Ego Damage and Repair : Toward a Psychodynamic Neurology 9781782413028, 9781782201700

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CHAPTER TITLE

EGO DAMAGE AND REPAIR

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EGO DAMAGE AND REPAIR Toward a Psychodynamic Neurology J. Allan Hobson

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First published in 2014 by Karnac Books Ltd 118 Finchley Road, London NW3 5HT

Copyright © 2014 to J. Allan Hobson. The right of J. Allan Hobson to be identified as the author of this work has been asserted in accordance with §§ 77 and 78 of the Copyright Design and Patents Act 1988. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher.

British Library Cataloguing in Publication Data A C.I.P. for this book is available from the British Library ISBN 978 1 78220 170 0 Edited, designed and produced by The Studio Publishing Services Ltd www.publishingservicesuk.co.uk e-mail: [email protected] Printed in Great Britain

www.karnacbooks.com

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CONTENTS

ACKNOWLEDGMENTS

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ABOUT THE AUTHOR

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INTRODUCTION PART I The power of suggestion Hypnosis—yes or no? The double-bind hypothesis of schizophrenia Individual therapy case vignettes Derrick Sutter: Did I kill him? Sarah Sage: Did I maim her? William Hitchens: Did I do more than play baseball with him? Francine Poppy: Did I keep more than her pain alive? Rosella Campobello: Did I teach her to eat? Yveline Cloche: Did I really help her avenge her husband? John Cabot: Did I help him get a job? v

1 1 2 4 4 7 9 11 12 15 17

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Sybil Newhouse: Did I save her from unnecessary plastic surgery? Melvin Blinder: Did I help him to get a checkbook? Gordon Golden: Was he as sick as his history? Group Psychology and the Analysis of the Ego Dr. Black Knight: Did his stone wall crumble? Soren Tooks: Did he ever get a real job? Zack Seidler: Does he now hug his father? Jane Hudson: Is her art enough for her? Gerald Green: Has he now lost all his fingers? Max Truman: Can he now pet his cats? Edward George: Does he teach the law of behavior? Xavier Theodorus: Can he now go over the bridge? Sylvia Gates: Is she able to stop shaking? Eliana Gergius: Does she still see her mother’s face? Dr. Irvin Yalom: Did science help him see straight? General considerations and conclusions: group or individual therapy? PART II The brain basis of normal and abnormal ego states Introduction Chemical intervention and the brain Aminergic neuronal systems Sleep and dreaming Containing dreaming in REM The heart of the brain The emotional brain Aminergic–cholinergic balance The muddy notion of stress Ego suicide Restoring autonomic balance the easy way Working full time The joyous effects of amine reuptake blockade Epilepsy and neuronal excitability Narcolepsy and REM sleep behavior disorder Anger management

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41 41 43 44 45 46 48 49 51 52 53 53 55 56 57 58 60

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Lucid dreaming Flying dreams The ego and the frontal lobes PART III Psychodynamic neurology: sample cases Obsessive–compulsive disorder (OCD) Martin Hoskins OCD and protoconsciousness Treatment results as they bear on causal models in OCD Depression Lieta Siciliano Anorexia nervosa Chiara Perugino Hypochondriasis Luciano Ferri Anorexia revisited PART IV Self-reliance and psychotherapy Can you be your own psychotherapist? The self-treatment of Glen Just Out-of-body experiences Dream plot control Post traumatic stress disorder (PTSD) Glen Just’s flying dreams Dream emotion Ego development Lucid dreaming Self-hypnosis Energetics Religion Sex Astral travel Communing with nature Psychosis The interpretation of dreaming

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69 70 71 75 78 79 83 85 86 89 89 90

95 95 96 101 103 105 106 107 109 111 112 115 117 118 119 120 121 125

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The universality of dream science Waking dreaming The ghost Psychopathology and the temporal lobe Self-reliance and the frontal lobe

126 129 130 133 134

PART V Ego repair: what every psychotherapist should know Philosophical considerations Brain–mind science Self-creation The importance of subjective data Personal history Childhood trauma The traumatic criticism of children The maternal bond revisited Keeping a journal Insight State stabilization Concluding remarks

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APPENDIX I: Glen Just’s altered states timeline

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APPENDIX II: Glen Just’s new self-observation experiments

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GENERAL BIBLIOGRAPHY

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REFERENCES

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INDEX

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ACKNOWLEDGMENTS

I am grateful to the many institutions that encouraged me in the critical thinking that is at the heart of this book. Of my many supportive friends and family members, I thank especially my wife, Lia Silvestri, my stepchildren, Luca and Caterina di Perri, and my twin sons, Andrew and Matthew Hobson, who taught me so much about family and cultural life. In parallel with my Italian education, I have been aided, both professionally and personally, by Nick Tranquillo, David Borodin, and Glen Just.

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ABOUT THE AUTHOR

J. Allan Hobson is Professor of Psychiatry Emeritus at Harvard Medical School, Boston, Massachusetts. He was born in Hartford, Connecticut on 3 June 1933, and obtained an AB degree from Wesleyan University in 1955, followed by his MD from Harvard Medical School in 1959. Between 1959 and 1960, he served his internship in medicine at Bellevue Hospital, New York, and from 1960 to 1961 and 1964 to 1966, he was a resident in psychiatry at Massachusetts Mental Health Center, Boston. From 1962–1963, Hobson was a clinical scientist at the National Institute of Mental Health. During the academic year 1963–1964, Dr. Hobson was Special Fellow of the National Institute of Mental Health, Department of Physiology at the University of Lyon, France. His successful career has brought Dr. Hobson many honors and awards, including admission to the Boylston Medical Society and the Benjamin Rush Gold Medal for Best Scientific Exhibit, American Psychiatrist Association, 1978. He was the recipient of the 1998 Distinguished Scientist Award of the Sleep Research Society. In addition to numerous committee assignments at Harvard Medical School, Dr. Hobson has participated in several national and regional medical committees, and served on the editorial boards of many xi

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medical journals. He has held many consulting appointments, including Consultant in Psychiatry for the Massachusetts Rehabilitation Commission since 1965. In 2004, Dr. Hobson received the Peter Farrell Prize from the Division of Sleep Medicine, Harvard Medical School for his lifetime dedication to sleep research at Harvard. His major research interests are the neurophysiological basis of the mind and behavior, sleep and dreaming, and the history of neurology and psychiatry. He has contributed numerous articles to scientific journals and chapters to medical textbooks, and is the author or coauthor of many books and monographs, including The Dreaming Brain, published by Basic Books in 1988 and Sleep, published by the Scientific American Library in 1989. Dr. Hobson’s work has focused on the cognitive features and benefits of sleep. The results and concepts of this work are reported in The Chemistry of Conscious States: Toward a Unified Model of the Brain and the Mind (Little, Brown, 1994); Consciousness (Scientific American Library, 1998); Dreaming as Delirium (MIT Press, 1999); The Dream Drugstore (MIT Press, 2001); Out of Its Mind: Psychiatry in Crisis (with J. Leonard) (Perseus Books, 2001); Dreaming: An Introduction to Sleep Science (Oxford, 2002); 13 Dreams Freud Never Had (Pi Press, 2005); Angels to Neurones: Art and the New Science of Dreaming (with H. Wohl) (Mattioli, 1885, 2005); Dream Life: An Experimental Memoir (MIT Press, 2011), and in this volume.

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Introduction

What does the new science of dreams teach us about how to understand and respond to the disordered states of consciousness that afflict so many people? I use the words “disordered states of consciousness” to emphasize the new approach that I now take to understanding those patients that I was taught to regard as psychiatric in the good old days when we were confident that we could use the medical model to think about those conditions as diseases of the mind and treat them all with psychodynamic psychotherapy. Those days are long gone. In 1960, when I began my psychiatric residency at the Massachusetts Mental Health Center (MMHC), this now seemingly quaint notion was firmly believed and promulgated. Massachusetts Mental Health Center was the flagship hospital of Harvard Medical School and, in 1960, attracted no less than twenty-five very bright trainees who were all convinced that they had been admitted to the best residency in the country, if not the world! I know this is true because I was one of those immodest recruits. Already in 1960, there were chinks in this armor. The mental hospitals had been emptying since the chance discovery in 1955 that the phenothiazine, Thorazine, was an effective antipsychotic drug, xiii

