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The psychodynamic implications of the physiological studies on dreams
PSYCHOSOMATICS a teacher and psychiatrist, describes the many fears, defenses and strategies utilized by the suffering neurotic. Although many books have been written to provide self-help, this is clearly one of the most practical. The avoidance of psychoanalytic jargon and the relative simplicity of the language account for this result. This book can thus help the many who are sufficiently motivated to discover their real fears by stopping to look at their problems realistically. Worrying about the wrong things prevents constructive action. The author points out that a book cannot replace competent professional help; nevertheless, it can certainly help one to understand some of their inner fears and repetitive futile attempts to cope with them. The book can also by of value to therapists of varying persuasions and degrees of training to help clarify some of the intricacies of the neurotic process. W.D. THE PSYCHODYNAMIC IMPLICATIONS OF THE PHYSIOLOGICAL STUDIES ON DREAMS. By Leo Madow, M.D. and Laurence H. Snow, M.D. Charles C. Thomas, Springfield) Ill. 1970.
This volume is a step in the direction of what is obviously needed at this stage in the history of dream research, namely, the recognition of the need for an integrative approach. The present series of papers is based on a symposium held at the Women's College of Pennsylvania in 1966 and are authored by six of the leading investigators in what might be truly called the new and modern era of dream research. The chapters are, for the most part, summary statements of work previously pUblished, but several, notably the ones by Whitman et al and Dement et al, go beyond 1966 and introduce both new experience and new theoretical concepts. The dream scene is reviewed from the point of view of neurophysiological mechanisms (Jouvet), the pharmacology of dreaming sleep (Hartmann), the function and clinical significance of REM sleep (Dement et al), the varying uses of the dream in clinical psychiatry (Whitman et al), the phenomenology of dreaming (Snyder), and finally, a consideration of dreaming and dream research from the point of view of classical psychoanalytic theory (Fisher) . Jouvet has been among the foremost exponents of the dual sleep theory. His work, based on animal studies, has led him to conclude that there are two distinct states of sleep which appear at different levels of the phylogenetic scale and which also manifest differences ontogenetically across species. His studies support the view that sero66
tonin may be responsible for slow wave sleep (SWSj and the catabolism of serotonin may be the triggering mechanism for some of the phasic activity (parietogeniculate-occipital spikes) that precede paradoxical sleep (PS). In both an experimental and theoretical extension of this work Dement offers a number of interesting new thoughts concerning the correlation of neurohumoral mechanisms and psychotic behavior. Renouncing earlier views on the significance of the REM state, his current emphasis is on the role of phasic events such as the PGO (parieto-geniculate-occipital) spikes that herald and characterize the REM state. There are, therefore, two systems involved in the REM state, one a tonic system maintaining the state itself and the other phasic systems governing the PGO spikes, muscle twitchings, etc. Concerning earlier discrepancies in experiments involving REM rebound, he now concludes that the important factor is the deprivation of phasic events such as PGO spikes, rather than REM time per se. He suggests that psychosis is related to the failure to confine phasic events to the REM period and their consequent spillage into waking life. Cats receiving p-chlorphenylanaline (PCPA) show this dispersal and at the same time display exaggerated drive behavior. Rebound fails to occur in theSe cats following REM deprivation. Dement noted a similar absence of rebound in acute schizophrenia and argues that, as in the PCPA cat, this may be due to the discharge of phasic events during the waking state. Considering such discharges analagous to what goes on during dreaming he concludes that they would be psychotic events by definition. He regards REM sleep as a safety valve for a drive energy accumulator system. Hartmann reviews our present limited state of knowledge concerning the influence of drugs on the REM state and offers evidence in support of the hypothesis that the build-up and metabolism of serotonin in the brain is essential in regulating the sleep-dream cycle. Snyder's p~per summarizes a broad investigative program YIelding much basic normative data concerning dreams. His effort to track and objectify the "typical" dream leads him to the conclusion that dreams are much more prosaic, much more banal and much more like waking thought than we generally conceive them to be. Whitman et al offer the only direct clinical application of REM research. They have in~ geniously integrated the laboratory-monitored dream into treatment and into various aspects of their teaching and training program. The dreams of a resident are monitored, for example, the night before he is to make a clinical presentation so that counter-transferential effects can be noted. Fisher, in a brief concluding chapter notes the ways in which current research supports classical Volume XIII
BOOK REVIEWS psychoanalytic dream theory. 'The only modification he has thus far proposed is that the REM dream is the guardian of REM sleep in contrast to NREM states which have no such protective device. He calls attention to the important work of Lairy who noted that schizophrenics, during the acute phase of their illness, show a significant increase in Stage I without REM, the so-called intermediate phase. There are, in the opinion of this reviewer many ways in which current research may be seen as equally, if not more, congruent with other points of view about dreaming. The laboratory effort has at least reopened the question as to where we are theoretically with regard to dreams and this is a healthy sign. This is a slender volume of 167 pages. It is priced at $10.50. MONTAGUE ULLMAN, M.D. Brooklyn, N.Y. THE GROUPSEX TAPES. By Paul Rubenstein and Herbert Margolis. David McKay Company, Inc. New York, 1971.
