Dream Content of Schizophrenic, Nonschizophrenic Mentally Ill, and Community Control Adolescents
Hadjez, Jack, Stein, Daniel, Gabbay, Uri, Bruckner, Judith, Meged, Sorin, Barak, Yoram, Elizur, Avner, Weizman, Abraham, Rotenberg, Vadim S., Adolescence
Psychoanalytic and psychodynamic literature has identified various functions of dream content. Freud (1958) claimed that dreams serve as a medium for the discharge of conflict and impulses in a more subtle, acceptable, and less anxiety-provoking manner compared with the waking state. According to Kramer (1993), dreams serve as a selective regulator of affect, positively influencing the individual's mood during the night. Greenberg, Katz, Schwartz, and Pearlman (1992) suggested that the manifest content of the dream contains real emotional problems and the attempts to solve them in an open or metaphoric way; as a result, the psychological defenses in subsequent wakefulness become more effective, and the ability to deal with problems is enhanced.
Search activity--defined as the activity oriented to change a situation or the individual's attitude toward it--is of importance in preserving mental and somatic health (Rotenberg, 1984). Functionally sufficient dreams restore search activity after its temporary renunciation in preceding wakefulness, whereas in neurotic and psychosomatic patients, dreams fail to fulfill this restorative function (Rotenberg, 1993). The functional insufficiency of dreams is manifested in these patients as a decrease in dream report, a decrease in dream vividness and imaginative activity, and less personal involvement of the dreamer in the dream content (Rotenberg, 1988).
To date, only a few studies have systematically evaluated the manifest dream content of schizophrenic patients. Dreams of these patients have been found to include more nonfamiliar and fewer familiar people, to feature people in groups, and to have a higher ratio of males to females than dreams of depressed individuals. They also contain more aggressive social interactions and reflect a more apprehensive attitude (Kramer & Roth, 1973).
The aim of the present study was to compare the manifest dream content of schizophrenic adolescents, adolescents with other emotional disturbances, and community controls. The thought process of schizophrenic patients during wakefulness is usually described as dull, concrete, and incoherent (Cutting & Murphy, 1988), and the thought content as bizarre or implausible (Jaspers, 1983). We sought to determine whether this is the case also for manifest dream content. Based on the findings for wakefulness, we hypothesized that the dreams of schizophrenic patients reveal more implausibility and incoherence, and less personal involvement, anxiety, and emotional expression, compared with the dreams of normal controls, and that schizophrenic patients have a shorter duration of dream recall. Nonschizophrenic patients were expected to fall between the other two groups on these dimensions.
The study population consisted of three groups. The first group contained 20 consecutively admitted schizophrenic adolescents, either hospitalized in an inpatient department or treated in a residential day center of a university hospital in Israel. These patients were treated with neuroleptic medications at the time of evaluation. In all cases the dosage was stable for at least four weeks. When we transformed the doses of the different antipsychotics administered into equivalent doses of haloperidol (Van Kammen & Marder, 1995), we found that the patients had received a mean dally dose of 7.5 mg (SD = 2.7; range = 2-10 mg). None of these patients received any other medication (including anticholinergics) at the time of evaluation.
The second group contained 21 adolescents with other mental disorders (consecutively admitted at the same hospital) who were matched with the schizophrenic patients for age and gender. This group included 7 patients with an affective disorder and 14 patients with either conduct disorder or oppositional disorder. Eight of these patients received medications at the time of evaluation (either serotonin specific reuptake inhibitors or mood stabilizers). …