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indicating that a biological and chemical mechanism was at work in psychosis. This pitted the mind-only Freudians against the brain-also psychiatrists and began a long internecine struggle for dominance that is still evident despite the persistent inadequacy of the biological approach. It turns out that Thorazine and its myriad kindred neuroleptics interact with the aminergic neuromodulators that control brain state. The conviction that talk only was enough flew in the face of both clinical experience and the more sober assessments of die-hard Freudians that psychoanalysis was never appropriately applied to psychosis anyway. At its most conservative self-appraisal, it was held that psychoanalysis was only a research tool. I have laid out my criticism of this claim in my recent article, “Ego ergo sum”, which offers an alternative to psychoanalysis based upon modern sleep and dream science. In “Ego ergo sum”, I advance the thesis that psychiatry and neurology share the common cause of understanding psychodynamics in terms of brain activity. These ideas have been published in a book titled Psychodynamic Neurology: Dreams, Consciousness, and Virtual Reality. The growth and maturation of neurobiology is, thus, another factor necessitating reform in psychiatry and psychology. Nowhere is that more evident than in dream science, the subject to which I have devoted my life, and to which I return here only enough to make new points about the treatment implications of my theory. I have recently been inspired in this endeavor by meeting Glen Just, a contemporary non-psychiatrist colleague who has performed therapeutic experiments on himself that only recently have intersected with my brain science and which dramatically illustrate the beneficial plasticity of the conscious state control system. In this book, I try again to recreate the transition from our overly confident position in 1960 through the shambles that has characterized academic psychiatry beginning in 1975 and which continues to limit the recruit of top-class medical students even today. Here, I try to go beyond criticism and to identify factors which show the shape of a new psychiatry that is based upon sleep and dream science but which retains the interest in the human and psychological level of discourse that made psychoanalysis so irresistibly popular. The result, I hope, is a genuinely progressive attempt to integrate mind and brain in a unified model that realizes, to an appreciable extent, Freud’s goal of a scientific psychology, expressed in his visionary

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1895 Project for a Scientific Psychology. To accomplish this goal, I review my own clinical experience and illustrate how and why I have moved away from classical psychoanalysis toward a more eclectic cognitive–behavioral stance. In making this move, I was neither original nor particularly interesting, since many of my colleagues have done just this. However, these colleagues have not explicitly acknowledged their move. I try to do so now. What is novel here is the integration of conscious state psychology and psychopathology with a wide variety of brain mechanisms that have been revealed by my study of REM sleep in the cat and the application of those findings to formal aspects of human dreaming. Because of its hard science core, Ego Damage and Repair thus claims to be more than an eclectic mix of psychotherapeutic maneuvers. Rather, it is a quasi bottom-up reformulation of psychotherapy and pharmacotherapy. Moreover, the protoconsciousness model upon which it is constructed suggests a new way of looking at psychopharmacology in terms of conscious state control. This is another reason for suspending judgment in the disease-disorder conflict. For the time being, I prefer the disorder paradigm because I consider the dynamics of the system to be universal and I see us all as prone to disorders of this system. Rather than suggesting that every one is neurotic and, therefore, in need of treatment, I mean to make everyone aware of the privilege and peril of carrying a complex brain within his head. According to the virtual reality model of protoconsciousness theory, the self can easily be damaged or even killed, self-multiplicity is normal, and selfunity is only a useful but problematical delusion. Finally, I hope to be able to show that the mastery of the symptoms of ego disunity depends upon the self-reliant recourse that afflicted persons take to overcome their disability. Otherwise, the family risks being used as an excuse for the symptoms and a refuge from them, whereas it is more properly regarded as a source of many symptoms and, as such, to be avoided lest it be used as an excuse for those symptoms and the agent of their perpetuation. There are two contrasting views of family life presented here. One is the traditional Latin view: family is the most important element in life, an end in itself, the be-all and end-all of human existence. The other is the view, espoused by some in Anglo-Saxon cultures, that the family is a means to an end and that end is self-reliance. Thus, a goal of Anglo-Saxon culture is severance of family ties in the interest of

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independence. Of course, this contrast between Anglo-Saxon and Latin cultures is an oversimplification, but the argument is designed to expose real conflict however exaggerated a picture of cultural contrast it may be. Attention is paid to the conflict in other world cultures where this kind of model competition is seen to be a central construct that plays itself out at the international level. The central idea of Ego Damage and Repair emerged from my musings about what these and all other clinical stories have in common, which is the effort to overcome genetic propensity and the divisive threat of parental conflict and dissent. Culture plays its part in both conflict and dissent and I use my personal experience of cultural difference to highlight this analysis of how the ego is threatened by cultural incompatibility and the steps that may be taken to reduce the divisive threat. The strategy of self-protection taken by many persons threatened by cultural dissent is distasteful and embarrassing to me. I am afraid that my conclusion is to avoid this threat rather than to try to compensate for it.

Organization of the book After a brief discussion of the pros and cons of hypnosis, I continue Part I by presenting a series of ten case vignettes to show how my mind has gradually changed about psychotherapy and, more specifically, how my native belief in self-reliance grew with the recognition that people most needed to believe in themselves through the power of suggestion: hypnosis proceeds first from the therapist to the patient, but then from one part of the patient to another. I remember my training and clinical experience as one in which my native rebelliousness and skepticism were nourished by a belief in myself and by the positive responses of my patients, which reinforced my convictions in the face of the strongly held notions of my teachers about psychopathology. I showcase the double-bind theory of schizophrenia as an example of the erroneous psychoanalytical teaching to which I was exposed during my training as a psychiatrist. As time went on, it became more and more clear to me that psychoanalysis was bankrupt and that its principles were not only misguided but frankly wrong with respect to the treatment of the mentally ill. I even question the residual conser-

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vative claim that psychoanalysis is a valid research technique. I take this strongly critical position because I believe that nothing of lasting scientific value has been gleaned by the followers of Sigmund Freud in over a century. Freud is rightly credited with promotion of the already widely held view that human behavior was determined by forces operating outside the reach of waking consciousness and of the idea that careful attention to dreaming could help us become more aware of those forces. But how was this theory to be operationalized? At the same time that my mind was gradually being changed by my clinical work, I was doing basic research on the physiology of REM sleep in the cat and using the results to appraise psychoanalytic dream theory. Freud’s disguise-censorship dream theory is the foundation stone of the clinical psychoanalytic model that I was taught. I soon came to doubt that model on both intuitive and experiential grounds. One thing that I learned in my residency was also useful in my experimental work: it was strategically useful in both domains to say, do, and think very little, letting the patient (in the clinic) or the cat (in the lab) do the talking, the doing, and the directing of the thinking. It was through inaction that psychological and neurobiological truth was revealed to me. People want to talk about hidden parts of themselves if they are convinced they will be listened to, and the brain evinces spontaneous change that cannot be appreciated if the experimental ideal of constancy is enforced. I have written in extenso about the creation of activation synthesis, the hypothesis that Robert McCarley and I published in 1977 as the first brain-based dream theory. I have not, until now, dealt with the implications of the neurobiology of dreaming for a general theory of psychiatric treatment, one that integrates the biological material with a psychology of therapy. This argument constitutes Parts III and IV of this book. In Part V, I try to show that both psychotherapy and pharmacotherapy share the goal of state stabilization and that that goal has been reached today via both psychological and biological interventions. I argue that state stabilization works because it serves to keep protoconsciousness forces in check in aid of effective and symptomfree waking consciousness. Sometimes, it is useful to manipulate sleep in the interest of waking, and sometimes it is useful to manipulate waking in the interest of sleep. Whatever the paradigm, the laws of

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state control prevail and it is, thus, important for all of us to know what those laws really are. In Part IV, I make a strong case for self-reliance and even for self-treatment. To illustrate this idea, I discuss the remarkable selfobservations of Glen Just, who, for reasons of his own, developed a program of do-it-yourself psychotherapy which goes far beyond anything I ever imagined but uses precisely those aspects of dream science that I have emphasized from an empirical standpoint. Of course, the consilience of Glen Just’s clinical self-observations with dream science are suspect in and of themselves. They could very well reflect the unintentional influence of my neurobiology. However, I write enthusiastically about this consilience because I am convinced that there are sufficient grounds for thinking that the two lines of work are, doctrinally at least, independent. I admit that both Glen Just’s self help program and my reading of dream neurobiology smack of Andrew Carnegie’s “power of positive thinking”, but it just could be that positive thinking is more helpful to people than negative thinking (and that optimism is more beneficial than pessimism) even if both can be justified by the facts of life. What is clear is that the brain generates both optimism and pessimism and it generates both with good reason. Misadventure really does happen and it probably happens more to those people who become patients than those happy few who sail through life unscathed. This book focuses on the positive side of brain function as it holds the negative side at bay. I am sure that this gambit is the essence of adaptive functioning for all people.

