Two dreams showing oppositional defiance in an obsessive-compulsive patient

A Single man in his mid-fifties, a devout Christian, who would give the shirt off his back to the needy, who is always apologizing for imagined transgressions and cannot thank enough for every consideration shown to him by others no matter how small, whose thoughtfulness towards his co-workers knows no bounds including buying card and cake for every single one's birthday, who often charges the customers at the bookstore, where he sometimes is on the cash register, less than the tag price and to make up the difference puts money from his own pocket in the till,  reported following two dreams in quick succession.

Dream 1. I dreamt that I left the back door of the bookshop open.  On finding my lapse the boss took me to task severely.

The patient added, "The dream was so real that I rushed to the book store early next morning and took a sigh of relief on finding the door locked though I knew all along it had to be that way since I am not even in charge of opening or closing that door."

Dream 2. I am in a concert. I am unfolding chairs for my co-workers. I hear people laughing at me and my boss is upset. Without realizing I had unfolded and placed those chairs facing away from the stage. 


Without going into the associations which were scanty anyways,  I could decipher the meaning easily. Knowing the patient for over 20 years made the task easy.

While the patient is picture of humility and consideration towards his co-workers, in his unconscious there are thoughts to insult and get even with them, a legacy of his childhood when he was bullied by other children.  He grew up in the Sixties, when long hair and lush sideburns were the rage. But not to his father,a barber, who hated seeing his business taking a nosedive due to the trend, and who  gave his sons - patient had a brother - hair cuts worthy of skinheads, and no doubt as a means to exhibit some control over the matter.

The father was cruel in other ways as well. He was quick to lose temper and any attempt on part of the sons to act with him with any equality was dealt with a quick physical punishment. He had arrogated himself to sanctimonious superiority with the sons especially since his humble station in life contrasted sharply with the patient's extraordinary talent with drawing, especially drawing cartoons.  To make matters worse the mother was anxious and agoraphobic and very fearful of all the lurking dangers of the world, which she worried would fall upon her sons and instilled fears in them about separating from her and taking chances. Added to this was the constant indoctrination at the church that Jesus loves those who avoid confrontation and turn the other cheek. All these factors had combined to sap the self confidence of the two boys, and their ability to defend themselves from their cruel peers. They had been subjected to relentless teasing and sometime brutal physical violence as children. The adulthood was marked by failure to approach any woman who took interest in him on grounds that she would be better off with some other man. If any rival appeared in the picture the dread of competition and confrontation, because every confrontation with the father had led to defeat and punishment, had caused him to invariably withdraw from courting the girl in favor of the other person on the rationale that he would make a better husband. The bottled up rage for facing defeat in hands of others, who were inferior to him, for the patient is extraordinarily talented and a most honorable and decent gentleman,  now emerged against his co-workers, who had become the substitute for the bullies of his childhood, and the boss who now represented his father.

Both the dreams were obvious attempts to cause harm to the bookstore and thus to all those who worked there. There were legitimate grounds for wishing ill to those people. He was the senior most person there but got the least respect and the lowest pay. He had joined long time back when all that was required was a high school degree. The co-workers had joined after their college graduations and had started at higher pay scales. He had special grudge against the boss who just did not like the patient because he dresses up in clothes more befitting the Sixties era, sports long side burns, brings down his hair over his forehead as Beatles did, appears somewhat grungy and a relic of the hippie era. The boss had another reason for disliking him because despite his desire to please everybody and offering to do every one else's job in addition to his own he makes subtle mistakes that irritates his boss out of proportion to their impact upon work.

The dreams were continuation of this tendency to cause trouble to his co-workers and boss in a passive-aggressive manner. Leaving the door open was to cause theft in the store.

The second dream was also of revenge. When asked why the concert. He said maybe it was not concert but a gym.

Why gym? He said that the college had its graduation ceremonies in the gym, and he was unfolding the chair for the co-workers to watch the students graduating.

Patient had resented watching students far inferior to him in talent getting diplomas. His co-workers were paid   higher than him because they were graduates while he was not. Also a few days ago he had received a letter of rejection from Disneyworld at his attempt to get a job there as a cartoonist. He suspected that his lack of education beyond high school had played a role in the rejection.

His turning the chair facing away from the stage was expression of contempt at the degrees of his co-workers and of the graduation ceremony itself.

