Sunday, July 27, 2014

Dream within a dream

A patient came crying to the session, extremely distraught. Her father had an auto accident in which he had suffered multiple fractures. The injuries were life threatening, he was in Intensive Care Unit, and there was a good possibility he would not live beyond a week.
After she abreacted the shock and pain of this trauma, she mentioned that every night she was having disturbed dreams, but one which had puzzled her greatly.


She dreamt that she was dreaming that the accident had happened. She felt so happy that the accident was after all only a dream.  She  could now continue to sleep because when she wakes up the nightmare will end too.  
But anyway she woke up and immediately reached for her smartphone to call her father to tell him as to what a terrible dream she had had about him, only to realize that she had pictures of her father on life support in that very phone, which on checking she found yes they were there, and all her pain came flooding back. 

Here is Freud on the issue of dream within a dream

The interesting and allied problem, as to what is meant when some of the content of a dream described in the dream itself as "dreamt' - the enigma of the 'dream within a dream' - has been solved in a similar sense by Stekel, who has analysed some convincing examples. The intention is, once again, to detract from the importance of what is 'dreamt' in the dream, to rob of its reality. What is dreamt in a dream after waking from the 'dream within a dream' is what the dream-wish seeks to put in the place of an obliterated reality. It is safe to suppose, therefore, that what has been 'dreamt' in the dream is a representation of the reality, the true recollection, while the continuation of the dream, on the contrary, merely represents what the dreamer wishes. To include something in a 'dream within a dream' is thus equivalent to wishing that the thing described as a dream had never happened. In other words, if a particular event is inserted into a dream as a dream by the dream-work itself, this implies the most decided confirmation of the reality of the event - the strongest affirmation of it. The dream-work makes use of dreaming as a form of repudiation, and so confirms the discovery that dreams are wish-fulfilments.

The dream within a dream of my patient confirms the correctness of Freud's explanation of this puzzle.
I may add here that sadly the patient's father did not make it out of the ICU and left the patient's dream of keeping him alive against all odds unfulfilled.


Sunday, July 20, 2014

An unfettered expression of the wish for a penis in a woman's dream

A patient, who is relatively well settled, married, with two children and a steady job, and who other than suffering from moderate life-long anxiety, that compels her to be constantly busy to bind the anxiety, brought in the following dream, prefacing it with the comment that it is the weirdest dream I ever had.

In my dream I look down and see that I have a penis. It sends a shock through my system. What the hell is down there.  I was completely freaked out.  I was like majorly upset. But then I must have accepted it because it became part of me and everything became fine.  I don't know how long this acceptance goes on for I lift it up to inspect whether it was the whole package or no and to my horror I see there is a hole in it. A black hole. I knew at once there was something majorly wrong.  It was scary. Then I notice it is infected. As if gangrene was going to set in, and it would fall off.  I felt like I would die, for it had by now become a part of me. Not that I wanted it to be there. In the beginning at least I did not. But now I had become accepting of it.  But there was a huge frigging hole in it. One could see through it,  I went into shock again.
I tried to take my problem to the doctors. I was like in a room in a hospital. But they would not realize that there was penis on me or that it could fall off. Like they were not understanding the problem. I had so many emotions go through me.  I cannot even describe the range of complex feelings that emerged during the course of this dream. There was bad anxiety, and sense of hopelessness and despair, as if I was going to die. They were dismissive in their attitude. They were like we can't help you, we can't help you. They would not like even comprehend or acknowledge what was happening to me. 
That room in the hospital it always comes in my dream. I always go there when my dream has to show hospital or medical treatment of any sort. It is a very familiar room. I know I have seen it before. It is always the same room. As if I have been there before, a million times.
Incidentally, there was none of the appendages with the deal. No testicles, just the shaft was there. And that did not matter, it was only the hole in the penis that was freaking me out.

Patient to hide the embarrassing nature of the dream assured me a number of times that she never ever has dreamt anything remotely similar to it before.
Now this patient is relatively new, sees me just once a month, for half an hour, primarily for medications for her anxiety and depression, and we had never ever subjected any of her dreams to analysis. So it surprised me that she narrated so frankly a dream which most people would have great reservations admitting to having let alone talking frankly about it to a relative stranger, even if he is  their psychiatrist.
She explained to me that she could talk so freely because she saw on the board outside my clinic that I do dream interpretation. But then she indicated that she was not shy about the dream for she had shared it with her sister, who is almost 15 years older than her, though they are very close and confide everything to each other, and also to her ex-boss, both of whom laughed at it, and dismissed it in exactly the same manner as the doctors in her dream did, her sister even burst out in a laughter with the exclamation, "E, only you would dream something like that."
Associations to the individual elements of the dream could not be obtained because the half hour flew quickly and there was another issue that had to be addressed in the session. So I will proceed with the analysis just based upon psychoanalytic theory.  
The shock and horror that she experienced on first discovering that she had a penis was actually the shock and horror that she must have experienced during the Oedipal period on discovering that she did not have a penis. In dream the affect had been shifted [displaced] from its absence to it presence. Such is the power of the wishes in our psyche.
The ever present wish in woman to have a penis of her own, and not through her husband or male child, emerged in this lady's dream in all its nakedness. Her statement: But then I must have accepted it because it became part of me and everything became fine is an excellent confirmation of the fact that dreams are wish fulfillment.  
But whatever experience during the day - some humiliation which she would not have been subjected to if she was not a woman - the unpleasantness of which was disturbing her sleep, and which was being negated through the fulfillment of the wish, reared its ugly head too, and the original trauma of the absence of penis, which she no doubt had become aware at a very tender age, reasserted in springing the doubt whether she had really gotten the coveted thing, and if she had was it defective, and would it not disappear again as a result of some misfortune like an infection or gangrene.  

