24th October 2023

Dreams

The most likely aspects to be tested on in your MRCPsych Paper A exam will be the definitions of the methods used by, and conceived by, Freud in relation to his psychoanalytic practice and work on dreams. These terms are all underlined in this section of the chapter, but included is some background to Freud and his theories to provide you with context to help better understand them and his thinking.

Sigmund Freud

Following medical school, Freud trained first as a neurologist, including a year of study in Paris with Jean-Martin Charcot (known for Charcot’s triad, foot, etc.). He was also influenced by a couple of other clinicians who both taught him hypnosis. After this, he returned to Vienna and began clinical work with hysterical patients. In collaboration with Joseph Breuer, an older and well established clinician, they treated a woman, referred to as Anna O, using hypnosis. They noticed that in this hypnotic trance state, the patient could relive a traumatic event and consequently release the associated emotions, a process they called abreaction. This, however, did not work on all patients, with some unable to access their memories during this process. Freud referred to this as resistance, which felt to be caused by the unconscious process of repressing such memories. Subsequently, he switched to adopt a technique called free association whereby the patient was encouraged to say whatever came to their mind.

Interpretation of dreams

During Freud’s clinical sessions, he noted patient’s dreams were often brought up during free association, and so in his landmark publication, The Interpretation of Dreams (1900), Freud proposed a theory that dreams were partly an experience of expressing repressed impulses or wishes. He also noted that dreams could include fragments of day residue (thoughts and preoccupations of the dreamer’s current life) and nocturnal sensory stimuli (pain, hunger, urge to pass urine).

Freud distinguished dreams into two layers – manifest and latent content. Manifest content is what could be recalled on waking by the dreamer, whereas latent content is the unconscious thoughts and wishes that threaten to wake the dreamer. Dream work was defined as the unconscious process of transforming latent content into manifest content.

Freud also described various different processes that could occur during dreams; he referred to these as the four primary process mechanisms:

Condensation – The mechanism of combining several unconscious wishes, impulses or attitudes into a single image in the manifest dream content. An example of this would be a scary monster (the image) appearing in a child’s nightmare, representing the unification of various people in their life (parents, teachers, bullies) as well as possibly their own repressed feelings (anger, frustration).

Irradiation/diffusion – This is the opposite of condensation, where a single unconscious wish, impulse or attitude is distributed into multiple images in the manifest content of the dreamer.

Displacement – The mechanism of transferring energy (cathexis) or feelings from an original object (e.g. the dreamer’s mother) onto a more neutral, symbolic representation of the object (e.g. an unknown female). The purpose of this is to obtain the dreamer’s repressed thoughts or impulses related to the mother.

Symbolic representation – The representation of intense ideas or complex feelings towards a person in the form of a simple or innocent image that was in some way connected to the idea or object involved.

Secondary revision

Primary process dreams were expressed as strange, unusual, or abstract images that were difficult to understand. When dreams became easier to understand and more rational, he referred to the process as secondary revision. This was felt to be related to more mature activity and thoughts during waking life.

Types of dreams

Affect in dreams – Secondary emotions could be completely absent from dreams, appear as their opposite feeling, or occur in an altered manner.

Anxiety dreams – Freud saw the primary processes and secondary revision mechanisms as a way to release unconscious impulses. If the dreamer had anxiety in their manifest content, then he felt these mechanisms had failed in their function to protect the dreamer.

Punishment dreams – Freud felt a dream containing the experience of punishment represented a compromise between a repressed wish and the conscience (responsible for repressing the impulse). The repressed wish for punishment is satisfied by the expression of punishment fantasies in manifest dream content.

References

• Sadock, B.J., Sadock, V.A., & Ruiz, P. (2015). Kaplan and Sadock’s Synopsis of Psychiatry:
• Behavioral Sciences/Clinical Psychiatry (11th ed.). Wolters Kluwer. 153-154.