She prefaced that the dream could equally well be considered a hallucination. She was kind of awake while dreaming it, aware that the frightening thing that she was seeing was a dream and that her mother and daughter were sleeping in adjacent rooms, and that she should get out of the bed to end the nightmare, though whenever she would attempt to do so she would find herself paralyzed to move and thus unable to get up and stop the dream/hallucination.
I told her that for practical psychotherapeutic purposes dreams and hallucinations can be treated alike. One has to pay attention to the associations that emerge in both cases to reach to the mental complex from where the dream/hallucination was originating.
And she narrated the following:
I am in my room, sometime in my mother's room. It really does not matter. The point is I have to reach her. And whether she comes to my room or I go to hers it is the same. But on seeing her I notice that she is not my mother. Well, she is my mother but at the same time something has changed. Her hair is jet black, her face pale, her body just bones, skeleton-like. She even moves in a jerky fashion, like a zombie would do in horror movies. But before I can get away from her I realize I am frozen. My arms and legs are paralyzed. I want to scream and move but I cannot. Then she is on top of me and is tickling me. I cannot breath because of the tickling. I have always hated being tickled, because I am an asthmatic and it triggers my asthma. But I cannot get away. As a last resort I bite her, taking a chunk out from her lower jaw. She kind of enjoys getting bit.
Patient bitterly complained that the dream which can occur up to three or four times a night is mentally draining her.
Her dreaming in a state of partial wakefulness in which she could not move despite her desire to do so, accompanied by frightening emotions and impulse to scream for help led to the diagnosis of sleep paralysis and the dream to be viewed as hypnogogic/hypnopompic hallucinations.
The practical value of making these diagnostic impressions however is of little value. Such distinctions and the pompous and tongue twisting medical terms used to label them may be very precious for those who have to come up with multiple choice questions for Psychiatry and Neurology Board Examinations - which is a ridiculous idea for it is insane to believe that the complexity of psychiatric illnesses can ever be understood by reading books with the aim of choosing the correct option in multiple choice formats - and also for those who have to concoct hundreds of diagnoses to give their diagnostic and statistical manuals (DSMs) ring of profundity, but for the psychoanalyst all dreams - for that matter hallucinations too - are basically the same: they are various ways to reduce mental tension (fulfill wishes).
Her inability to breath while getting tickled raised the possibility of sleep apnea - for sleep apnea sparks dreams of drowning, getting buried alive in a coffin or being subjected to other forms of suffocation - and I wrote a prescription for her to get sleep studies done to see if she does stop breathing in her sleep and would benefit from CPAP, and then we returned to psychoanalysis.
That the dreams were occurring immediately after the death of her father left us no choice but to deduct that they were a reaction to it. The patient then talked as to how her siblings, all of whom were 10 or more years older than her, even before the funeral rituals were over were talking as to how the house should be sold and she should move somewhere else and the mother should go to a condominium or an apartment and be relieved of the burden of maintaining that big house which would be too costly for her without the father's social security. She correctly deduced that this was less motivated by the wish to help their mother and more out of sibling jealousy as to why she should be allowed to live there for free of charge. Patient added that it is totally unfair for them to view her as someone who has exploited her parents for all these years for she had provided them with valuable companionship and for quite sometime had been nursing her father through his terminal illness. But added that she sees the writing on the wall and must make preparations to move out and part ways with her mother.
"Perhaps than the dream is about your need to go to your mother and get a closure on some unfinished business, perhaps a desire to get even with her, perhaps a last attempt to get something out of her that you feel she has withheld from you?"
"That makes lot of sense. We have in past therapy sessions addressed the theme of whether I am not leaving home because I have an ax to grind with my mother. And you are right. My mother is nice and a good mother but then there is this horrible side to her. She can be totally cold and abusive. I grew up never knowing when she would change colors. Out of the blue she would hit me, berate me, tell me that she is sick and tired of me and my father, and is leaving the house with no intention of ever coming back, that it was a mistake getting pregnant with me - you know I am the oops baby, and she always had mixed feelings towards me."
"And you reciprocated that mixed feelings towards her."
"Yes, I love and hate her. And that is why perhaps I never left home. Since I wished her harm when she would hit and threaten to not come back to counter my thoughts becoming reality I could never leave her. I had to be there to watch over her and prevent harm falling upon her. That also may be the reason I could not deepen any relationship with any of the boyfriends that came in my life. The minute it looked like I was about to have a life of my own, away from my mother, the guilt would kick in and I would panic and break off the relationship. Even Dick, my current boyfriend, if you can call him that, sticks around with me because he knows I will never demand to live with him. Because he is as useless about taking on the responsibility of a family life and being the man of the house, despite his being quite attached to me and fond of my daughter. He will freak out if we two decide to move in with him. Our relationship is primarily based upon our handicap -our fear of separating from our parents, growing up and being our own people.
