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Dreams and the Therapeutic Process[1]

Montague Ullman[2]

Psychiatry 21: 123-131, May 1958

Two sets of generally held assumptions pertaining to dreams, both arising from the Freudian concept of the dream work, will be re-examined in this paper: first, the view of the dream as a disguised expression or compromise formation and the nature of the symbols which participate in this disguise; and second, deriving from this, the view of the origin of the dream in terms of the topographical components of the psyche and their opposition to each other. In short, I shall try to replace with fewer assumptions the concept of the latent and manifest content of the dream and the role of the dynamic unconscious. It is my feeling that this can be done through a more explicit statement of the nature of consciousness and the manner in which it evolves under the impact of the socializing processes.

Every human being exhibits behavior in relation to other human beings and is possessed of a certain consciousness of this behavior. This consciousness may be a more or less accurate reflection of the nature, of the world about him, the particular circumstances of his life, and his relatedness to what is going on about him. On the other hand, it may be highly inaccurate, distorted, and only in a very tenuous fashion linked to current existing realities. The more accurate it is, the greater is his mastery over the problems that confront him. The more inaccurate it is, the more helpless and passive he is in relation to his own life experience. Consciousness is not, nor can it ever be, a static affair. It is born out of the struggle to achieve some mastery over one's own destiny, and it continues until death ends the struggle.

Now it is an interesting and significant fact that the human being, alone of all the organisms in the animal kingdom, can, within his own natural habitat, get lost in the kind of dead-end, self-defeating activity which is termed neurotic or psychotic. Freud sought the answer to this riddle in terms of what the development of the child did to his instinctual heritage, at the same time making the biological endowment the basis for all that was dynamic. In effect, Freud simply chose the first of two possible alternatives: That the wellsprings of neurotic behavior - which, certainly, are not known or controllable by the person - arise from sources primarily within the person; or that they arise from sources primarily external to the person.

To follow the latter path and see where it leads in connection with a theory of dreams, the first important fact which emerges is that the human being is forced to participate in the process of social living long before his consciousness can accurately reflect the true nature of the forces operating about him or the nature of his own participation. The lag between his existence as a participating member of human society and his understanding of his own role - the sources and limitations of his own freedom, the origin of his own suffering, the nature of the society about him, and his own nature - is a considerable one. This lag cannot be explained in terms of what man has in common with other animals - namely, his biology. It is to be explained in terms of what is unique about human beings - the existence of a cultural heritage and its molding influence on newcomers to the human race, through the significant figures about the young organism. A social environment created early in man's history, when survival needs made for social rather than anarchic living, now becomes in effect the creator of men. The growth of the child becomes contingent upon his mastery of the tools of social living.

This mastery, however, takes place in an atmosphere of struggle that is inherent in the fact that a child is engaged in activity long before he is aware of the nature of that activity. When the outside world is so constituted as to aid this process, the step is one from ignorance to knowledge. But when the reality external to the child demands adequate techniques of mastery without providing the child with an accurate consciousness - which can transform blind necessities into known, and, therefore, potentially changeable, necessities - neurotic behavior is the result. In other words, the compulsivity which is in essence an inability to alter a pattern of behavior is derived from a lack of knowledge of the underlying forces at work. This is not an abstract absence of knowledge in someone observing life, but a defect in someone participating in life. The operation of a neurotic equilibrium tends to preclude the possibility of knowledge. This is so because a neurosis is by its nature an individualistic technique of filling the gap referred to and has, therefore, to be safeguarded against any social influence which might expose the gap and undermine the structure and its functioning.

In attempting to approach dreams through the phenomenon of consciousness, one can begin by saying that there are two important characteristics common to dreams and to waking consciousness. First, both are reflections of the situation in which the person is involved. Second, both are felt reactions to the person's efforts to organize, integrate, and master stimuli in order to be able to engage in appropriate activity.

Dream consciousness has, however, other unique characteristics as compared with waking consciousness. Those which require explanation are, first, the general quality of being an unwilled, involuntary experience; second, the concrete, sensational form, usually as visual imagery; and third, the relation of significant meaning to the content.

