METAPHRENIA- THE PRESCRIPTION -

parivrajakananda

[ INTERNET EDITION ]

Alcheringa Book Trust MMXI

metaphrenia: the prescription

medicine + 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 shooting team. In competition, I was lucky just to hit the sizeable target, let alone get closer to its bullseye. The peppered product looked more like a distant small-gauge shotgun blast had splattered it with buckshot, rather than the tightly grouped patch of bullet-holes a Bren gun can deliver in the hands of a competent marksman.

The writing in this booklet is like that. The style is the man. It would have been far preferable to be able to write like Len Johnson, the text author of Jog with Deek: clearly and concisely; thorough-going, yet not a wasted word; always on target.

Perforce, I have often found sustenance in the words of Gilbert Keith Chesterton: “If something’s worth doing, it’s worth doing badly. “ Dom Basil Pennington, the teacher of Centering Prayer, recommends us always to “Pray as you can, not as you can’t.“ I hope you will 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 fingertips when first I cracked up in 1969, having recently turned 22 years of age and finally arrived in second year medicine after various interesting diversions. This is by way of a letter to that frightened and troubled young man. Being the way he was, in all likelihood it would have made little 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. If in the course of its nightly sleep, it regularly experiences regular healthy doses of normal REM dreaming sleep, all well and good. But if, for any reason – anxiety and distress, drugs, an unmanageable lifestyle – it is substantially denied this experience, then its dreaming activity is displaced out into waking consciousness. And so we dream while we are awake. This we call psychosis.

Our remedies – medicine, exercise, psychotherapy, meditation, social support – all these efforts are efficacious to the extent they normalise our dreaming sleep. Thus sleep cycle disruption is not just a symptom of the psychotic state – it is also its precipitating cause, and the appropriate 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 very briefly 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 good sleep 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 in this universe, and our own, for we are Stardust. Gaze down a microscope at a droplet of pond water, and we observe the origins of Life. Close our eyes and look within, and there we experience the biggest mystery of all – Consciousness. How can three pounds of stodgy tepid stale 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 four seasons, a monthly phased lunar cycle of 28 days, and a daily cycle of day and night. Even the corn on my right foot follows its own emergent 22 day recurring cycle of growth & decay. Each day, 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 ninety minutes or so, as REM-stage sleep allows our dream generator to blossom fully, much the way a spider orchid floresces in the Adelaide hills each year during the favourable conditions of early October.

There are many dream states known to homo sapiens. Amongst them are those out-of-body near-death experiences which later read very much like arche-stereotypal culture-dependent dream journal entries except there was no detectable brain energy generating them. There are shamanic journeyings, and the vision quests of the Native Americans and the spontaneous fevered dreams of Wovoka and Black Elk and Plenty Coups which guided their tribal leadership through later stages of the devastating European invasion, with disparate but equally bleak outcomes, about which science knows nothing. Also in this group are the mystical experiences of Jelaluddin Rumi, Francis of Assisi, Joan of Arc, Teresa of Avila and Ramakrishna, and of other Hindu, Jewish, Christian and Muslim saints et al. There are drug-induced visions such as Charles Baudelaire so vividly described in The Seraphic Theatre, and the alcoholic’s terrifying delirium tremens. There is the waking dream/nightmare of psychosis. There are those fleeting initiatory hypnogogic images of descending REM-stage sleep, and non-REM sleep’s anciliary philosophising. And finally, there are our full-blown authentic REM-stage dreams, “the underground movie house which nightly plays four or five Theatre of the Absurd versions of This 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 substantia nigra, ascending ultimately to regions of the frontal cortex, connecting along the way with structures which include the lateral hypothalamus, the forebrain nucleus basalis, bed nucleus of the stria terminalis, the shell of the ventromesial forebrain nucleus accumbens, terminating in the amygdala and anterior cingulate gyrus and ultimately the frontal cortex. Not all these structures are exclusively dopamine-driven: their parallel cholinergic aspect interfaces the dream generator Janus-like with the acetylcholine-driven REM state.