 ....I lift it up to inspect whether it was the whole package or no and to my horror I see there is a hole in it. A black hole.  I knew at once there was something majorly wrong.  It was scary. Then I notice it is infected. As if gangrene was going to set in, and it would fall off.  I felt like I would die....


This is an excellent description of the reaction that occurs in the little girl on discovering the presence of the penis in a little brother or a playmate or even a adult and its absence in one's own self. It is immediately assumed that some injury has occurred, there was a penis there which was taken away from her by violence and foul play, perhaps as a result of some punishment for erotically playing with it, and in its place there is now a wound, an illness.
Not only woman's discomfort and shame from her genitals, which she sees as a defect -  at least in her early childhood she does so - occurs from this discovery, her considering it as an illness leads her to search for all kinds of remedies from myriad of sources all through life. Women's much complained enigmatic nature, and the irrationality of her actions, springs from this never ending search for a cure for the mutilation. Not just real doctors - actually they are often avoided because they are more difficult to be convinced that there is a problem, and are less likely to go along with "the game" -  all kinds of healers, hustlers, soothsayers, medicine men, shamans, quacks, charlatans, mendicants and other holy men, especially those who practice tantra, witchcraft and sorcery, are searched for and the problem is laid upon their feet.
Our dreamer is in medical field and believes in the power of doctors to heal things and therefore in the dream was in the hospital asking them to straighten her problem. Herein lies the psychology of Munchhausen's Syndrome and of Briquet's Disorder. Under the sway of this very same complex the  patient goes from doctor to doctor, begging for medical treatment, medical procedures and surgeries with one wish in mind - a wish they can never bring to their lip, out of shame but more so because they themselves do not know what exactly is wrong about them for which they are seeking a cure.
And they show the doctors everything else about themselves except for the genitals where (in their  unconscious) they believe they have the illness/defect. In fact they show a hysterical prudishness about covering their genitals while dramatizing the sexuality of other body parts, proclaiming loudly about the defects and afflictions of these parts, demanding and seeking treatment, subjecting themselves to all kinds of surgical mutilations, in hope of getting cured by some lucky chance, by some halo effect. It is like repetition of the original trauma of the discovery that they had been cheated when it came to genitals. And by undergoing further mutilations they are hoping to have a better result this time around.
Their contempt for the doctors for failing to recognize their real problem and their inability to give them the cure is acted out in Munchhausen's Syndrome by misleading the doctors through giving fake symptoms. The logic being : you cannot cure my real problem so you are a charlatan and I will prove it to you for you will be conned in to believing that I have an illness when I really don't. You are a quack because you cannot see the problem where it exists but you will see one where it does not. The penchant for hysterical women - those who suffer from Somatization Disorder - to sue doctors and get  compensation, owes to the same castration complex. Doctors were not believing me that I had it. They were dismissive in their attitude. They were like we can't help you, we can't help you. They would not like even comprehend or acknowledge what was happening to me.  So they must compensate me for their idiocy and their failure to heal me.
There is an interesting difference between Munchhausen 's Syndrome and Somatization Disorder. In the former the person is not that eager to have procedures done and have parts of the body removed as in the latter. The former have a more narcissistic personality structure, and are more into playing the game of showing that the doctor is an idiot. It's aim is to show that the doctor (parent substitute) does not know what he is doing and he has done me wrong. And this is done through verbal game  playing and ruse. In Briquet's Disorder the patient has hysterical personality structure and she actually wants to be cured through losing parts of her body to the doctors' instruments in order to be compensated for it with the coveted penis. The complaints of hysterical patients do not correspond to the laws of anatomy and physiology - the source of much irritation to doctors - because their complaints arise from their grievance over the injustice done to them when it came to genitals, and they are complaining about being shortchanged and having a problem in that region which are superimposed upon some actual physical malady present in more respectable part of the body. 

Moving back to couple of other elements of the dream
  
Incidentally, there was none of the other appendages with the deal. No testicles, just the shaft was there. And that did not matter, it did not bother me. It was only that black hole in the penis that was freaking me out.

This part of the dream which the patient added as an afterthought is a great confirmation of Freud's statement that the interest in male genitals in both sexes is exclusively limited to the penis and the rest of the appendage is totally ignored.  
It is a very familiar room. I know I have seen it before. It is always the same room. As if I have been there before, a million times.

This room could be no other than her mother's womb. A place which was once the most familiar and where one lived for nine months. A place where the dreamer wants to return and be part of the sexual intercourse which gave her life, but in which sandwiched between the mother and father she wants to have a more favorable outcome, to be born as a boy instead of girl, wresting the penis off the father while the process is taking place, something she failed to do the first time. 
The patient kept apologizing for dreaming such a weird and bizarre dream and wondered if there was something wrong with her. But when told that what she dreamt is something that one reads in textbooks of psychiatry and one rarely comes across such a transparent dream in practice, and that it is a wish that is present in all women, but is withdrawn from consciousness at a very young age, between ages of 3 to 5, and that she is kind of unique in dreaming it so close to how its original nature is, without any distortions, as most women do, which makes it so hard to decipher the real nature of the wish, the patient felt that she was not crazy and took a sigh of relief.
But then added that she is very happy being a woman, and the last thing she wants in life is to be a man.
"You may not want to be a man. And are very happy with being a woman, granted. But you may still wish you had a penis."
"I don't want a penis. Never wanted it. They are not beautiful to look at. And in the beginning of the dream I distinctly remember getting upset that it was there."
"Being upset also could have been displacement of being upset at not having one which got reversed in the dream.. And why would you dream that you had one unless you wanted it? And why would you have so much anxiety and dread over losing it, unless possessing it meant so much for you?"
"I got to admit. Many a times I have wished I was a man. Life is so much easier for men than for women."