduct. A clinical case illustrates how these phenomena occur, showing the intersubjective relationship as the silent primary generator of psychic changes, consolidated and developed secondarily by means of the analytical dialogue.     

Dyadic death: murder-suicide.

Twenty homicide-suicides, drawn from death records of three major eastern United States cities, were analyzed in comparison to prior studies and samples of homicide offenders and suicide victims. Results indicated a lower incidence for this event than reported previously and several distinguishing characteristics of the murderer who subsequently commits suicide. Two primary types, from the perspective of ego fusion, are discussed.     

Jungian theory of dreaming and contemporary dream research – findings from the research project ‘Structural Dream Analysis’

The research method ‘Structural Dream Analysis’ (SDA) is described which allows for systematic and objective analysis of the meaning of dreams produced by patients in Jungian psychotherapies. The method focuses especially on the relationship between the dream ego and other figures in the dream and the extent of activity of the dream ego. Five major dream patterns were identified which accounted for the majority of the dreams. The clients’ dream series were dominated by one or two repetitive patterns which were closely connected to the psychological problems of the dreamers. Additionally, typical changes in the dream series’ patterns could be identified which corresponded with therapeutic change. These findings support Jung's theory of dreams as providing a holistic image of the dreamer’s psyche, including unconscious aspects. The implications for different psychoanalytic theories of dreaming and dream interpretation are discussed as well as implications for the continuity hypothesis.     

Parental Suicide: An Organizing Event in the Development of Latency Age Children

ABSTRACT: This paper proposes that children who are especially vulnerable to parental suicide have not resolved earlier developmental issues of separation-individuation. Five children, ages 6 to 12, were studied intensively. Parental suicide during the child's latency age period has profound influences on children's ego development and character formation because during this time childhood ego functioning is rapidly maturing and superego functions are developing. The trauma of parental suicide is heightened when difficulties for the surviving parent in mourning interfere with open discussion between the parent and child about the death. Parental suicide may stimulate childhood suicidal impulses if the child identifies with and idealizes the dead parent and has wishes of reuniting with the deceased.     

The descent into suicide

Suicidal breakdown requires attention both to attack upon the self (ego) as aggressive forces are unleashed against it by the superego, but also to the phases of self-breakup (ego regression) that follow. Less attention has been directed to ego-regression in suicide than to superego-directed assault on the ego in the psychoanalytic literature; this paper directs attention to the phenomena of ego failure and disarticulation of the self-representation. Clinical study of suicidal patients shows four aspects of suicidal collapse as ego loosens: affective flooding, desperate maneuvering to counter the resulting mental emergency, loss of control as the self begins to disintegrate, and grandiose magical scheming for mental survival as the self-representation splits up and body jettison becomes plausible. These phenomena are discussed theoretically in terms of failed affect regulation, ego helplessness, narcissistic surrender, breakdown of the representational world, and loss of reality testing.     

Emil Kraepelin's dream speech: A psychoanalytic interpretation

Freud's contemporary fellow psychiatrist Emil Kraepelin collected over the course of several decades some 700 specimens of speech in dreams, mostly his own, along with various concomitant data. These generally exhibit far more obvious primary-process influence than do the dream speech specimens found in Freud's corpus; but Kraepelin eschewed any depth-psychology interpretation. In this paper the authors first explore the respective orientations of Freud and Kraepelin to mind and brain, and normal and pathological phenomena, particularly as these relate to speech and dreaming. They then proceed, with the help of biographical sources, to analyze a selection of Kraepelin's deviant dream speech in the manner that was pioneered by Freud, most notably in his 'Autodidasker' dream. They find that Kraepelin's particular concern with the preservation of his rather uncommon family name-and with the preservation of his medical nomenclature, which lent prestige to that name-appears to provide a key link in a chain of associations for elucidating his dream speech specimens. They further suggest, more generally, that one's proper name, as a minimal characteristic of the ego during sleep, may prove to be a key in interpreting the dream speech of others as well.     

Drug dreams: a neuropsychoanalytic hypothesis

Recent studies have shown that the ventral tegmental pathway stimulates both dreaming and drug craving. To investigate a possible clinical link between these two psychic phenomena, psychotherapy notes from the first six months of an addicted patient's treatment were reviewed, together with verbatim notes from the four years of psychoanalysis that followed. Of 240 dreams reported by the patient,58 had manifest content involving the seeking or using of drugs. There was no particular temporal or emotional thematic pattern to these "drug dreams,"which persisted through four and a half years of sobriety. Drug dreams are observable phenomena that reflect both the innate structure of the brain and neural changes produced by exposure to addictive drugs. In some addicted persons, exposure to drugs produces a fixed change in neurological functioning with which they must contend for years, possibly the rest of their lives. Drug craving meets Freud's defining characteristics for a drive: it is a constant pressure, originating from within the organism, to do work, and it constantly demands satisfaction. Because ego and libidinal drives share a common neural pathway, they should not be separated conceptually. Solms's finding (in press) that the activating systems for dreaming and for craving are identical, a finding based on observations of tumor- or stroke-provoked brain lesions, is confirmed by observation of the dreams of a patient whose brain changes were created by drug exposure. This study provides further evidence that the origin of the dream is a wish.     

