The Interpretation of Dreams by Sigmund Freud
CHAPTER 1, Section H
 

H. The Relation between Dreams and Mental Diseases

When we speak of the relation of dreams to mental derangement, we may mean three different things: (1) aetiological and clinical relations, as when a dream represents or initiates a psychotic condition, or occurs subsequently to such a condition; (2) changes which the dream-life undergoes in cases of mental disease; (3) inner relations between dreams and psychoses, analogies which point to an intimate relationship. These manifold relations between the two series of phenomena were in the early days of medical science- and are once more at the present time- a favourite theme of medical writers, as we may learn from the literature on the subject collated by Spitta, Radestock, Maury, and Tissie. Recently Sante de Sanctis has directed his attention to this relationship. * For the purposes of our discussion it will suffice merely to glance at this important subject.

* Among the more recent authors who have occupied themselves with these relations are: Fere, Ideler, Lasegue, Pichon, Regis Vespa, Giessler, Kazodowsky, Pachantoni, and others.

As to the clinical and aetiological relations between dreams and the psychoses, I will report the following observations as examples: Hohnbaum asserts (see Krauss) that the first attack of insanity is frequently connected with a terrifying anxiety-dream, and that the predominating idea is related to this dream. Sante de Sanctis adduces similar observations in respect of paranoiacs, and declares the dream to be, in some of them, "la vraie cause determinante de la folie." * The psychosis may come to life quite suddenly, simultaneously with the dream that contains its effective and delusive explanation, or it may develop slowly through subsequent dreams that have still to struggle against doubt. In one of de Sanctis's cases an intensively moving dream was accompanied by slight hysterical attacks, which, in their turn, were followed by an anxious melancholic state. Fere (cited by Tissie) refers to a dream which was followed by hysterical paralysis. Here the dream is presented as the aetiology of mental derangement, although we should be making a statement equally consistent with the facts were we to say that the first manifestation of the mental derangement occurred in the dream-life, that the disorder first broke through in the dream. In other instances, the morbid symptoms are included in the dream-life, or the psychosis remains confined to the dream-life. Thus Thomayer calls our attention to anxiety-dreams which must be conceived as the equivalent of epileptic attacks. Allison has described cases of nocturnal insanity (see Radestock), in which the subjects are apparently perfectly well in the day-time, while hallucinations, fits of frenzy, and the like regularly make their appearance at night. De Sanctis and Tissie record similar observations (the equivalent of a paranoic dream in an alcoholic, voices accusing a wife of infidelity). Tissie records many observations of recent date in which behaviour of a pathological character (based on delusory hypotheses, obsessive impulses) had their origin in dreams. Guislain describes a case in which sleep was replaced by an intermittent insanity.

* The real determining cause of the madness.

We cannot doubt that one day the physician will concern himself not only with the psychology, but also with the psycho-pathology of dreams.

In cases of convalescence from insanity, it is often especially obvious that while the functions may be healthy by day the dream-life may still partake of the psychosis. Gregory is said to have been the first to call attention to such cases (see Krauss). Macario (cited by Tissie) gives an account of a maniac who, a week after his complete recovery, once more experienced in dreams the flux of ideas and the unbridled impulses of his disease.

Concerning the changes which the dream-life undergoes in chronic psychotics, little research has been undertaken as yet. On the other hand, early attention was given to the inner relationship between dreams and mental disturbances, a relationship which is demonstrated by the complete agreement of the manifestations occurring in each. According to Maury, Cabanis, in his Rapports du Physique et du Moral, was the first to call attention to this relationship; he was followed by Lelut, J. Moreau, and more particularly the philosopher Maine de Biran. The comparison between the two is of course older still. Radestock begins the chapter in which he deals with the subject by citing a number of opinions which insist on the analogy between insanity and dreaming. Kant says somewhere: "The lunatic is a dreamer in the waking state." According to Krauss, "Insanity is a dream in which the senses are awake." Schopenhauer terms the dream a brief insanity, and insanity a long dream. Hagen describes delirium as a dream-life which is inducted not by sleep but by disease. Wundt, in his Physiologische Psychologie, declares: "As a matter of fact we ourselves may in dreams experience almost all the manifestations which we observe in the asylums for the insane."

