Fear of needles and fear of going to the dentist.

I recently came across a gentleman, who is now in his early Sixties, who boasted that he has no fear of dentists. "Others chicken out at the very thought of going to the dentist but I can face without fear their prying in to my mouth, their giving injections in to my gum, and their putting in of those frightening instruments to keep my mouth open."
Now fear of the dentist arises from the castration complex. Teeth serve as an excellent symbol of the penis and any thought of harm coming to them provokes castration anxiety and a desire to run from the dentist's venue in a hurry.
What lay behind this nonchalance and absolute lack of fear?
Later in the session - it was his first session with me - when I suggested that he get some blood tests done for he had not seen an internist for a long time, he declared that that is out of question. He dreads needles and has avoided going to a doctor for God knows how long because the very thought of needle makes him faint. He bitterly complained that it is just not needles but the idea of  blood coming out of his arm in to the test tubes that makes him queasy and he falls to the ground when he witnesses it. He went on to declare that the medical profession should do the blood drawing while a person is lying down so he does not pass out, fall  and hurt himself.
Now the phobia of needles also arises from the castration complex. So this man's extraordinary castration anxiety found an outlet in the fear of needles with medical professions but as if by reaction formation he developed a completely opposite attitude towards the dentists.
The psychology of daredevils and those who climb the highest peaks and do bungee jumping etc. appear to be operating under the influence of the same reaction formation; a defensive maneuver designed to overcome their exquisite sensitivity to and fear of danger. 

A dream of revenge getting discharged upon the wrong person

A young man, recently divorced, had two dreams on the same night, back to back. He claimed the first dream was premonitory.

The First Dream:

I receive a text from K -the girl he had broken off a few weeks ago after dating her for couple of months- that she wants to meet, and not because she wants to get back together but for the sake of children [they have a child each from previous marriages who had begun to get used to each other].  I message back: absolutely not.

He added that surprisingly a few days later he did receive a text making the exact same request but so far he has not replied to it.

The Second Dream:

I am back in the house where I grew up. It is Christmas. My ex-wife is taking down ornaments from the Christmas tree. But it is not she who is doing it. A pair of sneaky hands just emerge and take away the ornaments.  It is difficult for me to explain how, but the best I can describe is that the hands belong to nobody, they just emerge out of nowhere and are taking off the decorations from the tree. I am watching all this through a camera that is monitoring the entire proceeding. I want so much to hug her. My love for her, which I no longer feel when I am awake because she cheated on me, returns in the dream. Then slowly the realization comes that we are divorced and I feel great sadness. I wake up missing her terribly.  

Patient initially was only interested in talking about how the first dream predicted what was to take place a few days later. There was an element of pride in his premonitory power and a desire for me to be impressed by it.

Since I hear all kinds of premonitory dreams especially from my obsessive patients who cannot dream enough the death of others and therefore once in a while their dream does turn premonitory, I was not very impressed by it and we quickly proceeded to analyse rather than appreciate this psychic gift of his.

But the task was not that easy. Why would he dream of receiving that text before it actually arrived? It is not that he needed some extra time to think over it before the reply. In fact in real life he had just sat upon it unable to make up his mind to accept this veil invitation to rekindle the relationship. If he was psychic and could foresee the future, even if only in dreams, couldn't his psychic abilities have done a better job and shown him dreaming of something more important than a mundane instant message text. Perhaps the clue to decipher the dream lay in his reply: absolutely not. He had ruthlessly rejected her.

Why did he reject the offer from K, who possibly really loves him, to get back together, and then immediately proceeded on to another dream where he is craving to hug and love his ex-wife, who had cheated on him and had broken his heart?

Now we know all the dreams on the same night arise from the same circle of ideas; same dream-thoughts. So unable to make head ways with the first dream, it was but natural to abandon it and go on with the second one in the hope of finding the common dream thoughts behind the two dreams.

To figure out the wish which had motivated the second dream was not rocket science. It was a desire to hug and love his ex-wife again.

But why on Christmas day, why was there a Christmas tree and what could be the meaning of those sneaky hands taking down the ornaments from it?

"Why was it Christmas day?" I asked him.

