Psychopathology can cause us to experience our daily lives in abnormal ways; from hallucinations and delusions, to mania and depression, psychopathology permeates the waking hours of millions of people around the globe. But what about the unconscious hours; the hours when we lay in bed and seek refuge from the world in our sleep?

The question of what differentiates the sleep of healthy individuals and those with a psychopathology, such as Schizophrenia or Bipolar Disorder, is an interesting one in itself. Though the implications of this question may also help us to learn something about the fairly mysterious nature of sleep and dreaming in general.

The scientific study of sleep and dreaming has been plagued with high-contrast debates about how we should approach the subject. Freud famously posited that dreams are a form of “wish-fulfillment” (i.e. if I dream about kissing my best friend, I probably actually want to do it in real life). This view assumes that dreams have a great, almost cosmic significance, and in the age of neurobiology many scientists have tossed aside Freud’s ideas in search of something more materially based.

Despite the assembly of a vast body of neurological, and neuropsychological research in recent decades we still don’t have answers to the questions we started with. In fact, we may have even more questions. One of the most accomplished sleep scientists, William Dement at Stanford University, famously said “we sleep because we get sleepy” (more from him here). A popular current theory of dreams comes from J. Allen Hobson; he says that dreaming may just be a result of random neurons firing in the brain, the patterns of which we make sense of upon awaking.

Hobson’s theory would suggest that dreams have almost no meaning beyond possibly the significance of how we tend to recognize those random patterns. This theory is difficult to test because it is difficult, if not near impossible, to study dream content. We can’t put an EEG on you and watch you acting out your dreams. We can only see that you are having a dream and then wake you up and force you to tell us about it. We must rely on recall.

Recall can be tricky.

We humans are incredible pattern recognizers – for example note the fact that in the image to the left you can see either a person in a big coat turned away from you, or the profile of a majestic face looking slightly upwards. On an even deeper level – that image is just a bunch of dots and we somehow see “something” in it. We are so good at recognizing patterns in overwhelming amounts of data that we hardly ever think about it. How do we know if the patterns in the brain are random if we interpret them upon waking, and the only way we can probe the patterns is post-interpretation.

One strategy that might help us study this theory is to compare groups who have abnormalities in their everyday processing to normal individuals (e.g. individuals with schizophrenia vs. an average person). In a meta-analysis of sleep and mental disorders it is clear that individuals with specific psychiatric conditions experience sleep disturbances and exhibit differences in sleep patterns in general. For the purpose of brevity I will just focus on two examples.

First, a study by Mota et. al. published in Nature used a new method of analyzing dreams to discover differences between normal patients and those with psychopathology. They found a way to chart the dream accounts of individuals in such a way that it ignored content in favor of word-count, connectivity, and other less subjective variables. They found important differences between patients with Schizophrenia, Bipolar Disorder I, and normal individuals. Schizophrenic patients used a dearth of words to describe their dreams, while Bipolar patients tended to use a wealth of words. Normal patients fell somewhere in the middle.

These results have been proposed as a potentially easy and inexpensive method for diagnosing patients. It’s also been posited as a support for the old Freudian notion that dream content has meaning. However, because the researchers purposely eliminated any subjective content judgements they have pulled away from anything Freud would have interpreted as “wish-fulfillment”. Hobson could also easily say that this study still aligns with his claim, because it is the firing that’s random, and their interpretations of that firing are a different story. Hallmarks of schizophrenia and bipolar are the impoverishment of speech and talkativeness, respectively, so those differences are not terrifically surprising. This just starts to look like a new version of the Rorschach inkblot test.

What do you see?

Let’s try to escape the recall conundrum for a moment. Semiz et. al. conducted a sleep study in 2008 on patients with Borderline Personality Disorder. Part of the aim of the study was to include this somewhat neglected, specialized group in the sleep and psychiatry literature. They found a strong relationship between the incidence of nighttime disturbances and nightmare disorders in this group when compared to healthy individuals. This evidence seems to have more to latch onto when trying to parse what is happening in the brain when we’re dreaming.

If individuals with a psychopathology are more likely to have nightmares, that is one thing. This is still that post-interpretation evidence we’re talking about. However, they found that patients with BPD often had nightmare disorders that involved waking up many times in the night due to nightmares. Now, if a specialized group are more likely to be waking up due to dreams this might tell us that the neural activation we experience at night isn’t entirely random. If it was random, we might expect them to have nightmares when they wake up in the morning, but not have issues staying asleep at night due to them.

There are hundreds of arguments to be made about the nature of sleep and dreaming, and just as many to make about the significance of these two studies I’ve presents. However, I’d encourage anyone to think critically about our culture’s common heuristics for referring to dreams. We’re comfortable with laughing about the meaning of our dreams, but then we are also able to dismiss them if they don’t fit our desired image of ourselves. Take some time to think about your own dreams. Random? What does it mean that you may naturally interpret them the way you do? As for me, I have too many nightmares to think about it anymore.

As always – mental health is as real as any physical ailment, even if the brain scans can’t always see it. If you or someone close to you are having issues with their quality of life due to what may already be or be becoming a pathology, please seek help. Psychotherapy is still a mixed bag (just like physical healthcare) – don’t give up if it doesn’t fit at first.