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Freudian Slip: Do Dreams Still Have a Role in Psychiatry

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March 12, 2001 -- Sigmund Freud called dreams the "royal road to the unconscious," but in many circles his ideas are as fashionable today as high-button shoes, corsets, and the turkey trot.

Scratch a psychiatrist today, and you'll more likely find under the surface someone who believes dreams are not a "royal road" but a blind alley filled with the randomly discarded trash of a day's experience.

On one side of the aisle are psychotherapists, many of whom believe dreams are a key to unlocking and liberating repressed memories of past traumatic experiences. On the other side are neurobiologists, many of whom hold that dreams are just byproducts of electrical activity -- random firing of brain circuits during sleep that cause bizarre images and weird associations.

As J. Allan Hobson, MD, professor of psychiatry at Harvard Medical School, told WebMD in an interview last year, dreams are essentially a form of delirium.

"You have visual hallucinations, you have memory loss, disorientation, ... confabulation; that's delirium by definition," he said.

But maybe, says psychiatrist Morton Reiser, MD, in an article in the March issue of the American Journal of Psychiatry, dreams are neither totally random and meaningless nor the answers to all the mysteries of the soul -- but rather a middle path between the acolytes of the brain (biologists) and the high priests of the mind (psychoanalysts).

"The place of the dream in psychiatry is shifting toward a more interesting and prominent position than it occupied in recent years, when we were being urged to regard it as a byproduct of brain stem physiology without intrinsic psychological significance," writes Reiser, MD, who is professor emeritus of psychiatry at Yale University in New Haven, Conn.

With the availability of sophisticated brain imaging techniques and improved understanding of what goes on in the brain during sleep, dreams have become "an ideal subject for experimental exploration of the relationship between mind and brain, which has always been an issue of central importance in psychiatry. And, as we become increasingly appreciative of the dream as an integrated product of adaptive mind/brain functions, the therapeutic potential for working with the dream clinically should become increasingly clear," Reiser writes.

Freud set forth his theories about the importance of dreams in his landmark work The Interpretation of Dreams, published in 1900. By his own admission, Freud never could figure out what women wanted, but when it came to understanding the importance of dreams, the old boy may really have been on to something, says Reiser in an interview with WebMD.

"I think there's so much emotion about Freud one way and another, but his statement [about dreams being the royal road to the unconscious], taken in the context of 1900, wasn't so bad," he says. "I would say that even then, I don't think he meant that dreams were the only road, but that dream images can lead us to convincing memories."

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