THE OTHER SIDE OF SLEEP:  THE MEANING OF DREAMSAs is the case with many aspects of sleep research, there is no real answer to the question of why we dream. But what about the content of dreams? Is a dream a subconscious “letter to oneself,” filled with cryptic instructions on how to cope with life? Or is it merely a garbled instant replay of the day’s events, with no structure or meaning? Any answer given by medical scientists will naturally reflect their concept of the origin of dreams. Those who see dreams as a purely physical, biological process will completely discount the significance of content and thus may overlook clues to the functioning of consciousness. On the other hand, those who see them as indispensable keys to personality are perhaps prone to imbue them with far more meaning than they actually contain.That many dreams are connected to the past day’s events is obvious. You probably recall your own dreams in which you rehashed a recent confrontation or replayed characters or scenes from the movie you watched before going to bed. These incidents are usually transformed; they might take place in an unfamiliar house, for example, or a person in the dream might have the face of a close friend but play an altogether different relational role— as a parent or sibling, perhaps. It is these very transformations or associations that intrigue psychiatrists and others, who wonder why the brain bothers to make the changes instead of just replaying the scene uncut, unrevised, and uncensored.*289\226\8*

Nowadays hypnosis is used more and more by doctors and psychologists. In 1958, hypnosis was formally accepted as a form of medical treatment by the American Medical Association, and three years later by the British Medical Association. Hypnosis is now no longer a magical act, but a well-respected science. Much research is conducted on hypnosis, and some medical journals are devoted entirely to hypnosis. The International Society of Hypnosis has thousands of members from all over the world, all of whom are doctors, dentists, and psychologists. Its headquarters is situated in the Austin Hospital, Melbourne.

Now back to the top hat magician and the lady. The lady went into a hypnotic state, commonly known as a trance. She was not sleeping; if we carried out an EEG recording on her, the brain waves would not be characteristic of sleep. She was aware of what was happening, but the scope of awareness would have been abnormally small. She was only aware of what the magician (hypnotist) was suggesting to her and was not aware of the presence of the audience. She was still thinking for herself and normally would not accept any suggestion from the hypnotist if it contradicted with her conscience or belief. When she was woken up from the trance, she remembered what happened, and this is generally the case with hypnotized subjects.

Hypnosis is not a magical act, but a special state of awareness, and everyone has the ability to go into this state. We are familiar with the other states of awareness, the conscious state and the unconscious state.

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This mechanism is often seen very clearly in cases of injury involving compensation. A man is injured at work. He knows that he is entitled to monetary compensation, but he does not know the exact figure until his claim is settled. The injury heals, but the pain persists. Sometimes the pain even gets worse. In spite of this he looks fit and well, but people near to him come to notice that his thoughts keep returning to this question of his claim for compensation. Doctors who examine him can find no cause for his pain, and they are inclined to regard him as malingering. Of course, everyone knows that cases of malingering do occur, but these represent only a small minority. The pain is determined unconsciously by the functional overlay without the patient having any real awareness as to what is happening. When no compensation is concerned patients recover from similar injuries without the same prolongation of the pain. Sceptics point to the fact that the pain clears up miraculously when the claim is settled, but this does not disprove the unconscious cause of the condition.

A man about forty-five years old was referred to me by his local doctor. The patient suffered from definite but mild rheumatoid arthritis. The local doctor was puzzled by the recent increase in the degree of pain suffered by the patient. It was little influenced by pain-killing drugs, and was on the point of ruining the patient’s life.

The patient’s wife was childless. Twenty years ago they had taken a baby girl to live with them. They had brought her up as their own, but the child’s parents had never allowed them to adopt her. The girl was now to be married and the real father had come to take his place at the ceremony. The patient was tense, bitter, resentful, and full of unexpressed hostility. His tension had provided the functional overlay to the organic pain.

A childless woman of fifty had had minor surgery three years previously. She complained of pain in the scar. She had sought help from overseas specialists to no avail. She used the following words to describe her condition: “Feels like a knife or something sharp. Like a metal plate. Conscious of it all the time. It is an inhuman sort of pain. It aches at the base of the incision. Stiff and sore as if bruised.”

She was a shallow society woman without any real sense of values, who for years had tried to escape life in an endless round of parties. Now she was older and no longer beautiful. She saw her friends with their children. The hurt of it all came to her, and she felt it in the scar of the operation.

I did not put these ideas to her. To do so would have been cruel, and would have made her worse by mobilizing her anxiety. It is usually unwise to tell people the cause of their trouble in so many words, much better to let it come indirectly; then they understand and know it to be true. This happened with this woman. She changed during the weeks she was doing the exercises, and it was clear that she achieved some inner acceptance of things in a way that is not uncommon when people come to do the exercises in meditative fashion. At the same time the pain subsided and she was able to resume a more active life.

*104\57\2*

Some of us find the prospect of letting go in meditation quite fearful. It can be too frightening even to think about it. We may think that by letting go we will lose control, and all our worst fears will come true. This is not the case. By letting go we are actually gaining control, not losing it.