What is protoconsciousness theory? Derived from modern dream science, protoconsciousness theory replaces the Freudian concept of a dynamically repressed unconscious inimical to consciousness, with the idea of a subliminal state of consciousness that is actually designed to facilitate waking consciousness. There are several critical differences between the Freudian unconscious and protoconsciousness: The first difference is developmental. Protoconsciousness is a natural process that arises from the early development of REM sleeplike brain activation. Instead of being a secondary effort to disguise the meaning of unacceptable id impulses in infancy, something like

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consciousness begins in utero as the maturing brain prepares itself for waking consciousness. The second difference is cognitive. Protoconsciousness is an entirely normal, but essential, factor in the development of consciousness. Once consciousness is established, it does not cease to be essential, but, rather, continues to operate throughout life in the service of waking consciousness. The third difference is dynamic. Like the Freudian unconscious, protoconsciousness may break through into waking and produce so-called symptoms. Psychopathology is, thus, seen as the natural consequence of the failure to contain protoconsciousness. When trauma and other misadventures befall an individual, this failure to contain protoconsciousness is increased. The fourth difference is therapeutic. Protoconsciousness can be manipulated in order to reduce the negative effects of failure of containment. Protoconsciousness is, thus, both enemy and friend of the symptomatically impaired individual. It is this fourth, therapeutic, aspect that is the main focus of this book. To fully appreciate and understand protoconsciousness theory, it is important to recognize other similarities and crucial differences between it and the Freudian psychoanalytic model. Both protoconsciousness and psychoanalysis have their origins in the study of dreams. Instead of regarding dreaming as a defensive disguise, protoconsciousness theory sees dreaming as naturally constituted and as fundamentally healthy. In fact, for the protoconsciousness theorist, dreaming constitutes a window on the normal and positive operations of the mind. Dreaming is the state of adult life in which the brain goes back to cognitive basics and renews itself, even as it incorporates information gleaned in waking. By cognitive basics, protoconsciousness theory implies the establishment and maintenance of a virtual reality model of the world that is used to establish: (i) a sense of self as agent. This gives rise to entirely new and distinctive theory of the ego. The sense of self as agent arises early in development and is used to organize and integrate; (ii) a model of the world, especially of space in which it can operate and rehearse off-line three crucial skills: 1.

Sensation, allowing the preconscious ego to see, hear, and perceive in the absence of external stimulation as it exercises.

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Movement, which is fictive but, in the main, faithful to real motility. Emotion, especially anxiety (fear), anger (self-defense) and joy (elation).

These three faculties are the building blocks of waking consciousness. The protoconsciousness hypothesis of virtual reality supposes that this system self-organizes early in intrauterine development and is used to convert a necessarily limited set of genetic instructions into an epigenetic program that we later perceive principally in our dreams. On this view, dreaming is anything but psychopathological and defensive, as Freud assumed. Rather, it is a key to understanding our cognitive success. Every evolutionary advance is achieved at a cost. Being endowed with a brain that dreams entails the risk that dreaming and waking may become intermingled, with disastrous consequences. It is important to keep waking, which depends upon dreaming, clearly dominant and separate from dreaming. That this separation is usually successful is evidenced by dream amnesia which is often total and which is very effective even in the best dream recallers. Because dreaming is so strongly correlated with REM sleep, we can investigate REM for clues as to what more specific use the offline activation of the brain might be as we shift attention away from dreaming per se and begin to formulate a neurobiology of consciousness. Again, I point out that this theory is the main focus of “Ego ergo sum” of which I have already published a summary article (see References). Ego Damage and Repair goes on to consider therapeutic implications of the new theory.

Manipulating the ego in the service of health This book places several phenomena and several clinical conditions in the spotlight as it strives to develop a new conception of treatment. The phenomena of greatest interest here are the hybrid states in which one can examine both protoconsciousness and normal waking consciousness work in parallel. By far the best known and best studied of these hybrid states is lucid dreaming, a state in which adepts are able to recognize that they are dreaming instead of erroneously supposing

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themselves to be awake. For the therapy theorist, lucid dreaming is significant for two main reasons: 1. 2.

Lucid dreaming can be used to tone down unpleasant emotions such as anxiety and anger. Lucid dreaming can be studied in the laboratory to determine its physiological basis. That physiological basis can be augmented in the interest of more positive thinking and feeling.

Because lucid dreaming can, to a variable extent, be induced voluntarily, it opens the door to interventions that are voluntary, an idea quite foreign to psychoanalysis, which emphasized both involuntariness and automaticity in its therapeutic prescriptions. Preliminary experimental evidence suggests that 40 Hz EEG power and lucidity can be enhanced by electrical stimulation of the scalp overlying the frontal brain. The power of suggestion and the powerful phenomenon of hypnosis can now be welcomed back to the therapeutic table from which they have been banished by the Freudians for over a century. It is no exaggeration to call the twenty-first century an age of enlightenment, and this book hints at the shape a glorious dawn might take.

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PART I

The power of suggestion

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key assumption of the approach to psychotherapy that is taken here is that the most powerful environmental force for change is suggestion.

Hypnosis—yes or no? As a resident, I was taught that suggestion imposed truth upon a subject and that suggestion was the enemy of insight, the discovery of the deeply buried unconscious impulses that truly drove all behavior. Consciousness was, therefore, positively misleading. Only the dynamically repressed unconscious was truly true. Thus, hypnosis was vilified as the devil that kept the unconscious demons from liberation by suggestion-free psychoanalytic psychotherapy. In retrospect, these psychoanalytically inspired injunctions were themselves suggestions of an intellectually numbing kind. My first psychiatric boss, the late Dr. Jack Ewalt, went so far as to drive the professional hypnotist and prestidigitator, Dr. Martin Orne, out of Harvard. Martin moved to Philadelphia, where he pursued his career in the more eclectic and more tolerant Department of 1

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Psychiatry at the University of Pennsylvania School of Medicine. With Martin’s departure, we lost what little chance we had of recognizing and manipulating the suggestibility that might have empowered ourselves and our patients to more positive and useful ways of thinking and being. Whether we were psychiatrists in training, or patients, or just normal human beings, it was in my opinion a major mistake to outlaw suggestion. Shame on you, Jack Ewalt! You were very tolerant of my dissent from the psychoanalysis that you espoused and you encouraged my interest in the brain. As my department head, you helped me enormously to develop an experimental career. But you exiled suggestion from my clinical education. I had to find out about this most important and potent force by myself, almost by accident. This book is a testimony to the negative effects of this error of omission as well as a screed against the falsity of other aspects of psychoanalysis.

The double-bind hypothesis of schizophrenia When I was a resident in psychiatry at Harvard in the early 1960s, the leading theory of the supposed psychogenesis of schizophrenia was a double-bind injunction attributable to mothers who confused their children by saying, for example, “Be independent but don’t ever leave me.” In 1960, the evidence was already strong that genetics played a large part in the determination of schizophrenia, but the psychodynamic model of Sigmund Freud was being extended far beyond the bounds of scientifically sound application. Freud himself inveighed against this practice. Psychoanalysis may have been justified in the case of Viennese and Parisian hysterics, but Freud’s theory was probably flawed even in those ostensibly neurotic cases. The assertion by my American teachers, most of whom were Freudian psychoanalysts, that schizophrenics were psychotic in part because their mothers raised them in a climate of mixed messages seemed dubious to me on its face. I nonetheless went along with this hypothesis because I was young, impressionable, and cowed by my professorial instructors. I feel now that I was intellectually and emotionally abused by them and it has taken the better part of a lifetime of self-reliance to overcome this early intellectual trauma. As dubious as was the double-bind theory of schizophrenia was the arrogant and insensitive way that the theory was often promulgated

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in my day. Mothers at their wits’ ends, with offspring who were unhinged, were made to feel guilty for causing states of mind over which the mothers had no control or responsibility whatsoever. I vividly remember one particularly exhibitionistic and sadistic hazing of a psychotic patient’s mother by a senior psychoanalyst. Such teachers were simply ignorant and should have admitted it. From them I did learn how to talk with such patients and how, by psychological means, to help them live their lives, but I never found a modicum of evidence for a theory that was, like most of Freud’s own ideas, nothing but speculative philosophy. Like so many other theories, the double-bind hypothesis was probably entirely false. Because evidence could not be found to support it, it was, in fact, put out in the pseudoscientific trash long ago. The later studies of Paul Wender and Seymour Kety, who studied identical twins reared apart, showed that it was genetic inheritance and perinatal insult, not later environmental misadventure, that was at the root of the psychopathology in schizophrenia. Many psychoanalysts believed then (as some of them still believe now) that they had transcended the rules of science. In fact, it was arrogantly claimed that a new science had been discovered which was free of the need for experimentation. All that was needed for a scientific psychology was psychoanalysis itself. Any doubts about psychoanalytic veracity were dismissed as psychological resistance to truth. Such resistance was thought to emanate from the neurosis of the doubter. I was sadly subjected to such outlandish and politically incorrect hazing. I remember being dismissed by Professor Ewalt as a “believer” in science; my retort was that science was our only hope for the correction of misguided belief. What had been discovered in psychoanalysis was little more than a new religion from which the intellectual world of the West has yet to escape. This is still another reason for challenging David Spiegel’s joke about the triviality of academic disputes (which are so acrimonious because there is so little at stake!). Spiegel’s bon mot turns on the ironic intensity of academic disputes. But the argument over psychoanalysis is anything but trivial. At stake here is nothing less important than a deep truth about ourselves. We are brained creatures who still do not see ourselves at all accurately because of our still profound ignorance of the brain.

