METAPHRENIA- THE PRESCRIPTION - parivrajakananda [ INTERNET EDITION ] Alcheringa Book Trust MMXI
metaphrenia: the prescriptionmedicine + meditation + matrimony
ad maiorem Dei gloriam“You thank God for the good things that happen to you, and not for the bad things as well, and that is where you go wrong...” - Ramana Maharshi “An optimist is a guy who looks forward to the great scenery on a detour.” - Milton Berle for Audine and Jock, without whose love I couldn’t be here… and for Chris, who changed the way I see the world... just making poetry by other means.
PREFACE During my final year in high school, I was drafted into the school’s cadet corps shootingteam. In competition, I was lucky just to hit the sizeable target, let alone get closer to itsbullseye. The peppered product looked more like a distant small-gauge shotgun blast hadsplattered it with buckshot, rather than the tightly grouped patch of bullet-holes a Bren gun candeliver in the hands of a competent marksman. The writing in this booklet is like that. The style is the man. It would have been farpreferable to be able to write like Len Johnson, the text author of Jog with Deek: clearly andconcisely; thorough-going, yet not a wasted word; always on target. Perforce, I have often found sustenance in the words of Gilbert Keith Chesterton: “Ifsomething’s worth doing, it’s worth doing badly. “ Dom Basil Pennington, the teacher ofCentering Prayer, recommends us always to “Pray as you can, not as you can’t.“ I hope youwill be prepared to forgive me that this pamphlet was written in that same spirit. The following discussion contains much of the information I wish I’d had at my fingertipswhen first I cracked up in 1969, having recently turned 22 years of age and finally arrived insecond year medicine after various interesting diversions. This is by way of a letter to thatfrightened and troubled young man. Being the way he was, in all likelihood it would have madelittle difference for him. But perhaps, just maybe, it can for someone else… The nub of oneirotherapy is this: above all else, the schizophrenic psyche needs to dream. Ifin the course of its nightly sleep, it regularly experiences regular healthy doses of normal REMdreaming sleep, all well and good. But if, for any reason – anxiety and distress, drugs, anunmanageable lifestyle – it is substantially denied this experience, then its dreaming activity isdisplaced out into waking consciousness. And so we dream while we are awake. This we callpsychosis. Our remedies – medicine, exercise, psychotherapy, meditation, social support – all theseefforts are efficacious to the extent they normalise our dreaming sleep. Thus sleep cycledisruption is not just a symptom of the psychotic state – it is also its precipitating cause, and theappropriate target for treatment. Chapter One herein suggests some of the underlying mechanisms that explain these processes.Chapter Two recasts Buddhism as cognitive behaviour therapy. And Chapter Three deals verybriefly with our common evolutionary vocation – marriage and procreation. Dharmashala Winter 2011
Life is short and art long, the crisis fleeting, experience perilous and decision difficult. - Hippocrates Chapter One: MEDICINE de oneirotherapeuticis [or, sleep-regulating our way back to sanity...] “I don’t know if it has happened to you at all, but a thing I’ve noticed with myself is that,when I’m confronted by a problem which seems for the moment to stump and baffle, a goodsleep will often bring the solution in the morning.” - Bertram Wilberforce Wooster
on psychosis as misapplication of the dreaming function Look up into the clear night sky, and those stars show the ancient birth-pangs of all that is inthis universe, and our own, for we are Stardust. Gaze down a microscope at a droplet of pondwater, and we observe the origins of Life. Close our eyes and look within, and there weexperience the biggest mystery of all – Consciousness. How can three pounds of stodgy tepidstale grey porridge give rise to our experience of the True, the Beautiful, the Just and the Good?How can this skull-cased blancmange create our vibrant nightly Dreamlife? Life on planet Earth is rhythmical, cyclical. It follows an annual solar cycle of the fourseasons, a monthly phased lunar cycle of 28 days, and a daily cycle of day and night. Even thecorn on my right foot follows its own emergent 22 day recurring cycle of growth & decay. Eachday, human consciousness follows a circadian cycle divided into eighteen ninety-minute periods.This last cycle becomes more evident when we go to sleep at night, and dream every ninetyminutes or so, as REM-stage sleep allows our dream generator to blossom fully, much the waya spider orchid floresces in the Adelaide hills each year during the favourable conditions of earlyOctober. There are many dream states known to homo sapiens. Amongst them are those out-of-bodynear-death experiences which later read very much like arche-stereotypal culture-dependentdream journal entries except there was no detectable brain energy generating them. There areshamanic journeyings, and the vision quests of the Native Americans and the spontaneousfevered dreams of Wovoka and Black Elk and Plenty Coups which guided their tribal leadershipthrough later stages of the devastating European invasion, with disparate but equally bleakoutcomes, about which science knows nothing. Also in this group are the mystical experiencesof Jelaluddin Rumi, Francis of Assisi, Joan of Arc, Teresa of Avila and Ramakrishna, and ofother Hindu, Jewish, Christian and Muslim saints et al. There are drug-induced visions such asCharles Baudelaire so vividly described in The Seraphic Theatre, and the alcoholic’s terrifyingdelirium tremens. There is the waking dream/nightmare of psychosis. There are those fleetinginitiatory hypnogogic images of descending REM-stage sleep, and non-REM sleep’s anciliaryphilosophising. And finally, there are our full-blown authentic REM-stage dreams, “theunderground movie house which nightly plays four or five Theatre of the Absurd versions ofThis is Your Life behind our backs.” (Professor Rosalind Cartwright)
