How do dreams differ in people with schizophrenia to from those without the
disorder?
Kristin Staub
Brookfield High School
Dreaming is a vital part in sleeping, yet in some individuals it interferes in their waking
state. For example, schizophrenics have hallucinatory images while they’re not sleeping
causing some psychologists to speculate why this happens. People without the disorder
and other people with other disorders have been found to dream while they’re in REM
sleep which is a major mental process that allows people to dream. The following
articles, “Sleep Fantasy in Normal and Schizophrenic Persons,” “An Extension of Freud
and Jung’s Theory of Relation of Dream States to Schizophrenia,” “The Neurochemistry
of Waking and Sleeping Mental Activity: The Disinhibition-Dopamine Hypothesis,”
“Dream Content of Schizophrenics, Nonschizophrenic Mentally Ill, and community
Control Adolescents,” “Sleep Disturbance in Schizophrenia” “Rorschach Responses
Subsequent to REM Deprivation in Schizophrenic and Nonschizophrenic Patients,”
attempt to explain the problem statement: How do dreams differ in people with
schizophrenia to those without the disorder, through REM sleep in normal individuals
and schizophrenics. Dream content will also be investigated to answer the problem
statement and certain sleep habits. In addition Jung’s and Freud’s theory attempt to
explain how dreaming is connected with schizophrenia in their conscious state rather than
in their sleeping state through thought processes and verbal patterns. Another article also
attempts to explain how certain chemicals react in certain parts of the brain to allow
dream states, whether in consciousness or unconsciousness. The following six articles
supports the hypothesis that a person with schizophrenia cannot recall dreams as vividly
as other people without the disorder because of sleep disturbances.
In the first article “An Extension of Freud and Jung’s Theory of the Relation of
Dream States to Schizophrenia” by Dixon (2005), the theories of Jung and Freud have
been conjoined to explain certain dream states in relation to schizophrenia. Dixon
explains that schizophrenics generally have a lack of emotional reactivity which is a vital
role in the dreaming state, which reflects on emotional activity (Dixon p.5). However,
the researcher goes on to explain that a schizophrenic might be defending himself
emotionally from unpleasant memories and therefore have a “flattened effect” on the
dreaming state while sleeping. The psychoanalytic theorist Jung (1958)supports Dixon’s
argument that speech, judgment and lack of willpower contributes to an exceptionally
inward violence on the schizophrenic because of the “flattened effect” (Dixon p.5).
Essentially, this means that a schizophrenic is under emotional stress which interferes
with their ability to differentiate between fantasy and reality in their delusional states.
Therefore Dixon furthers his argument that this emotional stress can have a
phenomenological effect in determining objects that are fantasized and objects that are
present in reality because of primary process thinking. Primary process thinking is
Freud’s concept of attempting to fulfill wishful desires and achieving that wish. In this
case schizophrenics use symbols to explain certain emotions lying deep within their mind
and possible emotional frustrations they may be experiencing and therefore manifest into
dream states in the waking consciousness (Dixon p.6). Cameron (1938) explains that
there is imprecision and incongruency between acts and words and therefore
schizophrenics have a hard time trying to handle their emotional problems which
manifest into dream-waking states (Dixon p. 7). In this sense, they also have certain
postulation systems which are distorted, because postulation is supposed to assume that
something is considered true and real. They are not able to differentiate if something is
real or not (Dixon p.10). Jung (1958) explains that in normal people dreams reflect
people or objects that are represented in their external environment whereas in
schizophrenics there are random objects that appear absurd and fragmentary. That’s why
they have certain delusions in their conscious waking state (11).