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I now resort to a discussion of some of the cases that helped me to reject psychoanalysis and to reach a humble consensus regarding selfreliance. These case vignettes are designed to make two reciprocal points: one is that theoretical and practical errors can be harmful and even fatal; the other is that common sense and open support are more likely to be helpful than subtle insight about parental behavior. First, I consider ten patients whom I followed in individual therapy. I try to balance the good that I might have done with frank acknowledgement of the harm that I am afraid I may have inflicted in the name of the psychoanalysis that I was taught. Then I tell about ten more patients that I saw in groups who helped me further to realize the pompous delusions of Sigmund Freud. A more positive point is made about the great efficiency and surprising efficacy of group psychotherapy, a modality thought by my psychoanalytic teachers to be greatly inferior to individual treatment. In presenting these cases, all of which were supervised by psychoanalytic faculty members of Harvard Medical School, I might, out of anger at what I consider to be deception, overly emphasize my inadvertent negative interventions. A paradoxical truth is that the intellectual weakness of my treatment was a cover for an almost devout adherence to clinical responsibility. At the same time that we residents were being brainwashed about the scientific probity of psychoanalysis, we were being sworn to the care of our patients for life. I am as proud to have taken the ethical charge seriously as I am ashamed to admit that I was gulled into confusing theory with fact. The irony of this contradiction of intellect and ethics is profound.

Individual therapy case vignettes Derrick Sutter: Did I kill him? Derrick Sutter was a thirty-five-year-old man who wished he could fly. Mr. Sutter’s problem was that he did not restrict his flying to his dreams or to his waking fantasy. He enacted his conviction in waking. His mother was understandably concerned about him and kept him on a very short leash lest he hurt himself. “Typical double bind victim” I thought to myself and began to pry Derrick Sutter loose from the source of his troubles, his benighted mother.

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One day, after a session with Mr. Sutter and his mother in which I recommended their separation, Derrick ran from my office and launched himself into space in the first floor corridor of the hospital. He aimed his head very accurately at a small window in the metal fire door that separated the corridor from the front lobby of the Massachusetts Mental Health Center. He hit the window with his head and broke the glass but tore his scalp apart with the wires that reinforced the glass in that fire door’s tiny light aperture. Because he had severed his left temporal artery, Derrick Sutter bled profusely and by the time his mother and I got to the scene of his failed flight, he had been whisked off to nearby Brigham and Women’s Hospital for emergency surgery. He recovered quickly and was sent home with his distraught double-binding mother. Two weeks later, he committed suicide by hanging himself in a stairway of their home. Why his mother did not sue me for malpractice, I will never know. Derrick, forgive me; Mrs. Sutter, I was only following orders. But I should have known better, shouldn’t I? In retrospect, I was guilty of Derrick Sutter’s death. I had applied a theory to his care that was unproven and implausible on its face. As a result he gave up and died of despair. Derrick Sutter was not a schizophrenic, although we diagnosed him as such. He was not bizarre, withdrawn, or odd in any way. We got the diagnosis wrong because, at Harvard and similar institutions influenced by psychoanalysis, diagnosis was not held to be very important, since all patients received the same treatment: talk. Obstreperous patients got Thorazine to calm them down (and sometimes knock them out) but we were confident that it was the talk that really mattered. Today, Mr. Sutter would probably be diagnosed as suffering from major affective disorder and treated, possibly successfully, with one or another of the drugs that directly play upon the same brain stem neurons that Robert McCarley and I, working in a basement laboratory just below Mr. Sutter’s launch runway, discovered to be key regulators of sleep and dreams. As I will later explain, the clinical efficacy of drugs such as Prozac is related not only to their antidepressant action, but also to their more fundamental role in conscious state stabilization. The link between sleep and both mood and psychosis is now biologically clear and I am proud to have been a part of such small but

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genuine scientific progress in this field. This is not quite as great an advance as we might want, but it is certainly better than the gratuitous double-bind hypothesis that was my accomplice in facilitating Derrick Sutter’s death. I am deeply sorry that Derrick Sutter died before a possibly helpful treatment could be tried. Of course, Derrick Sutter really killed himself. I was just an unwitting accomplice. How can our new view of the ego and its imputation of ego damage deal with the reality of suicide? Consider a variation on the theme of suicide, as is so commonly attempted by taking an overdose of psychoactive medication. Unpacking the language we use to describe suicide may help us understand this increasingly common event. It occurs not only in patients like Derrick Sutter, but also in people who want to die because life is no longer tolerable to them. I can only kill myself if there are at least two me’s: one me kills and that part, plus the rest of me, dies. The pills themselves might be procured by a relatively healthy me (now) who contemplates the day (then) when I will be too unhealthy to want to go on. Thus, there is one me now and another me then, not so much two half-me’s as one me that changes state over time. When I finally do take the fatal pills, I might not be depressed at all (as psychodynamic theory has tended to assume). I might actually be happy, relieved to suppose that I can make it out of life with dignity and freedom from pain. Of course, if I were to commit suicide, I would be vilified by those who believe that any willful taking of a life is a sin. It is such people that prevent the legalization of an act that the atheists among us consider rational and even noble. More Anglo-Saxons than Latins favor freedom in this domain, but many fundamentalist Anglo-Saxon religionists join with the Catholics in opposing voluntary death as part of their battle for the right to life. The implications of the Derrick Sutter case, thus, go far beyond my mea culpa regret about trying to separate him from his double-binding mother. Mrs. Sutter was, for all I know, a good woman who was doing her best to cope with a disabled son. The change in psychiatric thought and practice has now reached a new level of sophistication that may be obscured by the disenchantment with psychoanalysis that has brought the field down so low in public opinion. As irrational as was the optimism of 1960 is the pessimism of today. It is not just that the Derrick Sutters of today have a better chance at symptom relief. It is also that we are beginning to

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piece together a picture of how accurately the activity of the mind reflects the activity of the brain. A major reason for the low status of psychiatry is that we are understandably impatient. We want a quick fix for our woes and we want it now. As I will further recount in Part III, it is in large part the inappropriate use of effective drugs that is aggravating psychiatry’s current credibility problems. In truth, the same pills that college students take to improve test performance might also help today’s Derrick Sutters. Not just mood, but psychosis and sleep are today much better understood than in the 1960s and 1970s. Today, arousal, attention, and other cognitive faculties are falling within a genuinely scientific purview for the first time in human history. And life itself is increasingly seen as a secular privilege rather than a sacred obligation. We are living at the dawn of the greatest renaissance of all time, the understanding of the human brain–mind. When I say that 500 to 1000 years is the time that it may take to realize this renaissance at all thoroughly, I mean only to counter the unrealistic enthusiasm evinced by those who beg politicians for money to do the scientific job right. We will spend far more on brain research than we have already spent on cancer, but the cure for cancer is still optimistically said to be “just around the corner.” Until we know much, much more about the brain, we would be wise to obey Shakespeare when he said, in Hamlet, “Take physic pomp”, by which I suppose he meant be humble and be honest, physician. Heal thy self.