1. THE DREAM GENERATOR The human brain’s dream generator is composed of three dopaminergic tracts: a nigrostriatal,a mesolimbic and a mesocortical pathway. It originates in the brainstem, adjacent the substantianigra, ascending ultimately to regions of the frontal cortex, connecting along the way withstructures which include the lateral hypothalamus, the forebrain nucleus basalis, bed nucleus ofthe stria terminalis, the shell of the ventromesial forebrain nucleus accumbens, terminating inthe amygdala and anterior cingulate gyrus and ultimately the frontal cortex. Not all thesestructures are exclusively dopamine-driven: their parallel cholinergic aspect interfaces the dreamgenerator Janus-like with the acetylcholine-driven REM state. Two structures in particular seem to play a crucial role in dream production. Without anintact dopaminergic circuit of the ventromesial forebrain, there can be no normal dreaming. Anddamaged basal forebrain nuclei can result not only in greatly intensified REM-dreaming, butalso in vivid and deceptively realistic waking hallucinations. In some ways not unlike thepsychotic experience… As well as sparking REM-stage dreams, this oneiric generator is largely responsible fortriggering the waking dream of psychosis, and is also the target’s bulls-eye for psychotomimeticdrugs, for antipsychotic medicine and for the neurosurgeon‘s leucotomising ice-pick. It does notperform these functions on its own, isolated from other neural networks. What we experiencewhen it is switched on depends on how it interacts selectively with and recruits from the fertilediversity of the brain’s variegated neural programs that are online at the time. Psychotomimetic drugs activate the dream generator so that it comes into partial operationeven though the brain is not safely REM-dream-ing, and it’s the middle of the day in the middleof the crowded city. Research has repeatedly demonstrated that a wide variety of medicines and drugs whichpartially activate the dream generatoroutside of REM-stage sleep – ethyl alcohol,benzodiazepines, opiates, cannabis, cocaine, amphetamines etcetera – also suppress its fullestexpression in developmental REM-dreaming, its locus proprius, its sacred sanctuary. Just asthere are empty calories, so too there is empty sleep: sleep incapable of achieving fully itsnightly regeneration. In rat brains, exposure to cocaine and sleep deprivation both result in an augmentedpopulation of the same dopamine-2 receptors associated with schizophrenia in the human brain.Potent specially bred cannabis can achieve changes in the human dream generator, jamming itfully ‘on’ while awake, to a degree that can take months via the bottle and its accompanyingsleep cycle disturbances. The basal forebrain nuclei are a high priority candidate for thispsychotogenic damage. On the other hand, stimulants like caffeine delay and inhibit the full expression of the brain’sREM state, and antidepressant medicine can suppress it altogether. Paradoxically, depressionoften eases with this reduction in REM-stage dreaming sleep.
Both dopamine-blocking neuroleptics and sleeplessness sensitise the dream generator’sdopamine receptors. But with vastly different consequences. Prolonged sleeplessness charges up the dream generator with unrelieved dopaminergicpressure, expressed eventually in rebound REM sleep, all going well; and if not, in psychosis. The unmedicated psychotic dream generator loses its resilience. It does not bounce back fromsleep deprivation with the usual rebound REM. The sleep pattern of the ‘stabilized’ unmedicatedschizophrenic may not differ significantly from the norm, but it has lost its punch. The qualityof its REM dreams is stunted. Effete, banal, exhausted, depleted by untimely abuse of constantdaylight application. And often by drugs, as well. Even so, research shows that when it awakesfrom a full night’s sleep, its brain will then be at its peak condition of the whole 24 hour cycle.True, it deteriorates as the day progresses. But temporarily at least, as much it can, sleep hasdone its nightly defragmentation job on the schizophrenic brain. Whereas it often leaves adepressed brain even worse off. In prolonged exposure to haloperidol, the generator receptors are sensitised on an ongoingbasis, still being discharged each night during REM sleep, protected by medicinal blockadefrom daytime over-stimulation. The application of an ice-pick to the dream generator’sventromesial forebrain usually put an end to dreaming forever, but not to REM sleep. Whilst these two phenomena are properly locked together, they are distinct processes: theREM brain state – wherein our dream generator blossoms – is triggered by a global wake/sleepcentre deep in the brainstem. A micro-injection there of carbachol, an acetylcholine analogue,instantly plunges a cat’s brain into REM-stage sleep. Whether it may dream then or not ofchasing mice would depend entirely upon the integrity of its dream generator.2. REM-STAGE DREAMING SLEEP At the outset, it must be stated emphatically that REM-state dreaming is not universallyindispensable to the human brain as are air, water and food. Usually a leucotomised brain doesnot dream. Monoamine oxidase inhibiting antidepressant medicine typically reduces oreliminates entirely the REM stage of sleep and dreaming activity from a depressed brain‘s sleepcycle. The human’s need of REM-stage dreaming sleep is immensely variable and doubtlessgraphs the familiar bell-shaped curve, with schizophrenics at its other end. Somewhat controversially, research suggests that REM-stage sleep is the locus classicus forauthentic dreaming. Whilst dreams apparently indistinguishable from REM dreams are reportedfrom non-REM sleep, research indicates that these dream leakages are more likely to beexperienced as one’s schizophrenia score on the MMPI scale increases. Or following an increasein waking anxiety and its higher levels of cortical activation. (Cartwright) The waking dream ofpsychosis must be the ultimate in this dream leakage. It is in the healthy drug-free brain during the muscular paralysis of REM-stage sleep that thedream generator safely connects most prolific-ally with appropriate neural networks and their