Addiction to weather channel - an interesting manifestation of OCD

A woman in her mid-thirties, who suffers from Down's Syndrome, was brought to my office to be put on medications to stop her "ornery and feisty behavior".

Questioning led to the revelation that she is a "weather nut". Her caretaker - she lives in a Group Home - and her cousin, who came to the session as well, to explain her problems, claimed that the epithet was justified because the patient is constantly searching for news on storms, thunders, lightening and other natural disasters and then worrying about the havoc these events are causing. She is glued 24/7 either to the TV or the  radio or the newspaper for reports on weather and its aftermath. The cousin  who had brought her to the office said you can do only so much to prevent her from watching the TV or listening to the radio and getting upset over the terrible weather conditions. If you do too much to prevent her from worrying about disasters happening to others she goes in to panic and then becomes mean and fightsy.

The patient was immediately diagnosed as suffering from obsessional neurosis, and the cousin, a little surprised and impressed, confirmed that she is obsessive. She demands everything to be straight, in line and neatly organized. She had other quirks of obsessive-compulsive problems as well.

One wonders if the people who are glued to their radio and TV to get the latest report on the weather are not using it to block out the fear of disaster coming to themselves by worrying about it happening to others.  We know that obsessional neurotics worry about their ability to cause destruction by merely thinking about it, and therefore are highly vigilant to not think in those lines.  In order to not indulge in disastrous thoughts, but unable to stop them, they often find an interesting compromise. They allow their mind to think of all kinds of destructive thoughts, but instead of owning up to their authorship, they see it as being caused by others, including  nature. This projection acts as a balm to the sense of guilt. The reasoning goes like this," It is not I who is thinking (causing) this destruction, it is nature that is doing it. I am innocent. Yes I do watch all kinds of disasters happening at the hands of cruel nature, but primarily to prevent it from happening, not to cause it. If you will see me in front of the TV watching all those people getting killed by lightening or hurricane or tsunami it is not to derive any pleasure but to feel bad for those people. I even pray for them to survive and sometimes send donations." The affect of pleasure as a rule is overlaid by the affect of remorse and contrition.

I will not be surprised that folks who listen to talk stations all the time or addicted to news channels may also not be suffering from a milder variation of this obsessional neurosis. Here too, the purpose is to be on lookout for some bad thing happening somewhere and to identify with those unfortunate people and to feel bad about it as if somehow one is responsible for it, even if very minutely.

A friend of mine, who did residency with me in Norfolk, where he had quite a few friend, moved to another state where he was very lonely. The loneliness drove him into obsessive worrying, and he began spending all his lonely hours listening to news. Only when he went to India and got married and found a new and more pleasurable outlet of making love to his wife did his libido found freedom from the obsessional neurosis of  worrying about all the assorted problems of the world. Problems about which he could not do a thing anyway. 

Giving the bird on a public platform and the psychology of stage fright

Reading about the Sri Lankan singer's obscene gesture - see the excerpt below from a blog on the Internet - I wondered about its psychological roots.  

M.I.A and the middle finger malfunction!
Quite a bit of he thunder however was stolen from Madonna by the middle finger of M.I.A or Mathangi”Maya”Arulpragasam the British singer of Sri Lankan Tamil descent, if reactions in the western media are a measuring device to gauge its impact.All “MIA” (Missing In Action)did was to raise her middle finger in a seemingly spontaneous manner with lips mouthing an alleged expletive during Madonna’s performance of “give me all your luving”.A wag on twitter called it a middle finger malfunction!

”Flip the bird” is what they call the act of raising the middle finger as a rude,obscene gesture.Maya’s middle finger “uplift” and the ensuing blaze of negative publicity

She was born in Hounslow,London on July 18th 1975. Her father is Arulpragasam an engineer who was a founder member of the Eelam Revolutionary Organization of Students(EROS) which later evolved into the Eelam Revolutionary organization (EROS) He is called Arular and wrote the Tamil novel”Lanka Rani” based on the 1977 anti-Tamil violence. 
MIA or Mathangi Arulpragasam known as “Maya” is a Rapper, vocalist, singer-songwriter, record producer, visual artist, activist, photographer, fashion designer, model. Her musical compositions are classified as being a combination of different elements from genres like alternative dance, electronic,world,hip hop,alternative rock etc.

