A Trazodone induced incest-nightmare

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


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


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


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


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


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

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

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

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

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

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

But why do humans dream of returning to the womb?

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

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

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

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

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

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

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

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

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

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

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

The Psychology of Lucid Dreaming and a few comments on Borderline Personality Disorder

In psychiatric conferences, there are two topics that cause no end of excitement, and it is hard to find standing room when a lecture on any one of them is going on.

One of them is Borderline Personality Disorder. Why this diagnosis gets the mental health professionals to get so animated? Perhaps because the concept has no true existence. It is a pejorative rubric created to dump under its province all those irrational, erratic and difficult to understand behaviors that leave the therapist helpless.  There is nothing like condemning a problem, especially on scientific grounds,  to avoid dealing with it. By naming it as borderline, by which it is tacitly acknowledged that the patient is a jerk, one feels there is no more need to condemn oneself as incompetent. She is borderline and therefore it is her and not my problem. And it is this avoidance in real life that is overcompensated by talking endlessly over it in conferences.

And boy do they get profound in the lectures on this topic. Every one of it that I have attended on Borderline Personality Disorder starting from the great Otto Kernberg himself, to his wife   - isn't it strange that both husband and wife are experts on the same illness - to lesser mortals, I have found their talk so erudite that in a matter of five minutes every member of the audience is grasping for straws.  And therein lies the second reason for its appeal. If nobody can make head or tail of what the speaker is talking about then everyone in the audience becomes equal - obfuscation is a great leveler. And just like the supernatural does not exist and therefore human beings talk and write about it like no other issue the borderline disorder since it is a sham diagnosis it provokes the greatest attention.

The last but not the least important reason is the belief, which an astonishing number of mental health professionals harbor, that they themselves have a touch of Borderline Personality Disorder. We all have irrational aspects to ourselves which we don't understand and to varying degrees dread it's overpowering our rational front. These fans of borderline personality lectures are genuinely rushing to attend these lectures hoping to find some shortcut to heal themselves.

And what lies behind the cleverly annoying behaviors of the so-called Borderline patients that mental health professionals cannot scream enough as "splitting" - a concept that was introduced by Freud and never with any intention for it to be used as a pejorative epithet against the patients - which gets their goat? It is a negative transference towards authorities stemming from their rage at their parents for not doing enough for them. Making staff members on the hospital ward fight with each other - the so-called splitting - is at bottom nothing but making the parents fight with each other. And their self-destructiveness is also often a way to punish themselves, but, at the same time, a means to annoy and frustrate authorities (parents).

The lure of Lucid Dreaming is a little harder to figure. But it is guaranteed that a lecture on the topic will jam pack the lecture room with the fans overflowing into the corridor. And the psychology of its appeal, just like with the Borderline lectures, lies in the hope of finding some great pearl of wisdom that will enable them to start dreaming lucidly themselves and through this mastery over that mystical process, cure oneself.  It is therefore driven by a desire for self-therapy. And this brings me to the unpleasant task of bursting the bubble of enthusiasm surrounding lucid dreaming. There is not much to its metapsychology.  Lucid dreamers are people who are more awake while dreaming than others.

Dreaming is a state of semi-wakefulness to begin with - the failure of our ego to go to sleep completely (complete withdrawal of cathexis)  - and not some special third state of consciousness which neither belongs to wakefulness nor sleep as the authors of that completely idiotic Activation-Synthesis hypothesis claim. While dreaming we are only partially asleep. Part of our brain gets activated and awake. This is why, if one fully wakes up a person out of intense dreaming, he can quickly get oriented to the real world. The neuronal networks responsible for wakefulness are already somewhat in gear.

Now individuals differ greatly in regards to the ratio of their wakefulness and sleepiness while dreaming. Some tolerate a high degree of partial wakefulness while dreaming, others do not, and get out of dreams/sleep altogether at quite low thresholds. Lucid dreamers appear to be individuals who can continue to dream while the centers responsible for wakefulness are quite active. They are individuals who can more easily ride the two horses of partial wakefulness and dreaming at the same time. They can divide their consciousness into taking cognizance of the dream world and the real world at the same time.