programs and produces developmental dreaming. Dreaming is a developmental process whichinitiates with descending REM-stage sleep’s hypnogogic theme-setting imagery, drawn from theday’s emotionally most significant task, which continues to develop overnight through all stagesof sleep, eventually culminating in the final problem-solving denouement dream, the one atleast whose central image we are most likely recall on waking. When all goes well, anyway.(Let’s not overlook the regular retrospective reprise, the side-shows and the warm-up acts.) Our brain is quite as pulsatingly active during REM dreaming sleep as it is in its wakingstates. Just running on different neurotransmitter circuits. As the EEG slows and passesdown through non-REM stage I and II and III to almost comatose slow delta brain-wave non-REM stage IV oblivion, and then up again through those same stages in reverse order, by thetime the brain reaches REM’s dreaming it has switched off the serotonin and noradrenalinecircuits, allowing their vesicles to recharge their fuel to respond rationally throughout thecoming day’s challenges, whilst it runs exclusively acetylcholine circuits in conjunction with thedopaminergic dream generator. And so we dream… Just why it is on acetylcholine is yetunclear. Perhaps because memory is largely cholinergic work. Professor Robert Vertes would deny any cognitively-significant role to REM-stage sleep,suggesting instead its vigorous physiological activity, in itself sufficiently necessary tomaintaining homeostasis to explain adequately our regular need of nightly REM-sleep therapy,may have evolved to rescue and resuscitate the brain from non-REM stage IV’s near coma. Butin fact it is the only mildly more active non-REM stage III which performs that tricky operation,and then on to stages II & I as the brain makes its gradual, measured and purposive return to fullREM dreaming. And onwards. Overnight, this ninety to one hundred and twenty minute cycle repeats itself four to six times.The first lengthy non-REM stages subsequently truncate, as the REM stage progressivelyextends and develops its themes. Professor Alan Hobson espouses a pons-generated, anti-Freudian, cholinergic theory ofdreaming’s vital signs, while Dr Mark Solms stresses a frontal-generated, pro-Freudian,dopaminergic model. REM-stage dreaming includes both – and more besides. Developmental dreams are directed by story-telling circuits in the frontal cortex, butnormally occur during REM-sleep, which is triggered by control centres deep in the brainstem.Homo sapiens passes through stages of development described by Sigismund Freud, and hispsychoanalytic therapy can be very helpful in traversing blockage and regression, but humanpotential is not limited necessarily to the Freudian Weltanschauung. Certain dopaminergiccircuits are necessary for the brain to sustain dreaming activity, but this usually occurs in thecontext of acetylcholine’s REM-stage sleep. Our dreams can range from encoding the most profound, insightful and practical guidance wewill ever receive at every cross-roads of our lives to a reference library of footnotes in the formof hallucinatory metaphors continuously available for our consultation which will amuse,delight, surprise and enlighten in their quotidian application. “Constant observation pays theunconscious a tribute that more or less guarantees its cooperation.” (Dr Carl Gustav Jung)
Dreams are subtle, shifting, they are meant to be read, not taken literally. Hidden awayin what they appear to present are signs that must be seized on by a mind that can see past mereactualities to what hovers luminously beyond. (David Malouf) Our REM-dreaming, inter alia, is the brain processing offline our main emotional concernsand problems. When the brain shifts into psychotic gear, our delusions and hallucinationsexpress the same function: the brain utilises psychosis as yet another opportunity for problem-solving. This is not to suggest that psychosis is in any way ‘a good thing’. It is characteristicallya disastrous waste of life. Even so, evolution tends to make productive use of whateveropportunity comes along, be it the idle hours of planetary darkness or the tragic vacuity ofmental illness. Nature abhors a vacuum: “As soon as a food source comes into existence,something develops to live off it.” (William Andrews) To watch our ravelled wounds knit and mend, slowly but surely – from a scratched mosquitobite, a slipped knife, the surgeon’s scalpel – is to experience one of evolution’s great triumphs:Life that can amend and heal itself. So too, to watch our dreams heal our brains each night.Most of it goes on beyond our sight… Yet those nightly doses of Coyote & Roadrunner, sillyand insubstantial, routinely repair and rehabilitate our stressed-out brains.3. MODELS AND METAPHORS A suitable model for cerebral neurotransmitter activity could begin with what we experienceas Consciousness subsisting as variations on a theme extemporised by the jazz quartet ofnoradrenaline, serotonin, dopamine and acetylcholine, expanding out to a full concert orchestrato accommodate the dozens of different neurotransmitters that are being discovered. Noradrenaline and dopamine are the ‘hare’ brain’s speedy nerve fuel; whereas serotonin andacetylcholine are neurotransmitters of the more placid ‘tortoise’ brain. Together, somehow thisunlikely Aesopian coniunctio oppositorum usually gets us by, one day at a time. The wake/sleep cycle is a bit like that self-contained Bren light machine gun, which simplyredirects the high-pressure propellant/exhaust gases from its primary function in order to eject,reload and then cock once again and fire its primary function, all this sans any recoil to speakof. And so it goes... The BMW motorbike engine – two reciprocating horizontally opposed four-stroke cylinders –suggests the steady continuous day/night throb of consciousness, wherein vigilant wakefulnessand dreaming REM-sleep are equally important terminal endpoints on a recurring homeostaticcontinuum of aminergic and cholinergic demodulation. The engine of consciousness is driven as much by its eight hour night cycle as by the longerday cycle. When we reflect upon our conscious life, if we but contemplate it deeply enough,we are bound to conclude it is not made up of separate, disconnected compartments such aswork and sleep and play and dining and dreams and emotions and daydreams so much as it is aseamless cyclical twenty four hour continuum. As one dream researcher has observed: “We are
