What can be said of the naked manifest dream?

 

A clinical experience the other day led me to revisit a long-standing psychoanalytic controversy.

One of my patients told me that she had remembered a small piece of a dream. She is in termination phase and is only reluctantly appreciating the profound changes that have occurred as a result of the analysis. The session was filled with negative thoughts. Nothing had changed, she was depressed and feeling hopeless etc. In the last third of the hour, she reports a dream which goes as follows: I dreamt I was in my home and I suddenly discovered an attic, like an extra space I never knew existed. Later she added: It was big…you could stand up in it. In her brief associations, she mentioned that the attic in her home was actually more a crawl space not somewhere where one could stand.

The reported dream in psychoanalysis is called the “manifest dream.”  Freud’s initial theory of mind concluded that the bizarreness of dreams is a consequence of the effects of disguise and censorship combined with need to represent conflict in pictures. Freud was adamant that to understand a dream, one had to follow the extensive associations a patient provided to each small piece of dream material. He insisted only then could the latent dream thoughts be revealed. The dream itself was nothing more than a reworked defensively packaged amalgam, a piece of “bric a brac”.  Over the years many psychoanalysts have questioned this point of view and felt the “manifest content” to be replete with meaning as a creation on its own. Using Freud’s famous “Irma dream”, some notably Eric Erickson, have attempted to demonstrate that many of the key conflicts could be demonstrated in the manifest dream material itself without extensive associations.

Theoretically I adhere very much to Freud, but for many years, I have felt that the manifest content does have a unique value.  The “manifest dream” (that which is reported to the therapist) is an exquisite “compromise formation”; like all mental products, the result of the interplay of wishes to reveal and to disguise, instinct and defense. However, as the state of sleep (and associated motor paralysis) requires less strenuous censorship, the resulting dream is very frequently, a revealing self-portrait; a partly involuntary representation of the state of the ego itself.

In my view, the structure of the dream space, the metaphorical symbolic structure and the “action” of the manifest dream does correlate well to the flexibility, competence, confidence of that individual in solving his problems in his awake state, in other words the state of his ego.

To return to the problem at hand, the patient is in termination phase. This means that part of her wants to go on with her life and part of her wants to stay with me. On the surface, we hear how everything is terrible, nothing despite our work has changed and life is hopeless. BUT she dreams and reports to me of “suddenly finding ‘more room’. In the setting of termination and her reluctance to appreciate that our goodbye is approaching, she fights with me about her progress yet her dream reveals in the manifest content her expanding inner world. With few associations, the analyst can be fairly clear that she is experiencing growth. I am aware that it is always a possibility, as some analysts might point out, that this could be a dream of “compliance” and that she is trying to be a “good girl” in her dream life but the timing of the dream, the surrounding contrary material makes me more convinced of its veracity.

As I listen, I have a few more associations of my own which I “tuck away”. The attic is a place where one puts discarded “old things”. The attic could represent a place where secret/sexual things go one while kids hide from parental authority. Does her discovery of an “attic” indicate more of a willingness to address early childhood sexual wishes and will more of the patient’s past be revealed as she explores her “attic” in the remaining sessions?

The “house” dream symbol beautifully represents herself, her body with the “attic” at the apex (head) but it is also a universal symbol of mother. This individual, who felt clearly emotionally suppressed by her “mother” may now be aware of being able to “stand up” to her as an adult and, in the transference, to “stand up” to me. That the attic was “discovered” suggests it was there all along (as a potential) but had been subject to repression.

My point more generally is how this snippet of a dream, without associations, can be fruitfully understood as an internal ego/self representation. Even when a dream seems particularly murky, or often when a patient is unable or unwilling to provide associations to individual dream elements, it can still prove valuable in the immediate moment as a statement about the treatment and the patient’s relationship to the work.

I would emphasize that the dream, as a result of its regressive (topographic) nature has much more to reveal, primarily about early fantasies/memories of childhood and deeper instinctual longings, the recovery of which is central  in redressing neurotic conflict. Freud, as usual,  is correct in emphasizing that patient associations are key to unearthing this richer and more subterranean material.

However, as a snap-shot of her psychic world, in the physical/spacial language of dreams, my patient is telling us that as a result of  our work, we are fulfilling Freud’s anticipated analytic outcome “Where id is, there shall ego be”.

 

The Dream Screen/Isakower Phenomena and “self-cutting”.

Recently I posted some thoughts about the peculiar symptom of self-cutting. I indicated that the solution of self-cutting lay with the “skin” being the special sense organ that first mediates between an “interior” and an “exterior”. As such it plays a central role for the baby in his gradual discovery of an “outside” including the discovery of need fulfilling objects which ultimately leads on to the discovery of the “other” (mother).

Recently I came across some very similar ideas in a paper by Bertram Lewin “Reconsideration o the Dream Screen”. From the central idea that dreams are wish-fulfilling and serve to prolong and protect sleep, Dr. Lewin had suggested, via a series of clinical observations, that the dream is projected (as in dream screen) by the sleeping infant onto the white curved surface of the (phantasized) or real breast of the mother as the baby sleeps in her arms. The “screen” reported frequently in adult dreams is curved and often blank akin to the breast itself.  In the paper referenced above, he adds his observations to those of Otto Isakower and the so-called “Isakower Phenomena”. This was a hypnagogic  experience of a doughy, rough, dry crumpled feeling in the mouth,  poorly localized, which represented the experience of being partly crushed by the feeding breast as it looms overly large in front of the nursing child. I will quote: “The distinctions between different regions of the body is blurred, as well as the distinction between the mouth and the skin and between the inside and outside of the body”.

The early satisfactions of the nursing situation with mother is central to the successful development of the pleasure-unpleasure ego and ultimately the core core optimism of the individual. A bad mother-baby interaction can, in my judgment, frequently result in the chronic negativism, depression and demoralization most self-cutters experience. It would then be most natural, for such an individual, at times of great stress, to attack the one sense organ that maintains in unconscious memory traces its distant connection between himself and “mother” namely the skin.