Tuesday, March 6, 2012

A Trazodone induced incest-nightmare

A young man in his late twenties, who suffers from anxiety and obsessions, took Trazodone (Desyrl) for insomnia and had the following nightmare:

"It was weird man. I can swear it would not have happened but for that medication. It was so real and so frightening that I could not believe it was happening. I was busted for doing shitload of drugging and drinking. Put in jail. My wife was very against whatever was going on. Against me for what I had done.  She brought my [2-year-old] son and he wanted to hug his dad. You know how much I love my son, and how attached he is to me. But my wife was making it appear to him as if I was a piece of garbage. She was using my son against me. Deprive me of his love.

"Not just my son. Her sister was there too. In fact all her relatives, especially the Mom's side - the Mexican side - were there. Her mom, her grandmom, the entire Mexicans clan.  And I was stumbling in front of her grandmother. She was the one who speaks no English. She was the only one who was willing to forgive me. You know how Catholics are. They forgive you no matter what sin you commit. That must be the reason why the dream brings those Mexicans in to the dream. Those relatives of my wife are super religious people. But even they looked as if they were not willing to forgive me. Only the grandma. She was giving me hugs. Though I could not understand her, for she was speaking in Spanish. I was calling her Ayah. That is what her relatives call her. 

"And it is just not her relatives who are against me. In the jail there are people from my past. My buddy Jim is there. They are all major problems. For these buddies, the things we did together, were major problems. I have abandoned them. But they were back in the dream, and right inside  that jail. 

"And then it gets even darker. You know I am in jail and how things are in jail. There are big guys there, taunting me that I will be somebody's bitch. Somebody's homo bitch. One of them hits my buddy Jim. It is scary. It was like warning to me.  In fact the dream goes in to the Scared Straight Zone. There is a big back guy. He comes in the movies. He is a big ass black dude.  He was lecturing me as if we were doing the Scared Straight stuff. And I couldn't do anything about anything. I was like restrained.  Finally I woke up. In extreme fear. I would not go to sleep for an hour or so, the dream was so vivid and frightening.

Since the patient sees me just for half hour - he cannot afford more time than that - the individual elements of the dream could not be subjected to analysis, but there was no question that the entire thing was a series of punishment being meted out to the dreamer.  In fact there was hard to see any trace of any wish fulfillment anywhere. To sleep experts like Ernst Hartmann, Alan Hobson and Robert McCarley who do not see dreams as wish fulfillment, this would be a treasure trove of a dream. For it thoroughly contradicts the classical Freudian view as to why we dream. Hobson and McCarley will find it especially heart warming for the fact that the dream appeared totally chaotic and senseless to the patient. This so much supports the contention of their Activation-Synthesis hypothesis that dreams are nonsensical and generated by random stimulation coming from the base of the brain. As to why such a chaotic and senseless visual imagery would cause such severe fear in the patient that he could not go to sleep for an hour, would of course be asking way too much from those Harvard professors.

But I was not ready to give up the idea that the long series of humiliation - the derision of his wife, denial of the love of his son, the refusal to forgive him for whatever transgression he had done even on part of those super Christian Mexicans - was not a reaction on part of his conscience/superego for some momentous crime.

But what could be that momentous crime [wish] which had provoked such a series of  punishment?

For the whole dream is nothing but punishment in one form or other.  His doing drugs and alcohol - which he has not done for years - and getting busted for it! The  taunting that he'll be made into somebody's bitch - a homo bitch on top of it - his admonishment by the black film star in the style of  "Scared Straight",  his friend Jim getting pummeled and made into an example as to what fate awaits him - were more of the same.

Was there any hint of that crime/wish in the manifest content of the dream or had it remained shackled in strong repression and only the violent reactions to it had been able to attract the dream-consciousness?

Now we know that going to jail in dreams is often the manifest content of the wish to return to mother's womb - one of the primal fantasy of mankind. Both are places where one remains confined.

But why do humans dream of returning to the womb?

If life becomes too stressful or painful, the primordial memory of the womb and its safety becomes the sanctuary which one seeks to find;  if not in real life then in one's sleep/dreams. Also the forbidden wish to copulate with the mother, once the incest barriers are erected can only be fulfilled by entering into the womb as a whole person. The dread of incest/castration is so strong that entry into the mother through copulation becomes impossible and the dreamer has to substitute his entire person as a substitute for the penis.  I will not be surprised if more thorough psychoanalytic investigation shows us that many habitual offenders, who prefer confinement over living on the outside, are not fulfilling the womb fantasy in a very distorted fashion, and acting it out in real life not just in dreams.

We also know that  this fantasy to return to the womb to escape from the painful world, when indulged in real life or in dream, hardly brings any happiness. In dreams one's rivals from the childhood, the father, the siblings, and their substitutes in the larger society, they return too  to prevent one from enjoying the fulfillment of this most forbidden of wishes. And in my patient's dream we can see how a whole slew of people were out to spoil his pleasure of being reunited with his mother. The fear that he will be made into a homo bitch in the prison was again a dread of his being subjected to the same treatment by his father which he wanted to subject his mother.

Some of his other dreams from the past on analysis had shown how his dread of his father for the forbidden Oedipal wishes had bred a desire to placate his father with homosexual submission, which he energetically repudiated and which only emerged, and very indirectly, in his dreams.

"Why was the grandmom, the one you were calling Ayah, giving you hugs? I asked the patient.

"I don't know. But she was the only one in that whole frigging dream, who was not against me."

"Is it because you two were kind of exchanging affection while everybody else was like condemning you for doing that?"

"Yes. It makes lot of sense. That old Mexican lady, she  reminds me of my mother. I could do anything wrong but could still count upon my mother to always be on my side and forgive me. Now she is gone, and I look upon this Mexican lady as my Mom. She is so kind, and looks so helpless, just like my mother was when she was dying and I had to take care of her for almost two years as she lay terminally ill."

"What was the role of Trazadone in all this?" I asked him.

"You know how these psychiatric medications sometimes can bring up the most weird-ass things to the surface. I think the Trazadone just made my mind to dream whatever I was dreaming."

I did not disagree with the patient loudly but I could not help but think that he should be made a Harvard Professor of psychiatry too, for they too, like him, believe that a pill or random signals running up from the Pons to the Cortex can produce dreams.

However, the more correct explanation would be that Trazodone caused enough arousal in the brain that his dream-thoughts  which on other nights would not have attracted consciousness did so on that particular night. For dreaming state is a state of partial wakefulness. The PGO (Ponto-geniculo-occipital ) waves during REM sleep are not responsible for producing the dream thoughts, they are responsible for producing a state of partial wakefulness, which enables dream-thoughts to be perceived, and which gives us the illusion that we are awake and watching what is happening in the dream as if it is real.