Two structures in particular seem to play a crucial role in dream production. Without an intact dopaminergic circuit of the ventromesial forebrain, there can be no normal dreaming. And damaged basal forebrain nuclei can result not only in greatly intensified REM-dreaming, but also in vivid and deceptively realistic waking hallucinations. In some ways not unlike the psychotic experience…

As well as sparking REM-stage dreams, this oneiric generator is largely responsible for triggering the waking dream of psychosis, and is also the target’s bulls-eye for psychotomimetic drugs, for antipsychotic medicine and for the neurosurgeon‘s leucotomising ice-pick. It does not perform these functions on its own, isolated from other neural networks. What we experience when it is switched on depends on how it interacts selectively with and recruits from the fertile diversity 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 operation even though the brain is not safely REM-dream-ing, and it’s the middle of the day in the middle of the crowded city.

Research has repeatedly demonstrated that a wide variety of medicines and drugs which partially activate the dream generatoroutside of REM-stage sleep – ethyl alcohol, benzodiazepines, opiates, cannabis, cocaine, amphetamines etcetera – also suppress its fullest expression in developmental REM-dreaming, its locus proprius, its sacred sanctuary. Just as there are empty calories, so too there is empty sleep: sleep incapable of achieving fully its nightly regeneration.

In rat brains, exposure to cocaine and sleep deprivation both result in an augmented population 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 it fully ‘on’ while awake, to a degree that can take months via the bottle and its accompanying sleep cycle disturbances. The basal forebrain nuclei are a high priority candidate for this psychotogenic damage.

On the other hand, stimulants like caffeine delay and inhibit the full expression of the brain’s REM state, and antidepressant medicine can suppress it altogether. Paradoxically, depression often eases with this reduction in REM-stage dreaming sleep.

Both dopamine-blocking neuroleptics and sleeplessness sensitise the dream generator’s dopamine receptors. But with vastly different consequences.

Prolonged sleeplessness charges up the dream generator with unrelieved dopaminergic pressure, 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 from sleep deprivation with the usual rebound REM. The sleep pattern of the ‘stabilized’ unmedicated schizophrenic may not differ significantly from the norm, but it has lost its punch. The quality of its REM dreams is stunted. Effete, banal, exhausted, depleted by untimely abuse of constant daylight application. And often by drugs, as well. Even so, research shows that when it awakes from 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 has done its nightly defragmentation job on the schizophrenic brain. Whereas it often leaves a depressed brain even worse off.

In prolonged exposure to haloperidol, the generator receptors are sensitised on an ongoing basis, still being discharged each night during REM sleep, protected by medicinal blockade from daytime over-stimulation. The application of an ice-pick to the dream generator’s ventromesial 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: the REM brain state – wherein our dream generator blossoms – is triggered by a global wake/sleep centre 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 of chasing 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 universally indispensable to the human brain as are air, water and food. Usually a leucotomised brain does not dream. Monoamine oxidase inhibiting antidepressant medicine typically reduces or eliminates entirely the REM stage of sleep and dreaming activity from a depressed brain‘s sleep cycle. The human’s need of REM-stage dreaming sleep is immensely variable and doubtless graphs the familiar bell-shaped curve, with schizophrenics at its other end.

Somewhat controversially, research suggests that REM-stage sleep is the locus classicus for authentic dreaming. Whilst dreams apparently indistinguishable from REM dreams are reported from non-REM sleep, research indicates that these dream leakages are more likely to be experienced as one’s schizophrenia score on the MMPI scale increases. Or following an increase in waking anxiety and its higher levels of cortical activation. (Cartwright) The waking dream of psychosis 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 the

dream generator safely connects most prolific-ally with appropriate neural networks and their programs and produces developmental dreaming. Dreaming is a developmental process which initiates with descending REM-stage sleep’s hypnogogic theme-setting imagery, drawn from the day’s emotionally most significant task, which continues to develop overnight through all stages of sleep, eventually culminating in the final problem-solving denouement dream, the one at least 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 waking states. Just running on different neurotransmitter circuits. As the EEG slows and passes down 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 the time the brain reaches REM’s dreaming it has switched off the serotonin and noradrenaline circuits, allowing their vesicles to recharge their fuel to respond rationally throughout the coming day’s challenges, whilst it runs exclusively acetylcholine circuits in conjunction with the dopaminergic dream generator. And so we dream… Just why it is on acetylcholine is yet unclear. 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 to maintaining 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. But in 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 full REM 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 progressively extends and develops its themes.