In the next topic, “Sleep Disturbance in Schizophrenia,” Wulff, (2006) did a case study to
explore the abnormal sleeping patterns of schizophrenics that potentially disrupts the
daily routine of a person. In addition they have shorter dream recall than those without
the disorder along with less personal involvement, anxiety as a result of sleep
disturbances. A 27-year-old man would have urinary samples collected from him every
48 hours while he is at home. The urinary samples would reveal levels of abnormal
melatonin production. Melatonin production would be able to predict how much sleep
the individual actually gets. The researchers also used actigraphy which is a portable
wrist-watch sized unit worn on the least dominant arm using accelerometer sensors to
detect light waves either outside or inside the home. The patient then had to write in their
diary of their daily sleeping routines and their other daily routines (Wulff p. 485). After
all the urinary samples were collected, the results indicated that the subject showed a
progressive delay in sleep. This means his biological clock was off, and in the last week
it completely reversed. He did not sleep when it was dark as normal people would, and
some days he would sleep all day. It is concluded that light can drive a person to have
delayed sleep activity, especially in schizophrenia. However this lack of sleep could also
pertain to the medication the patient was using therefore affecting his sleep cycle. Even
though this is a medicated schizophrenic patient, a person who is not institutionalized
could have even more severe cases of sleep delay (Wulff p. 493).
In relation to the previous article, the next article, “The Neurochemistry of
Waking and Sleeping Mental Activity: The Disinhibition-Dopamine Hypothesis,” Claude
Gottesmann attempts to explain the neurochemistry of dream states in schizophrenia and
the disinhibition-dopamine hypothesis. He explains that dreaming is disorderly and
fragmented like the symptoms of schizophrenia in their waking delusional states. In
support Schopenhauer and Maury state that dreams are a brief madness and are a kind of
delusion (p. 345). Dreams mainly occur in the cerebral cortex structure of the brain
especially in the dorsolateral prefrontal cortex where it is deactivated during dreaming..
This allows for reasoning and logic to be absent in the dream state. This decrease in logic
and reasoning occurs during REM (rapid eye movement) sleep. REM sleep is the stage
of sleep that occurs throughout marked periods of the night with rapid eye movement and
brain activity. Normal people have dopamine levels that increase in the cortex while
sleeping therefore, increasing brain activity accounts for visual images (Gottesmann p.
347). However, in schizophrenics Gottesmann notes that in schizophrenics the opposite
is true in the dream state. There is a decrease in dopamine production during REM sleep
allowing the dorsolateral prefrontal cortex (DLPFC) to deactivate during the dream state.
Therefore, dream content is non-reactive in schizophrenics because the DLPFC is not
able to produce images in this dream state or is fragmented. Furthermore, an increase in
dopamine levels accounts for hallucinations and delusions in waking states (p. 349).
Gottesmann mentions that dreams are made up of visual contents yet in schizophrenia
there is an increase in auditory hallucinations which accounts for the dopamine being
dysfunctional in most people with psychoses (p. 348). IN addition the decrease in
dopamine production also contributes to the decrease in REM sleep appearance therefore
dreams do not appear as vividly (p. 349).
In response to the previous article of REM sleep, Vincent Zarcone (1965) did a
case study, “Rorschach responses subsequent to REM deprivation in schizophrenic and
nonschizophrenic patients,” using schizophrenic patients and nonschizophrenic patients
to test REM deprivation. He hypothesized that schizophrenics have a lack of dream
content and REM sleep which results in behavior disruptions. All subjects in this study
were deprived of 75% REM sleep. Each night before they slept he used the Rorschach
test (248) to gauge their responses. During the night he used the EEG, EOG, and EMG to
record electric pulses in the brain. After they awoke in the morning he used the
Rorschach test again to gauge responses. Each test would determine their adaptiveness or
maladaptiveness and how well they respond to each of the cards used. The results did
not show many differences, but when a second analysis was conducted it showed a
significant difference in adaptive aggression. This means that schizophrenics had a
harder time controlling their responses as a result of a lack of REM sleep.
In another response to REM sleep and schizophrenics, “Sleep Fantasay in normal
and schizophrenic persons” is a study that was done by Rosalind Dymond Cartwright
(1971) comparing sleep fantasy between normal and schizophrenic people. In this study
three groups were tested. He hypothesized that the three groups would differ
significantly in fantasy levels, and a second hypothesis states that dream content would
be less vivid in schizophrenics. Several scientists support this hypothesis. He uses an
EEG monitor to prove that schizophrenics think conceptually during the day and
hallucinations during REM sleep. For four consecutive nights the patients were admitted
into the psychiatric hospital dream content tests were administered using the MMPI.