Stages of decompensation in combat-related posttraumatic stress disorder: A new conceptual model

This conceptual article presents a model of severe, chronic combat-related PTSD based on several years of longitudinal clinical observations of Vietnam veterans. The model describes a repeating cycle of decompensation that profoundly disrupts the veteran’s life. There appear to be “stages” of decompensation that can be described clinically and may be distinct physiologically. The stages describe a wide range of functioning, from adaptive to totally dysfunctional. PTSD core symptoms, as well as several other dimensions of clinical functioning, such as affect regulation, defenses, ego states, interactions with the environment, capacity for self-destruction/suicide and capacity for attachment and insight are described for each stage. Clinical and research implications are discussed.     

Suicide of Japanese Youth

ABSTRACT: The uniquely intense stress due to the Examination Hell (shiken jigoku) not only generates a basic drive for Japan's economic success but also contributes to a high rate of young people's suicide. This paper discusses the major factors in the intensity of Japanese stress on both institutional and psychological levels. The social structural factors which convert stress to suicide are analyzed in terms of weak ego; restraint on aggression; a lack of social resources; and views of life, death and suicide. Japanese views of life, death and suicide are treated in terms of Absolute phenomenalism, the original form of Shintoism, to which Buddhism and Confucianism have been adjusted in Japan. Japanese phenomenalism affects suicide through its three aspects: animism, present-time oriented small groupism, and the absolute acceptance of the established social order. Confusion and conflict since World War II have increased anomic suicides; however, elements of fatalistic suicide (due to excessive formal or informal social regulations) and altruistic suicide (due to strong social integration) are evident. Suicide is still a highly institutionalized adjustment mechanism in Japan.     

The unmourned wound: Reflections on the psychology of Adolf Hitler

Fifty years after his death by suicide, Adolf Hitler continues to arouse profound feelings of revulsion and attraction. This paper is an exploration of Hitler's psyche from the perspective of a depth psychology. After examining analyses of Hilter's personality by Richard Rubenstein and Alice Miller, the argument is made that we need C.G. Jung's concept of psychic inflation to understand more fully Hitler's impact upon the world. Hitler is seen as inflated by the compensating energies of the Self in response to his deeply wounded ego, a wound he could not mourn. Consequently, he became identified with the dark and destructive energies of the Self which inflated and then usurped his ego. Hitler's demonic and destructive career resulted from that inflation, which he was not able to neutralize. The paper concludes with reflections on the role of mourning in protecting us from the experience of psychic inflation, especially by the Self in its dark and destructive aspects.     

Adolescent suicide and defensive style.

This empirical study investigated the relation between ego defense mechanisms, diagnoses, and suicidality among 200 adolescent psychiatric patients ages 12 to 16 years. Based on a structured diagnostic interview, adolescents were divided into three groups: suicide attempters, suicidal ideators, and nonsuicidal patients. Using the Defense Mechanisms Inventory (DMI), suicidal adolescents scored higher on the defense of turning-against-self and lower on reversal, as compared to nonsuicidal adolescents. Although suicide was significantly more common among adolescents with an affective disorder, turning-against-self remained significantly associated with suicide attempt even when diagnosis was controlled for. Results demonstrate the importance of defense mechanisms in understanding adolescent suicidal behavior.     

3 Culture and Ego-Ideal in Suicide: An Adult Case

A case is presented in which the patient's self-expectations, arising from his ego ideal, were violated by a conflict with his wife, who came from a different culture and did not share his marital and family values. When she left him he was devastated, not only by the loss of his family, but by the destruction of his ideal vision of himself as a husband and father. A dangerous suicide attempt followed. The psychodynamic formulation of the case and the treatment that followed from it are discussed.     