Now the analysis:

Two motives are easy to conjecture. M.I.A is a Srilankan Tamil who deeply identified with the cause of the Tamil Eelam - the creation of a separate nation for Tamils in Sri Lanka. Their efforts,  after decades of struggle, which spanned the entire life of the singer, ended with a brutal genocide, the heinous character of which matches that of the Nazis. So the primary  motive for showing the finger had to be a gesture of defiance against the world for its indifference towards - if not secret enjoyment of - the genocide. 

The second motive of course had to do with it being her only chance to make it super big.  It is not every day that an aspiring female artist, especially who is neither White nor African-American but a South Asian, gets to be on the Superbowl half-time show.  Now or never; either she was going to be catapulted to thunderous global chatter or drawn back in to  obscurity, wresting no more than 15 second of fame, as Madonna's extra, at her tryst with destiny. And she grabbed the moment. 


The courage to be able to move that middle finger let alone make that gesture while being watched by hundreds of millions of eyes shows that the woman has guts.


But beyond these two obvious reasons there are always  deeper unconscious motives to such behavior, the analysis of which may explain as to why so many of us have such a crippling fear of appearing on stage. 


The desire to be famous, to be in the limelight and the center of attention, to watch others go gaga at one's performance, has its roots in wanting to reverse our lot with that of our parents. Not the parents of today, but how our parents appeared when we were tiny tots; from our prehistoric childhood, when our universe was nothing but a miraculous creation of our all powerful father, and everything that was lovely and worth admiring was the extension of the most beautiful woman in the world, our mother. 


In our earliest childhood our parents appear to us as the grandest people in the world, virtually king and queen, whose every action looks divine. But as we grow older, and our critical faculty sharpens, no doubt because of the repeated disappointments life metes out despite the presence of our parents, we begin to compare them with others, and it goes without saying, to their disadvantage. Little by little they start to lose their grandeur and appear no better than the average Joe. In fact worse. For taller you are, the harder you fall.  And we rarely ever forgive them for this great let down. And as if to make up for this earlier false overestimation of their real worth our fault-finding faculty is always on a lookout for an opportunity to even the scales; to teach them a thing or two.


Without forgetting that the original attitude of great respect and love for the parents (filial piety) persists side by side, it is this desire to grievously insult them if the opportunity arises that lies behind "stage fright". For if they happen to be on the ground and looking up at us, as we once looked up to them with awe and respect, then it offers the perfect chance to show them the contempt that they were once so quick to display to us. For when our parents take that precipitous fall from our grace, society/public/social institutions take the significance of the parents. And it is this wish to say something really defiant, blasphemous, insulting, abusive, sexual to the gathering of people - parent substitute - which, one is afraid, may inadvertently escape, despite one's best efforts, that causes fear of being on the stage. For behind public performance and public speaking lies a nagging concern that instead of doing the right thing in society one may say something wrong or make some terrible gesture. It is the fear of behaving like "M.I.A." that keeps many talented people from ever reaching their full potential. Though they have no knowledge in their conscious mind that behind the desire to please the multitudes and be their darling lurks the fantasy to horribly insult them. 


For by flipping the finger at the world she was also serving her parents and society - the society of those Tamilians who were butchered, raped and treated worse than slaughter house animals, while the world   watched and just let it happen.

Flipping the finger from the stage at public deserves a few more psychoanalytic comments. Stage is the place where one puts up one's show to the public/society. If public/society takes over the significance of one's parents then the desire to appear on stage has its origins in putting up a show for the latter. Once again a reversal of the situation of childhood when we were the eager spectator and they were on the pedestal.  

Now there is one show of our parents that we desired to see more than anything else. The show which the Hindus call ras-lila - the song of Krishna consorting with gopis. Really an artistic religious rendering of the father making love to the mother. It is the desire to see the father's genital organ in action - which later would become the rationale behind all pilgrimages: to get the darshan (viewing) of Shivalingam and other deities in their glory, with the elaborately carved temple and its chambers representing the mother - to witness the parental intercourse which later in reversal becomes the motivation to put up one's own show for the public.