THE INVOLUNTARY NATURE OF THE DREAM

Waking consciousness is associated with an active relationship to the events in the outside world, with communication, realized or potential, based on thought processes which in turn are derived from the use of language, and, in greater or lesser measure, with voluntary activity. Dream consciousness occurs, on the other hand, at a time when the outside world is excluded, when communicative needs disappear, and when voluntary activity is impossible. The person is simply engaged in the activity of sleeping, an activity which, once initiated, proceeds in an involuntary fashion, with physiological determinants playing the major role in its deepening and lessening, and, in the absence of outside influences, in the ultimate awakening. The person is carried along involuntarily through the various stages and the cyclic variations of the sleeping state. His consciousness no longer controls behavior in the direct fashion that characterizes the waking state. There may, indeed, be long lapses of time in which there are no manifestations of consciousness in any form.

Whenever the level of sleep is sufficiently light, whether as a result of external or internal stimuli or both, for the brain to be activated sufficiently, consciousness may appear in the form of a dream. This consciousness does not evoke voluntary behavior. But there is an indirect effect on behavior, for the dream can influence the level of sleep. The person is not prepared to deal with stimuli experienced in this transitional stage, whether from without or within, in the manner in which he would if he were awake - that is, through thought and action in the waking sense. He is involved at the moment in an involuntary process, the movement and change in the level of sleep. All that he can do is to reflect the stimuli in their relationship to these circumstances and through this reflection continue the awakening process if the tissue needs governing the depth of sleep are diminishing, or pave the way to a return to deep sleep if the tissue needs for sleep prove stronger than the arousing stimuli. In other words, the dream in its inception is potentially capable of facing in either of two directions. It is no more the guardian of sleep than it is the precursor of awakening. It may play a role in either process.[3]

Thus the involuntary character of the dream may be correlated with the fact that the activity reflected in the consciousness of the dreamer at the time is involuntary and under the control of agencies which to all intents and purposes might as well exist outside of what he considers to be his self. The concept of an "unconscious" to account for the involuntary upsurge of the dream presentations is an artificial psychological construct necessitated by the arbitrary separation of dream consciousness from the actual activity engaged in by the dreamer.

THE FORM OF THE DREAM

The dream form embodies the use of symbols, usually expressed as visual imagery, less often as auditory or olfactory experiences. The emotions which accompany such effects may range anywhere from great fright to sublime bliss. Once again this points in the direction of a biological explanation rather than a psychological one involving unconscious processes and censorship. The only problem facing the sleeping organism in relation to the outside world is whether or not it is safe to continue sleeping. Physical stimuli influence the sleep-waking balance by virtue of the intensity of their sensational effect. If they are not sufficiently strong to induce awakening, the person is swept back into deep sleep, and the dream invents a fictitious disposition of the offending stimulus. In other words, it is not the wish to continue sleeping that creates a wish-fulfilling dream, but the other way around. Objectively, the dream, following the activity of the dreamer - in this case, the return to a deeper sleep - depicts the elimination of the stimulus because it has in fact been eliminated by the counterinfluence of all the factors operating to maintain sleep. It is only in a subjective sense that the dream appears as a wish fulfillment. The situation is analogous in the case of psychological stimuli. The vigilance needs are best met by reactions that occur at the immediate and sensational level. This involves, in the case of psychological stimuli, the reduction of past conceptualized experience into concrete, sensory impressions.[4]

THE MEANING OF DREAMS

Viewed in relation to the above set of factors, the lack of logic and the distortions which appear in dreams do not serve the function of disguise. The dream is illogical and distorted because it is a subjective representation - a portrayal in visual terms - of the felt reactions to aspects of the current life situation; and because the dream itself is an involuntary form of activity, it deals with unmastered and hence involuntary aspects of experience. In other words, it provides a glimpse at the way in which the person experiences all of the forces determining his existence, over and above those of which he may be aware at any given time. The dream expresses his complicated relations with the outside world in a condensed and summarized form, permitting an immediate, unified response. The spatial and temporal condensations and distortions are illogical only when considered by the standards of the waking consciousness; they are logical in the context of the dream consciousness as it seeks to express at a sensational level the conflict between the mastered and unmastered aspects of the person's existence.

These considerations lead to a different explanation for the discrepancy between manifest and latent content than that usually assumed. The essential questions are, Why do dreams have to be interpreted? and, Why does their interpretation often open up new insights and aspects of the personality?