Professor Alan Hobson espouses a pons-generated, anti-Freudian, cholinergic theory of dreaming’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, but normally 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 his psychoanalytic therapy can be very helpful in traversing blockage and regression, but human potential is not limited necessarily to the Freudian Weltanschauung. Certain dopaminergic circuits are necessary for the brain to sustain dreaming activity, but this usually occurs in the context of acetylcholine’s REM-stage sleep.

Our dreams can range from encoding the most profound, insightful and practical guidance we will ever receive at every cross-roads of our lives to a reference library of footnotes in the form of hallucinatory metaphors continuously available for our consultation which will amuse, delight, surprise and enlighten in their quotidian application. “Constant observation pays the

unconscious 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 away in what they appear to present are signs that must be seized on by a mind that can see past mere actualities to what hovers luminously beyond. (David Malouf)

Our REM-dreaming, inter alia, is the brain processing offline our main emotional concerns and problems. When the brain shifts into psychotic gear, our delusions and hallucinations express 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 characteristically a disastrous waste of life. Even so, evolution tends to make productive use of whatever opportunity comes along, be it the idle hours of planetary darkness or the tragic vacuity of mental 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 mosquito bite, 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, silly and 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 experience as Consciousness subsisting as variations on a theme extemporised by the jazz quartet of noradrenaline, serotonin, dopamine and acetylcholine, expanding out to a full concert orchestra to accommodate the dozens of different neurotransmitters that are being discovered.

Noradrenaline and dopamine are the ‘hare’ brain’s speedy nerve fuel; whereas serotonin and acetylcholine are neurotransmitters of the more placid ‘tortoise’ brain. Together, somehow this unlikely 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 simply redirects 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 speak of. 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 wakefulness and dreaming REM-sleep are equally important terminal endpoints on a recurring homeostatic continuum of aminergic and cholinergic demodulation.

The engine of consciousness is driven as much by its eight hour night cycle as by the longer day 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 as work and sleep and play and dining and dreams and emotions and daydreams so much as it is a

seamless 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 perhaps discomfiting 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 in new information and experience, and can tell us so much about the true state of the psyche and its health or otherwise.

4 . DREAMWORK

Dream researchers have found that overnight over time a regular healthy sleep cycle automatically achieves at least three tasks which assist the dreamer to adapt psychologically to ever-changing circumstances and add dramatically to their chances of ongoing survival. In many of us, most of these feats are achieved without our ever being even vaguely conscious of it; ex opere operato, as the theologians say. Without the assistance of a sleep laboratory, at best we will 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 memories such as geographical and biographical details or technical information and the like. Secondly, the maintenance and development of new motor skills and strategies, such as hunting 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’s fellows is imperilled. Over a period, this dreaming process ‘kaleidoscopes’ such dangerous uncontrollable threats into more familiar and manageable patterns. Very often, depression andpost-traumatic stress disorder represent a significant failure of this repatterning process to deal adequately with such loss or threat.

If we reflect for a moment, we will recognise these as much the same preoccupations as ourwaking consciousness and its survival. Incidentally, together all these functions achieve the further foundational goal of establishing one’s sense as an autonomous self, and of creating a constantly 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 really talking about neuroplasticity. Every time we think a thought or feel a feeling, we are changing our brain structure, to an extent determined by the intensity and its repetition. Whenever we do psychotherapeutic work – whether psychoanalysis or Twelve Step work or meditation or cognitive behaviour therapy, or whatever forms it may take – this activity translates in the

plastic brain rewiring itself. Underpinning and underwriting this endless process in the healthy brain are neurogenesis and synaptogenesis – the constant creation of adult neuronal stem cells, and their development into functioning interconnecting network neurons. Whilst these possibilities are finite, they are nonetheless potentially revolutionary in transforming lives.