"That is when everything came to a head - on the Christmas day year and a half ago.  For weeks we had been arguing on how the Christmas day should be spent between the two families. I was exhausted by the bickering as to whose parents' house we will go for what, and for how long, yet I was looking forward to the Christmas day hoping that somehow the spirit of the holidays will straighten things out between us. Then came the shock. She disappeared, leaving me and my son waiting for her all day, not returning till the next morning. I had no choice left but to do some detective work, which, in this day and age with electronic trail everywhere is not hard, and found that she was having an affair. So I guess in the dream I was going back to that Christmas day, a time when I was still not aware that she was cheating on me and when my love for her was still untainted."

"Why was the dream taking place in the house you grew up instead of the house where you lived with your ex-wife?"

"My fight with my ex-wife at least partly arises from my anger at my mother. She was addicted to prescription medications for many years and could not take care of us the way she should have. She was either depressed or busy partying and drinking with a bunch of card players in a bar not too far from home. And I think my anger at her for this neglect has become generalized to all women and it emerges as a need to control them. I drove my ex-wife away because of my subliminal anger at her and my need to reform her. I could not control my mother from her self-destructive behavior because she was my mother and I had little power over her, but that impulse found an outlet with my wife. And I think she could not handle my controlling nature and finally copped out of the marriage by having the affair."

"Whose hands were removing the ornaments?"

"They are my wife's. Perhaps my mother's. Perhaps the snake who broke our marriage. He was my close friend, he grew up with me, I trusted him, and he stabbed me in the back by having an affair with my wife. The hands are doing the job sneakily because the destructive influence upon the marriage of the three was not visible. They were all working behind my back, or at least out of my consciousness, to pull the plug on my marriage. I think the dismantling of my marriage is being symbolized by the ornaments being pulled off the Christmas tree.

"But also by making those sneaky hands do that dastardly deed I was protecting my ex-wife from blame. If I could convince myself that she cannot be faulted for cheating on me then I could love her again. My pride cannot  forgive her. Without forgiving her I cannot love her again.  But in the dream I found the way to love her by making the blame as much as my mother's and my friend's as her's.

"The camera monitoring the dream field itself is a reflection of my need to control everybody. I drive my mother crazy too by trying to control every aspect of her life which comes in guise of stopping her from smoking and taking all the medications that doctors prescribe her which I think have worsened her in the long run than helped her. And I think I drove my wife away by trying to improve her beyond her ability to improve and micromanaging our marriage."

After getting the associations to the second dream [which have been condensed and put as a monologue here for easy reading] from the patient it was not hard to decipher the first one.

The condition for his loving his ex-wife was for him to absolve her from the guilt of having cheated on him. One way to do was to reject that aspect of his ex-wife which had cheated and only remember the part that he had loved till that Christmas day. And this rejection was being practiced against the girl K from whom he had recently separated from. In the dream he was making K, the innocent one ,as the culprit, who had done nothing wrong to him, in order to salvage his love for his ex-wife.

Patient told me that he meets his ex-wife many times a week to pick up or drop off their son and though he still finds her extremely beautiful, he no longer feels any love for her.  But, he added, in the dream it is another matter. Perhaps his pride goes to sleep allowing him to forgive her and to love her with all his heart the way he had done once upon a time.

Paranoid Illness changing into Bipolar Disorder

A woman in her early forties came to her monthly session, primarily to get her medications for she does not like to talk about herself or her illness, and complained that she is once again in her down mood.

"It started a week ago and it is so bad that my son - the only one who still lives at home - left the house. To add insult to injury I flipped my finger at him as he was leaving, which is insane. For the poor boy had done nothing wrong.  All week long I had been on his case. It is good he left on his own because last night given my nasty mood I could have physically kicked his ass out. When I am in that down mood I want nobody around. My son called me this morning to ask if it was safe to return. Thank God he is not upset because he knew it was my mood and not me which was making me behave like that. What lies behind such nastiness of mood?"

Patient denied that anything triggers it. With no leads to go upon as to why she went nasty the session shifted into talking the next thing that was bothering her. It was her anger at her mother. Patient could not be more angry, "She has chest pain but refuses to go to a doctor, treating herself with cold water and aspirin. I am afraid she will die just like my father did."

It too had started a week ago. What came first her worrying about the mother and getting angry over it or her nasty mood.

