15 - 3. Dynamic interpretation of dreams

3. Dynamic interpretation of dreams

© SPMM Course 3. Dynamic interpretation of dreams

Freud was initially trained as a neurologist. Joseph Breuer & Freud together treated Bertha Pappenheim, (Anna O.), after which hypnosis became a psychoanalytic technique. Freud later used the cathartic method of abreaction - the process of recovering and verbalizing suppressed feelings that cause the symptoms. However, Freud encountered patients who could not recall significant memories – he called this resistance. He later proposed resistance to being caused actively by largely unconscious forces involved in repression - which leads to symptom production. This made him abandon abreaction/catharsis and pursue free association – where patients are allowed to ‘speak their mind’ without censor.

Patients often reported their dreams during free association - Freud noted that dream content was related closely to repressed memories and unconscious. Freud declared dreams were the ‘royal road to the unconscious’. According to his wish fulfillment theory, dreams are attempts to fulfill unconscious wishes in a surrogate manner.

The content of dreams may include nocturnal sensory stimuli (e.g. thirst, hunger, etc.), the daytime residue (thoughts and ideas from waking life), and repressed impulses.

Freud distinguished two types/layers of dream content - manifest content refers to what is recalled by the dreamer; latent content refers to unconscious thoughts and wishes that threaten to awaken the dreamer. The unconscious mental operation by which latent content is transformed into manifest content is called the dream work.  Condensation - several unconscious impulses are combined into a single image in the manifest dream content. e.g., One’s father and the horrible teacher may be unified and occur as a single dreadful monster in a child’s dream.  Irradiation or diffusion – this is the converse of condensation where multiple images in dreams represent one unconscious impulse  Displacement refers to the transfer of energy from an original object to a symbolic representation of the object. It is not the mere formation of alternate substitute but includes transfer of affective energy on that substitute – cathexis.  Symbolic representation - highly charged objects or abstract concepts could be represented by using innocent images that were in some way connected with the original object. e.g., a dream of intense dancing may represent one’s desire to attract a colleague sexually.  The mechanisms of condensation, displacement, and symbolic representation characterize the primary process thinking that defies logic, lacks a sense of time and space, can accept

© SPMM Course Notes produced using excerpts from  Casey, P. & Kelly, B. (Ed) Fish’s Clinical Psychopathology. 3rd ed. RCPsych publications.  Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 10th Edition. Lippincott Williams & Wilkins 2007  Vaillant GE. Adaptation to Life. Boston: Little, Brown; 1977  http://www.eric.vcu.edu/home/resources/pipc/Other/Personality/Table_Defenses.pdf  Semrad E: The operation of ego defenses in object loss. In The Loss of Loved Ones, DM Moriarity, editor. Charles C Thomas, Springfield, IL, 1967; the presence of contradictory items simultaneously, and often incoherent. (This primary process thinking is the modus operandi for Id – refer below).  A more mature aspect of the ego helps to organize primitive aspects of dreams more coherently; this is called secondary revision. The process by which secondary revision occurs is called secondary process – this is logical, with intact time and space boundaries and is mature.  According to Freud, anxiety dreams reflect a failure in the protective function of the dream-work mechanisms.  Punishment dreams defy wish fulfillment theory – Freud explained that these dreams existed as a compromise between conscience and repressed wish. The wish for punishment is supposed to exist as an unconscious wish.

DISCLAIMER: This material is developed from various revision notes assembled while preparing for MRCPsych exams. The content is periodically updated with excerpts from various published sources including peer-reviewed journals, websites, patient information leaflets and books. These sources are cited and acknowledged wherever possible; due to the structure of this material, acknowledgements have not been possible for every passage/fact that is common knowledge in psychiatry. We do not check the accuracy of drug related information using external sources; no part of these notes should be used as prescribing information.