This book consists of a collection of interviews of participants in group sexual activities. The interviews are not statistically significant from a scientific standpoint for internal comparison and there are no controls. The interview may be taken as representative for a segment of a population. From the psychiatric standpoint the overly defensive, apparently reactively exhibitionistic attitude of some of those interviewed is noteworthy. They protest too much to justify and defend their group sexual activities. Some of the participants spoke of this form of sexual behavior as being therapeutic. In a description of group sox with changing sexual partners the homosexual rela-
January-February 1972
tions were confined to the women. 'The psychodynamics of this and other descriptions given in this book are suggested, but the interviews do not provide sufficient material for a conclusion. This book provides a sample of one kind of human sexual behavior current in the United States. It gives a generally favorable v:ew of group sexual activity. EDWARD L. PINNEY, JR., M.D. New York, N.Y. PSYCHOANALYTIC CONTRIBUTIONS TO COMMUNITY PSYCHOLOGY. Edited by Milman, D.S. and Goldman, G.D. Charles C. Thomas Springfield, Ill., 1971, 320 pp.
This book is a varied collection of twenty papers given at a recent Adelphi University postdoctoral program in Psychotherapy Conference. The Conference emphasized community psychology with an attempt to bring into focus the contributions of the psychoanalytic perspective. The quality of the papers is quite variable. Some are well written and lucid, such as "Social Change and Psychopathology." Others pertain to specific agencies and often seem to have a provincial perspective which is not necessarily psychoanalytic. I was impressed by the intriguing chapter entitled "Community Psychology? In Northwestern Europe?" by the late David J. Vail. Although he Is not a psychoanalyst, he made a formal study of social and psychiatric problems by corresponding with European friends. The editors give a brief editorial overview of each paper. These add much to the book which is to be recommended to community-oriented psychologists and psychoanalysts. M. J. MARTIN, M.D. Rochester, Minn.
67
This volume is a step in the direction of what is obviously needed at this stage in the history of dream research, namely, the recognition of the need for an integrative approach. The present series of papers is based on a symposium held at the Women's College of Pennsylvania in 1966 and are authored by six of the leading investigators in what might be truly called the new and modern era of dream research. The chapters are, for the most part, summary statements of work previously pUblished, but several, notably the ones by Whitman et al and Dement et al, go beyond 1966 and introduce both new experience and new theoretical concepts. The dream scene is reviewed from the point of view of neurophysiological mechanisms (Jouvet), the pharmacology of dreaming sleep (Hartmann), the function and clinical significance of REM sleep (Dement et al), the varying uses of the dream in clinical psychiatry (Whitman et al), the phenomenology of dreaming (Snyder), and finally, a consideration of dreaming and dream research from the point of view of classical psychoanalytic theory (Fisher) . Jouvet has been among the foremost exponents of the dual sleep theory. His work, based on animal studies, has led him to conclude that there are two distinct states of sleep which appear at different levels of the phylogenetic scale and which also manifest differences ontogenetically across species. His studies support the view that sero66
tonin may be responsible for slow wave sleep (SWSj and the catabolism of serotonin may be the triggering mechanism for some of the phasic activity (parietogeniculate-occipital spikes) that precede paradoxical sleep (PS). In both an experimental and theoretical extension of this work Dement offers a number of interesting new thoughts concerning the correlation of neurohumoral mechanisms and psychotic behavior. Renouncing earlier views on the significance of the REM state, his current emphasis is on the role of phasic events such as the PGO (parieto-geniculate-occipital) spikes that herald and characterize the REM state. There are, therefore, two systems involved in the REM state, one a tonic system maintaining the state itself and the other phasic systems governing the PGO spikes, muscle twitchings, etc. Concerning earlier discrepancies in experiments involving REM rebound, he now concludes that the important factor is the deprivation of phasic events such as PGO spikes, rather than REM time per se. He suggests that psychosis is related to the failure to confine phasic events to the REM period and their consequent spillage into