Patient first claimed that they had started simultaneously but then after being forced to carefully examine had to admit that mother's chest pain had begun a few days earlier. She also recalled that when her anger towards mother could not be contained it was only then some of it had escaped control and despite her best intentions to not do so had begun to get displaced upon her son.

"Why did you think that she will die just like your father?"

"Yes, that is my fear. All I can think of is that she is going to die like my father did. It was traumatic seeing my father die in 2009. He had clogged arteries, just like my mother has."

"Did your mood swings start when your father died?"

"No. His illness and death did not affect me quite that way. I did not get upset. I did not care for him that much. He was not around. For that matter my mother was not around either."

"Then what started the bad moods?"

"The death of my grandmother in 2010. But in the beginning they were not bad moods. It began as a slowly emerging conviction the house in which she had lived and died was haunted. I missed my grandmother very much. She was my real mother. My father and my mother were never really available to me. After her death I started hearing her voice and could feel her presence. I was admitted to the hospital and diagnosed as paranoid schizophrenic because of those voices. They put me on a lot of Seroquel which was the only thing that could block out the hallucinations and allow me to sleep. Even now I am afraid to go off the Seroquel despite your warning that it is making me fat and may cause me diabetes, because I am afraid of the return of the voices.  When I came back from hospital I moved out of my grandmother's house. But her presence followed me to the new house."

"When did the mood swings start?"

"They came gradually. As my fear of my grandmother's presence hovering over me decreased the mood swings started. They are always accompanied by anger towards my mother."

"You became sick after your grandmother's death, but your anger is always directed towards your mother, why is that?"

"Because I think I have a big time grudge against my mother. I loved my grandmother but hated my mother."

"Why you hated your mother?"

"Because she favored my brother over me. He was my half-brother. She preferred him over me, because his father was not around, while mine was,  and she felt he deserved special treatment because of that."

This patient's illness which started as paranoid schizophrenia shows no trace of it now. She is quite warm and social in her interactions when she is not in her down mood. This transformation occurred when she could allow her rage to emerge against her mother. This happened after the death of her grandmother. Prior to that her loving relationship with her grandmother kept her rage bound. Once her grandmother died her rage emerged unchecked and could only be contained through developing a paranoid projection . She started hearing voices that kept her rage from being acted out.  

Once the rage could be expressed against others - the latest being her son - it did not have to be projected and come against her in forms of voices. However since she could not be permanently in a state of rage her psyche developed bipolarity. A time was allotted to be in rage and a time to be nice and good to other people.

A transference dream

A patient of mine who has been with me for more than two decades and treats me with great familiarity and friendliness, came for his biweekly session and said I had this hilarious dream from which I woke up laughing, because it is something that could never happen in real life.

The dream is about you. I come to the office at our usual time. But the location of your office has changed. It is not this old ranch building - not that anything is wrong with it, I love your place -  but  a magnificent high rise, all glass and beautiful. The staff has changed too. They are young, spiffy and professionally dressed, not like how your staff dresses so casually.  But what is funny is that they are not one bit friendly.  In fact they are nasty and hostile. They ask me who I was, and do I really have an appointment. I tell them what are you talking. I have been seeing Dr. Kelwala for 22 years, and you all should know I come here every other Friday at 11 or 11.30 am. 

I at once knew that it was an expression of hostility towards me that was being "projected" into my being hostile towards him though I was being represented by my staff.

When I told the patient that perhaps behind accusing my staff as being nasty and hostile it is me who he is accusing of being nasty and hostile, he said that that is impossible for he respects me too much. Then he suddenly remembered another section of the dream which confirmed that the interpretation was in the ballpark.  

"A part of the dream that I had forgotten now comes back to me. While I am being blown off by your staff you come out of your office and say that my appointment is at 8.30 pm. And I woke up laughing aloud as to how you could be so ridiculous, for you never see patients that late in the evening. 

"That I don't even know as to what time I see my patients, is it an expression of contempt ?" I asked him.

The patient protested that in no way he can be contemptuous towards me for he respects me too much but then immediately confirmed the accuracy of the interpretation by stating that recently he has been talking big-time in his sleep, and waking out out of his dreams laughing. For example the other day "I woke out of a dream laughing because I was calling my Dad you son-of-a-bitch, you crazy man. Which is  surprising for I never ever said anything like that to him when he was alive."