The specific points of agreement in consequence of which such a comparison commends itself to our judgment are enumerated by Spitta, who groups them (very much as Maury has done) as follows: "(1) Suspension, or at least retardation of self-consciousness, and consequently ignorance of the condition as such, the impossibility of astonishment, and a lack of moral consciousness. (2) Modified perception of the sensory organs; that is, perception is as a rule diminished in dreams, and greatly enhanced in insanity. (3) Mutual combination of ideas exclusively in accordance with the laws of association and reproduction, hence automatic series-formations: hence again a lack of proportion in the relations between ideas (exaggerations, phantasms); and the results of all this: (4) Changes in- for example, inversions of- the personality, and sometimes of the idiosyncrasies of the character (perversities)."

Radestock adds a few additional data concerning the analogous nature of the material of dreams and of mental derangement: "The greatest number of hallucinations and illusions are found in the sphere of the senses of sight and hearing and general sensation. As in dreams, the fewest elements are supplied by the senses of smell and taste. The fever-patient, like the dreamer, is assailed by reminiscences from the remote past; what the waking and healthy man seems to have forgotten is recollected in sleep and in disease." The analogy between dreams and the psychoses receives its full value only when, like a family resemblance, it is extended to the subtler points of mimicry, and even the individual peculiarities of facial expression.

"To him who is tortured by physical and mental sufferings the dream accords what has been denied him by reality, to wit, physical well-being, and happiness; so, too, the insane see radiant images of happiness, eminence, and wealth. The supposed possession of estates and the imaginary fulfilment of wishes, the denial or destruction of which have actually been a psychic cause of the insanity, often form the main content of the delirium. The woman who has lost a dearly beloved child experiences in her delirium the joys of maternity; the man who has suffered reverses of fortune deems himself immensely wealthy; and the jilted girl sees herself tenderly beloved."

(This passage from Radestock is an abstract of a brilliant exposition of Griesinger's (p. 111), which reveals, with the greatest clarity, wish-fulfilment as a characteristic of the imagination common to dreams and to the psychoses. My own investigations have taught me that here is to be found the key to a psychological theory of dreams and of the psychoses.)

"Absurd combinations of ideas and weakness of judgment are the main characteristics of the dream and of insanity." The over-estimation of one's own mental capacity, which appears absurd to sober judgment, is found alike in both, and the rapid flux of imaginings in the dream corresponds to the flux of ideas in the psychoses. Both are devoid of any measure of time. The splitting of the personality in dreams, which, for instance, distributes one's own knowledge between two persons, one of whom, the strange person, corrects one's own ego in the dream, entirely corresponds with the well-known splitting of the personality in hallucinatory paranoia; the dreamer, too, hears his own thoughts expressed by strange voices. Even the constant delusive ideas find their analogy in the stereotyped and recurring pathological dream (reve obsedant). After recovering from delirium, patients not infrequently declare that the whole period of their illness appeared to them like an uncomfortable dream; indeed, they inform us that sometimes during their illness they have suspected that they were only dreaming, just as often happens in the sleep-dream.

In view of all this, it is not surprising that Radestock should summarize his own opinion, and that of many others, in the following words: "Insanity, an abnormal morbid phenomenon, is to be regarded as an enhancement of the periodically recurring normal dream-state" (p. 228).

Krauss attempted to base the relationship between the dream and insanity upon their aetiology (or rather upon the sources of excitation), thus, perhaps, making the relationship even more intimate than was possible on the basis of the analogous nature of the phenomena manifested. According to him, the fundamental element common to both is, as we have already learned, the organically conditioned sensation, the sensation of physical stimuli, the general sensation arising out of contributions from all the organs (cf. Peisse, cited by Maury, p. 52).

The undeniable agreement between dreams and mental derangement, extending even to characteristic details, constitutes one of the strongest confirmations of the medical theory of dream-life, according to which the dream is represented as a useless and disturbing process, and as the expression of a diminished psychic activity. One cannot expect, for the present, to derive the final explanation of the dream from the psychic derangements, since, as is well known, our understanding of the origin of the latter is still highly unsatisfactory. It is very probable, however, that a modified conception of the dream must also influence our views regarding the inner mechanism of mental disorders, and hence we may say that we are working towards the explanation of the psychoses when we endeavour to elucidate the mystery of dreams.