As yet, this branch of science is in its infancy, already it has legs and is learning to walk in the rehabilitation of neurological and psychiatric patients. For our purposes here, it is helpful to take 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 cells regenerating themselves, that stem cell memory stuff our dreams are made on. REM-sleep deprivation 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 – whether neuromuscular exercise, or cognitive or social. Less clear is the effect of antipsychotic medicines. As yet, it doesn’t look like they have an inhibitory effect. There is more than a suggestion that at least some neuroleptics have a stimulating effect on neurogenesis – but it remains to see how important this is, or even whether it is a long-term ongoing effect. Both longterm alcohol and cannabis use in moderation seem to promote neurogenetic processes. It’s their likely disruptive effect on successful synaptogenesis that is a problem.

Antidepressant SSRI medicines like Prozac not only stimulate serotonin activity – they also normalise basic hypothalamic drives involving thirst, hunger and sex, as well as encouraging hippocampal adult stem cell production. You don’t get much wider-ranging therapeutic bang for your medicinal buck than this. It is clear that brain diseases ranging from depression to dementia involve some failure of neurogenesis.

It seems that schizophrenia may involve, inter multa alia, a genetic flaw in some of the neurons continually generated in the hippocampal dentate gyrus, thus compromising their ability accurately to encode learned memories, resulting in cognitive disorder. Nonsense in, nonsense out.

This entirely novel area of research adds a whole new level of understanding underpinning REM sleep’s memory consolidation. Not so long ago it was entirely inconceivable, the received established orthodoxy being that our brains were born to grow, develop and live with their allotted cells at birth, which thereafter could only die and decrease in number unto the eventual beckoning grave. This discovery is a scientific switcheroo of incalculable magnitude, adding neuroregenerative dimensions to the humblest of routine activities, cerebral or somatic, to our familiar and even more to our unfamiliar daily social interactions, and to our nightly slumbers as they 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 bare foot with its spring-loaded shock-absorbing arch “buttressed from all sides with a high-tensile web of twenty six bones, thirty three joints, twelve rubbery tendons, and eighteen muscles, all stretching and flexing like an earthquake-resistant suspension bridge” (Christopher McDougall), and millions of evaporative-cooler sweat glands, our human dreaming brain circuits evolved over hundreds of Pleistocene millennia on the African savanna and in coastal caves, to assist our hunter-gatherer ancestors survive in their active, athletic lifestyle, in which daily survival threats were predominantly physical.

Endowed with this same basic equipment, we may since have walked on the Moon, split the atom, 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 a horse, evolved by pace tracking multi-marathon persistence hunts – and by dreaming. This newfangled meat protein food source they ran to ground then helped to grow these burgeoning brain circuits.

One thing that would have been intimately familiar to our ancestors was the raw experience of frequent trauma, unshielded by police and ambulances and hospitals and morgues and the sanitising distance of the networks’ evening news casters. So often a primeval version of the Kokoda Trail was their daily vocation. If like the immune system, developmental dreaming evolved as a therapeutic function endowing increased chances of survival, how it deals with traumatic insults would be a defining litmus test. If along the way it also processes and stores data 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 repetitive and ‘stuck’ so that they ‘freeze’ the usually dynamic dreaming process, or so horrific that they terminate abruptly the whole sleep process with premature awaking. Dreaming like this is painfully characteristic of post-traumatic stress disorder. And yet, Professor Ernest Hartmann suggests that nightmares evolved as a nocturnal solution to assist the psyche process the emotional impact of threats to one’s very existence. Hartmann argues that the nightmare is the most useful dream, although ‘nightmare’ here denotes a much wider-ranging concept than the clinical definitions.

Nautici Cavete: There is as yet no comprehensive theory of dreaming which can embrace and reconcile all the research data. Nor does this essay purport to fill that lacuna. For instance, I have made no reference to Professor Antti Revonsuo’s seminal contributions. Cambridge University Press’s encyclopaedic Sleep and Dreaming contains compendious contributions from seventy six of the leading research teams in the area, all espousing differing and often contradictory or opposing views.

Indeed, one may speculate as to the existence of six and a half billion unique and distinct experiences of and views on dreaming, all varying in some subtle respects along with our DNA

and 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 any viewpoint. Just how – or even whether – our dreaming contributes to our problem-solving capacity is as yet a scientifically moot and unequivocally unanswered question. Which considerations give rise to the First Law of Oneirotherapy: for every sleep study, there is always an equal and opposite research project.