The answer to the first question is that a dream is not a communication, in contrast with waking thought, which is always, actually or potentially, a form of communication. Therefore, to have any meaning in the waking state, communicative elements have to be added to the dream. This is precisely what the associative process does as it brings into focus the conceptions that have been involved in the reduction process.

The answer to the second question again involves an understanding of the vigilance needs of the sleeping organism. The entire longitudinal experience is potentially available as the source of dream constructs. The dreamer, as Freud demonstrated, does not make a capricious selection. Whatever the current life situation is which the dream is concerned with and which forms the psychological stimulus, it cuts longitudinally through the personality so that its total subjective impact is exposed. It is experienced in the dream both as what it appears to be currently - an insignificant event, the day's residue - and also for the implications it has in reality for the total and historically constituted personality. If one is to be vigilant, one cannot afford to be expedient or involved in self-deception, and so the true subjective impact of an event is depicted in the dream. The explanation which clothes the event in the dream is a mixture of truth and myth, depending on how accurately the event is understood. When the person is awake and cushioned by familiar and habitual patterns of relatedness, these vigilance needs dissipate themselves and are often replaced by varying measures of expediency, rationalization, and self-deception, Hence the interpretation of a dream so often proceeds against what appears as resistance.

Why should the day's residue appear in the dream and play a role of such great importance? Freud tied it to the unconscious, saying that in relation to consciousness it was simply an incidental event. But when one regards human beings in action, it is apparent, as I suggested earlier, that some of the activity is rather accurately reflected in consciousness and can be constructively modified by consciousness, while some of it is unknown or inaccurately reflected in consciousness. In the latter event, there is a discrepancy between the nature of the activity and the person's understanding, and, hence, mastery over it; he can neither modify it nor predict its results. If the person is not so fortunate as to widen his consciousness and eliminate this discrepancy, he may, as he continues to engage in activity over which his consciousness has no control, develop an illusion of control. A myth arises, which takes the form of rationalizations in the neurotic and delusions in the psychotic.

The appearance of the day's residue in the dream is an event which by its nature can puncture a particular myth - that is, expose the gap between thought and action, between false ideas about oneself or others and reality. Such an event has three characteristics: First, in relation to the existing state of affairs, as conceived of by the person, it is incidental and insignificant. Second, in relation to the transformation it can effect in the person by virtue of its myth-puncturing qualities, it is of great significance. Third, it is of a disturbing nature because it constitutes a challenge to an existing set of conceptions which the person holds. The degree of threat is a function of the extent of development of the myth and the importance of the area of activities which it governs.

DREAM INTERPRETATION

The following clinical material is presented as an example of the interpretation of a dream along the theoretical lines described.

The patient was a 30-year-old physician in psychoanalytic training. He had entered treatment three years earlier, ostensibly because it was a requirement for his professional work, but also because of his difficulties in accepting his marriage, which had taken place a year before.

His life had unfolded thus far in a pleasurable and relatively untrammeled fashion. He had moved through school and professional life in an easy-going and casual manner, getting what he wanted without much apparent effort. His personality was ingratiating, and he had been popular throughout his school career, managing, in his own words, to be all things to all men. His sexual exploits had been daring, frequent, and generally short-lived.

He had felt pressured into his marriage and often stated his desire to lead a freer and less responsible sexual existence. He professed great respect for his wife and took all the blame for their difficulties. He had rejected the idea of having children because of his feelings of uncertainty about the marriage.

The analysis had been going along in a somewhat desultory manner, with spurts of movement occasionally breaking through a tough, encapsulating, impersonal approach. The events of both his marriage and his professional career, however, were making him experience more sharply than ever before his sense of passively drifting ahead in life and his reliance upon expedient and temporizing techniques.

In the period immediately preceding the first hour to be discussed, the patient had expressed feelings of disgruntlement and dissatisfaction with life sparked by a series of adverse events, all occurring within a relatively short period of time. First, his marital difficulties had flared up in a more critical way than ever before and had reached a point just short of an open break. In the past these periodic crises had been resolved without either partner's achieving a deeper grasp of the problems involved or any basis for effective action to alter the situation. On this occasion, however, his wife, who had long thought of entering analysis, finally did so. Second, the patient had been very upset on learning that his younger sister, the only one of his five siblings to whom he felt close, had been forced to take final steps toward a divorce and was returning home to her mother. Lastly, he had also been very distressed because his father, who apparently for the first time in his life was working at something he enjoyed, had recently been taken ill and was in need of hospitalization. In this family, the maternal grandfather exerted a very dominating influence, and the patient's father, of whom he was very fond, was regarded as a mediocrity because of his complete lack of talent for earning a living. He had in the past year taken up a new line of work which he enjoyed and which earned a modest but regular income.

