Interpreting signs and symbols

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The disturbed perceptual experiences of delirium, for instance hallucinations and delusions, have been shown to be significantly absent from those of more florid neuropsychiatric disturbances (Trzepacz et al., 2011). Such a difference is believed to be as a result of neurocognitive impairment resulting from failure of the patients generalised brain function (Carpenter, 2014). However, vivid dreams and nightmares are often associated with the onset of delirium. Therefore, the presence and or conspicuous absence of signs and symbols expressed by the patient’s unconscious in dreams may enable health care professionals to identify the pernicious onset of subsyndromal delirium and perhaps differentiate it from full syndromal delirium. The reason being is that if the patient's psyche is capable of generating normal, healthy dreams, i.e. an intact virtual sensorium during sleep, then it would suggest their brain is optimally functional, given that dreaming serves as the basis of protoconsciousness (Hobson, 2009). As such, methods of interpreting the content of dreams may be applied to patients at risk of delirium to test any of these hypotheses.

Dream interpretation is haunted by the conceptual methods of hermeneutics that have composed the majority of its developmental legacy. Indeed, the term hermeneutics itself derived from the Greek messenger of the gods, Hermes, betray this scandalous origin in mysticism (Smythe, & Baydala, 2012). The interpretation of dream content has largely been based upon cultural interpretive methods such as the cipher method and the analogous symbolic method. The cipher method is based on the assumption that dream content is a code that can be understood by translating it into an already established code. Examples of this include the use of dream dictionaries. The analogous symbolic method is derived from the prophetic tradition of dream interpretation and serves to replace the dream content as a whole with an analogous intelligible comparison. Often this method focuses upon forecasting the future and many examples can be found in the Old Testament (Freud, 1900). In contrast to these pre-scientific methods, Freud proposes the use of free association. Free association is based upon the premise that the components of the dream have two dimensions, the manifest content and the latent content. The manifest content is that which is experienced by the dreamer when asleep. The latent content is the result of unconscious psychological processes such as condensation, displacement, (Freud, 1900). The latent content is unconscious, and hence is composed of processes, of which we are unaware, that are involved in producing the manifest content. The purpose of free association is to highlight the latent content and integrate it with consciousness so that it would add insight into the problems experienced by the patients.

The difference between symbols and signs in the experience of dreams also needs to be stated. The nature of signs is that they are codified elements that link and connect an element with another in a chain of association, encoded by our memory systems. Symbols have aspects of this sign encoding and processing, but have an additional dimension, a more affect driven dimension that is beyond conscious thought and experienced as numinous. Such symbols transcend the faculties of rational thought and connect the individual psyche with the ontological category of the transcendent (Beebe, 2004). In mythology, it is through the symbols that complexes which are unconscious can be understood by the conscious ego as well as by empirical observers (Cambray, 2001). Building upon the method of free association, Jung employed an expanded model of dream psychology. The methods and theory were derived from his conception of the psyche as a whole. Although free association enabled a patient and therapist to identify through the connecting of images and thoughts the structure and function of the unconscious complex, within the dream itself, there were dimensions of symbols that could not be traced back to memory experiences. They were by definition transcendent of the person’s life. They were representing something new in the person’s life, but old in the sense of being a phenomenological expression of the phylogenetic psyche. These symbols were based upon archetypes (Kuburski, 2008).

The archetype was an evolving concept to Jung and no clear definition of it exists (Hogenson 2004). Jung described them as forms without content, and environmentally dependent. He also made the distinction between archetypal expressions which were composed of archetypal images (and their ideas) and the archetype as such, which is described as the 'irrepresentable' existence of the archetypes (Jung, 1959). Modern researchers have redefined the archetype as an 'image schema', 'action pattern', 'domain specific algorithms', and ‘mathematical principle of organization in a non-linear system' (Hogenson, 2001; Knox, 2003; Hogenson, 2009; Stevens, 2013). Modern neuroscience talks of neurognosis in terms of the knowledge of our experience as being derived exclusively from the underlying neural substrate. The initial organisation of the brain mediates its functions of experience and cognition (Laughlin, 1996). The structural and functional components of the brain laid out during foetal and early infancy have significant genetic and molecular guidance. Given that these components are unknowable in and of themselves, only the temporal and perceptual dimensions of them can be known. This indicates that these inherited functional units are the neural substrate of the archetypes of the collective unconscious (Laughlin & Loubser, 2010). The neocortex being a complex neural system that is based upon a 'cognitive imperative' in turn composes a coherent understanding of all domains of experience (d'Aquili & Newburg, 1999). This cognitive imperative drives the neurognosis function by integrating altered states of consciousness with symbols from the collective unconscious to produce for example, mythological motifs (Laughlin, 1996).

According to Jean Knox, the ‘irrepresentable’ archetype as such, is based upon the neural substrate of the image schema. This construct develops from bodily experience, as encoded by multimodal imagoes in the ventro medial prefrontal cortex (VMPFC) and forms the foundation for abstract meanings. These schemas have the dual function of creating an interpretive order for the external world and the internal world of metaphor. These components, then serve as the abstract scaffolding by which images and other symbolic contents can then be integrated with to create the archetypal symbol. Such an account of archetypes negates Lamarkian explanations of the origin of these very real phenomena of the psyche (Knox, 1997, 2004). Encoding of stimuli that is highly affective to the ego complex involves roughly three main psychological processes. The first is internalisation, whereby abstract cognitive models of the external world are built up and amended over time. Such a complex connects the external world and the internal emotional responses. The second is identification, where the ego is altered due to the associative coding of the represented object from the environment where typical examples include authority figures such as parents and teachers (Sandler 2012). The third is introjection, which is dedicated to the development of internalised regulation of the ego via the superego (Perlow, 1995: 91). Although the existence of mythological motifs in culture and their parallel manifestation in the dreams of patients rendered this enough evidence for the existence of the archetypes, the reason behind the existence of particular mythological motifs is still the subject of active research (Jung, 1959; Goodwyn, 2013). For instance, cognitive anthropologists have attempted to account for the existence of cross-cultural mythological motifs and rituals within religion by examining the possible cognitive mechanisms that would be required in establishing these collective phenomena. Dan Sperber proposes that generational transmission through a culture of motifs is not an exact replication, but is complex and based upon the constraints of our neurobiology (Sperber, 2000; Sørensen 2007).

The inability of the ego to directly understand the archetypes is due to their expression through the non-ego neural substrates, namely the complexes (cognitive schemas). In dream symbolism there is a convergence of the personal and the collective. Personal in the sense that memory traces, encoded as imagoes (structural and functional units of complexes) by the VMPFC and linked to unconscious psychological processing systems, are influenced by the self-reflective manifestation of the evolutionary derived psyche, the collective unconscious (Jung, 1959). As an analytical technique to understanding symbolism from the unconscious, amplification sets out a method to explicitly establish the parallels between archetypal symbols and mythological motifs. This of course is in stark contrast to the method of free association which links the images and symbols to personal experiences. The comparative study of myths enables the therapist to draw attention to the collective, and hence evolutionary, aspect of these symbols (Jones, 2003). This shift in focus both strengthens the therapeutic alliance and emboldens the patient to contextualise this particular experience with the rest of their life (Samuels et al., 1986; Cambray, 2001). In post-traumatic stress disorder resulting from florid delirium and associated nightmares about hospitals, such techniques may be part of an integrated therapeutic modality aimed at enhancing recovery from the patient’s traumatic experience (Drews et al., 2014). At the very least such techniques may enhance contemporary attempts at a qualitative analysis of the phenomenology of delirium.