One of my morning patients on Tuesday reported a dream in which three approaches to solving a problem were portrayed-one avoidant, one excessively aggressive, and the third a strong but tempered and effective response. Of course the dream itself, as dreams do, conveyed these ideas with vivid images and a rather extreme story line. Without my prompting, the patient interpreted the dream to mean that he was beginning to be free enough of old conflicts and psychological roadblocks to chose a new approach.

A couple of hours later, at lunchtime, I picked up the Science Times, a section of every Tuesday's New York Times, and saw Benedict Carey's story, "A Dream Interpretation: Tune-ups for the Brain". Carey is a great mental health and psychology reporter, and as usual he tells the story well. A new paper by sleep researcher Allan Hobson claims to have discovered the "main function" of REM sleep--to "tune up" the brain for the day's work. Hobson seems to be arguing that those who think there is psychological meaning to dreams, like psychoanalysts and my patients, for example, can now be shown to be self-deluding romantics. I was curious how Dr. Hobson, having discovered a new function for dreaming, could conclude confidently that this was the main or only function served by dreaming.

What puzzles me the most in these kinds of arguments, besides the familiar "gotcha" attitude towards my field, is the persistent bent towards dichotomous thinking. Personally, I feel so done with the idea that we have to figure out if something is psychological or physiological. If it has meaning or it is neurons firing. If the brain is tuning up to run, or processing input from the day before. It doesn't have to be one or the other. It's nature AND nurture, brain AND mind, physiology AND psychology. Researchers interested in the interface between psychoanalysis and neuroscience have begun to locate, on fMRI, things like transference, empathy, affective regulation. I am excited about the possibilities that lie ahead to integrate meaning making and psychological development with new discoveries about brain function.

Dr. Hobson goes on to report that he has found that "dreaming is a parallel state of consciousness that is continually running but normally suppressed during waking". Wait a minute. Isn't this a perfect description of the unconscious? Maybe even neurophysiological evidence for the existence of the unconscious?

In my clinical work, I relate to dreams as stories a patient constructs using images, plays on words, narrative twists, juxtapositions, and emotional saturation to communicate to himself and to me something that cannot yet be told in ordinary ways. Actually, this fits with Dr. Hobson's idea that "dreams are tuning the mind for conscious awareness". But he seems to be referring to the mind at its most mundane level (just being awake) while I see a dream as a way of preparing the mind for awareness at the very highest levels-of complex meanings, painful feelings, new possibilities. I am always struck by how much more creative we can be in our dreams than in our waking life.

Psychoanalytic Excavation

A Look at What Lies beneath the Surface of Human Behavior and Motivation
Prudence Gourguechon, M.D.

Prudence Gourguechon, M.D., served as President of the American Psychoanalytic Association from 2008-2010. She has a clinical and consulting practice in Chicago.

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