And one of the motives for seeing the parental intercourse is to compare one's own prowess with that of the father. And here one finds oneself severely short. The father in all respect outclasses the little Oedipus - the principal reason why the oedipal phase in the boy comes to an end. One simply cannot compete with the father at that tender age. Reluctantly the boy gives up the parents as love objects and enters the latency phase. But not without sustaining a permanent narcissistic scar of inferiority. Here we come upon, as if by accident, into the clue that explains the notorious inferiority complex of mankind and it's preoccupation with lengthening of the male sexual organ.


And it is to reverse this nagging sense of inferiority which lies behind all spectacular deeds and shows, including such flamboyant ones as pyrotechnics, stunts, jumping from great heights, climbing the tallest mountains, playing the guitar like Led Zeppelin, and bending it like Beckham, they are all trying to prove to the father that see, in public eye, I am uniquely superior to you. Just like the father once appeared as the most unique person in the world the son is showing him that he is even better.


Flipping the finger - symbol of erect penis - is also in the same series, and here one cannot help but notice that by showing his penis to the public the son is also making an attempt to overcome his castration fears. It is in its own way declaring, "I don't give a shit for you any more. The power which had impressed me so much once, I am harder than that now, and can stand my own ground."

A dream expressing contempt of men

A housewife in her late thirties reported the following dream:


I am screaming and yelling at Mike to not start it again. Then I start hitting him on the chest. Finally I tell him to just forget it, I am leaving. I walk down a narrow set of steps which is green. When I reach down I tell my dog Shadow, "Come I am leaving." 


"Who is Mike?"

"That is the strange thing about the dream. I don't know any Mike. Or at least any Mike who looks anything like the Mike of the dream."

"How does the Mike of the dream look?"

"He is a heavy set man. With a blue t-shirt. Navy blue. Has a 5 o'clock shadow."

"Where is the blue t-shirt taken from?"

"Gary my husband wears navy blue t-shirt. In fact navy blue t-shirts is what I see him most in. And he is heavy set."

"Where is the 5 o'clock shadow taken from?"

"That belongs to my step-father, Ted. He is old now, but when he was young, he often sported that 5 o'clock shadow."

"Anybody else you can think of who goes to make up the figure of Mark?"

 "Yes my Dad. He is heavy set too. Gary and my father look alike. They are both aggressive. They are both big men. They both love dogs. So I guess all the three men who had the most influence over my life are subsumed under the figure of Mike."

"Why are you yelling and hitting them?"

"Because I am so fed up of men. They have done nothing but controlled  my life. My father would hit me when I would not do all the work there was to do at the house. It was not my fault that his wife left him, and I looked like my mother, and he was stuck with me. It was simply not fair to dump all that house work on me, and then yell and hit me, when I could not do it to his satisfaction. He had no sense that a 13-year-old girl cannot possibly remember and do everything that is required to be done in a house.

"And I cannot forgive my step-father for sending my mother to her grave, when she was barely 65,  by controlling her every move. He gave her no space to breath. And my husband is no better than Ted, for he is doing to me what Ted did to my mother. I feel so suffocated in my house.

"What is so interesting is that in real life I always freeze with fear in the presence of these three men, and it is they who control me. But in dream it is I who is hitting them; and that Mike guy, whoever he is, is just standing still and doing nothing. So it is really a wish fulfillment, as you claim all dreams are. I am just turning tables on these controlling men, and they have no say in the matter as I have no say with them in my waking moments."

"Why did  the dream  give this composite figure the name of Mike?"

The patient thought for some time and said,"Oh my God. I totally forgot it. But I did know someone called Mike. A boy named Mike Castelli who made my life hell from age of 5 till I got out of elementary school at 12. He would hit me at every opportunity he got. He would tease me when I would get off the bus. He would throw snow balls at me and once smeared a new fur coat of mine. I hated him."

"Why those steps come in the dream and why are they green?"

"The green is my favorite color. It is so soothing. It comforts me. When the world gives me too much trouble I always escape in to my bed and cover myself with my favorite pastel green comforter."

Since climbing up and down stairs usually is a substitute for sexual satisfaction, it was assumed that the green passageway was the genital passage. So it was the fantasy of returning to the womb, such a common fantasy of mankind, which she was using to get some peace from the bullying world of men. After getting even with them, she was retreating into the safety of her mother's womb.

But the girl rejected the interpretation and said more than my mother's womb I was returning in to my own self. "My mother was as harsh to me as my dad.  From my earliest age I hated her and had learnt to be my own mother."