a multiplicity of states in constant interaction.” The dream as bowel motion of the brain (Philip Adams) is a profoundly apt if perhapsdiscomfiting metaphor: the end product of a complex and lengthy process of digestion,absorption, assimilation and elimination which begins afresh each morning as we start taking innew information and experience, and can tell us so much about the true state of the psyche andits health or otherwise.4. DREAMWORK Dream researchers have found that overnight over time a regular healthy sleep cycleautomatically achieves at least three tasks which assist the dreamer to adapt psychologically toever-changing circumstances and add dramatically to their chances of ongoing survival. In manyof us, most of these feats are achieved without our ever being even vaguely conscious of it; exopere operato, as the theologians say. Without the assistance of a sleep laboratory, at best wewill recall only one per cent of this activity, and fail utterly to plumb its significance. Firstly, the processing, interpretation, integration and storage of rote factual data memoriessuch as geographical and biographical details or technical information and the like. Secondly, the maintenance and development of new motor skills and strategies, such ashunting techniques and ways of escaping predators; dancing, sporting and vocational aptitudes. Thirdly, the processing and integration with prior memories of recent emotional experiences,especially the negative ones involving threats to one’s wellbeing, reputation and social standing;to one’s familial or tribal relationships; and situations where one’s existence or that of one’sfellows is imperilled. Over a period, this dreaming process ‘kaleidoscopes’ such dangerousuncontrollable threats into more familiar and manageable patterns. Very often, depressionandpost-traumatic stress disorder represent a significant failure of this repatterning process todeal adequately with such loss or threat. If we reflect for a moment, we will recognise these as much the same preoccupations asourwaking consciousness and its survival. Incidentally, together all these functions achieve thefurther foundational goal of establishing one’s sense as an autonomous self, and of creating aconstantly updated model of the world it operates in.5. REM DREAMING AND NEUROGENESIS When we talk about “memory” and “learning“ and “developmental process”, we are reallytalking about neuroplasticity. Every time we think a thought or feel a feeling, we are changingour brain structure, to an extent determined by the intensity and its repetition. Wheneverwe do psychotherapeutic work – whether psychoanalysis or Twelve Step work or meditation orcognitive behaviour therapy, or whatever forms it may take – this activity translates in theplastic brain rewiring itself.
Underpinning and underwriting this endless process in the healthy brain are neurogenesis andsynaptogenesis – the constant creation of adult neuronal stem cells, and their development intofunctioning interconnecting network neurons. Whilst these possibilities are finite, they arenonetheless potentially revolutionary in transforming lives. As yet, this branch of science is in its infancy, already it has legs and is learning to walk inthe rehabilitation of neurological and psychiatric patients. For our purposes here, it is helpful totake a brief glance at basic research on how sleep, drugs and exercise interplay with neuro-genetic brain processes. A fundamental component of our experience of REM dreaming is our hippocampal cellsregenerating themselves, that stem cell memory stuff our dreams are made on. REM-sleepdeprivation shuts down neuro-genesis in the hippocampal dentate gyrus of the adult rat brain,incontrovertibly demonstrating sleep’s critical role in facilitating plasticity. Incontrovertible too is the stimulatory effect of exercise on neurogenesis – whetherneuromuscular exercise, or cognitive or social. Less clear is the effect of antipsychoticmedicines. As yet, it doesn’t look like they have an inhibitory effect. There is more than asuggestion that at least some neuroleptics have a stimulating effect on neurogenesis – but itremains to see how important this is, or even whether it is a long-term ongoing effect. Bothlongterm alcohol and cannabis use in moderation seem to promote neurogenetic processes. It’stheir likely disruptive effect on successful synaptogenesis that is a problem. Antidepressant SSRI medicines like Prozac not only stimulate serotonin activity – they alsonormalise basic hypothalamic drives involving thirst, hunger and sex, as well as encouraginghippocampal adult stem cell production. You don’t get much wider-ranging therapeutic bang foryour medicinal buck than this. It is clear that brain diseases ranging from depression to dementiainvolve some failure of neurogenesis. It seems that schizophrenia may involve, inter multa alia, a genetic flaw in some of theneurons continually generated in the hippocampal dentate gyrus, thus compromising their abilityaccurately to encode learned memories, resulting in cognitive disorder. Nonsense in, nonsenseout. This entirely novel area of research adds a whole new level of understanding underpinningREM sleep’s memory consolidation. Not so long ago it was entirely inconceivable, the receivedestablished orthodoxy being that our brains were born to grow, develop and live with theirallotted cells at birth, which thereafter could only die and decrease in number unto the eventualbeckoning grave. This discovery is a scientific switcheroo of incalculable magnitude, addingneuroregenerative dimensions to the humblest of routine activities, cerebral or somatic, to ourfamiliar and even more to our unfamiliar daily social interactions, and to our nightly slumbers asthey reinforce and integrate these experiences.