This essay is underpinned by the experience and observation of many: that our nocturnal dreaming is a valuable component of our psyche’s problem-solving capacity comparably significant with its daytime rational consciousness, at the same time accepting that this may not universally be true at all times for all homines sapientes, every one of whom is unique and idiosyncratic, no more so than in our nightly sleep cycle. There is perhaps nothing more intimate and inalienably our own than what happens when we sleep. As Thomas Aquinas observed: “The greatest glory of God’s creation is in its diversity.” Six and a half billion experiments-of-one...

Quibus dictis, according to Professor Hartmann the brain is constantly at work, awake or dreaming, solving problems incidental to better quality survival. As in waking rational processes, in dreams it ‘contextualizes’ survival threats, reviewing them in the broader context of previous experience. Dreaming provides a safe place to ‘contextualise’ the quaking terror which 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 calm emotionally rough seas and stormy weather.

Dreaming does this using pictorial metaphor, a punster mechanism taken to a visually symbolic extreme, often in a lived movie form. A literalistic dreaming function is not a healthy dreaming function; whether awake or in dreams, with a homely metaphor the foreign & potentially shocking becomes familiar & potentially useful. InHartmann’s view, the nightmare process is a paradigm example of successful dreaming because it illustrates most vividly these core evolutionary aspects of dreaming.

When our ancestors encountered a pride of lions, or witnessed one tear a clan-member to shreds, complementing their rational processing of this ultimate survival threat was an emotional processing of this outrage against humanity, this extreme violation of existential boundaries. Over the millennia, their dream generator evolved a mechanism for coping: the nightmare process. Today we may experience the same nocturnal phenomenon in response to wartime battles, natural catastrophes, terrible accidents, assault, abuse, rape or torture.

Our nightmares can play an important role in the healing power Paul Johannes Tillich referred to: “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 of affirmation of life in spite of has vanished. The negative elements are possible consequences of man’s basic nature, of finite freedom. They are universally real, but they are not structurally necessary. 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 wax

poetical 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: an overwhelming tidal wave, a ravenous beast of prey, a home in flames, a gang of threatening men – a central image which encapsulates their vulnerability, their helplessness and their ultimate insignificance, which is often slightly different from the traumatic incident. It’s the casual way the Cosmos-as-Executioner indolently goes about cutting its random swathe and delivering its haphazard blows that gets to us. But this is merely the first stage of an ongoing process.

All going well, according to Hartmann’s research next come images more familiar to the psyche, as it contextualizes the trauma within dreams which make broader and broader connections 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 follow a discernible pattern. First the trauma is replayed vividly and dramatically but not necessarily in precisely the way it occurred: there is often at least one major change in the dream, something that did not actually occur. Very rapidly the dreams begin to combine and connect this traumatic material with other material that appears emotionally similar or related … The process of connecting the trauma with other emotionally related material from the dreamer’s life (and imagination, reading, daydreaming) gradually expands and takes in more and more other material; 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 less intense and concentrated, drawn from an emotionally more diffuse and varied experience, and this 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 how much 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 and sleeplessness, or it gets ‘stuck’ repeating over and over its terrifying central image stage, and fails to progress and resolve without the assistance of professionally-supported self-talk therapy and medicine. We call this post-traumatic stress disorder. Yet Hartmann’s research shows that routinely ex opere operato our dreams successfully take care of our traumatic experience of bushfires and road accidents and terrorism and earthquakes and tsunami without the need for any external assistance.

This nightmare process endowed the dreamer an added dimension as they dealt with their trauma: coming through it, they were likely to emerge even stronger and wiser to respond to the next confrontation with their ultimate meaninglessness. It has survival value. If it doesn’t break us with an oneiric equivalent of prophylactic shock. The risks are great. But so too is the everyday 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) of Sleep.’ It’s rather like the humble needle, which can be used to darn a hole in the heel of a sock or a cardigan’s ravelled sleeve, or tack together a shirt, a pair of pants, or a dress, or finely to embroider a delicate work of high art; to puncture and express a boil, or suture a wound after surgery; to attach rope to canvas and so fly a dinghy, or bind loose leaves into this more durable publication; in elongated form, to knit gloves or a scarf or jumper; in hollow form, to inject antibiotics or drain effluvia or direct glue onto model ship parts; harnessed to a machine, the needle cobbles together leather into moccasin and jackboot alike.