"I think the green passageway phylogenetically represents your mother's womb. Though you are right you have become your own mother so you are kind of withdrawing within your own self."

The time ran out so we could not analyze the dream further and get to the bottom of why she was telling Shadow, the dog, Come I am leaving. But Shadow, was her faithful companion, shadowing her day and night for 18 years. He fulfilled some of her need for male companionship. He had recently died, and it had caused her intense pain and bereavement. In the dream her wish for him to be alive again was getting fulfilled.

An Oedipal dream in an anxious girl

An intelligent young teenager, accomplished in many areas, especially music, but who unfortunately suffers from crippling anxiety, revealed the roots of her illness in the following Oedipal dream, which she reluctantly recalled and only when asked to tell any dream that she could remember from past or present.

I dreamt this a long time back. I was not even 7 then.


My brother Nate has something wrong with his eye. He goes to Joshua, our older brother for help. But Joshua instead of helping hurts his eye even more. 


The dream was so old and laconic that she could hardly give any associations to it. But the girl being a good sport tried to fill the gap by giving more details of the dream itself.


It happened in the laundry room, which is strange. For only my mother and I do the laundry. The boys never even go to the laundry room.

So here was the clue that the dream was about her mother and herself, only displaced upon her brothers. And if we take their ages in to consideration, Nate was representing her, and Joshua, the elder one, her mother.  And what was happening in the dream between the boys could be assumed as the essence of the conflict between her and her mother.

The girl did not object to or agree with the interpretation, and added


 it was dark outside. Perhaps it was evening. 


This was interpreted as an allusion to repression. Darkness, night, obscurity, fog often represent the shady underworld of the unconscious where one thing can easily represent another, and sinister and unthinkable alterations can happen. Perhaps even sex change can occur.

"What exactly was wrong with the eye? And how did Joshua further hurt it?"

"The eye was inflamed and red. And Joshua swatted upon it, how one may kill a spider on the wall."

Now we know the spider is the typical symbol of female genitals. Was the girl taking the complain of her genital being red and inflamed [open wound/proud flesh], and hence defective/sick, to her mother for repair/correction and the mother instead of helping was swatting upon the problem and making it worse?

That the problem was shown as happening between the brothers instead of between her and her mother was acknowledgement that this defect of her genital can only be resolved if she takes it to men instead of keeping it between two women. The Oedipal shift which the girl has to make, giving up the mother and substituting the father as the primary love object.

Her anxiety was a reflection of this transition too. With shift of her libido from mother to the father there arose in her the death wishes towards the mother - mother becomes the chief target of the girls aggression/death drive/thanatos, whether justified or not, once the girl makes this transition - and it was fear of the loss of her mother's love, if only she would get a hint of how she (the daughter) nurtures such evil thoughts towards her (the mother), was what was sparking the anxiety.

Psychogenic etiology of Sleep Paralysis, Hypnagogic Hallucination and Sleep Apnea

It is taken for granted that parasomnias like "sleep paralysis" and "sleep apnea" are organic/somatic disorders. If there are psychogenic factors in these illnesses,  it is assumed that they play an ancillary role, and in all likelihood have nothing to do with the primary etiology. The medical logic used to justify such an assumption is that stress is a non-specific noxious factor. It has a psychophysiologic role but there is no evidence that  the nature of the psychological conflicts determines as to what part of the body and what pathophysiological process will succumb to the stress.

Recently I came across a patient who remembered the exact time period when her sleep paralysis started and the specific conflict [psychological stressor] that started it. The woman who is now in her mid-twenties reported the following:

"When I was 10 my parents got divorced. They explained to us as what was going to happen, so I cannot blame them that they kept us in dark and the horrible surprise traumatized us. But what they did, did not make sense, and perhaps it did traumatize me. My dad was a nice man. My mom should not have divorced him. Though they fought a lot. Most of the time he was gone. And I think she felt trapped for getting married too early in life, because he got her pregnant. She was not ready to give up being single when I came in to this world. She resented me and resented the marriage. She did not really love him. She wanted out. Anyway, my mom's complaints against him appeared unjustified to me. I felt so sorry for him.

"One day mom took us to our aunt, her sister, and told us that she will be gone for a while to help move somebody. That somebody was us. She had got us, the children, out of the way to go and pack and move. But she did not pack some of the stuff that I specially liked. She left many things behind.

