September 26, 2004
Dreams and psychosis

Recently at our ISPS-US conference in Chicago, psychoanalyst Danielle Bergeron from Quebec City described her therapeutic approach in which she helps psychotic patients replace the delusion with the dream.  The latter speaking the truth of one’s unconscious (the latter being for the most part under the desire of the Other).  The psychotic individual feels sacrificed to the jouissance of the Other, she or he must complete the Other.  These ideas are more fully explicated in her “The work of the dream and jouissance in the treatment of the psychotic” contained in After Lacan: Clinical Practice and the Subject of the Unconscious edited by Willy Apollon, Danielle Bergeron and Lucie Cantin in 2002 for State University of New York Press.  Bergeron and her colleagues at ‘388’ have been adopting Lacanian psychoanalysis in their therapies with severely mentally ill persons (their research of over 10 years has demonstrated success in this approach at 388).

Listening to Bergeron’s presentation encouraged me to pay more attention to dreams with my psychotic patients (although I have always written down the dreams of my patients as they speak them, unless they ask me not to).  Jung used dreams quite often in his work at the Burghözli Psychiatric Clinic with psychotic patients.  Sullivan related psychotic referential processes to nightmares.  Ernest Hartmann related both nightmares and schizophrenia to ‘thin’ permeable boundaries (see his Dreams and Nightmares: The New Theory on the Origin and Meaning of Dreams published in 1998 by Plenum Press).  Personally, I believe that one of the functions of dreaming is to maintain relational attachments during sleep.  Nightmares signify the threat of annihilation of the self secondary to object ties being obliterated or jeopardized.  They could be attempts to process and work through endangerment to the self, whether from past traumas or present day challenges which are central to the integrity and cohesion of the self.  More frequent REM sleep in infancy, perhaps, could be in the service of not losing the attachment to the necessary caregiver.

In the past, I posted the following thoughts on psychosis and dreams:

Schizophrenic Symptoms, Separation Panic & Seeking

It occurs to me that there is a significant connection between the productive-positive symptomatology of schizophrenia, such as delusions and hallucinations, and the negative symptoms, such as anhedonia, alogia, anergia etc, that is held together by the psychoneurobiological systems mediating attachment, separation and seeking, as well as dreaming....  Absence of the primary object, which confers the ability to mentalize one’s affects and self states, drives the person to seeking (separation-distress call) a sense of connection (e.g., hallucinations & delusions) with the primary object and dreaming (I have noticed when my patients diagnosed with schizophrenia begin to recover they report more dreams, perhaps because dreams feel too psychotic with little differentiation between internal and external reality -- ’thin’ boundaries’, or as Bion thought, impaired containment leads to massive evacuation of the elements that are precursors to dreaming, i.e., beta elements -- I was so pleased when after six years of intensive psychotherapy one of my patients reported his first dream.  Franco De Masi (2000) published an interesting article on dreams and psychosis in the International Journal of Psychoanalysis, 82.

In terms of psychoanalytic attention to dreams, I would highly recommend the following:

Paul Lippmann (2000). Nocturnes: On Listening to Dreams. Hillsdale,NJ: The Analytic Press.

Mark Blechner (2001). The Dream Frontier. Hillsdale,NJ: The Analytic Press.

Brian Koehler PhD
New York University


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