Sarah Sage: Did I maim her? Sarah Sage was another of my double-bind-as-folly teachers. At age forty-seven, Sarah was more schizophrenic than Derrick Sutter. She was also higher functioning, perhaps because her very traditional Anglo-Saxon family believed so strongly in self-reliance. Sarah lived alone in an apartment in Boston and worked as a copywriter for a major publishing house. She kept to herself because she often had the feeling that her co-workers were talking about her in an unflattering way. They probably were! The paranoia that she sometimes felt was responsive to small doses of Stelazine, a phenothiazine cousin of the pioneer antipsychotic drug, Thorazine. Hers was a bland, somewhat humdrum existence, but Sarah was admirably self-reliant and socially useful. Books were

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still being read in the pre-digital era that spawned both Sarah Sage and me. When Sarah told me that she was thinking of quitting her job and going home to live with her aging mother, I reacted with inexcusable horror. A part of me realized, appropriately, that she might not do well at home, but a part of me was misled by my fear of the probably nonexistent double-binding mother into whose grips she would inevitably fall. A prolonged power struggle between me and Sarah ensued and a standoff settled in. Sarah ended the standoff when she jumped in front of a tram as it pulled out of a downtown Boston subway station. Mercifully, she survived, but two broken hips and a broken pelvis were her ticket home to her double-binding mother. Naturally, Sarah never consulted me again. I like to think that today I would be more lenient with Sarah and wiser about the limitations of my knowledge, but these stories and recent personal experiences make me wonder. A relationship with one’s mother is better than no relationship at all and easily beats talking to a psychiatrist like me once a week for fifty minutes or so. In retrospect, it might even be that Sarah Sage realized that her aging mother needed her as much as she needed her aging mother. I am now embarrassed to admit that what Sarah really needed was a good social worker and a protected living situation (something like a halfway house) to provide her with shelter and a limited and controlled set of peers to keep her company. She might have rejected such a solution out of a mixture of pride and diffidence, but it never even occurred to me to recommend it. This kind of social splint has helped keep much sicker patients than Sarah out of the now mostly closed mental hospitals. Halfway houses and group homes liberate the likes of Sarah Sage from parents who might be unhelpful whether or not they emitted the dreaded double-bind curse. The halfway house concept is used well in eldercare housing, too, where it is called, euphemistically, “assisted living.” People of all ages and of all character types need each other as much as they need a job or self-reliance. The subsequent section on group psychotherapy will make this point crystal clear. Human beings are powerfully driven to seek closeness to others. Our self-esteem grows as we are perceptibly helpful to one another. This, as much as science or religion, keeps us alive. We are born close, we need closeness to make it to school, and we need closeness to keep

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us first at school and then at work. Social bonding must be a biological imperative that grows out of the same soil as our primordial contact with our mothers. Sarah Sage vitally needed that contact and had to outwit me to get it. I didn’t quite commit ego murder in her case. Just ego assault and battery! My teachers should have had the common sense of a social worker, not the self-congratulatory sophistication of a Harvard psychiatry professor.

William Hitchens: Did I do more than play baseball with him? Bill Hitchens was forty-five and chronically unemployed when he terrified his parents by entering their bedroom at night and standing over them swinging a baseball bat. He never used it on them but he looked angry enough to do so. He never told them, or me, or anyone else why he used his parents’ bedroom as a batting cage. As far as I could tell, his parents were God-fearing folk who were completely mystified by their son’s anomalous behavior and probably made the mistake of saying so. We psychiatrists knew better. We knew that William had an oedipal fix on his mother and the best way to have her to himself was to hit his Dad out of the park. Although I was not eager to be alone with Bill Hitchens, I accepted my supervisor’s reassurance that no harm would befall me since I was not his father. But suppose, I wondered to myself, that Mr. Hitchens develops the desired transference to me? Surely the oedipal heat would shift to my poor head and I would be confronted by Bill and his Louisville Slugger in my office. Fortunately for me, Bill, who was mute as well as murderous, would not consider entering my office, and so I was able to see him in the relative safety of the ward dayroom. Despite the fact that he was a card-carrying psychoanalyst, my boss, Jack Ewalt, was a very helpful chief because, in spite of his psychoanalytic credentials, he had developed a set of common sense rules about the psychotherapy of psychosis. Bill Hitchens was certainly psychotic, at least as suggested by his catatonic nocturnal behavior. Professor Ewalt began each academic year with a series of lectures devoted to those rules. One of them, and it is capital, is to see assaultive or threatening patients in public places where both the patient and the therapist can feel safe from harm. This reduces the likelihood of assault.

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I was never assaulted, although I treated many patients as dangerous as William Hitchens in both individual and group settings. One potentially assaultive patient of mine was relieved when, following one of Jack Ewalt’s simple rules, I suggested moving from my office to the hospital lobby where police attendants were stationed. That patient had just said to me, “If anything happened to you, I would be blamed for it!” and the Ewalt bell went off in my head. William Hitchens did not have to warn me about the possibility of assault. But what were we to talk about if not assault? You guessed it, baseball! I did not tell William Hitchens that I was a Yankee fan, but I did get him to begin talking about the Red Sox, whom I pitied but had learned to like a little because they were so important to Bostonians. The Red Sox, who were then still perennial losers, appealed especially to Bostonians who, like Mr. Hitchens, had very little to feel good about. I had played the sport myself and knew how hard it was to excel in it. Bill Hitchens and I stopped short of going to Fenway Park together, but I now think that was a bit stuffy on my part. One of my colleagues, Bob Coles, was a renegade psychiatrist at the Judge Baker Guidance Center where my wife, Joan, worked as a teacher. My psychoanalytic amour-propre was scandalized by Joan’s accounts of Bob’s outings with young patients in his sports car. I am now embarrassed to admit that maybe Bob was right to fraternize with his charges in that innocent but exciting way. At least Bob Coles was real, really affectionate, and he probably did no harm. It certainly did no harm for me to talk baseball to William Hitchens either, and, with the help of Stelazine, before long he was able to go home on weekends and spend the night without using his parents’ bedroom as a batting cage. For once, insight was no part of the treatment plan. It was probably as much the Stelazine as it was the baseball talk that helped to stabilize William Hitchens. In any case, his Oedipus complex was dissolved and he never assaulted his parents again. Meanwhile the poor old Red Sox slipped out of contention and, as usual in those bad old days, finished the season in last place or thereabouts. William Hitchens was so sick that even a budding psychoanalyst like me could not suppress his humanity.

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Francine Poppy: Did I keep more than her pain alive? I have written before of the suicide committed at age fifty-five by my very sick patient, Francine Poppy. I now have a new way of understanding her decision to take her own life, which I previously understood to be a symptom of depression. She was ashamed of her failure as a mother. When I began my residency, I was very fearful of the death of a patient by suicide. The hospital organized intensive investigations of all deaths that occurred on the premises and I was pleased and proud that none of my inpatients ever attempted suicide when they were hospitalized. With my own self-righteous right-to-life zeal, I had saved Francine from four previous attempts made as an outpatient with pills that I had prescribed for her. Francine’s fifth, and finally successful attempt at suicide, was by hanging. She did not call me for help that last time and no one was particularly surprised or concerned about Francine’s death. It seemed justified under her very painful conditions. Francine Poppy was depressed but she had been depressed for years, so it cannot have been a mood swing that brought her down. Instead of a Sarah Sagelike move seeking support from her own mother (who was long since dead and buried) I believe that it was Francine’s youngest daughter’s rejection of her that triggered the hanging. A part of her ego, the mother part, was found wanting by her daughter. Her daughter announced her disappointment in Francine with the same angry intensity focused on a parent by any disenchanted child. If that child had been mine, I hope I would have been able to say that I would never take an overdose of pills because of rejection. Hopefully, I would be able to say that I would love to be with you and to talk about all the things that I lovingly remember about you. I have the good fortune to have many young friends who love me almost as much as they do their own fathers. With them I am not inclined toward parental criticism and I do not have to instill discipline. Someone else has done that and may have been hated for it. My own ego and that of my young friends are on an equal footing as far as upbringing is concerned. They have chosen science and, for them, I am a talking icon. How lucky I am to have chosen science, too. I did have qualms about Francine Poppy when she told me that she could easily purchase, from a fellow employee in the hospital kitchen, the same sort of uppers that today’s college junkies use to

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pump themselves up for exams. I stopped short of turning Francine in because those drugs, which I could not conscionably prescribe, and she obtained illegally, really helped her. But my conscience hurt and my self-esteem plummeted. I felt that the drug industry, which my neurobiological research had helped to spawn, was being used against me. Not only had I failed to cure Francine Poppy’s mental illness, but I had poisoned the very culture of self-reliance that I hoped to save. All four of the case histories just recounted share a caution about the imposition of one’s own ego on the ego of others. This is a powerful and dangerous force that psychoanalysis wisely tries to avoid via its wrong-headed opposition to hypnosis, the assumption of therapist neutrality, and the ideal of the therapist as a blank screen. Whether either therapeutic neutrality or screen blankness is ever really possible is questionable, however. No matter how much one tries to keep his own personality at bay, it is inevitably sensed by the other, as if it were of paramount importance for a person to know whom he is dealing with and to establish a real emotional context for interaction. Thus, it seems probable that it is therapists, not therapies, that make a difference to patients and that getting well is as much about suggestion and social learning as it is about the analysis of the transference or suppression of the countertransference. My experience with Rosella Campobello is a case in point.