"The next we knew we were living with our grandparents, her parents.

"I did not like staying there a bit, and wanted to be in my house, with my Dad. And that's when the sleep paralysis started. In the night, when I would fall asleep, I would see myself walking out of the bedroom only to realize that I was not really walking but dreaming. But it felt as if I was really walking. It was scary. And I would struggle to come out of the sleep. But unable to do so. I would feel like I was trapped. My brain would be awake, but my body will stay paralyzed. I would moan and whisper. From the awake part of the brain I would keep sending messages to the asleep part to get up. I would imagine myself rocking. Finally the messages would succeed in moving my head and neck. And then I would  actually rock back and forth, waking up at last, my stomach in knots"

This narration immediately made me think whether "sleep walking" too at its core does not start with some disturbing conflict which requires the person to leave the cocoon of his bed.  It was not difficult to analyze that what she was trying to do in her dream was to leave her grandparents house and reunite with her father. But this wish was against the wishes of her mother and would have aroused the latter's ire. And it was this fear that was generating the scary affect. For it makes no sense otherwise as to why the dream imagery of just walking out of the room would generate so much fear. 

From that point onwards the girl regularly dreamt of walking out of her bedroom, only to realize that it was a  dream. But a dream in which part of her mind was awake, and a dream from which she could not wake out of because of sleep paralysis.  And the dream was so vivid, and so scary, that it had the character of hallucination.

Over time another factor got added to the dream. Paranormal entities! She could feel the presence of other people in the dream but whom she could not see, This led her to start believing in ghosts, and her house being haunted. Sometimes the fear of ghosts was so strong that out of fright she would stop breathing as not to make those ghosts aware of her presence.

Does the germ of sleep apnea lies in such fright emerging in sleep/dream?

Over time these ghosts became more aggressive and she would feel them covering her face and nose, or submerging her in water. She would hold her breath in response, till she could hold the breath no more, forcing her to swim upwards to the surface, ending with her waking up gasping for air. 

The ghost like entities would walk past her, watch over and touch her, sit or stand next to her bed. She hated the touching. It would make her twitch and jerk. Sometime touching would go to the extent of moving her hand or caressing her face. She described the experience as if she was being messed around with. But she rejected the construction that the touching perhaps had its roots in sexual touching that she may  have experienced as a child. She said she was never sexually or physically abused. 

However, the construction led her to admit that lately this ghost like character which messed with her, had been taking on the visage of her father and her boyfriend. And their presence in the dream gave her some comfort and lessened the scary feeling. It also lessened the fear associated with the dream of drowning and struggling to come to the surface for air, the sleep apnea dreams. 

So the original overwhelming wish to reunite with her father which had started the sleep paralysis, and which had progressed into, or rather had found another dimension in sleep apnea, found some relief when she turned her father, and her boyfriend (a father substitute), into guardians watching over her while she dreamt forbidden things. So while they appeared to cause the scare, they really had been conjured up by the dream to give a face to the scary feeling and deep down they were comforting in nature and had the stamp of her father, her childhood protector.

Some other things the patient brought up with regard to her sleep paralysis that are worthy of additional  comments.  She considered these dreams symbolic of being out of control. And the scary feeling that emerged while dreaming was at bottom a fear of  being out of control. And the way she tried to regain control was to keep reminding herself, even while dreaming, that it was a dream and try to wake herself out of it through moaning, groaning and sending messages to rock back and forth and overcome the sleep paralysis.

Patient also brought a recurrent dream which bolstered the view that behind the sleep paralysis there was fear of going out of control. Ever since her teenage years - perhaps around 15 or 16 years when she started driving - she would have dreams in which she would be driving and would suddenly find that her brakes are not working. The accompanying affect was that of fear. "For I am a very controlled person. Though at times I have been reckless and irresponsible. But for the most part I hate being out of control."

Now we know from psychoanalytic literature that brakes failing in one's vehicle in dreams is a typical symbol of one's libido being out of control. So once again the theme of this recurrent dream of her vehicle being out of control was continuation of the dream of her passion for her father - walking out of the grandparents house for him - being out of control. 