In the few sessions immediately preceding the dream there had been a mutually intensified effort to tackle his passive, drifting attitude and the untenability of his position as someone playing a waiting game. He was nearing the end of the didactic portion of his training, and there was a growing realization that his colleagues were completing their analyses while he appeared to be stagnating in his.

Saturday, October 22

The patient began the hour by making final arrangements for a fourth hour each week - he had so far been in analysis three times a week. He then went on to discuss a class he had attended the previous Thursday night. The instructor, in discussing the case that had been presented, emphasized the patient's lack of seriousness in treatment and his technique of playing around during the sessions. My patient immediately identified himself with the situation and later felt somewhat relieved when another student admitted to him that he, too, had made the same identification.

His mood that Thursday evening was a mixed one, combining nostalgia for a less complicated and happier past, a sense of being caught up in a series of impending catastrophic events, and a feeling of things crumbling from under him - and at the same time a blind determination to do something about the situation in some way. He talked a little about his father, who cut a very pathetic figure as a man warm in heart and poor in business ability, and generally pushed around by other people. The patient spoke of his own feeling of having played around in treatment.

In the middle of the night he had been awakened by the following dream:

I was at a winter resort where there was skiing. I had been out skiing and had just returned after a morning in the invigorating sun. I came into the lodge. There was a blazing fire going in the fireplace. Food was being served. The arrangement, however, was something like an amphitheater. Everyone was sitting at various levels. They were using these armchair dining set-ups. Everyone was eating. At the top level, the ceiling appeared very high. The people on the top level were all calling for me. It seemed as though they needed me. There was no aisle, however, and I had to clamber and climb all over the people. I kept getting in people's way and stepping over them, so that every moment I was saying something like "Pardon me," or "Excuse me." Everyone, however, was quick to assure me that it was perfectly all right. Everyone seemed to be interested in my getting to the top, even though it appeared to me to be a tremendous intrusion on my part. I finally got to the top where I found a bunch of young collegiate-looking fellows. It was a real college atmosphere. They wanted me to be the top man on the pyramid. I climbed to the top amid great cheers and huzzahs.

After awakening from the dream he committed it to memory and went back to sleep, recalling it again only while seeing his own first patient the following morning.

In discussing the dream, he said:

It was as if everything I did was fine and I could write my own ticket. The feeling is very pleasant. It was a very spirited dream, filled with great cheer and vigor. I guess it shows my way of seeing the aim of therapy as a guy who reaches the top of the pyramid. ... of getting through with analysis as a requirement, of stumbling my way over people instead of working my way through, and getting away with it. My wife tells me that I get away with too much.

The patient was then asked for his specific associations, which were as follows:

Skiing. Thursday night in class, I had the feeling I was skimming along here in a cold, dispassionate way. You always pointed out how therapy is so detached from me, as something apart and cold.

Amphitheater. I think of medical school. There all of the classrooms had amphitheaters . . . . I often think of what an injustice I did myself as a medical student, how anxious I was and how little I thought I knew. It wasn't until eight or nine years later that it has become clearer to me how much I did know . . . how unnecessary all that anxiety was and what a distorted picture I had.

Being on top. My first thought is that it was a goal that had to do with appearances. What a fitting climax to a grandiose dream. It was a real "hail the conquering hero" atmosphere. I climbed all over everyone and messed up their trays. At the top the gang was waiting to crown me. I suppose this has to do with my never taking a stand, always acting in accordance with what is being expected and not in accordance with my real needs. I could be led to any position I ever wanted by using this "good guy" technique.

He was then asked what he thought of the dream. Did he regard it as pure wish fulfillment or were there elements of struggle in it?

It shows the conflict between the way I see myself operating, in the superficial, stationary way, and the pressure by you, me, and my wife to act differently. It seemed to have to do with my feeling of Thursday night of having to get down to brass tacks and work on problems one by one and stick with them until they are solved.