Personality Preferences and Their Relationship to Ego Development in Australian Leadership Program Participants

The growth of adult ego development to post-conventional levels is associated with many adaptive advantages for the individual and society. However, the vast majority of adults across a wide range of samples demonstrate ego stages well below the maximum potential. In an effort to advance understanding of why and how development to higher ego levels might occur for some individuals and not others, we explored whether particular personality preferences and combinations thereof (as measured by the Myers-Briggs Type Indicator or MBTI) are associated with higher ego levels and whether particular personality preferences might act as inhibiting or facilitating factors in ego development. Participants were 374 adults (aged 18–61; 50 % female) undertaking 11 community leadership development and 2 professional management development programs. After adjusting for effects of age and education, a preference for Intuition on the MBTI was associated with significantly higher ego development on program entry and with greater ego development during the programs. These results are consistent with previous research and provide support for Manners’ and Durkin’s (Developmental Review, 20:475–513, 2000) proposal that dispositional personality characteristics may enhance or constrain ego development.     

Unwilling but not unable to control: Ego depletion increases effortful dishonesty with material rewards

Previous studies have found that ego depletion increases dishonesty. However, it remains unclear whether ego depletion makes participants unable to exert self‐control or unwilling to exert self‐control when it increases dishonesty. The present study aimed to clarify this. Based on the process model, ego depletion causes individuals to pay more attention to material rewards and increases the motivation to act on impulse. Therefore, it is possible that ego‐depleted participants are unwilling, rather than unable, to be honest. We conducted two experiments to examine this hypothesis. Results showed that ego depletion increased material‐based dishonesty even when the dishonest behavior was more complicated and effortful than was the honest behavior. However, participants were reluctant to cheat just for convenience, and ego depletion had no apparent effect on convenience‐based dishonesty without any material rewards. The theoretical implications and future directions of these results are discussed.     

The immersive spatiotemporal hallucination model of dreaming

The paper proposes a minimal definition of dreaming in terms of immersive spatiotemporal hallucination (ISTH) occurring in sleep or during sleep–wake transitions and under the assumption of reportability. I take these conditions to be both necessary and sufficient for dreaming to arise. While empirical research results may, in the future, allow for an extension of the concept of dreaming beyond sleep and possibly even independently of reportability, ISTH is part of any possible extension of this definition and thus is a constitutive condition of dreaming. I also argue that the proposed ISTH model of dreaming, in conjunction with considerations on the epistemic relationship between dreaming and dream reports, raises important questions about the extent to which dreams typically involve a detailed body representation—an assumption that plays an important role in philosophical work on dreaming. As a commonly accepted definition of dreaming is lacking in current dream research, the ISTH model, which integrates conceptual analysis and epistemological considerations with results from empirical research, is an important contribution to this field. By linking dreaming to felt presence, full-body illusions, and autoscopic phenomena such as out-of-body experiences in wakefulness and in the hypnagogic state, the ISTH model of dreaming also helps integrate dream research, both theoretically and experimentally, with the study of other altered states of consciousness involving hallucinations. It makes straightforward and investigable predictions by claiming that all of these experiences have amodal spatiotemporal hallucinations as their common denominator. Finally, it is theoretically relevant for the philosophical discussion on minimal phenomenal selfhood.     

How to integrate dreaming into a general theory of consciousness--a critical review of existing positions and suggestions for future research

In this paper, we address the different ways in which dream research can contribute to interdisciplinary consciousness research. As a second global state of consciousness aside from wakefulness, dreaming is an important contrast condition for theories of waking consciousness. However, programmatic suggestions for integrating dreaming into broader theories of consciousness, for instance by regarding dreams as a model system of standard or pathological wake states, have not yielded straightforward results. We review existing proposals for using dreaming as a model system, taking into account concerns about the concept of modeling and the adequacy and practical feasibility of dreaming as a model system. We conclude that existing modeling approaches are premature and rely on controversial background assumptions. Instead, we suggest that contrastive analysis of dreaming and wakefulness presents a more promising strategy for integrating dreaming into a broader research context and solving many of the problems involved in the modeling approach.     

Are Young Adults' Suicides Psychologically Different from Those of Other Adults? (The Shneidman Lecture)

ABSTRACT: This Shneidman Lecture addresses the question: Are young adults' suicides psychologically different from those of other adults? Eight clusters (or patterns) as possible predictors of suicide notes and, by implication, suicide are discussed to address this question. The eight clusters are as follows: unbearable psychological pain, interpersonal relations, rejection-aggression, inability to adjust, indirect expressions, identification-egression, ego, and cognitive constriction. Comparisons between young adults (aged 18–25) and other adults indicate that young adults' suicides do differ psychologically in a number of patterns, but that considerable commonalities exist across the adult life span. The presentation emphasizes that a life span developmental perspective is essential when one is attempting to understand the suicides of young adults. A number of genuine suicide notes of young adults are presented to illustrate, from an idiographic view, what it might have been like for these individuals in the last moments of their lives.