"Calling your father son-of-a-bitch and telling me that I don't even know the timing of my own office hours appear to have the same origin: contempt for authority/father figures. Where is the contempt coming from?"

"I dreamt the dream this morning, a few hours before coming for the therapy session. Around 8.30 a.m to be exact for I looked at the clock on waking out of the dream. I had run out of my Suboxone and Xanax couple of days ago, because I had been taking them more than the prescribed dosage. I was withdrawing and feeling nasty and could not wait for 11.30 to arrive when I could see you and get new prescriptions. Then I dozed off and had the dream. Now you know how you get mad when I take too much of these medicines and have at times refused to refill them or told your staff to not call them in if I have demanded them on phone if they are not due. So I always have this fear when I take too much of these medications that you will not refill the prescriptions or the appointment will get cancelled or you will fill them but not right away."

So his fear of that I may not refill his prescriptions which will prolong his withdrawal symptoms was making him think of all kinds of insulting thoughts towards me.

"Why the building was tall and magnificent?"

"It was eight stories high too!" the patient added

"Why eight?"

"It has to do with the 8 mg. of Suboxone tablets. I was craving for them and if only I could have gotten the 2 mg. tablet [Suboxone comes in two strengths 2 and 8 mg.] it would have eased the suffering. But 8 mg. would have been ideal. So I was granting you an eight stories high office building instead of this modest ranch of yours if you would prescribe me that dosage right away."

The magnificent office and professional looking neatly dressed staff were expressing two other concepts which were diametrically opposite to each other. On one hand it was an attempt to exalt my position. If only I would fill his prescription without any problem he would value me as a real upper class doctor whose office    was in a magnificent high rise building with professionally dressed staff instead of the humble office in which I see patients and the unpretentious staff who work for me. On the other hand it was an expression of contempt that given your humble office and even humbler staff and the fact that you don't even know your own hours of practice you better not make me wait for my prescriptions. And the dream was expressing this contempt by showing the offices of the more magnificent doctors with their sparkling glass offices. 

Fear as the driving force behind an 8 year old boy's ADHD

An eight-year-old boy, his older sister, his mother, and I went out to look at some foreclosed homes. I was going to buy one as an investment property, and she was going to rent it if we found one which suited her needs and her budget, and the purchase price of which was within my investment comfort zone.

I was really enjoying the boy's high spirits, his rushing out of the car to be the first to climb up the porch steps of the houses, his patter about how he wants a place that has second floor so he can climb up and down, and a bathroom that has shiny black toilet as he had seen on a TV show, a fireplace, and all the other cool things that his friends' houses had.

The mother declared him to be a child who gets into everything but told me to diagnose him less as an  ADHD and more as an Irish child: "they must stick their nose into everything."

Now we were driving from one house to another without a Realtor, who could open the lockbox with the code and show us the houses from inside. We had printed out a list of foreclosed homes from the Internet and were assessing their worth from the outside and by looking through the windows. Though most of the houses had some window latch somewhere not properly secured, or a sliding back door that could be slid open, or a main entrance that despite the lockbox hanging from the doorknob could just be pushed open, and the mother, endowed with the same Irish genes as the son, would with an uncanny ability manage to find and stick her nose into these deviant openings , and voila we would be inside, free to explore the in and out of the house.

But what really caught my attention about that child was that the last house that we went to see that  afternoon, instead of rushing out as he had done earlier, he refused to come out altogether on grounds that somebody was inside the house.

The mother said that is nonsense. The house is bank owned, and foreclosed, so nobody could be inside.

But when the son could not be persuaded to leave the car, the rest of us decided to go inside the house without him.  However, when we climbed up the porch steps and peeked through the stained glass panes, lo and behold, there was somebody inside.The house indeed was occupied. We rushed down the three steps,  ran over the grass and quickly got in to the car so we do not get subjected to rude shooing off for trespassing. The mother had not done her homework right. The house was not in foreclosure but in short sale.

The mother asked the child how in the world did he know the house was occupied.

"Because the smoke was coming out of chimney,' the boy replied.

"And what does that mean?"

"It means that either the furnace is on or somebody is drying his clothes in the dryer."

So this hyperactive boy was constantly scanning the environment wherever he went making lightening fast deductions whether it was safe to go ahead with his exploratory urges or take to his heels.