6. WHEN THINGS GO AWRY Primordially, along with our large powerful gluteal muscle to break the constant falling-forward motion of loping after game and away from hungry predators, our ground-grasping barefoot with its spring-loaded shock-absorbing arch “buttressed from all sides with a high-tensileweb of twenty six bones, thirty three joints, twelve rubbery tendons, and eighteen muscles, allstretching and flexing like an earthquake-resistant suspension bridge” (Christopher McDougall),and millions of evaporative-cooler sweat glands, our human dreaming brain circuits evolvedover hundreds of Pleistocene millennia on the African savanna and in coastal caves, to assist ourhunter-gatherer ancestors survive in their active, athletic lifestyle, in which daily survivalthreats were predominantly physical. Endowed with this same basic equipment, we may since have walked on the Moon, split theatom, drafted Four Quartets and composed that defiantly passionate yet intensely lyrical death-bed String Quintet in C, but homo sapiens, at our speed with a stride longer than that of ahorse, evolved by pace tracking multi-marathon persistence hunts – and by dreaming. Thisnewfangled meat protein food source they ran to ground then helped to grow these burgeoningbrain circuits. One thing that would have been intimately familiar to our ancestors was the raw experience offrequent trauma, unshielded by police and ambulances and hospitals and morgues and thesanitising distance of the networks’ evening news casters. So often a primeval version of theKokoda Trail was their daily vocation. If like the immune system, developmental dreamingevolved as a therapeutic function endowing increased chances of survival, how it deals withtraumatic insults would be a defining litmus test. If along the way it also processes and storesdata memories, and enhances neuromotor skills and behavioural strategies, so much the better. Nightmares can be a problem. And a big one. Particularly when they are blindly repetitiveand ‘stuck’ so that they ‘freeze’ the usually dynamic dreaming process, or so horrific that theyterminate abruptly the whole sleep process with premature awaking. Dreaming like this ispainfully characteristic of post-traumatic stress disorder. And yet, Professor Ernest Hartmannsuggests that nightmares evolved as a nocturnal solution to assist the psyche process theemotional impact of threats to one’s very existence. Hartmann argues that the nightmare is themost useful dream, although ‘nightmare’ here denotes a much wider-ranging concept than theclinical definitions.Nautici Cavete: There is as yet no comprehensive theory of dreaming which can embrace andreconcile all the research data. Nor does this essay purport to fill that lacuna. For instance, Ihave made no reference to Professor Antti Revonsuo’s seminal contributions. CambridgeUniversity Press’s encyclopaedic Sleep and Dreaming contains compendious contributions fromseventy six of the leading research teams in the area, all espousing differing and oftencontradictory or opposing views. Indeed, one may speculate as to the existence of six and a half billion unique and distinctexperiences of and views on dreaming, all varying in some subtle respects along with our DNAand our fingerprints, our handwriting and our gait, our politics and our religious beliefs. Like
Scripture, the research literature is a fecund source for authority to support almost anyviewpoint. Just how – or even whether – our dreaming contributes to our problem-solvingcapacity is as yet a scientifically moot and unequivocally unanswered question. Whichconsiderations give rise to the First Law of Oneirotherapy: for every sleep study, there is alwaysan equal and opposite research project. This essay is underpinned by the experience and observation of many: that our nocturnaldreaming is a valuable component of our psyche’s problem-solving capacity comparablysignificant with its daytime rational consciousness, at the same time accepting that this may notuniversally be true at all times for all homines sapientes, every one of whom is unique andidiosyncratic, no more so than in our nightly sleep cycle. There is perhaps nothing moreintimate and inalienably our own than what happens when we sleep. As Thomas Aquinasobserved: “The greatest glory of God’s creation is in its diversity.” Six and a half billionexperiments-of-one...Quibus dictis, according to Professor Hartmann the brain is constantly at work, awake ordreaming, solving problems incidental to better quality survival. As in waking rationalprocesses, in dreams it ‘contextualizes’ survival threats, reviewing them in the broader contextof previous experience. Dreaming provides a safe place to ‘contextualise’ the quaking terrorwhich the survival-obsessed rational waking consciousness cannot afford even to admit.Dreaming is Nature’s own psychotherapy, providing a ‘safe place’ and a process to calmemotionally rough seas and stormy weather. Dreaming does this using pictorial metaphor, a punster mechanism taken to a visuallysymbolic extreme, often in a lived movie form. A literalistic dreaming function is not a healthydreaming function; whether awake or in dreams, with a homely metaphor the foreign &potentially shocking becomes familiar & potentially useful. InHartmann’s view, the nightmareprocess is a paradigm example of successful dreaming because it illustrates most vividly thesecore evolutionary aspects of dreaming. When our ancestors encountered a pride of lions, or witnessed one tear a clan-member toshreds, complementing their rational processing of this ultimate survival threat was an emotionalprocessing of this outrage against humanity, this extreme violation of existential boundaries.Over the millennia, their dream generator evolved a mechanism for coping: the nightmareprocess. Today we may experience the same nocturnal phenomenon in response to wartimebattles, natural catastrophes, terrible accidents, assault, abuse, rape or torture. Our nightmares can play an important role in the healing power Paul Johannes Tillich referredto: “The experience of meaninglessness, emptiness and despair is not neurotic but realistic.Life has all these elements. The experience becomes neurotic or psychotic only if the power ofaffirmation of life in spite of has vanished. The negative elements are possible consequences ofman’s basic nature, of finite freedom. They are universally real, but they are not structurallynecessary. They can be conquered by the presence of a healing power.” At first the nightmare process responds literalistically: the initial shock is too great to waxpoetical or philosophical. There will be a raw graphic image close to the traumatic incident. The