Rosella Campobello: Did I teach her to eat? Rosella Campobello was twenty-eight years old when she first consulted me in the outpatient clinic because of an eating disorder and a host of phobic inhibitions. She was still living with her mother, ate garbage regularly, and, for ten years, had menstruated not at all. Rosella had been treated by a psychoanalyst for an amenorrheic decade prior to coming to our hospital clinic. By the time I met Rosella, I had left my psychiatric residency to begin my career in behavioral neuroscience. When I returned to my residency three years later, I had changed my mind significantly, but the psychoanalytic commitment at Harvard was still shrouded in orthodoxy. Rosella began her account of her problem by reciting the symbolic character of the many foods she could not eat: tapioca pudding was white and therefore represented her mother; other foods, like pork,

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were associated with sex and could not be eaten innocently. She had learned an impressive amount of symbolism from ten years with her orthodox psychoanalytic therapist but her “insight” did not seem help her a bit. It appeared to me that she had, if anything, been made worse by her concretization of her analyst’s symbolic interpretations. In addition, Rosella was a Roman Catholic, one of those whose most crippling symptom was her compulsive need to confess the sin of her desires to a priest who could only give her satisfaction by acknowledging her base motives and offering her absolution for them. Rosella was well known to the diocese of Boston because she visited at least five churches a day in search of priestly chastisement and forgiveness. Needless to say, her analyst never contacted the church for fear of violating the sacred rules of confidentiality and therapeutic neutrality. His analysis of the transference and blank screen rules he followed were also obviously inappropriate and useless to Rosella. In my opinion, the use of interpretive language with such a concrete mind as Rosella’s was a comical and colossal mistake. A simple mental status exam or an IQ test would have ruled out anything but supportive psychotherapy. Since I myself was by then suffering from an overdose of psychoanalysis, I decided to try a more direct behavioristic approach. Latin neurotic meets Anglo-Saxon experimentalist who tries an end-run around the Vienna defense. My courage was bolstered by my encounter with Joseph Wolpe, the behaviorist psychologist from South Africa who had been recruited to the University of Virginia Medical School in Charlottesville, where I visited him. Inspired by Wolpe, I told Rosella that I would see her for only five minutes a month because that was all the time she needed to recount her rare moments of pleasure to me. If she found more positive issues to discuss with me, I would see her more frequently and for longer sessions. I pointed out that in our brief therapy time together, she was not to complain to me about her guilt or share accounts of her grotesque eating habits. I was in trepidation of the dire effects that my rebellious countertransference stance might induce. Of course, I did not tell my psychoanalyst supervisors what I was up to. To my amazement and delight, in her first five-minute session a month after my draconian prescription, Rosella reported that her menses had miraculously returned and, she seductively added, she was looking forward to seeing me. This was the kind of transference

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that I had been looking for. Young man excites young woman. Ego to ego, they couple in fantasy and out pop the eggs. Flushed with success, I called the Boston Roman Catholic diocese and enlisted a progressive young Jesuit priest to help me help Rosella. Confessionals were put off limits by order of the church. Instead, the sinlessness of hot baths and other innocent bodily pleasures were encouraged by my new hypnotic self and my new Catholic priest ally. The war against mental illness does make strange bedfellows, doesn’t it? Within three years of positive reinforcement and seduction, Rosella had increased her monthly therapy time to thirty minutes, moved out of her mother’s house, been retrained as an X-ray therapist, and begun to experiment with her social life. Her would-be sexual encounters were as bizarrely comical as Dylan Thomas’s Adventures in the Skin Trade. They were also mainly unsuccessful, but she was having more fun than eating garbage at home and feeling quite good about it. With my encouragement, Rosella joined an art group devoted to the celebration of nature and began to paint sensitive (if not quite cutting edge) landscapes. She never became a gourmet in her mother’s kitchen but she did come to enjoy some foods that were previously on her index of forbidden fruit. All I did was to forbid regression and encourage progress toward normalcy. Naturally, she thought I was a magician, but there was no sleight of hand involved. Just common sense, a good will, the power of positive thinking, and enthusiastic praise. Not to mention sex appeal. This approach worked for about twenty years and only fell apart after Rosella’s mother died and many of her newfound friends moved away or moved on. Rosella was adorable and elicited rescue behavior in many other people besides me. But with the menopause and older age, she became increasingly phobic, cancelled art trips, and then— fatally—quit her X-ray technician job. I went along with her request for disability compensation after I warned her about it, not because she was undeserving, but because I thought that the loss of selfreliance would be crippling. It was. Rosella stopped driving her little Honda automobile, became a shut-in, and died reclusive and self-starved in a Harvard University subsidized apartment in Cambridge. Rosella had always feared that the university would evict her, but she endured no such tragedy even when her rooms were littered with the detritus of thirty years of obsessive hoarding. Rosella left her carefully monitored bank

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account of $120,000 to three deserving friends. I do not think that she ever weighed more than 100 pounds in all the time that I knew her. Here was a motherectomy that worked, up to a point. I provided her with a hard headed, soft-hearted therapy that got somewhere instead of nowhere. As might have been the case with Derrick Sutter, if he had survived my ill-advised cutting of his lifeline umbilical cord to his mother, Rosella lived long enough to benefit from newly developed antianxiety medication. But she could not tolerate the more definitive pro-aminergic drugs for as severe an obsessive–compulsive disorder (OCD) as she undoubtedly had. I failed utterly to end Rosella’s addiction to cigarette smoking and thought that her nicotine abuse might have interfered with her treatment by biogenic amine reuptake blockers (such as Prozac) that many OCD victims swear by. Together with what appears to have been the justified break with psychoanalysis, the treatment of OCD with drugs is an advance of which we can be proud. We do not know why these drugs work, but we do know that they effect the brain stem state control neurons that Robert McCarley and I were recording when we were not in the clinic with our many Rosellas. I discuss the new medications in relation to the new neurobiology of dreaming in Part II. What really helped in Rosella’s case? I am not sure, but I feel certain that it was not a matter of technique, not something I could teach to someone else other than to describe the combination of behaviorism and resort to informal hypnotic suggestibility. Talk about these themes, yes. Inspire innovation, possibly. But render suitably scientific? No way! Rosella’s case, thus, raises as many questions as it answers. If I had not obeyed the moral injunction that she was my patient for life, I would never have seen the recurrence of the fatal symptoms that only died when she did. Would she have been better served by psychoanalysis? You decide.

Yveline Cloche: Did I really help her avenge her husband? At about the same time that I began my radical experiments in outpatient psychotherapy with Rosella Campobello, I was assigned what seemed to be an ideal case for treatment using the psychoanalytic psychotherapy that I had come to Harvard five years before to learn. By then it was 1965 and, although I had committed half my time

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to hard science, I was still looking for evidence of the Freudian dynamically repressed unconscious. Yveline Cloche was the fifty-two-year-old Belgium-born wife of the well-known painter, Johannes Cloche. Johannes, who was an inveterate European-type skirt chaser, had run off again, this time with a young ballerina. Yveline was crushed and put her head in the oven of her gas stove hoping to end it all. Since the door of the oven and the windows of the kitchen were wide open, her suicidal gesture was completely ineffectual but it did get her a referral to our outpatient clinic. To retaliate for Johannes’s humiliating infidelity, Yveline had taken a pair of scissors into the clothes closet that she shared with her husband. There she defiantly cut off all of his neckties, the long ends of which fell to the floor in a limp heap! Yveline was, by then, aware that she could never satisfy her husband sexually. Why not? Johannes was adventurous and flirtatious while Yveline, who was a not unattractive, sophisticated woman, was constitutionally prim and she was aging. She had helped Johannes to navigate the shark-infested waters of the Boston art scene, but he took his career success for granted and repeatedly jumped over the marital traces in search of new romance. I licked my psychoanalytic chops as I began to investigate her history. Yveline recounted a clearly incestuous relationship with her suave European father, Pierre. Here, surely, was a golden opportunity to work therapeutic wonders, to learn that psychoanalysis was really where it was at. I could finally begin the clinical career that had called me and my twenty-four fellow all-star residents to psychiatry in 1960. Amazingly, I was still a believer seeking confirmation. Imagine my excitement when I learned that Yveline could not perform fellatio, her licentious husband’s favorite sex act, because she gagged on the wads of Johannes’s sperm just as she had gagged on the oysters her father had insisted that she swallow when she was his adolescent sweetheart years before in Belgium! I was sure that this revelation would at least free her to find a new lover, even if she could not please Johannes. On the contrary, recounting these stories only seemed to make Yveline’s commitment to despair grow deeper and deeper. The reasons for her despair soon became evident. Finding his neckties castrated, Johannes made it clear that he was leaving Yveline definitively, not so much because his ballerina girlfriend loved his