 Later we went to a restaurant to eat and once again he was observing everything. As we waited for the waiter to bring out the food,  the boy remarked that there is a gold record of some singer mounted on a plaque inside a glass case on the wall next to the cash register. He wanted very badly to examine it at close quarters, but could not be persuaded to do so.

The mother remarked Zach has grown now. Before he would have rushed to it physically. But now he is afraid to do so.

And I wondered if the boy was very high spirited and full of observations to fulfill a bundle of inborn (genetically determined) needs and since they all had to be satisfied in a limited time he was rushing from one thing to another and which was behind his ADHD.

But the mother said no, that cannot be entirely true. Because Zach, if you encourage him, or if he is genuinely interested in something, he can sit on it for a long time without getting distracted.

So despite having all these needs to be fulfilled, all clamoring for expression, and all wanting exploration of the environment for the objects of their desire, the boy could stay and concentrate on something if he was given proper encouragement (output of dopamine generated through pleasure experienced due to parental appreciation?) or through his own intrinsic enjoyment of it (self generated dopamine?).

I asked the mother then what is the cause of his ADHD.

And she said his exploratory urges have been prematurely blocked by a frightening world. It is the fear of getting into trouble with grown ups [with their superior power/authority] that keeps him going from one exploratory behavior to another. If you are exploring something and get yelled at, and a fear arises in you that you will get into trouble doing that, then at the slightest hint of somebody coming after you makes you give up what you are doing and pick up something else to explore.

And now my child instead of rushing into whatever interests him [out of fear of everything and everybody] first scans the environment to locate all the possible sources of danger and if he sees any, quickly abandons that avenue of exploration and moves on to the next. Only if I am around to encourage him to continue exploring which implies that I will be at his side to deal with the danger, or if the exploratory behavior has high dividends such as when he is playing sports, that he continues his activity without bolting to another.

And I wondered if both these factors: presence of the mother while he is doing his exploratory behavior and big rewards that he obtains from sports and other activities that he enjoys improve his attention via the medium of higher dopamine secretion.

Reversal of letters in a dyslexic boy a manifestation of opposition/defiance

A woman in her late thirties came to the session and flat out declared herself to be a borderline personality,  in treatment since age of 9, and having been tried on every psychiatric medication under the sun.

When asked why she was borderline she replied, "Besides that I am also bipolar, schizoaffective, obsessive-compulsive, ADHD, in short a pain in the ass, and therefore psychiatrists [pejoratively] find me borderline. When they do not know what to make of you they call you Borderline."

"Why are you a pain in the ass?"

"Because I fight with everybody."

"And why do you fight with everybody?"

"Because I always have to be in opposition."

Then she added that her two children, and they are the same way. They oppose everything too. Though they have different styles. The older does by having emotional meltdowns. Slightest thing can spark a major upheaval in him and then everything around has to come to a halt. So he stops everything and everybody by overreacting emotionally. The younger one, his oppositionalism, is expressed through his refusal to cooperate with learning. I even think that his tendency to write letters and numbers backward is just an extension of this stubbornness. He must do everything in  reverse of what is expected of him.

And I wondered how much of dyslexic tendencies in children is initiated and maintained by this oppositionalism, perhaps an expression of grudge against parents or simply as a symbolic manifestation of one's life agenda being at loggerheads with that of the world's.

8/16/2014

Last week I came across a dream the analysis of which further confirms that much of dyslexia arises from an opposition existing between one's agenda versus society's.

A woman who is now in her forties, who had a traumatic upbringing, where both of the parents were more interested in their own agendas than that of their two daughters, divorcing when the latter were 10 and 12, going their own ways, bringing step-children in to their respective houses, to which the daughters were shuttled back and forth, sometimes wanted, when they could be used to do chores or to get even with the other parent, sometimes despised, when they came in their way, often beaten, sometimes even boxed, to keep them in line, and who naturally harbored great grudges towards the parents, brought in the following dream, a year after her mother's death.

It is a very short dream. I would call it snap of a dream. For all it shows is my mother. She looks so pretty. The whole dream is like white. For there is a beautiful white silk gown that she is wearing. And my baby, who I lost,  is in her arms, held inside a white blanket, like they use for christening, as if he was being accepted in Kingdom of Heaven and becoming alive again. Everything about the dream is white except for a red ribbon that is over the blanket like a bow, and the natural colors of my mother's hair and face. Which enhance her beauty. 