He was asked whether he saw all of this in the dream.

Well, I guess it isn't in the dream.-perhaps that's the part I forgot [facetiously]. This appears to be my inclination - that is, to get elected to the office - so I must get satisfaction out of it, but at a greater and greater cost. I haven't been getting away with it. You, my control analyst, my wife, pull me up short.

Again he was asked where he saw all of this in the dream. He replied rather sheepishly:

I guess it's not there. Are you suggesting that my dream points up my inability to realize that I see life and successful living as operating in this way?

I again indicated that I was concerned simply with following the dream and discovering what conflict or struggle it concerned. At this, he seemed to give up and said:

Yes, I guess I am leaning quite heavily on the part that isn't there or was forgotten.

I next said something along the following lines: The Thursday night case discussion had centered about the question of seriousness in the approach to treatment. The situation in the dream seemed to point in two possible directions. It depicted superficial and expedient aspects of the patient's behavior, symbolized, as the patient correctly analyzed it, by the winter resort, the attitude of the people, his attitude toward them, and the goal of being top man. The amphitheater, on the other hand, seemed to symbolize serious study, concern over accomplishment, and medical endeavor. Yet the reality of therapy as a serious medical endeavor was represented as simply a stepping-stone to grandiose heights.

The patient replied with a feeling of agreement and interest:

The amphitheater was certainly there but I guess it wasn't seen, it was so heavily camouflaged. It is amazing that I didn't see the interpretation in spite of all the associations I had to medicine . . . my medical school, serious work, and so on. One of my thoughts as you were telling me this was, what a beautiful dream it would be to teach by. This would be a good demonstration dream.

To take a closer look at the patient's activity during the hour, he depicted with great accuracy certain aspects of his own neurotic activity. Yet he did not clearly perceive the manner in which his real and healthy qualities were subverted in order to achieve his superficial and expedient goals of popularity and success. It was as if he were vaguely aware of these healthy qualities in himself, but had to be far removed from the situation before he could see them clearly, as illustrated by his belated discovery of his own abilities as a medical student.

While the event responsible for precipitating the dream and exposing the conflict between these aspects of the patient's personality was the class discussion that evening, similar interpretations had been made in the past without striking home in such a meaningful way. Thus it is of interest to consider what aspects of his equilibrium were shaken at this particular point and how they were dealt with in the dream. I have already mentioned the main contributory factors - the recent series of adverse events concerning his wife, his sister, and his father, as well as his increasing realization of his unsatisfactory progress in analysis. All of these factors assume a significant interconnection when one recognizes the patient's need for a stable home base from which to operate in his irresistible, irresponsible, and somewhat grandiose manner. He had, on the evening of the dream, had the feeling of things crumbling all around him; while this had been a frequent fantasy in the past, real life events had now brought it closer to realization. The classroom discussion aroused anxiety based on his sharp awareness of the inroads being made on his old way of life, and his ill-preparedness for a new and healthier mode of existence, the seeds of which were beginning to manifest themselves. His self-disparagement and self-effacement and his real vulnerability to exploitation arising out of his entrenched passivity stood in his own way and hampered the development of his own potential serious attitudes. The reality base, symbolized in the dream as the amphitheater, carried with it associations of being an unchangeable fixture universally found in all medical schools and having a quality of immovability and permanency. This was almost lost sight of in the dream. There was, however, a sharp awareness of how he had to upset others who were seated in the amphitheater in order to achieve his goal.

The patient, in his own attempts to deal with the dream, did succeed in giving meaning to the symbols, but he was not able to see them in their interrelationships and hence to understand the full implication of the dream. His response to the interpretation itself was of interest in its characteristic duality. It had, on the one hand, a strengthening effect, helping him to see more completely his peculiarly self-effacing yet grandiose activity, while on the other hand it played into these same trends, as witnessed by his altruistic surrender of the dream to the examiner as a contribution to scientific education.

Monday, October 24

The patient began this hour with associations to the week end and related a dream he had had the night before. He was then brought back to the dream of the previous session and asked for his reactions regarding the work we had done on it. The following dialogue took place:

Patient: You know, I have to fight against the tendency to depersonalize it. I seem to have to push down the inclination to see it as a beautiful teaching example .... All of this, I guess, goes hand in hand with my robbing this of the quality of being a medical or treatment experience.