victim dreams the dominant emotional response in the form of a powerful central image: anoverwhelming tidal wave, a ravenous beast of prey, a home in flames, a gang of threateningmen – a central image which encapsulates their vulnerability, their helplessness and theirultimate insignificance, which is often slightly different from the traumatic incident. It’s thecasual way the Cosmos-as-Executioner indolently goes about cutting its random swathe anddelivering its haphazard blows that gets to us. But this is merely the first stage of an ongoingprocess. All going well, according to Hartmann’s research next come images more familiar to thepsyche, as it contextualizes the trauma within dreams which make broader and broaderconnections between this recently experienced material (day residues) and older memories. “Over a period of weeks or months as the trauma gradually resolves, the dreams often followa discernible pattern. First the trauma is replayed vividly and dramatically but not necessarily inprecisely the way it occurred: there is often at least one major change in the dream, somethingthat did not actually occur. Very rapidly the dreams begin to combine and connect this traumaticmaterial with other material that appears emotionally similar or related … The process ofconnecting the trauma with other emotionally related material from the dreamer’s life (andimagination, reading, daydreaming) gradually expands and takes in more and more othermaterial; the trauma itself plays a smaller and smaller role and the dreams return to their pre-trauma state.” For the hypothetical ‘normal’ dreamer, their significant dream images will be much lessintense and concentrated, drawn from an emotionally more diffuse and varied experience, andthis will be reflected in a more flexible, less anxious dreamlife. This is painful territory: our idea of Hell may well have come from nightmares. That’s howmuch we value our survival and are impelled to protect it, even in violation of our better nature.All too often, this therapeutic nightmare process is stymied by premature awakening andsleeplessness, or it gets ‘stuck’ repeating over and over its terrifying central image stage, andfails to progress and resolve without the assistance of professionally-supported self-talk therapyand medicine. We call this post-traumatic stress disorder. Yet Hartmann’s research shows thatroutinely ex opere operato our dreams successfully take care of our traumatic experience ofbushfires and road accidents and terrorism and earthquakes and tsunami without the need for anyexternal assistance. This nightmare process endowed the dreamer an added dimension as they dealt with theirtrauma: coming through it, they were likely to emerge even stronger and wiser to respond to thenext confrontation with their ultimate meaninglessness. It has survival value. If it doesn’t breakus with an oneiric equivalent of prophylactic shock. The risks are great. But so too is theeveryday pay-off.
7. SLEEP AND THE REGULATION OF MOOD: DEPRESSION As yet, it is quite impossible to define or catalogue or limit in any way ‘The Purpose(s) ofSleep.’ It’s rather like the humble needle, which can be used to darn a hole in the heel of a sockor a cardigan’s ravelled sleeve, or tack together a shirt, a pair of pants, or a dress, or finely toembroider a delicate work of high art; to puncture and express a boil, or suture a wound aftersurgery; to attach rope to canvas and so fly a dinghy, or bind loose leaves into this more durablepublication; in elongated form, to knit gloves or a scarf or jumper; in hollow form, to injectantibiotics or drain effluvia or direct glue onto model ship parts; harnessed to a machine, theneedle cobbles together leather into moccasin and jackboot alike. The applications of the needle are numberless, ranging from life-saving to routinemaintenance to creative time-wasting. It’s much the same way with sleep and its seeminglyendless list of functions and accomplishments. One of sleep’s multifarious evolutionaryapplications is the regulation of mood, purrtickerly of depression. For many of us much of the time, our moods come and go as easily as the weather and itsclear or clouded skies. At certain critical times – the death of a loved one, breakdown of a basalrelationship, loss of a way of living – depression can close in on any one of us and stick aroundlike a threatening iceberg. At such times, a healthy dream life can assist us in working throughand resolving our grief. However, as with the nightmare process, it seems that not all of us arecreated equal in this regard. In the normal healthy brain, the first and primary emotional/cognitive task of dreaming sleepis to clean out the muck from the stables and weed the garden, i.e. deal with our negativedaytime experiences: to defuse them, neutralising their ongoing toxicity. Up to 80% of ourdreams are negative in affect. However, like the aforementioned needle, the nocturnal needs and uses of our sleepingbrains are all different and uniquely blended mixtures. Some of us are owls and others larks.There are geniuses, genii, who thrive on only the snippiest of short shrift night shifts:Bonaparte, Edison, Franklin , Talbot et al. There are those of us who without much longerregular sleep rapidly become destabilised and worse. And there are those of us for whom a fullnight’s sleep can be positively toxic and debilitating. With too much sleep, we are much more likely to be dull, detached, deadened anddepressed. More likely to see things as they are, clear and unvarnished of value; unveiled ofillusion, of the underlying communal delusion that it is better somehow to be than not to be, orthat it really does matter what we may think, or what significant other people may think of us.Never can you prove such prolegomenaries rationally, yet we all take them seriously, andwithout them the happiness we all seek and each in some measure finds would be unattainable. Cut back on sleep, and some minds lose that bleak familiar regimented outlook: the grey foglifts. This is precisely the chemotherapy some depressed brains respond to, through their maoior ssri antidepressant medicine. Simply to cut back on the total time spent in bed asleep can alsohelp, through this same mechanism, but the problems once again return with the next full
