Dreams: psychological and biological perspectives

Dreams

Mental illness impacts all areas of a person's life, from social interactions to self-perception, from cognitive functioning to spiritual belief systems. Dreams are no exception. Every person spends a good deal of time in the dreaming state, whether or not dreams are recalled or valued upon awakening. A person's sleep state is impacted by a number of factors ranging from the biological to the emotional. When mental illness affects a person's life, it includes the large portion of life that takes place in the sleep state. Neurochemical processes, linked to emotionality, cognition, and behavior, may also have an effect on the content -- both manifest and latent -- of dreams. Similarly, the content of dreams could change a person's emotional state and subsequent neurochemistry. Generally, if mental illness affects waking life, then it must also impact dreams. The nature of the impact will be qualitatively different depending on the type and severity of the mental disorder, due to the great diversity between the different disorders classified by clinical studies. Just as dream analysis and proactive dream therapy can be used for the general population, there is also evidence suggesting that dream therapy can be an important component of clinical therapy for those who suffer from mental illnesses of all types.

"People who suffer with mental illness often also have arousal disorders, which can increase the likelihood of hallucinations at sleep onset, and may increase the chance to have a lucid dream due to increased awakenings throughout the night," (Hurd 1). At the same time, "being sleep deprived, stressed, drugged or physically exhausted" can cause hallucinations that make up for a lack of rapid-eye movement (REM) sleep stages (Hurd 1). Not all mental illnesses include arousal disorders, as unipolar depression may inhibit cohesive and well developed dreams altogether (Cartwright, Baehr, Kirkby, Pandi-Perumal and Kabat). Therefore, it is critical to differentiate between different mental illnesses in the study of dreams rather than generalize, as it is impossible to generalize about dreams in the general population as well. There is also the question of which came first, the mental disorder or the sleep/dream disturbances. As Purse points out, "psychiatric disorders are common in sleep disorder patients, and disturbed sleep often afflicts patients with psychiatric disorders," (1). The directionality of the relationship, and even the causality, have yet to be determined in clinical psychiatric literature.

However, there are some factors that distinguish the phenomenology of dreams in those with clinical mental disorders vs. those who do not have the diagnosis of a mental disorder. Mood disorders present a good case in point. Much research has been conducted on the relationship between bipolar disorder and dreaming. Bipolar disorder, characterized by major and intense mood and behavioral swings, has an especially noticeable and measurable impact on sleep and dream patterns. The difference between depression cycle and manic cycle sleep and dream phenomena reveals how the brain manifests different dreams at different times, potentially in line with neurochemical and neurobiological changes. "People with bipolar disorder have extra-vivid dreams and an inordinate number of nightmares or other sleeping disorders," (Purse 1). Likewise, "bipolar patients report bizarre dreams with death and injury themes before their shift to mania," and the "dreams of bipolar depressed patients have more anxiety than those of unipolar patients," (Purse 2). Dreams can be used as a benchmark or signal for those with bipolar, helping people to recognize the onset of a manic stage and adjust medication or treatment interventions accordingly.

Unipolar mood disorders, such as clinical depression, also impacts dreams. Depending on the severity of the clinical depression, the dreams will be affected. Some depressed individuals have dreams that parallel their flattened emotional affect, with "bland" dreams (DeKoninck 160). Other depressed persons, such as those who manifest self-hating or self-harming behaviors, may have dreams with masochistic manifest content (DeKoninck). It is as if the dream state is mimicking the waking state and allowing in fact for the expression of desires that are taboo, as Freud might point out. Depression is associated strongly with sleep disorder in general, and has been linked with insomnia. Insomnia may result in sleep deprivation, which directly reduces the amount of time spent in REM sleep, the stage during which dreaming takes place. If less time is spent in non-REM sleep, then it makes sense that the depressed person's sleep will be characterized by a greater proportion of dreams and improved dream recall due to the shallow sleep of the REM state. Research substantiates these theories, as "people suffering from depression also report more dreams than average. This would be true even among patients who experience insomnia and other depression-related sleep disorder symptoms. In fact, people who are clinically depressed may dream three or four times as much," (Hurd "The Link Between Depression and Dreams" 1). It should be noted, however, that dream recall does not necessarily correspond with actual time spent in the dream or REM state, or indicate the manifest content of a person's dreams. In any case, there are proven links between clinical depression and differential dream states and dream patterns.

