Some Aspects of the Dream in Psychosomatic Disease

Abstract

Sleep is a regression to a primitive narcissistic state when the ego attempts to recover from injuries to its narcissism by going back to earlier stages in instinctual development. These nightly regressions serve two purposes: They temporarily deny reality on one on one hand, and on the other hand block the motor portion of the brain center. A case of angioneurotic edema and one of convulsive seizure were shown to have had symptoms only during and after a dream state. In both of these cases, impulses to act out the conflict in dreams could not be exercised by the motor apparatus so that these energies seemed to reinforce the sensory apparatus and to increase internal perception. The increased internal perception produced dreams in which forbidden aggressive and instinctual drives were acted out in the dream state and the symptom complex was substituted for the thwarted motor discharge. In one individual the psychic charge was released through the vegetative system. There is some evidence for a familial and personal predisposition for skin disorders in this man. It can only be conjectured that the skin represented an erotic outlet which was equated in some manner to an earlier stage of sexual development. In the other case, an unendurable psychic conflict generated enough energy to stimulate the motor cortex and cause a convulsive seizure. This seems to have represented the ego's attempt to defend itself against murderously aggressive drives by regressing to an infantile stage in which rage and uncoordinated movements could be discharged without danger to the ego or offense to the super-ego. The symptoms in both cases seemed to represent a simultaneous gratification and punishment for forbidden sexual and aggressive strivings. It is commonly accepted that the actions during the day and repressed thoughts of that day may be portrayed in dream. However, it is less fully realized that symptoms may follow dreams; fairly frequently minor somatic symptoms, which appear most often in the morning, may be attempted solutions of unresolved conflicts in a dream of the night before. Such symptoms may appear 1) as safety valves against the appearance of repressed material 2) and/or as a harbor for libidinal energy. Endopsychi'c perception of illness in dreams has often been reported in cases of psychoses and in not a few cases of serious organic disorders. Some writers have even included death as having been predieted. In the presented cases, the temporal sequence of dream and disease is suggestive of the manner in which the unconscious may forecast organic illness. As an addition; in the above cases, suggestion under hypnosis prevented the reliving of a symptom by producing amnesia from the moment of conflict awareness, to a period several hours after the symptoms subsided. Thus the period when physiologic changes occurred was circumvented. By short-circuiting the psychic charge produced by a conflict the symptom-complex which usually followed could be avoided. This may offer some tentative evidence that symptoms anticipated in dreams can be avoided by other psychologic means. At the present time, psychoanalysis offers the best means for this.