night’s sleep. Professor Rosalind Cartwright has researched the night life of a group of depresseddivorce(e)s for up to eight months after marital dissolution. For the majority, their dream lifeplayed an integral part in their grieving process and recovery. Over the course of a night’s seriesof REM-sleep episodes, their dream outcomes progressively became more positive and moreoptimistic, both overnight and increasingly over the research period. They awoke rested andrefreshed. Their former spouses played increasingly neutral and detached dream roles whichreflected and facilitated the resolution of their emotional conflicts. As with Hartmann’snightmare subjects, in due course both their mood and their dreamlife returned to normal, andin general they successfully moved on with their lives. For a more problematic minority such was not the case atallatall, as they exhibited a numberof characteristic tell-tale signs. After the nightly onset of sleep, their brains rushed prematurelyinto REM dreamepisodes without due conscious daytime preparation or adequate non-REMpreliminaries. Their dream generator was incapable of producing well-formed, bizarre andcomplex dramas which included a reconciling role for the former spouse. Their dreams failed tocreate sanguine associations between their current problems and previous happier resolutions tosimilar problems, following instead a pattern of repetitive negative dreaming, and so ultimatelyfell short of resolving over time into positive and more hopeful territory. Unlike the majority,they awoke feeling unrested, irritable and fatigued, and usually they were unable to recall theirdreams the next day. Rather than being part of their solution, their dreamlife was a deeperaspect of their problem. In a work of literary fiction, Evelyn Waugh has well described the disappointed anddepressed housewife’s poignant dreamlife in his perspicacious case note: “Long, tedious dreamsborn of barbituric, dreams which had no element of fantasy or surprise, utterly real, drabdreams which, like waking life, held no promise of delight.” The depressive’s brain is different from the norm: it doesn’t seem to need REM-sleep toperform many of its normal functions. For a normal rat brain, REM-sleep deprivationinterrupts neurogenesis. The latest antidepresssants typically reduce or even eliminate REM-stage sleep. This medicinal loss of REM-sleep doesn’t interrupt neurogenesis in a depressive’sbrain. Quite the opposite – it actually stimulates it. Similarly, a depressed brain can learn torelieve its dream generator of toxic nocturnal overload with daytime cognitive behaviour therapythat solves and salves emotional problems normally the province of REM-stage dream therapy. To a varying degree, we can all sidestep a need of medicine and/or therapy if we manage tonormalise the depressed neurological processes with a substantial daily dose of hot and sweatyphysical exercise. Quite incidentally, besides investing our life with their fun and physicalfitness, vigorous daily aerobic high jinks tend to normalise depressed brain chemical activity,releasing adrenaline and noradrenaline, and raising serotonin levels, at the same time as theylower our blood levels of the stress hormones, including cortisol, that galvanise the body tofight, to flight, or to freeze, even as they cloud and obscure our calm reflection. Over many hundreds of thousands of years, millions of years, our bodies have gradually
evolved as efficient steeple-chasing machines, and a mere twelve thousand years of sedentaryagricultural life hasn’t changed that basic anatomical fact one whit. Here in Adelaide where Ilive, we suffer unnecessary disease and perish prematurely because we ignore this coreevolutionary law of being human: we were born to run. Exercise is the surest, sweetest, most effective antidepressant medicine and cognitivebehaviour therapy combined together into the one carefree liberating package requiring nodoctor‘s prescription nor psychologist‘s coaching. “Only when becoming an athlete fails shouldwe treat the disease itself,” wrote Dr George Sheehan of coronary artery disease. He mightequally have been referring to the depressed brain. Try it – we have nothing to lose but ourblues… “Blithely kicking off the flip-flops and running barefoot across the green grass to catchthe stayed departing train, ‘One thing I know I can do is run.’” (The author to himself in adream, winter solstice full moon, 2002) # # # # # In November 1990, I made the first of three trips to India, specifically to Rishikesh, apicturesquely Arcadian “village of seers“ nestling among the toes of the Himalayas besideGangaMa as she pours out onto the plains. After one week in that elysian mediaeval Disneyland,I ran out of trifluoperazine, my antipsychotic medicine at that time. In a naively inane attemptto compensate, in its stead I increased the dosage of phenelzine, the maoi antidepressant I hadbeen prescribed three months earlier for my panic attacks, unwittingly thereby pouring petrolonto an already raging conflagration. With no REM-sleep whatsoever, precious little repose of any sort, and without anytranquillising neuroleptic medicine, rapidly I became manic