She is getting prettier and prettier with each new dream, ever since she died. 

Patient added that the dream is refusing to go out of her mind and expressed surprise how can one single dream image affect a person so much. "I am trying to keep doing everything else to forget the image but cannot. Ever since the dream I have been crying, remembering my mother, and the baby I lost." 

Since the patient is familiar with the technique of dream interpretation I asked her without any preliminaries, "What sparked the dream?"

"The dream occurred on Sunday afternoon, while, after an exhausting night, in which I was awake for the most part, I fell asleep. In the morning my husband had come from his bedroom to mine, to lie next to me, and we talked and talked, like we have not done in years, for four full hours, at the end of which I nodded off and had the dream."

"What was the conversation about?"

"Everything under the sun. It was the frankest discussion we ever had. Things that we never ever bring up. Things no other couple would bring up, like mortality rates, life insurance, my mother's death last year. She was just 63. My grandfather died when he was 42, my grandmother's in her fifties. So I told him I won't be living for too long. And he better start getting serious about my funeral. At most I will live for another decade." She said half as a joke, half because of actual fear that she may die early like her mother.

"So the dream was sparked by the fear of your own death. But instead of your own death you saw the death of your mother, and to compensate her for thinking of her death, your shrouded her with the most beautiful white gown. White generally symbolizes death. Why the gown was silky?"

"My mother loved silk. My favorite image of her is in her wearing silk gown."

"Why is the baby in white blanket?"

"So he can be christened and be eligible to enter heaven and be with my mother. White stands for purity. He is pure and it was not his fault that he was subjected to abortion. He should be living in heaven." The patient began to cry.

"Why your mother has everything about her white?

"It symbolizes purity. Absence of evil. When I had the abortion they were real nasty about it. Just pushed me in to it. I don't think they gave anesthesia properly. The whole thing was so painful. But there was a nurse. She was wearing a white sweater. She was very kind. And talked to me throughout the procedure. She behaved to me how my mother should have behaved. The white of the dream is taken from the white of that sweater."

"What is the meaning of the red bow?"

"Yes, why couldn't it be blue, pink or another color? It had to be red." The patient exclaimed in anger. 

"Why? What does red mean?

"It means blood  It means murder.  It means abortion. The abortion, which I did not want. It was the most painful thing I ever experienced. I never got over it. I never will. My mother forced me to do it. I could not do anything about it, because I was living with her. That time Arthur was just an year old. I was already separated from his father and my mother did not want another child. I was barely twenty, and could not stand up for myself." 

"So the dream was sparked by the wish for death, which quickly changed into fear of death, and wishing that upon your mother, or rather contemplating about her death - though making up for it by making her most beautiful and living in heaven - to shift away the fear of your own death, and then the wish was countered by the thought that you cannot afford to die yet, because you have to reverse that abortion and make that baby alive again. In the dream you are succeeding in doing so, according him christening in heaven."

"Yes. Since my mother died I think that the baby I lost, he is now in heaven with my mother."

"Why is your mother becoming prettier and prettier with every new dream?"

"Because she was real ugly to me in my real life. She was selfish and did not think twice before having an affair which broke the marriage and tore the family apart. But she was beautiful too. She had lovely face and lovely hair. That is what comes in the dream without being converted into white. Because they do not need changing. Rest of her I want to change and make her into how my mother should have been. Now that she has died. I am mourning for her and changing her into Madonna - pure white, holding my baby like Jesus, instead of sending him to death.

"And now I realize why for the last three days I am doing everything backwards. I am writing orders backwards, dropping 'n's or 'g"s at end of the words, reversing my letters, even writing whole words backwards, turning into a new Leonardo Da Vinci, with all my childhood dyslexia coming back. Soon I will be using a white-out more than the pen. And I know it is happening to reverse that abortion. I am surprised I am not writing down-upwards, given how I hate my mother for forcing me to do what I did."

Mother appearing as an evil impostor in a dream and its analysis

A woman in her early thirties, who had lived with her parents all her life because they had had her when the  mother was in her early forties and the father almost 60, and therefore they had subtly prevented her from separating and forging a life of her own, a few weeks after the death of her father, began having the following recurrent dream.

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.