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oysters, but because he found life with Yveline to be intolerably dull. He wanted out. That left her vulnerable to eviction from the choice apartment the Cloches had been assigned when the art museum originally recruited Johannes from Europe. Furthermore, the curatorial job that she held was tenuous: she was not popular with her fellow workers, who considered her stand-offish, a prig, and a bit of a snob. Thus, Yveline lost her husband and her apartment at the same time. Disoriented and dislocated, she soon found that she was also unmotivated for work. Dismayed by her downward spiral, I reluctantly abandoned any vestige of psychoanalytic psychotherapy. Getting Yveline Cloche back on track was obviously a job for more active intervention. Almost apologetically, I wondered about formal hypnosis. Would she try it? Yes, she would. I had recently met a young Japanese artist who was a self-declared hypnotist. Furthermore, he was looking for a museum job and brought enthusiasm and experience to his quest. I secretly thought that Yveline might at least avenge herself more effectively on her husband (who no longer wore neckties anyway) by finding someone to take over his job while he performed sexual pirouettes with his ballerina. At the same time, Yveline might enjoy an exotic, if Platonic, flirtation with her hypnotist/husband replacement. I would not be telling you this story if I had not finally worked wonders with Yveline Cloche. Naturally, I did not breathe a word of my hypnotic apostasy to my Harvard professor supervisors. And, I sadly admit, I have no idea what happened to her after the romance of the hypnotic interlude. I only know that her hypnotist did get her ex-husband’s art teaching job. One of Professor Ewalt’s prime commandments was never to actively seek follow-up data. This was good advice, which derived in part from the security blanket that long shielded Freud’s preposterous clinical claims from his still disabled former patients.

John Cabot: Did I help him get a job? One of my favorite teachers at Massachusetts Mental Health Center was Lee Hasenbush. (That, for a change, is his real name and I really enjoy praising him!) Lee seemed to combine the solid good sense of a scientifically well-educated physician with the sympathetic heart of a caring psychotherapist. It is probably no accident that he had not been

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trained in psychiatry at Harvard but, rather, at Rochester Medical School, where the biosocial model was still regnant. Lee’s use of psychoanalytic psychology was muted and tempered by his innate good sense. Lee must have felt the same way about me because he referred several patients to me shortly after I finished my residency training and was beginning to practice privately. One such patient that I remember quite well was John Cabot, who sought Lee’s help because he was stuck at home and unable to work. John was also without romantic prospects because he was so socially isolated. John Cabot was from a good old Boston family and had a trust fund from which he said he could easily pay my modest fees. By then, however, I knew better than to take money from trust funds, especially from privileged men like John Cabot who complained that they could not work. Therefore, I set a ludicrously low fee, one that I knew John Cabot could easily earn even if he only delivered newspapers. I was imbued with the work ethic for reasons of my own and believed that Freud was right when he said that there were only two activities in life that gave satisfaction. One was work and the other was love. My experience with John Cabot confirmed this simple dual aphorism. He is now both gainfully employed and happily married. I know this because each year he sends me a Christmas card with a photo of himself, his wife, and their large dog, all smiling happily. There are no children. I had other good reasons for taking my position against dipping into John Cabot’s trust fund. Among my social acquaintances were several friends who were hopelessly entangled in the sticky briar patch of their wealthy Boston Brahmin families. I began to suspect that it was not any easier to be a rich man than to be a beautiful woman and I am now even more certain that these apparent paradoxes are true. Wealth can be a liability. If John Cabot did not work, he might become separated from an important source of self-esteem. Self-esteem depends to a very significant degree on self-reliance. I could not very well preach this truth to an unemployed patient if I had been bought off by a bountiful but crippling trust fund. Don’t get me wrong. I was financially ambitious and I went into private practice because I wanted to augment the rather meager salary that I was paid by the Commonwealth of Massachusetts for my work as a public sector psychiatrist. I took that low-paying state job because

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it enabled me to pursue science and, thereby, to redress what I perceived to be huge deficits in our knowledge about mental illness. However, I wanted to live well as well as to do good. John Cabot probably recognized that my well-being, as well as his, hung in the back-to-work balance. John Cabot had plenty of other psychological reasons to be stuck at home and we discussed them in our low-cost psychotherapy sessions. He had an overprotective mother and a demanding father whose noisy marital disagreements contributed to their only child’s dysfunction. One striking detail remains fresh in my memory. John would lie in bed in the morning listening carefully for the tell-tale noises that his father made when he got up to go to his job in Boston’s financial district. His mother was already downstairs in the kitchen, where she had made breakfast for her stern husband and their wayward son. When John heard his father getting up, he would hurry to the bathroom they shared and occupy it for as long as he dared, just to frustrate his father. He would then go back to bed and snooze until he was sure his father had gone to work. Then, and only then, did he get up and go down to breakfast with his mother. The oedipal themes were clearly audible in this story but, because my patient was not particularly psychologically minded, I ignored them in the interest of a more direct and superficial attack. John Cabot was clearly very angry at his father but took his anger out mainly upon himself, and he did not need to do this to win over his mother. She was already his. I pointed this out to him and he heard me even as he vociferously derided my interpretive psychotherapy. He devalued himself even more than he devalued psychological theory and that trust fund did not help because it implied that he might need it. I might have shamed John Cabot into taking that first job because he hated paying me so little. With all his connections to the moneyed world of Boston, he got a job easily, and paid my steadily increasing bills from his own steadily increasing earnings. Being by nature stingy, John Cabot loved playing a hyper-conservative role in managing other stingy people’s money. My fee quite happily went up with his salary, which made him quite proud. So much for work. What about love? This one was not so easy but, with missteps, it was also successful. John Cabot began social work on his own account in the wealthy North Shore suburbs of Boston where, in the late 1960s, heavy drinking and heavy petting abounded. I remember tales about his chasing

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“wenches” around kitchen tables with carving knives and threatening to give his rivals “a mouthful of chicklets” for crossing him. He impulsively decided to marry because he was anachronistically guilty about premarital sex. Maybe this was because he, like Rosella, was Catholic. When John Cabot’s first marriage soon dissolved, his ex-wife berated me for not warning her about the angry monster that still lived within her ex-husband. I was, therefore, cautious and skeptical when he announced his intent to marry again. By then, I had become even less doctrinaire than I had been in the beginning of my career. I therefore accepted the invitation to attend his second marriage and enjoyed the lavish reception in the home that he and his new wife had bought and furnished together. I accepted this invitation, against professional rules, because I felt that John Cabot wanted to share his amorous and social success with me. By then, my own father had come to live in my house and, having made a surprising killing on the stock market, needed the most conservative possible investment advice. John Cabot to the rescue. Through him my father and I met the counselor of our dreams and I now live as comfortably as my own stinginess will allow.

Sybil Newhouse: Did I save her from unnecessary plastic surgery? When I was about forty-five, I had another clinical experience that made me think that direct suggestion might be more powerful than insight. This patient, whom I will call Sybil Newhouse was, like Rosella Campobello, a recipient of brain-mediated sex vibes from my ego to hers. Sybil was referred to me by a psychoanalyst colleague who wanted a sleep disorders consultation. He thought Sybil had insomnia. So she did, but her insomnia seemed to me to be both entirely non-specific and highly symptomatic. In other words, I thought she had no specific sleep disorder but, rather, suffered from too great a commitment to waking. I have since modified my diagnostic views, as I will explain in Part V under the rubric of state stabilization. Instead, Sybil seemed to me to be an ideal candidate for psychodynamic, insight-oriented psychotherapy, and I said so to both her and my psychoanalyst colleague. He was not interested in treating her, because Sybil could not pay for the four sessions a week that Boston psychoanalysts at that time routinely required. I was recently

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informed that some psychoanalysts still do insist on seeing patients two to four times a week and that this practice may last for years. This comes to at least $250 to $500 per week or $12,500 to $25,000 per year. That’s nice work if you can get it. Only trust funds make this kind of practice possible today. I saw Sybil once a week at a fee that reflected her husband’s modest income. Like John Cabot, Sybil did very well when she went out to work for herself, not in finance, but in the management of high-cost environmental clean-up projects mandated by the federal government and paid for by polluting businesses. In contradistinction to Rosella Campobello, Sybil was intellectually gifted, ravishingly attractive, and quick to pick up on both subtle and direct suggestions. I thought her insomnia would disappear when she got her life in order. I was wrong about this and now think I know why: I severely underestimated the addictive power of the sedative drugs that she was already taking when I met her and which she continued to take fifteen years later when she dropped out of treatment with me. But addiction to sedatives is not what I want to emphasize about Sybil Newhouse. There were two aspects of my ten years of association with Sybil that were remarkable. The first aspect was my strongly stated injunction against plastic surgery on her nose. I wanted to help her get her body image in tune with the perceptions of others. The other was her pregnancy, which felt to me very much like a posthypnotic response to my suggestion that she could conceive a child if she would only relax and let it happen. Both details favor the view that direct intervention is effective and can be as useful, or more so, than insight. First, the no-no nose job. After Sybil left her first husband, she decided that she needed to have her nose operated upon to make her more physically acceptable to a better match. Her father had broken her nose during a traumatic beating, instituted in response to a complaint from her mother of Sybil’s adolescent rebelliousness. As significant and psychologically important as was this historical detail, I felt that she would realize no physical benefit from the proposed surgery because I myself was completely unaware of any physical obstacle to her desire for a new husband. I declared, therefore, that she should instead work with me to correct her self-image distortion. Of course, she might have derived a psychological benefit to her body image whether I myself or any other man could see any effect of the surgery.