Results were extracted from other studies that Cartwright used to support his study.
Hence the results from all the studies showed that the three groups had significant
differences in fantasy levels during REM awakenings. Groups 1 and 2 were shown to be
significant from group 3. The results from the experiment prove that REM dreaming is
related to the psychological disturbance of schizophrenics and dream content would be
less vivid in schizophrenia. As the disturbance levels increase in schizophrenics, the
more widely distributed the episodes of hallucinatory images are.
In relation to the previous article another case study was done by Jack Hadjez
(2003), “Dream Content of Schizophrenic, Nonschizophrenic Mentally Ill, and
community Control Adolescents,” to measure dream content in nonschizophrenic
mentally ill adolescents, schizophrenic adolescents, and community control adolescents.
He hypothesized that schizophrenics have some incoherency and implausibility in their
dreams, with less anxiety, personal involvement and emotional expression. IN addition
they also have shorter dream recall, if hardly any (Hadjez p.332). To conduct this study
Freud’s psychoanalytic theory of dreams was used and he claims that dreams are
supposed to help resolve conflict and impulses in a more acceptable manner than in
waking states, (Hadjez p. 331). The test used, Formal Dream Content Rating Scale
(FDCRS) includes the measurement of anxiety, cognitive disturbance, implausibility,
involvement, primitivity, emotional expression, and duration of dream report to evaluate
the outcome of the study. All participants were administered the test and interviewed
between 8 and 9 AM in the morning so the participants could more easily remember their
dreams. All the interviews were taped and analyzed independently. Results showed that
there were no considerable differences between the groups in dream content (Hadjez p.
335). However, there was significantly less involvement and emotional expression from
the schizophrenic patients, but there were no significant correlations between the three
groups. Hadjez found that adolescents with schizophrenia were not more disturbed than
other patients with other disorders. However, the community control adolescents had
more vivid dreams than schizophrenic or nonschizophrenic patients. In addition,
schizophrenic dreams were more symbolic and there was an overall emotional and
cognitive constriction as the primary manifestations of dreams in schizophrenia (Hadjez
p. 338).
All these sources confirm that schizophrenics do not have very vivid dreams and
tend to have a very inactive DLPFC during REM sleep, which further explains why they
have sleep disturbances as well. Freud and Jung’s psychoanalytic theories of dreams
proved to be a supporter of the hypothesis that schizophrenics have trouble handling
certain emotional issues that in turn causes them to have delusions and hallucinations in
the conscious state. This is very important for diagnosing patients with schizophrenia
because lack of emotional expression and vividness in dreams could be a sign. The four
case studies presented all pointed to the fact that schizophrenics are unable to sleep
properly and have less dream content than those without the disorder. Not only that, but
their sleep cycle is disturbed as shown in the study with melatonin samples and use of
actigraphy. By presenting Jung’s and Freud’s theory first provided a basis for the
problem confronting schizophrenia and dreams, which then leads to their sleep
disturbance cycle which then leads to other case studies of how the content in their
dreams are primitive.
One flaw in most of the articles was that they mostly dealt with patients having
other disorders rather than normal people which was in my initial question, however there
were some articles that explained the processes in the brain of how dreams occur in
normal people. I thought it was important to establish how dreams work in normal
people so then readers could have a better understanding of what the differences are
between normal and schizophrenic people. The methods used to calculate dreams were
very useful especially the actigraphy and the melatonin test which detected sleep
disturbances within the patient.
Another good indicator was the Rorschach test which tested the responsivity of
the patients after a lack of REM sleep. Then the diaries were important because they
explain certain sleeping patterns and dream recalls that most of these patients had.