Therapist: You wake up in the middle of the night in response to the dream, yet you describe the affect in the dream as pleasant. Was that the affect you recall on awakening?

Patient: The thing I was most struck by, as I recall, was the scramble through all of these people and the need to apologize. It seems the people I frustrate the most are the people who are most interested in my getting ahead. There is something else interesting. The dream terminated amid cheers and huzzahs and being on top of the world. I didn't awaken in sweat or excitement or fear ... perhaps I awoke because of the very thing I didn't feel. It reminds me of a situation I recall from medical school. We had an old professor of pharmacology. There were a bunch of dead-end kids in the class who used to kid around in the back of the amphitheater. They actually did things like light bonfires and sail airplanes. There was something of this feeling in the dream, and perhaps I awoke because I was making a shambles doing these acrobatics. Whatever it was we were doing, it was all detached from the diners. We had our own group up there. I felt no trepidation or anxiety at being on top of the pyramid. This is interesting too, because I am not a very courageous guy in terms of doing things like that. As a kid I was always warned about riding bikes in the street and all this overprotective business.

Therapist: In the first part of the dream, were you skiing alone?

Patient: There were other people on the slope. I walked into the lounge alone. I don't remember skiing with anyone. There is something strange about the whole thing. Here I was alone, with all the trials and tribulations of getting up to the top and all the inappropriateness you pointed out, yet it was a sunny day. My association is that this was my attitude to my problems. Sure I have problems, but so has everyone. Dr. K [a former teacher] used to tell me he didn't think I needed treatment. Wednesday night after class we all went out for a bite. N [a classmate] said he would be finished with his analysis by the end of the year. I was pessimistic about mine. He made the same remark about my not needing it. I guess it must be the bright sunny aura I give off.

Therapist: The dream seems to be somewhat satirical in so transparently depicting the goals as collegiate and adolescent: Perhaps the word sunny can be taken in its other meaning, sonny. The impact of the recent events around your father, your sister, your school, and your wife seems to have had the effect of shaking up the old order of things.

Patient: As you were talking, I was thinking that my practice is now 35 hours. It's fine, but I haven't been getting many referrals lately. My first thought was that my colleagues have gotten on to me and I am no longer able to pull this thing off as I did in my first year, when I was able to speak with great sophistication and caution and never get out on a limb. They seem to be growing, and I am not. Maybe I have reached my more valid level in their eyes. On this question of satirizing my goals, I don't feel I was doing it consciously in the dream, although, looking back on it, it does appear that way. Yet I cannot say for sure. It was like the feeling you get when you are horsing around .... There is something intoxicating about it. Satire implies a certain cleverness, whereas this sort of activity is more associated with ignorance and blindness. Something else also occurs to me. Here I am skiing down the slope, but I can't really ski very well . . . . I also began to wonder about life without Ann [his wife]. I saw myself as footloose and living a dilettantish life, and going with many sharp-looking women. It appears to be a good picture, yet it seems intolerable. In the past two or three days I have had the feeling, that I really couldn't go back to that life. I could move, I could go to Europe, but this business of meaningless relationships - I don't know that I could get away with it without examining myself critically.

The rest of the hour was devoted to a further exploration of the dream. His tendency to dissociate himself both from the dream and the interpretive activity around it had to be actively combatted. His associations brought out more clearly that despite the movie-hero ending, his concern both in the dream and upon awakening was focused mainly on the interplay between himself and the diners. He indicated quite clearly that behind the facade that beguiled people into thinking of him as well-adjusted lay ignorance and blindness. Anxiety arose when these techniques carried him to the point of almost total loss of contact with the reality situation. The two techniques he relied upon to restore his balance were both in evidence during this hour: emotional withdrawal from the entire episode and intellectual breast-beating.

To sum up, the day's residue in the dream - the discussion of the case presented in class - evoked some anxiety in the patient as it opened the way, in conjunction with other recent events, for the exposure of the manner in which his real ability was subverted for the maintenance of the illusion of being on top. As the dream progressed, voluntary elements - that is, reflective reactions about what was happening to him in the dream appeared in the form of his increasing awareness of his imposition upon other people in the process of climbing up. The climax of the dream and the felt reactions upon awakening had more to do with what he was doing to others and the way they accepted his activity than with the fact of his having reached the top as the conquering hero. This may have accounted for the arousal impact of the dream.

