The meaning of dreams in the psychotic state - Theoretical considerations and clinical applications

The authors consider that the Freudian theory of dreams is not directly app licable to psychotic and borderline patients with their constantly varying states of mental integration. Because these patients' dreams lack associati ons, the usual psychoanalytic approach cannot be used to ascertain their me aning. After reviewing the literature on the speck quality of dreams in the psychotic state, the authors point out that such dreams have nothing to do with the metaphorical language of the dream work but instead express the c oncreteness of the hallucinatory construction. For this reason, a dream's m eaning may fail to be understood by the patient even if it seems clear to a n observer. Yet the analyst's reception of a 'psychotic dream' is a unique and essential source of valuable information on the manner of construction of the delusional system, allowing analytic work on the psychotic nucleus. In the authors' view, such dreams may help the analyst and the patient-whil e still lucid-to acquire insight, thus affording a stable foundation for em ergence from psychosis. The paper includes some case histories, in one of w hich a psychotic female patient is enabled by work on dreams to reconstruct a psychotic episode and thereby to ward off an imminent fresh lapse into p sychosis.