The applications of the needle are numberless, ranging from life-saving to routine maintenance to creative time-wasting. It’s much the same way with sleep and its seemingly endless list of functions and accomplishments. One of sleep’s multifarious evolutionary applications 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 its clear or clouded skies. At certain critical times – the death of a loved one, breakdown of a basal relationship, loss of a way of living – depression can close in on any one of us and stick around like a threatening iceberg. At such times, a healthy dream life can assist us in working through and resolving our grief. However, as with the nightmare process, it seems that not all of us are created equal in this regard.

In the normal healthy brain, the first and primary emotional/cognitive task of dreaming sleep is to clean out the muck from the stables and weed the garden, i.e. deal with our negative daytime experiences: to defuse them, neutralising their ongoing toxicity. Up to 80% of our dreams are negative in affect.

However, like the aforementioned needle, the nocturnal needs and uses of our sleeping brains 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 longer regular sleep rapidly become destabilised and worse. And there are those of us for whom a full night’s sleep can be positively toxic and debilitating. With too much sleep, we are much more likely to be dull, detached, deadened and depressed. More likely to see things as they are, clear and unvarnished of value; unveiled of illusion, of the underlying communal delusion that it is better somehow to be than not to be, or that 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, and without 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 fog lifts. This is precisely the chemotherapy some depressed brains respond to, through their maoi or ssri antidepressant medicine. Simply to cut back on the total time spent in bed asleep can also

help, 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 depressed divorce(e)s for up to eight months after marital dissolution. For the majority, their dream life played an integral part in their grieving process and recovery. Over the course of a night’s series of REM-sleep episodes, their dream outcomes progressively became more positive and more optimistic, both overnight and increasingly over the research period. They awoke rested and refreshed. Their former spouses played increasingly neutral and detached dream roles which reflected and facilitated the resolution of their emotional conflicts. As with Hartmann’s nightmare subjects, in due course both their mood and their dreamlife returned to normal, and in general they successfully moved on with their lives.

For a more problematic minority such was not the case atallatall, as they exhibited a number of characteristic tell-tale signs. After the nightly onset of sleep, their brains rushed prematurely into REM dreamepisodes without due conscious daytime preparation or adequate non-REM preliminaries. Their dream generator was incapable of producing well-formed, bizarre and complex dramas which included a reconciling role for the former spouse. Their dreams failed to create sanguine associations between their current problems and previous happier resolutions to similar problems, following instead a pattern of repetitive negative dreaming, and so ultimately fell 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 their dreams the next day. Rather than being part of their solution, their dreamlife was a deeper aspect of their problem.

In a work of literary fiction, Evelyn Waugh has well described the disappointed and depressed housewife’s poignant dreamlife in his perspicacious case note: “Long, tedious dreams born of barbituric, dreams which had no element of fantasy or surprise, utterly real, drab dreams 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 to perform many of its normal functions. For a normal rat brain, REM-sleep deprivation interrupts 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’s brain. Quite the opposite – it actually stimulates it. Similarly, a depressed brain can learn to relieve its dream generator of toxic nocturnal overload with daytime cognitive behaviour therapy that 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 to normalise the depressed neurological processes with a substantial daily dose of hot and sweaty physical exercise. Quite incidentally, besides investing our life with their fun and physical fitness, 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 they lower our blood levels of the stress hormones, including cortisol, that galvanise the body to fight, 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 sedentary agricultural life hasn’t changed that basic anatomical fact one whit. Here in Adelaide where I live, we suffer unnecessary disease and perish prematurely because we ignore this core evolutionary law of being human: we were born to run.