The specific symbols in the dream were concrete presentations of the various facets of his personality which played a role in the conflict. The winter resort set the stage around the problem of seriousness and his experiencing the therapy as a kind of cold vacation. The skiing scene was a remarkable expression of his shallow approach, the gratification he derived, the underlying ineptness he really felt, and, in a more subtle fashion, the compulsivity and involuntary nature of the mechanism - for once someone starts down a ski slope, his movement becomes less and less personally controllable and more and more dependent on forces outside of himself. The amphitheater as the standard equipment in a medical learning experience appeared as the underlying basis upon which all of this inappropriate activity took place. The setting included all the elements of warmth, food, youth, fun, self-centeredness, recognition, and almost complete license. This is his personal, although illusory, alternative to the prescribed realities before him. The interaction with the diners depicts his ingratiating, appeasing approach and his real success in fooling and beguiling others. The pyramid also admirably depicts the hollowness, precariousness, and immaturity of his goal.

The point was made earlier that the dream is a subjective reflection of unmastered aspects of the person's life experience. This is revealed in two ways in the dream presented. The patient is carried along to the top of the pyramid by the as yet uncontrollable aspects of his own character structure and by the help of others who are charmed into aiding and abetting this form of activity. His colleagues, through their unwitting participation, act as a sustaining influence for his neurotic patterns. The other problem requiring mastery has to do with the struggle to transform the amphitheater into its proper medical meaning and himself into a member of the learning group. Thus the therapeutic value of the dream lies in the fact that, however distorted the representations may be, they still relate to unmastered aspects of existence.



[1] Read before the Association of Psychoanalytic Psychologists, November 17, 1966.

 

[2] B.S., Coll, of the City of New York 35; M.D., New York Univ. Med. School 38; Intern, Morrisania City Hosp., New York 39-41; Assist. Res. Neurol., Monteflore Hosp., New York 41-42; Res. Psychiat., N.Y. State Psychiatric Inst. 42-43; Neuropsychiatrist U.S. Army 43-46; Graduate, Comprehensive Course in Psychoanal., N. Y. Med. Coll 48; Assistant Clinical Professor Psychiat, New York Univ. Coll. of Med. 59; Training Analyst, Comprehensive Course in Psychoanal. 51‑; Assist. Clin. Prof. Psychiat. N. Y. Med. Coll. 56-; Diplomate, Amer. Board Psychiat. and Neurol.; Fellow. Amer. Psychiat. Assoc.; Charter Fellow, Academy of Psychoanal.; Pres., Soc. of Medical Psychoanalysts 57-58.

 

[3] These considerations may be correlated with the findings of Magoun and others on the role of the ascending reticular pathways in the arousal reaction. The dream, whatever its content, is simply a psychological stimulus, and as such it is one among many stimuli impinging upon the subcortical centers regulating the equilibrium between arousal and the maintenance of sleep. The dream is, in effect, here considered both as a response to stimuli, psychological or otherwise, and in itself a stimulus in relation to the lower centers. The effect of any particular dream would depend on the intensity of the affective reverberations accompanying it. The point is that the content of the dream is not arbitrarily geared to the maintenance of sleep so that when waking occurs the dream has failed in its function. Depending upon the balance between the lower controlling centers, the dream may as readily have as its function the restoration of waking consciousness as the continuation of sleep. See Horace W. Magoun, "The Ascending Reticular System and Wakefulness," pp. 1-15; Frederic Bremer, "The Neurophysiological Problem of Sleep," pp. 137-158; and G. Moruzzi, "The Physiological Properties of the Brain-stem Reticular System," pp. 21-48; in Brain Mechanisms and Consciousness, edited by Edgar D. Adrian, Frederic Bremer, and Herbert H. Jasper; Springfield, Ill., Charles C Thomas, 1954.

 

[4] Elsewhere I have attempted to delineate the neurophysiological correlates of this reduction process. See "The Dream Process;" Psychotherapy (1955) 1:30-60; "Physiological Determinants of the Dream Process," J. Nervous and Mental Disease (1956) 123:45-48.