In regard to the clinical and etiological relations between the dream and the psychoses, I will report the following observations as paradigms. Hohnbaum asserts (see Krauss, p. 39), that the first attack of insanity frequently originates in an anxious and terrifying dream, and that the ruling idea has connection with this dream. Sante de Sanctis adduces similar observations in paranoiacs, and declares the dream to be, in some of them, the "vraie cause déterminante de la folie." The psychosis may come to life all of a sudden with the dream causing and containing the explanation for the mental disturbances, or it may slowly develop through further dreams that have yet to struggle against doubt. In one of de Sanctis's cases, the affecting dream was accompanied by light hysterical attacks, which in their turn were followed by an anxious, melancholic state. Féré (cited by Tissié) refers to a dream which caused an hysterical paralysis. Here the dream is offered us as an etiology of mental disturbance, though we equally consider the prevailing conditions when we declare that the mental disturbance shows its first manifestation in dream life, that it has its first outbreak in the dream. In other instances the dream life contained the morbid symptoms, or the psychosis was limited to the dream life. Thus Thomayer70 calls attention to anxiety dreams which must be conceived as equivalent to epileptic attacks. Allison has described nocturnal insanity (cited by Radestock), in which the subjects are apparently perfectly well in the day-time, while hallucinations, fits of frenzy, and the like regularly appear at night. De Sanctis and Tissié report similar observations (paranoiac dream-equivalent in an alcoholic, voices accusing a wife of infidelity). Tissié reports abundant observations from recent times in which actions of a pathological character (based on delusions, obsessive impulses) had their origin in dreams. Guislain describes a case in which sleep was replaced by an intermittent insanity.
There is hardly any doubt that along with the psychology of the dream, the physician will one day occupy himself with the psychopathology of the dream.
In cases of convalescence from insanity, it is often especially obvious that, while the functions of the day are normal, the dream life may still belong to the psychosis. Gregory is said first to have called attention to such cases (cited by Krauss39). Macario (reported by Tissié) gives account of a maniac who, a week after his complete recovery again experienced in dreams the flight of ideas and the passionate impulses of his disease.
Concerning the changes to which the dream life is subjected in chronic psychotic persons, very few investigations have so far been made. On the other hand, timely attention has been called to the inner relationship between the dream and mental disturbance, which shows itself in an extensive agreement of the manifestations occurring to both. According to Maury,47 Cubanis, in his Rapports du physique et du moral, first called attention to this; following him came Lelut, J. Moreau, and more particularly the philosopher Maine de Biran. To be sure, the comparison is still older. Radestock54 begins the chapter dealing with this comparison, by giving a collection of expressions showing the analogy between the dream and insanity. Kant somewhere says: "The lunatic is a dreamer in the waking state." According to Krauss "Insanity is a dream with the senses awake." Schopenhauer terms the dream a short insanity, and insanity a long dream. Hagen describes the delirium as dream life which has not been caused by sleep but by disease. Wundt, in the Physiological Psychology, declares: "As a matter of fact we may in the dream ourselves live through almost all symptoms which we meet in the insane asylums."
The specific agreements, on the basis of which such an identification commends itself to the understanding, are enumerated by Spitta.64 And indeed, very similarly, by Maury in the following grouping: "(1) Suspension or at least retardation, of self-consciousness, consequent ignorance of the condition as such, and hence incapability of astonishment and lack of moral consciousness. (2) Modified perception of the sensory organs; that is, perception is diminished in the dream and generally enhanced in insanity. (3) Combination of ideas with each other exclusively in accordance with the laws of association and of reproduction, hence automatic formation of groups and for this reason disproportion in the relations between ideas (exaggerations, phantasms). And as a result of all this: (4) Changing or transformation of the personality and at times of the peculiarities of character (perversities)."
Radestock gives some additional features or analogies in the material: "Most hallucinations and illusions are found in the sphere of the senses of sight and hearing and general sensation. As in the dream, the smallest number of elements is supplied by the senses of smell and taste. The fever patient, like the dreamer, is assaulted by reminiscences from the remote past; what the waking and healthy man seems to have forgotten is recollected in sleep and in disease." The analogy between the dream and the psychosis receives its full value only when, like a family resemblance, it is extended to the finer mimicry and to the individual peculiarities of facial expression.
"To him who is tortured by physical and mental sufferings the dream accords what has been denied him by reality, to wit, physical well-being and happiness; so the insane, too, see the bright pictures of happiness, greatness, sublimity, and riches. The supposed possession of estates and the imaginary fulfilment of wishes, the denial or destruction of which have just served as a psychic cause of the insanity, often form the main content of the delirium. The woman who has lost a dearly beloved child, in her delirium experiences maternal joys; the man who has suffered reverses of fortune deems himself immensely wealthy; and the jilted girl pictures herself in the bliss of tender love."
The above passage from Radestock, an abstract of a keen discussion of Griesinger31 (p. 111), reveals with the greatest clearness the wish fulfilment as a characteristic of the imagination, common to the dream and the psychosis. (My own investigations have taught me that here the key to a psychological theory of the dream and of the psychosis is to be found.)
"Absurd combinations of ideas and weakness of judgment are the main characteristics of the dream and of insanity." The over-estimation of one's own mental capacity, which appears absurd to sober judgment, is found alike both in one and the other, and the rapid course of ideas in the dream corresponds to the flight of ideas in the psychosis. Both are devoid of any measure of time. The dissociation of personality in the dream, which, for instance, distributes one's own knowledge between two persons, one of whom, the strange one, corrects in the dream one's own ego, fully corresponds to the well-known splitting of personality in hallucinatory paranoia; the dreamer, too, hears his own thoughts expressed by strange voices. Even the constant delusions find their analogy in the stereotyped recurring pathological dreams (rêve obsedant). After recovering from a delirium, patients not infrequently declare that the disease appeared to them like an uncomfortable dream; indeed, they inform us that occasionally, even during the course of their sickness, they have felt that they were only dreaming, just as it frequently happens in the sleeping dream.
Considering all this, it is not surprising that Radestock condenses his own opinion and that of many others into the following: Insanity, an abnormal phenomenon of disease, is to be regarded as an enhancement of the periodically recurring normal dream states" (p. 228).
Krauss39 attempted to base the relationship between the dream and insanity upon the etiology (or rather upon the exciting sources), perhaps making the relationship even more intimate than was possible through the analogy of the phenomena they manifest. According to him, the fundamental element common to both is, as we have learned, the organically determined sensation, the sensation of physical stimuli, the general feeling produced by contributions from all the organs. Cf. Peise, cited by Maury48 (p. 60).
The incontestable agreement between the dream and mental disturbance, extending into characteristic details, constitutes one of the strongest supports of the medical theory of dream life, according to which the dream is represented as a useless and disturbing process and as the expression of a reduced psychic activity. One cannot expect,