Outside of the psychological stance, these articles and cases could provide a deeper
understanding of dreams between people without schizophrenia and those with
schizophrenia. This is especially useful for doctors who are trying to find medicines to
reduce the delusions and REM deprivation. In addition, it is important to have dreams to
deal with certain emotional issues a person might have in their waking life. If a person
does not have these dreams then their emotional problems in real life will become
stressful and the person will be unable to resolve these emotional issues. Hence, it is
important to study schizophrenia and dreams because the disease can interfere with
everyday life. Therefore it makes it harder for the person to function socially with other
people and have an appropriate sleep cycle.
Much is still not known about dreams in schizophrenia because the concept is
very complex and can also be inaccurate. Dream recall can especially be inaccurate
because the person can alter the true results of the content of their dreams. Therefore, a
better method for dream recall still needs to be found in order to have precise results.
Right now, diaries, EEGs, melatonin tests, actigraphies, and the Rorschach test are the
most accurate instruments used for testing dream vividness and content.
For the research design a study should be conducted with several schizophrenic
patients who do not take medications and several people without disorders to provide
more accurate results. First, the study should measure sleep disturbance using
actigraphies and urinary samples to measure melatonin. Every subject will be hooked up
to an EEG monitor to measure brain wave activity while they are sleeping. This should be
done in a month. Everyday each subject will have a diary and after they wake up they
should write down in their diary the dreams they had. Then the Rorschach test should be
administered to the subjects to gauge their responses to the images they see. By using
this research design, perhaps results will be more accurate and more able to differentiate
dreams or symptoms between schizophrenics and people without disorders. Also this
study will help explain how exactly brains of schizophrenics function when there is a lack
of dream content.
Works Cited
Cartwright, Rosalind D. “Sleep Fantasy in normal and schizophrenic persons.” Journal of
Abnormal Psychology 80 (Dec. 1972): 275-279. Rpt. in The Journal of Abnormal
Psychology. PsycINFO. EBSCO. Brookfield High School Lib., Brookfield, CT.
23 Nov. 2008 <http://search.ebscohost.com/
login.aspx?direct=true&db=psyh&AN=1973-09314-001&site=ehost-live>.
Dixon, Paul W. “An Extension of Freud and Jung’s theory of the Relation of Dream
States to Schizophrenia.” Current Psychology 24 (Nov. 2005): 4-23. Rpt. in
Current Psychology. PsycINFO. EBSCO. Brookfield High School Lib.,
Brookfield, CT. 23 Nov. 2008 <http://search.ebscohost.com/
login.aspx?direct=true&db=psyh&AN=2005-13775-001&site=ehost-live>.
Gottesmann, Claude. “the neurochemistry of waking and sleeping mental activity: the
disinhibition-dopamine hypothesis.” Psychiatry and Clinical Neurosciences 56
(Aug. 2002): 345-354. Rpt. in Psychiatry and Clinical Neurosciences. PsycINFO.
EBSCO. Brookfield High School Lib., Brookfield, CT. 23 Nov. 2008
<http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=200215703-001&site=ehost-live>.
Hadjez, Jack. “Dream Content of Schizophrenic, Nonschizophrenic Mentally Ill, and
Community Control Adolescents.” Adolescence 38 (Oct. 2003): 331-342. Rpt. in
Adolescence. PsycINFO. EBSCO. Brookfield High School Lib., Brookfield, CT.
23 Nov. 2008 <http://search.ebscohost.com/>.
Monti, Jaime M. “Sleep Disturbance in Schizophrenia.” International Review of
Psychiatry 17 (Aug. 2005): 247-253. Rpt. in Psychology and Behavioral Sciences
Collection. PsycINFO. EBSCO. Brookfield High School Lib., Brookfield, CT. 23
Nov. 2008 <http://search.ebscohost.com/
login.aspx?direct=true&db=pbh&AN=17523102&site=ehost-live>.
Zarcone, Vincent. “Rorschach responses subsequent to REM deprivation in
schizophrenic and nonschizophrenic patients.” Journal of Clinical Psychology 30
(July 1974): 248-250. Rpt. in Journal of Clinical Psychology. PsycINFO. EBSCO.
Brookfield High School Lib., Brookfield, CT. 23 Nov. 2008
<http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=197624215-001&site=ehost-live>.