and enraged, incoherent, paranoidand delusional, and upon my return to Australia ten days later, although briefly back on mymedication, for my riotous misconduct on arrival there I was forcibly hospitalised out of Sydneyairport. Thus far, my final detention. Eleven months later I returned to my Shangri La – “Yoga Capital of the World” - to discoverjust round the corner from my Ghat Road hotel room, on the road to Dehra Dun, a little chemistshop dispensing trifluoperazine 5 mg tablets over the counter, at five rupees or at that timeroughly twenty Australian cents apiece... Were it not for that unpropitious Burke-&-Willsian experiment of nature, every three weeks Iwould doubtless still be consulting with my endlessly patient psychiatrist, every night I wouldbe consuming trifluoperazine 15 mg, an unnecessarily high and brain-numbingdosage, as I had every night for the previous thirteen years, and every day, a variety ofmedicines for the resulting panic attacks; and to dull the indignity, employing unhealthyquantities of ethyl alcohol and tetrahydrocannabinol which only made everything, particularlythe panic attacks, even worse. Why on that occasion did I crack up so very swiftly? Previously it had always been a long
sad drawn-out deterioration taking months. Years even. Certainly never just a few days. But forthat initiating misfortune, there would not have been the tantalising evidence to provoke theinexorable curiosity, with the subsequent twenty year-long lattice of events and research tocrystallise out the answering discovery outlined herein. Certainly not in this form, anyway.“God works in mysterious ways.“ (Dr Julian Andrews) Or, if you choose to eschew theeschatological, using different words to say the same thing, “Truth is more often stranger thanfiction.” (Samuel Langhorne Clement) In the immortal words of Aleksandr Popcsynski, “Thereis a reason for everything.” “Nothing is ever wasted.” (Mohandas K. Gandhi)8. SLEEP AND MOOD REGULATION: BIPOLAR DISORDER What is outstandingly clear, both from our everyday experience and the research literature, isthe profound relationship betwixt sleep disturbance and mood disturbance: sleep is critical inaffect regulation. In unipolar depression, as already we have seen, this relationship is literally “less is more”:REM-sleep reduction classically relieves depression, whatever the exact mechanics may be. Underlying the mood swings of bipolar disorder is an equally profound and chronic but farmore complex sleep architecture disturbance which impairs sleep between episodes, escalatesjust before an episode, and exacerbates still further during the course of an episode, whether ofdepression or of mania. (Dr Allison G. Harvey) Whilst hypersomnia is a classic symptom ofdepression, lack of sleep and mania so often go hand in hand. These oneiric fluctuations are notso much symptoms as the underlying cause at work. Alternatively, the mood disorder’s underlying oneiric disorder often manifests in the guise ofsleeplessness & insomnia. This can be even more painful, because at least in hypersomnia,much of the time you are no longer there, in conscious misery. At least you are out of it,however unsatisfyingly. Whereas to be awake in your misery is sheer hell. The remedy for bipolar disorder is to normalise the underlying sleep disorder, and itsdysfunctional circadian rhythms and the cyclical wake/sleep/dreaming stages of our veryconsciousness. Our therapies and our medicines are efficacious to the extent – directly orindirectly – they effect this end.9. DEPRESSION AND INSOMNIA The depressed brain is obsessed with its grieving, with life’s injustice, often with very goodcause. Throughout the day it chews over its predicament, well described as ruminating. Thedepressed brain continues this obsessional preoccupation mercilessly even as we sleep. Itsavours its repetitive negative dreaming without let, to this end often extending the period ofsleep into unsatisfying & barren hypersomnia. Alternatively, the brain finds this bleary dreaming process too painful and distressing, and
wakens prematurely to insomnia. Sleeplessness may not be as disabling or crippling as PTSD’snightmares, yet – as any sufferer knows – at three o’clock in the morning it can be excruciating.In this situation, we still look forward each night to sleep’s temporary oblivion, even when weawaken short hours later with our depression even worse than when we went to sleep. If we’relucky... Sleep disturbance, whether too much or too little, is intrinsic to depression’s activity. Theproblem is in the dream generator as much as the conscious brain’s circuits. The depressive’sdream generator is broken, no longer capable of staging each night four or five therapeuticproductions of developmental dreams. Even a normal load is too much for it. The nightlyalchemical feats of spinning our negative experiences into fine gold require a determinedcheerfulness and a doggedly optimistic energy beyond our depressed generator’s capacity. Onesure hallmark of recovery is when we find ourselves no longer giving sleep a second thought, itis again so normal. It is part of my thesis that this is not coincidental but causal. Usually essential to this recovery is medicine, whether lithium, antidepressants and/orneuroleptics. More and more we can take the load off our dream generator with the help of anytherapy that actually gets us dealing with our life, living it as it happens, moment by moment,instead of ruminating endlessly over the past. Whether we exhaust the emotion in moment tomoment mindfulness, or divert the mind back to external reality, at the end of the day there isno burden of unfinished business to weigh down the susceptible dream generator. Of course,there will always be some residue, but we can keep it down to a manageable level. Demandingphysical exercise is one sure-fire way of concentrating our mind in the present moment, inaddition to all its other proven more physiological antidepressant benefits. Much of thisopuscule was drafted aimlessly shuffling alongside Karrawirra Parri...