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Freudian Slip: Do Dreams Still Have a Role in Psychiatry


Reiser contends that although Freud lacked the scientific data available today, he understood intuitively that talking about the significance of dream images through psychotherapy could lead the patient back to early traumatic memories. Freud thought that if the patient could be induced to recall repressed, painful memories -- and those memories could be aired and examined in the light of day -- they would be rendered harmless and the patient would be cured. "We no longer think that all," Reiser says.

But dreams can be used, he contends, to help a patient understand that the conflicting emotions he is currently experiencing are complicated by older, unrecognized emotions that are still meaningful, but just beyond his conscious grasp, a bit like a word at the tip of the tongue that just won't come to mind.

"In a way, [a dream] can show the patient that was then, and this is now," Reiser says. "You don't have to so terrified of offending your boss, just because you were so terrified of your father way back then."

Reiser emphasizes that dream interpretation won't cure a psychiatric disorder the way that penicillin will cure a bacterial infection. But dreams may be signposts along the road that can point the way to improvement. And here the "old school" of psychoanalysis finds itself in parallel with the "new school" of brain biology research.

"As a tool of the psychiatrist, dreams in fact probably do give you an insight into ... processes that are not readily accessible in waking," says Robert A. Stickgold, PhD, a neurophysiologist at Massachusetts Mental Health Center and assistant professor of psychiatry at Harvard Medical School, both in Boston.

Dreams are a kind of natural inkblot test, Stickgold tells WebMD. "This is the brain putting things together without intent, without design, without purpose, without understanding," he says. "It just knows that these are things that might be worthwhile for the brain to consider together, because they might help to explain something."

He says that during rapid-eye-movement (REM) sleep, the phase of sleep where dreaming occurs, there is an interruption in the flow of information out of the hippocampus -- the brain's center for learning and memory. Instead, the brain seems to be processing sporadic, disjointed images from another part of the brain, the neocortex, where fragmented visual memories, sounds, and random ideas are stored.

Stickgold likens the process of dreaming to doing a search on the world wide web: "If you do a web search and go down the list of items, the first two or three are usually spot on, more or less what you were looking for," he says. "Then there are four or five where you say, 'That's not what I was looking for, but I know why those came up.' And if you keep going down there are about 50 where you want to say, 'I didn't ask for these at all; I don't know where they came from.' The brain is just sort of futzing and doing some [formula] to try to find things that fit together, and maybe it works and maybe it doesn't."

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