"But why does my mother change in to that evil person?"
"It must be projection of your own feelings towards her. If your unfinished business with her is to attack her/punish her the dream may have reversed the depiction of it out of guilt. The fact that you are frozen shows that the dream censor is preventing you from acting out some impulse, in this case it is obviously an evil impulse towards your mother. If you cannot move your muscles then you cannot harm her. Making her come after you with similar intentions is making you doubly under control - in fact putting you on a self-protective instead of destructive mode."
"That reminds me," the patient added, "Another part of the dream which I had forgotten to tell you. Before she can get on top of me and start tickling me sometimes I make an escape. But she pursues me. Sometimes I fly. Sometimes I can fly so high that she cannot reach me. Often the chase goes into my running out of the house. But the outside looks so ominous. The trees are barren. It is lonely and cold and though I have managed to leave her far behind I still fear running in to her.
"And let me tell you it is not a projection of my own evil nature and her preventing me from acting out my evil intentions but a reflection of her evil nature too. For she has a split personality and I do fear her. Especially if my going to her is to get something from her. You know she was a wonderful artist. Her paintings are incredibly beautiful. She would have been world famous if she had devoted her life to it. In fact as a young girl she had got a scholarship to go to a prestigious Arts School but her parents overruled it and instead encouraged her to just become a housewife. And then when she finished raising her children I came along and ruined it for her one more time. She could never get that great adulation from public that she deserved. And the anger over it is what is reflected in her evil appearance."
"Where does the tickling fit in?"
First the girl could not come up with any associations but then after going through some intermediate links recalled that when she was a very little girl a sister's boyfriend - who was a "jerk" - would tickle her till she could not breath. "I would go into asthmatic attack and almost pass out and they would treat it as funny, and my mother who knew how much distress I was in would make no move to stop that son-of-a-bitch from torturing me in the guise of just kidding."
"So that is another grudge you have against your mother. And before you leave the house and part ways with her mother you want to subject her to what she failed to protect you from, but because of your guilt and fear you are reversing the situation and repeating that childhood trauma with mother replacing the boyfriend. But why is her face pale, her hair jet-black and she looks like a zombie?"
"That is taken from a TV show which my mother and I watch together and which has a character that looks as if she was death warmed over. But that character is not a zombie so I don't know why I make my mother appear as a zombie?"
"Zombies are our projected death wishes [that uses paranoid process of imputing the ones we want to harm as the ones trying to harm us]. It is you who wants to attack your mother - hesitatingly, in a zombie like fashion, for the impulse to protect her is putting brakes upon the impulse to harm giving the movements the staccato character. However the dream under the influence of filial piety reverses it and projects your motor movements on your mother. You inability to move is being imputed to her."
"But I thought you said I could not move and scream because I was in Sleep Paralysis!"
"You were in sleep paralysis but the dream will use any physical event to fulfill its psychological motives. Your sleep paralysis was used to find expression for your guilt over wanting to attack your mother. Your sleep apnea was used to give expression to the memory of that abusive tickling and to show in visual language your ambivalence towards your mother. Using the mechanism which is present in Capras Sydrome - where the person sees a close family member or someone close as not the real person but an impostor with evil intentions. You see your mother as an impostor and an evil one."
"Where is the biting of the jaw coming from?"
This was very difficult to explain to the patient for the only association to it that the patient could come up with was that zombies do it.
So we had to resort to psychoanalytic theory and my knowledge of her complexes from previous sessions. Now the girl had never separated from the parents, partly to control her worries that if she was not there with them some harm will befall on them, but there was another motive. Being highly competitive she was saddled with intense penis envy and much of her inexplicable and pathological behaviors arose from the wish to possess one so she could stand up to the men who had done wrong to her. She had been raped at the age of 14 by a boy who she had trusted and the pain of the trauma and unfairness of the world towards women had worsened because the mother had blamed her and instead of taking steps to punish that boy. She knew the family of the boy and not to spoil relations with them had hushed it. If only she could obtain the organ that put women in the role of the second sex she would not have to rely upon other men to redress wrongs done to her and she could stand up for herself. She could never leave the house until she obtained from her mother - if necessary by force - what she was seeking.
The mother's feeling at the biting could not be analyzed but in all likelihood it was affirmation to her that her basic love bond with her mother despite the ambivalence was strong enough that she will be happy at her daughter getting what she desires so much even if it means losing part of herself.