In the next session she reported that before the sleep paralysis dreams started at age 10, she had another set of dreams. It was less of a dream and more a weird feeling. It was not a normal dream. For there were no pictures. No people. No faces. It was just a lot of sadness. There was anxiety and fear. "It started when my parents moved in to the house they built. Just before the divorce." 

When I objected that if there were no pictures could it be considered a dream she said well there were two visual objects. Two identical objects one small and other big; somehow communicating with each other.

And she added, "Nothing could make me more miserable than dreaming this very big object communicating with the very small one. I would wake up bowling my eyes out. I would be so scared too."

First she could give no association to the dream of the big and small object. Very reluctantly she said may be the bigger object is being mean to the smaller one.

A construction was made that perhaps it was her mother being mean towards her.

The patient immediately associated to this construction by giving details of how the mother was the disciplinarian at the house and would go overboard with it. "I remind her of my father. But I also remind her of her own mother, who she hates." And then she added, "You are right about the big object being my mother and the small one myself.  For the two objects are always identical. And I am a spitting image of my mother."

So the sadness accompanying the dream of the two objects was sadness over her poor relationship with her  mother.

With help of some more associations, the details of which I will spare you, we could find two further meanings that lay behind that dream.

The big and small objects symbolized the differences between the sexes. Her utter sadness, anxiety and fear attached to the dream were connected with her comparing her genitals with that of male sex and feeling  miserable about it. She claimed that she really feared her father, and felt greatly inferior to him specially when she compared her subdued squeaky female voice to his deep masculine one.
.

The other mental complex that had found expression was the most interesting. The big object stood for her mother and the smaller one for her father. For her father was short and the mother was tall, and she was always yelling and being mean to him.

It was this meanness of her mother to her father that made her feel sad, miserable and sympathetic towards  her dad. And it was this sympathy for her dad, and the counter impulse that she should side with her mother lest it provokes her wrath that had weaved the dream of sleep paralysis. 

The sequence of mood changes in Manic-Depressive illness

After seeing a number of manic-depressive patients I have found that there is a typical sequence to their mood changes.

First there is a high spirited sense of triumph and superiority that is so overabundant that it spills into enjoyment of others miseries and inferiority. This is based on a burst of self confidence and appreciation  - and well justified for manic-depressive folks are generally beautiful people with superior looks, attractive bodies and quick mind - of one' excellent attributes. The person is completely self centered and feels no hesitation in thinking of the death of anybody who crosses one's path.

This phase is followed by emergence of guilt and anticipation of punishment. These two negative emotions are clearly relate to the earlier joy at the plight and inferiority of others. The anticipation of punishment - forewarning of pain - creates great anxiety. To control the anxiety and guilt - guilt itself is kind of anxiety (anticipation of punishment from one's conscience) - all kinds of obsessive thinking and rituals emerge in those whose preferred mode of defense is obsessive, while in the hysterics, body aches and pains emerge to assuage the guilt (through suffering). These obsessive/hysterical symptoms are kind of repentant activities. If the fear of punishment is not placated by these obsessive/hysterical maneuvers, the patient resorts to actually punishing herself - the most favored way to torture is to start dreading the impending poverty which sometimes becomes frank delusions that one soon will be a destitute homeless bag-lady. The psychodynamics behind punishing oneself even before fate (parents) does lies in the following reasoning: let me punish myself which will placate my parents and avert their wrath from falling upon me. When self-torture goes way beyond one's capacity to handle, the person goes into frank depression and ceases partaking of all enjoyments and all activities. The excessive delight at one's superiority during the manic phase is now fittingly punished with the belief that one is utterly worthless.

Today a patient of mine, who I have been seeing for over 15 years, and who has classic manic-depressive illness, and who was in good remission for a long time, came with the complaint that she is very shaky and her son stated that her manic-depressive confusional state is round the corner. When patient was asked as to what could be causing this sudden deterioration, she said that a friend of hers, who she has known for years, and with whom she rode every morning to go to dialysis had died.

When asked how had she died, the patient's face showed a triumphant pleasure. This was certainly against her good sense and perhaps without even her knowledge. She followed it up with the following statement, "She got a kidney transplant. But it did not last for even 2 months. She died. She would have been better off not getting it." I could feel her secret joy at the death of someone who had got the kidney transplant while she had not. But mixed with it was the sadness at her friends death and guilt over the triumph.