Sometimes we may experience a ‘surge’ attack during meditation. If this or other types of attacks happen in meditation, the secret is to let them happen. Not to fight them, but let them come. We keep our mind focused on our meditation technique. Although this may seem frightening as you read this, in actuality it isn’t frightening. When you let the attack happen and keep focused on your meditation, the attack will move through your body and disappear as quickly as it came. This is taking back the power.

It may take some time for people to gain the confidence to begin to let go of their control. Other people are able to let go within meditation immediately, and as they let go they can meditate naturally and easily. This is the beginning of full recovery. It is a very important step, because meditation teaches us that it is all right to let go of the control we are trying so hard to maintain. As we let go of this control we realise our major fears don’t come true, and as our practice continues over time we begin to understand why they never will.

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Relaxation doesn’t mean curling up with a book or watching television. If it were that simple, we wouldn’t have the disorder in the first place. Establishing the discipline of practising a relaxation technique may appear inconvenient to some people, despite the extraordinary inconvenience of their disorder, but recovery is worth the effort.

The main relaxation techniques are various forms of progressive muscle relaxation, and meditation. Progressive muscle relaxation is a step-by-step technique which teaches us to tense, then relax the major muscle groups in our bodies. If practised successfully, our minds also begin to relax. As our minds relax we may find ourselves meditating.

Meditation techniques work in the opposite way. If our practice is successful our minds relax first, then our bodies relax easily and effortlessly by themselves.

Meditation is over five thousand years old and while we use meditation as a relaxation technique, it is also the oldest cognitive technique in the world. Besides enabling us to access deep levels of relaxation, meditation teaches us how to be aware of and control our thoughts.

The next chapter outlines two meditation techniques. I used meditation because I found it was simpler and easier for me, during the years I had panic disorder/agoraphobia. This is also true for many people I have worked with over the years. This doesn’t mean progressive muscle relaxation doesn’t work—it does, and I have known people who find it easier. It is an individual choice.

Much of our recovery depends on our commitment to lower and keep down our levels of anxiety and panic. Practising a relaxation technique is a proven natural way to do this.

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Bill walked from his manager’s office. He knew the day would come-when he would be found out and today was that day. He had been caught drinking during working hours in the bar of the hotel, a few doors down from the office. He had been a regular visitor to the hotel, as he made his daily courier rounds to the head office, a few blocks away. Having a drink was the way he had found to help him cope with the panic attacks and perpetual anxiety. Bill had a regular routine. A drink before going to work, one during his morning round, two at lunch, one on the afternoon round and two before he drove home. He felt he had at least one thing in his favour. The manager didn’t know about his anxiety problem. Bill thought that having a drinking problem was much more socially acceptable than having an anxiety problem. What Bill didn’t know was that his manager also had the same anxiety disorder!

Patricia

The prescription lay on the table. Will she or won’t she have it filled? Years ago Patricia had been given a similar medication. She had never liked the thought of taking it, but the panic attacks and the anxiety finally convinced her she had to do something. It had helped for a while, but over time she found she had to keep increasing the dose for it to have any effect. Finally she decided enough was enough, and slowly withdrew from the medication. Patricia had learnt to cope with the panic attacks and the anxiety, but over the last two months they had become more and more intense. She didn’t want to take the medication, but as no one could suggest any other way of controlling the disorder she felt as if there were no alternative.

Robyn

Robyn looked at her mother in silence. It was no use, her mother was never going to understand that Robyn’s panic disorder was a legitimate condition and that Robyn was not just being ‘stupid’. Her cousin also had panic disorder/ agoraphobia and had committed suicide a month before. No one had known until after his death exactly what had been wrong with him. He had never told anyone outside his immediate family. Yet Robyn’s mother still would not be convinced. She told Robyn that the family was not the type to have this sort of problem and that she had better ‘pull herself together’ and stop being so ridiculous.

*27\94\8*

In 1980 the economic cost of panic disorder, calculated in terms of employment losses, disability benefits, financial support and health care costs, was estimated at US $1 billion (Sheehan et al. 1980). A survey in the United Kingdom placed the economic cost of panic disorder, calculated solely on the basis of absenteeism, at £3 billion per year (Phobic Trust NZ 1991).

After speaking with over 12 000 people with an anxiety disorder, I have no doubt in my mind we are the most medically tested group of people in the country. In an effort to find out what is wrong we may see a number of doctors and specialists. We can undergo a range of medical tests including cardiographs, brain scans, testing for ulcers, numerous blood tests, not once but at least twice if not three, four or more times. As our symptoms can be unremitting we may regularly seek professional help either through our doctor or by attending the casualty department of our local public hospital.

Unfortunately this can be to no avail. Without a diagnosis and appropriate treatment many people become so disabled through the disorders they are forced to give up their jobs and rely on social security benefits. Others may refuse a job promotion or may need to take a lower paid position in an effort to cope with their disorder.

The cost to the community through these disorders is still not acknowledged, let alone addressed. Health care costs are soaring, yet many of the costs could be lessened through understanding and relevant treatment. Anxiety disorders and the secondary conditions are treatable. People can recover and resume normal lives. Greater awareness and understanding within the health professions and the general community will lessen both the personal and monetary costs.

*11\94\8*