Pharmacological interventions used to treat mental disorders will also have a strong bearing on dream patterns and dream content. Therefore, researchers must take care to value the role that pharmacological interventions play when evaluating the dreams of patients with mental illness. Likewise, patients with mental illness as well as substance abuse problems could have dreams that are related to their substance use even more so than the mental illness. In any case, patients taking medications to treat their mood disorders might also experience changes in their dreaming patterns. For example, patients taking anti-depressants, and in particular, tricyclics, remember their dreams less often than people who are not taking these medications to treat depression (Schimelpfening). Whether or not dreaming less often correlates with reduced symptomology of clinical depression remains to be seen. It is important to pay attention to the link between dreams and mental illness because of the correlations between suicidality and sleep disturbances as well as the known link between antidepressant medications and suicidal ideation (Cukrowicz et al.). Dream awareness may be used to help persons with clinical depression monitory their cognitions and affect.

The dream research conducted by Sigmund Freud initiated a revolutionary view of the phenomena related to neurosis. In patients with neuroses, "neuroticism was correlated positively with aversive dreams, more incorporation from waking life, and personal significance of dreams," (Aumann, Lahl and Pietrowsky 124). Dreams can be used to gauge neurosis too, especially because dreams can affect waking life. For example, McNamara suggests that, "dreams have a significant role to play in shaping interactions between people," because dreams shape self-image, attitudes, and emotions (1). The link between mental states and dream states is bidirectional, meaning that dreams influence states of mind and states of mind also influence dreams. There could be a feedback loop that both creates and reflects neurosis. Paying more attention to dreams could unlock mysteries to mental illness, just as mental illness may unlock mysteries of dreams. This is why Freud and his contemporaries like Carl Jung spent a good deal of their research studying dreams.

Dreams may not be related at all to emotional states or chemistry, but could point to a unified theory of consciousness that shows that mental illness is itself an illusion. In The Dream Drugstore, Hobson suggests that the Freud-based theories of dream interpretation and psychoanalysis are wrong in that they suggest binaries between dream and waking state, neuroses and health. In reality, "dreaming, dissociative states, psychosis, and drug-induced hallucinations" are all "functions of brain chemistry and that replaces the psychodynamic view of dreams," (Diamond 90). The brain is fused with the mind, and emotion with thought.

Eric Fromm points out that dreams are often universal markers revealing a collective unconsciousness. The language of dreams is similar to the language of myth, as well as to the language of hallucinations and shamanic states of being. Mental illness, viewed as part of a spectrum of human experience rather than as a negative mind state, can be used to showcase the powers of the brain and mind. Schizophrenia and schizotypical disorders can be fruitful to study, for they reveal alternative mechanisms of mind such as hallucinations and other waking dream realities. Human beings have not always drawn as sharp a line between mental health and mental illness; nor between waking and dreaming. As DeKoninck points out, dreams were "not distinguished from waking reality and could lead to erroneous behaviors," in some people with so-called "primitive" worldviews (150). The schizotypic or schizophrenic patient likewise does not distinguish between the dream states and the waking realities that he or she shares with peers. Delusions and hallucinations correspond with dreaming, which can influence daily decisions. In some cultures, dreams could be used as a means of making important political decisions (DeKoninck). The unique confluence of waking and dreaming states in the mind of the schizophrenic with positive features like hallucination has a direct bearing on dreams, with schizophrenics actually reporting "very little hallucinatory content" theoretically because the hallucinatory content is already present in the mind of the waking state person (DeKonick 160).

One mental disorder that has been researched with regard to its effect on dreams is post-traumatic stress disorder (PTSD). "The reexperiencing of a traumatic event in the form of repetitive dreams, memories, or flashbacks is one of the cardinal manifestations of posttraumatic stress disorder ("Sleep Disturbance as the Hallmark of Posttraumatic Stress Disorder" 697). These findings correlate findings related to neurosis, in which incorporation of events from daily life into dreams can create anxiety dreams and aversion dreams. The trigger event plays itself out over and over in the mind of the sufferer of PTSD, both in waking and dream life. For example, research on the neurophysiology of animals shows that central nervous system responses that lead to the genesis of REM sleep also are linked to the "classical startle response," and this is akin to the startle behavior commonly described in PTSD patients." ("Sleep Disturbance as the Hallmark of Posttraumatic Stress Disorder" 697). Any mental illness, like PTSD, that has a strong emotional as well as cognitive component, is likely to have a stronger impact on dreaming than mental illnesses without a strong triggering emotional component. This is because dreams are related directly to emotion, and particularly negative emotions coupled with the presence of external or waking life stimuli may in fact cause the genesis of dreams (DeKoninck).