waking life. Cats receiving p-chlorphenylanaline (PCPA) show this dispersal and at the same time display exaggerated drive behavior. Rebound fails to occur in theSe cats following REM deprivation. Dement noted a similar absence of rebound in acute schizophrenia and argues that, as in the PCPA cat, this may be due to the discharge of phasic events during the waking state. Considering such discharges analagous to what goes on during dreaming he concludes that they would be psychotic events by definition. He regards REM sleep as a safety valve for a drive energy accumulator system. Hartmann reviews our present limited state of knowledge concerning the influence of drugs on the REM state and offers evidence in support of the hypothesis that the build-up and metabolism of serotonin in the brain is essential in regulating the sleep-dream cycle. Snyder's p~per summarizes a broad investigative program YIelding much basic normative data concerning dreams. His effort to track and objectify the "typical" dream leads him to the conclusion that dreams are much more prosaic, much more banal and much more like waking thought than we generally conceive them to be. Whitman et al offer the only direct clinical application of REM research. They have in~ geniously integrated the laboratory-monitored dream into treatment and into various aspects of their teaching and training program. The dreams of a resident are monitored, for example, the night before he is to make a clinical presentation so that counter-transferential effects can be noted. Fisher, in a brief concluding chapter notes the ways in which current research supports classical Volume XIII
BOOK REVIEWS psychoanalytic dream theory. 'The only modification he has thus far proposed is that the REM dream is the guardian of REM sleep in contrast to NREM states which have no such protective device. He calls attention to the important work of Lairy who noted that schizophrenics, during the acute phase of their illness, show a significant increase in Stage I without REM, the so-called intermediate phase. There are, in the opinion of this reviewer many ways in which current research may be seen as equally, if not more, congruent with other points of view about dreaming. The laboratory effort has at least reopened the question as to where we are theoretically with regard to dreams and this is a healthy sign. This is a slender volume of 167 pages. It is priced at $10.50. MONTAGUE ULLMAN, M.D. Brooklyn, N.Y. THE GROUPSEX TAPES. By Paul Rubenstein and Herbert Margolis. David McKay Company, Inc. New York, 1971.
This book consists of a collection of interviews of participants in group sexual activities. The interviews are not statistically significant from a scientific standpoint for internal comparison and there are no controls. The interview may be taken as representative for a segment of a population. From the psychiatric standpoint the overly defensive, apparently reactively exhibitionistic attitude of some of those interviewed is noteworthy. They protest too much to justify and defend their group sexual activities. Some of the participants spoke of this form of sexual behavior as being therapeutic. In a description of group sox with changing sexual partners the homosexual rela-
January-February 1972
tions were confined to the women. 'The psychodynamics of this and other descriptions given in this book are suggested, but the interviews do not provide sufficient material for a conclusion. This book provides a sample of one kind of human sexual behavior current in the United States. It gives a generally favorable v:ew of group sexual activity. EDWARD L. PINNEY, JR., M.D. New York, N.Y. PSYCHOANALYTIC CONTRIBUTIONS TO COMMUNITY PSYCHOLOGY. Edited by Milman, D.S. and Goldman, G.D. Charles C. Thomas Springfield, Ill., 1971, 320 pp.
This book is a varied collection of twenty papers given at a recent Adelphi University postdoctoral program in Psychotherapy Conference. The Conference emphasized community psychology with an attempt to bring into focus the contributions of the psychoanalytic perspective. The quality of the papers is quite variable. Some are well written and lucid, such as "Social Change and Psychopathology." Others pertain to specific agencies and often seem to have a provincial perspective which is not necessarily psychoanalytic. I was impressed by the intriguing chapter entitled "Community Psychology? In Northwestern Europe?" by the late David J. Vail. Although he Is not a psychoanalyst, he made a formal study of social and psychiatric problems by corresponding with European friends. The editors give a brief editorial overview of each paper. These add much to the book which is to be recommended to community-oriented psychologists and psychoanalysts. M. J. MARTIN, M.D. Rochester, Minn.
67