The psychological mechanism behind this appears to be similar to how hysterics can tolerate the co-existence of multiple personalities. People who are highly suggestible and enter into hypnosis easily - traits of hysterical disposition - appear to have a greater ability to dream lucidly. While dreaming their mind splits into two states of consciousness, one aligned to the real world and the other to the dream world with the ability of the former to influence the course of what is happening in the latter to varying degrees.  And this is felt by them to be a special gift akin to some magical ability. It is the wish to go magical which underlies the fascination with this phenomenon and the great rush to hear lectures upon it. The lure of Lucid Dreaming is at bottom a lure of magic and a desire to become a magician with one's dreams and one's problems.

I recently came across a couple of lucid dreams in a patient who had never shown this gift previously. The analysis threw some light upon the nature of lucid dreaming and it is worth reporting it here.
The patient suffers from obsessive-compulsive disorder and was in throes of deep depression because of separation from her husband and because she got fired from her job due to her obsessive perfectionist behavior which was affecting her productivity. She brought in to the sessions the following three dreams.
The first dream was not at all lucid, but it was its analysis that made possible the emergence of the phenomenon of lucidity in her subsequent dreams.

It was so real. I go into the garage where there was a pile of rope. [In real life my garage does not have any such rope]. I grab the rope, throw it over the beam, grab a step stool, and hang myself. All the while I am also watching myself doing it even after I die till I woke up in shock and extreme fear.  It took a while before I realized that it is a dream and I am not dead. 

The dream was subjected to analysis among other issues that emerged in the session. Some of the elements of the dream,  like the garage symbolizing the mother's womb, where she wants to return to escape her current painful life; hanging as castration, with the head symbolizing penis that was being severed from the body by the rope [castrating the father by identifying with him while he was having sexual intercourse with the mother, during the time she was in the womb and thus robbing him of the penis and through that emerging in her next incarnation as a boy instead of girl was the full wish behind the dream] were suggested to the patient.
A week later when she came to the session she had had two dreams to report which she found quite strange because while dreaming them she was aware that they were dreams and she could influence their course. She is not familiar with the concept of lucid dreaming and did not use the term when reporting them The two dreams, though dreamt on two subsequent nights, were upon the same theme and quite similar in content and therefore she narrated them together.

Once again I am in the garage and the pile of rope is there but I am telling myself this is not how it is going to happen. I am telling myself that this is a dream.  I see through the garage at a pond which is at the back of the house [in real life there is no such pond]. There is a sheet of ice upon the pond. I keep saying to myself I am not doing this but nevertheless I start jumping up and down upon that ice bent upon breaking it and then I see myself floating under that ice, dead.  The same dream is repeated the next night with the only difference that I have complete control over what I am dreaming. I am aware what is happening and I keep telling to myself that I am not going to do it and when I break through the ice I do not go dead but shoot out like a rocket, flying up into the sky as a superhero. She made the gesture of a superhero, putting one arm over her chest and the other over her head to make the figure of a superhero.

The two dreams are of course the continuation of the theme of returning to the womb - the expanse of water replacing the garage - to escape the unpleasant present, and through death to be reborn and as the ideal male version of herself. But the wish to watch the parental intercourse while she was in intrauterine existence with the aim of robbing the father of his penis and emerging this time as a boy, and a boy who was a superhero (the very personification of phallus) was accompanied with less dread (fear of the father), a less fear of dying, with greater emphasis on rebirth than on death, and the whole fantasy played out in the dream was under greater control of the ego. The latter had not gone completely into sleep, but remaining partially awake was controlling the process going on it the dreamwork. Because of the analysis of the first dream, the fantasy of stealing the penis from the father was felt to be not as wrong and dreadful, and the wish to be born with it was more clearly shown in the third dream.

That the above analysis has validity was confirmed by the fact that the patient also reported that after the analysis of the first dream she had gone to the house of her estranged husband whom she had not seen for a year and since he lived in the same house where they had lived for 25 years - she was the one who had moved out -  she had the key to it, and had taken out his 10-month-old dog which she had never seen before, in his absence and without informing him, and gone to a park to play and walk with it, doing it for hours, till she got a call from her son as to what was wrong with her that she stole that dog and to return it immediately to her estranged husband before the cops are called.