Exercise is the surest, sweetest, most effective antidepressant medicine and cognitive behaviour therapy combined together into the one carefree liberating package requiring no doctor‘s prescription nor psychologist‘s coaching. “Only when becoming an athlete fails should we treat the disease itself,” wrote Dr George Sheehan of coronary artery disease. He might equally have been referring to the depressed brain. Try it – we have nothing to lose but our blues… “Blithely kicking off the flip-flops and running barefoot across the green grass to catch the stayed departing train, ‘One thing I know I can do is run.’” (The author to himself in a dream, winter solstice full moon, 2002)

# # # # #

In November 1990, I made the first of three trips to India, specifically to Rishikesh, a picturesquely Arcadian “village of seers“ nestling among the toes of the Himalayas beside GangaMa 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 attempt to compensate, in its stead I increased the dosage of phenelzine, the maoi antidepressant I had been prescribed three months earlier for my panic attacks, unwittingly thereby pouring petrol onto an already raging conflagration.

With no REM-sleep whatsoever, precious little repose of any sort, and without any tranquillising neuroleptic medicine, rapidly I became manic and enraged, incoherent, paranoid and delusional, and upon my return to Australia ten days later, although briefly back on my medication, for my riotous misconduct on arrival there I was forcibly hospitalised out of Sydney airport. Thus far, my final detention.

Eleven months later I returned to my Shangri La – “Yoga Capital of the World” - to discover just round the corner from my Ghat Road hotel room, on the road to Dehra Dun, a little chemist shop dispensing trifluoperazine 5 mg tablets over the counter, at five rupees or at that time roughly twenty Australian cents apiece...

Were it not for that unpropitious Burke-&-Willsian experiment of nature, every three weeks I would doubtless still be consulting with my endlessly patient psychiatrist, every night I would be consuming trifluoperazine 15 mg, an unnecessarily high and brain-numbing dosage, as I had every night for the previous thirteen years, and every day, a variety of medicines for the resulting panic attacks; and to dull the indignity, employing unhealthy quantities of ethyl alcohol and tetrahydrocannabinol which only made everything, particularly the 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 for that initiating misfortune, there would not have been the tantalising evidence to provoke the inexorable curiosity, with the subsequent twenty year-long lattice of events and research to crystallise 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 the eschatological, using different words to say the same thing, “Truth is more often stranger than fiction.” (Samuel Langhorne Clement) In the immortal words of Aleksandr Popcsynski, “There is 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, is the profound relationship betwixt sleep disturbance and mood disturbance: sleep is critical in affect 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 far more complex sleep architecture disturbance which impairs sleep between episodes, escalates just before an episode, and exacerbates still further during the course of an episode, whether of depression or of mania. (Dr Allison G. Harvey) Whilst hypersomnia is a classic symptom of depression, lack of sleep and mania so often go hand in hand. These oneiric fluctuations are not so much symptoms as the underlying cause at work.

Alternatively, the mood disorder’s underlying oneiric disorder often manifests in the guise of sleeplessness & 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 its dysfunctional circadian rhythms and the cyclical wake/sleep/dreaming stages of our very consciousness. Our therapies and our medicines are efficacious to the extent – directly or indirectly – they effect this end.

9. DEPRESSION AND INSOMNIA

The depressed brain is obsessed with its grieving, with life’s injustice, often with very good cause. Throughout the day it chews over its predicament, well described as ruminating. The depressed brain continues this obsessional preoccupation mercilessly even as we sleep. It savours its repetitive negative dreaming without let, to this end often extending the period of sleep 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’s nightmares, 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 we awaken short hours later with our depression even worse than when we went to sleep. If we’re lucky...

Sleep disturbance, whether too much or too little, is intrinsic to depression’s activity. The problem is in the dream generator as much as the conscious brain’s circuits. The depressive’s dream generator is broken, no longer capable of staging each night four or five therapeutic productions of developmental dreams. Even a normal load is too much for it. The nightly alchemical feats of spinning our negative experiences into fine gold require a determined cheerfulness and a doggedly optimistic energy beyond our depressed generator’s capacity. One sure hallmark of recovery is when we find ourselves no longer giving sleep a second thought, it is 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/or neuroleptics. More and more we can take the load off our dream generator with the help of any therapy 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 to moment mindfulness, or divert the mind back to external reality, at the end of the day there is no 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. Demanding physical exercise is one sure-fire way of concentrating our mind in the present moment, in addition to all its other proven more physiological antidepressant benefits. Much of this opuscule was drafted aimlessly shuffling alongside Karrawirra Parri...