Interestingly, research shows that acute stress, as opposed to PTSD and anxiety disorders, can suppress dream recall (DeKoninck). This apparently conflicts with the high arousal state experienced by bipolar and PTSD patients, showing that mental illness may indeed affect dreaming in ways that the non-mentally ill do not experience even when acute stress is a variable. There are also personality trait factors, unrelated to personality disorders like narcissistic or borderline personality disorders, that are related to dream content, ability to recall dreams, and dream patterns (DeKoninck). Most correlations between dream recall frequency and personality traits like extraversion/introversion, anxiety, dependence, openness to experience, and boundary thickness have revealed no statistically significant results. Of these traits, the boundary thickness or thinness is the personality trait factor most strongly correlated with dreaming in the research. Thin boundaries mean that a person more open, trusting, and vulnerable, and also has a richer fantasy life vs. The average person or the person with thick boundaries. A thick boundary person will be rigid, and "do not differentiate clearly between thoughts and feelings," (DeKoninck160). Thin boundary persons have dreams that are more emotional and with greater potential for nightmares (DeKoninck). Auhmann, Lahl, and Pietrowsky likewise found that thin boundary people have dreams that are more personally meaningful vs. those with thick boundaries.

The clinical use of dreams in people with mental illness is a fascinating field of research that transcends the typically shallow insight into cognitive functioning. Applying a contemporary revision of shamanic practices to dreaming, a practitioner can aid a person to confront fears and anxieties. For example, a person with PTSD can be helped in therapy using multimodal and holistic practice. By having the person record his or her dreams over the course of several weeks or months, the therapist helps the individual take control of the contents of his or her psyche and reactions to stress. Coping mechanisms express themselves in dream life as well as waking life. Exploring the dream world provides a set of keys and symbols to the subconscious processes operating in waking life, which may give rise to symptoms like panic attacks or bouts of anger and anxiety. Keeping a dream journal, the person can then discuss the content and emotionality of the dreams in therapy. Through the discussion of the dreams in therapy, the person will be rehashing the anxiety to the point where the person may be able to eliminate the need for medications.

Factors that influence dreams in addition to the presence or absence of mental illness include neurophysiological organization, cognitive organization, intellectual capacity, maturity, past experiences, culture, gender, personality, memory, concerns, mood, presleep experiences, and stimulations in the environment during sleep (DeKoninck). The relationship between dreams and mental illness is not as direct and obvious as expected. Some persons with mental illness, like those with schizophrenia, do not have vivid dreams, whereas those with bipolar disorder do. Yet depression is linked to nightmares and night terrors, showing that some mental illnesses can lead to dreams that manifest the contents of subconscious fears even when other mental illnesses lead to dreams that parallel flattened affect (Purse). Much of the phenomena may be related to brain chemistry. The brain may give rise to the mind, which is an illusion, and which is also why pharmacological interventions can alter cognitive and sleeping states (Diamond).

There are some disorders that reveal the intimate and complex connection between brain, mind, and body. For example, isolated sleep paralysis (ISP) has been commonly confused with some types of mental illness because of the link between ISP and night terrors (Nielsen and Zadra). Disruptions of emotional states lead to sleep state disruptions with waking state consequences. Dreams also have a potent linguistic component, in which analyzing a dream verbally as in therapy can lead to an understanding of the latent content of that dream and aide with an understanding of the underlying emotional mechanisms. Thus, dreams can be used as part of clinical recovery and treatment for mental disorders. The study of dreams should include attention paid to the potentially therapeutic function of dreams as vehicles to express challenging cognitive or emotional content. If persons with mental illness can train themselves to dream lucidly, or at least to recall dreams with greater frequency, then perhaps the social and psychological functioning of those individuals may improve. It may also be helpful to research the genetic component of mental illness, as it correlates to the genetic component of dream patterns.