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What she needed, I argued in no uncertain terms, was the elimination of the entirely psychological distortion of her body image. I thought this would do the trick, and it did. She had no trouble attracting men and (all too soon) she married a social icon with some unfortunate parental abuse problems of his own. Sybil and her husband are now divorced but, in therapy, I saved her from unnecessary plastic surgery, corrected her somatic dysmorphia, and, in the process, helped her to have a child whom she adores. Meanwhile, she has used her anger at abuse by punishing careless industries that pollute the environment. Second, the unexpected pregnancy. Sybil was sure that she could never conceive an infant any more than she could attract a man with that funny nose of hers. Using my own feelings as a guide, I suggested that she would get pregnant easily if she would only give her compulsive self-control up to biology. I remember certain sessions in my living room office that smacked of hypnotic trance or voodoo spirit possession. I simply repeated the mantra “You can and will get pregnant.” I was so determined that I often thought that I would impregnate her myself if her husband could not do the job. Although I did see Sybil as an attractive woman, I was scrupulous as a physician and was never tempted to sleep with her. She thought I was a magician when she soon found herself pregnant. Thereafter, she bragged to me and to many others that I had “saved her life.” Not so. But I did give her ego life in the same sense that I gave Rosella Campobello’s ego life. Here was another transference cure effected by the hypnotic insertion of a sincerely believed idea from my brain–mind to that of my patient. This is a “transference cure” all right, but it is more in keeping with immaculate conception than with psychoanalysis. It may not be entirely irrelevant to note that Sybil Newhouse, like Rosella Campobello and John Cabot, was raised as a Roman Catholic. My work with Sybil Newhouse was more deliberate than my wild therapy with Rosella Campobello. By the time I met her I was older, less obviously seductive, but a lot more sure of myself. My science had convinced me that the future of psychology depended upon the furtherance of brain science. Meanwhile, the least we psychiatrists could do was to correct the egregious errors of the recent past. However, it was not yet at all clear to me how an effective synthesis

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between brain science and psychodynamics might be made. That synthesis is still not entirely clear, but there are enough threads now available to begin to weave a tentative tapestry. The form of the tapestry came from an unexpected source, lucid dreaming, of which I will give a detailed account in Part II of this book.

Melvin Blinder: Did I help him to get a checkbook? After I had finished my residency in 1966, I kept my clinical hand in by seeing patients privately. This helped me to keep the financial wolf from the door and was both diverting and rewarding. When people asked me how I could do both experimental neurophysiology and psychotherapy, I replied that each practice was one side of a two-faced coin. Just like the mind and the brain, my two apparently disparate professional activities actually fit together, or at least promised to do so. Furthermore, it was obvious that they both elicited the same reaction in me: watchful waiting. The mind and the brain gave up their joint secrets only if I kept still long enough to be told what was really going on. Then, and only then, could I act, boldly and experimentally. My psychiatric training had inadvertently created a unique kind of scientist. Thus, I owe my deplorable psychiatric education a surprising debt of gratitude. Melvin Blinder required more immediate intervention than I was trained to provide. He needed an injunction of the sort I had given to Sybil Newhouse. Therefore, I forbade him to frequent the downtown Boston hotels that he visited in order to discover, by peeping through bedroom keyholes, if his girlfriend was being surreptitiously unfaithful to him. I told him, in no uncertain terms, that he must desist this compulsion, lest he get himself arrested, be badly beaten up as a Peeping Tom, lose his job, or become otherwise rendered incapable of receiving treatment by me. At the same time, I said nothing to him about his exceptional habit of carefully placing his forty dollar fee (in cash, as two twenty-dollar bills) on the left-hand front corner of my desk as each therapy session began. I reasoned, secretly and somewhat psychoanalytically, that he paid in cash, in advance, because he was loath to owe me a cent, so deep was his distrust of me and of himself. Melvin Blinder was romantically involved with a woman named Kathleen, who seemed to me very unlikely to be unfaithful to him.

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Even if she were a vamp, Kathleen would certainly never be seen dead in a hotel like the Statler, which was one of Melvin’s infidelity hunting grounds. Kathleen and I never met, but we were clearly in collusion to allay Melvin’s fears. As time went on, Melvin’s relationship with Kathleen ripened. At that point, they nicknamed me the Hobbit, a reference to the Tolkien imaginary creature that I had never met, even in the pages of a book. I was too busy with the brain and with reading Marcel Proust’s Remembrance of Things Past (1981) to dally with Tolkien. After about a year of therapy, Melvin asked me how he would know if and when he was cured. I said I never used that word (cure) but that I would feel more confident about his chances for success in life if he opened a checking account and paid my bill monthly instead of by cash in advance! This was a shamelessly direct but effective communication. For years thereafter, I received Christmas cards from Melvin and Kathleen, who were married and living together. They have a joint checking account. Neither goes to the Hotel Statler (even to eat at Trader Vic’s Restaurant). I think the therapy worked because I was bold and confident, traits that Melvin learned to use in his own life. Another transference cure? Have it your own way. I do not use the word “transference” any more than I use the word cure.

Gordon Golden: Was he as sick as his history? I was already well known at Harvard when I was consulted by a faculty colleague who headed up an important university program. Gordon Golden was overweight, in part because he got up at night and sleepily devoured the entire contents of his icebox. “Was this a sleep disorder and, if so, what could be done about it?” he wondered. Since the time that I saw Gordon Golden in psychotherapy, quite a bit has been learned about compulsive nocturnal eating. It is a stereotyped behavior pattern arising in sleep. Gordon presented a clinical picture that we now know to be quite typical. At the time that I first saw him, the condition was scientifically undescribed. Gordon slept soundly for the first hour or two of each night. He then often got up, somatically aroused but only partially awake in a cognitive sense, and found himself standing before his open icebox wolfing down all the food it contained. Upon careful questioning, he made it clear that he was partially awake and quite aware of what he

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was doing. He even knew that what he was doing was not in the interest of his avowed intent to lose weight, but claimed that he could not control himself. Thus, he was dissociated, like a sleep-walker, with part of his brain awake and another part asleep. While one Gordon ate, the other Gordon slept. This case helped me to understand that hybrid dissociated states of consciousness were possible. Gordon’s nocturnal eating disorder had been dismissed as trivial by a prominent New York psychoanalyst who said that, given Gordon’s traumatic family history, he was lucky to get off so lightly! I reviewed the horrendous story of his childhood and at first agreed with the psychoanalyst. I then discovered that Gordon had, in fact, not gotten off so lightly after all. Obesity is life threatening, it is true, but it is far less dangerous than the compulsive boy-toy-calling that Gordon had not felt comfortable enough to tell the New York psychoanalyst about. His reasons for confiding in me were related to his own growing awareness of the risks he was running and, I like to think, the same sort of patient and watchful waiting that helped me discover some of the brain’s well-kept secrets. I thought that the sleep eating could be reduced by hypnotic suggestion, and it was, but the male prostitution had to be stopped by fiat, just as Melvin Blinder had to be kept out of the Hotel Statler. I felt that I needed to protect Gordon Golden from the murderous fate that lurked in the dark mind of some of his callboys. At the same time that Professor Golden was apprising me of his high-risk sexual behavior, there appeared in the New Yorker magazine an article about a wealthy businessman who was shaken down and ultimately killed by a male prostitute who threatened to make his client’s kinky sex habits known to his wife and business associates. Dr. Golden was very wealthy and, because of his prominent university and social position, eminently vulnerable to blackmail. Therefore, I broke all the rules of psychoanalytic therapeutic neutrality, clipped out the New Yorker article and gave it to Dr. Golden as a warning. As far as I know, Gordon heeded my injunction. In any case, thereafter he restricted his love life to a male ballet dancer with whom he enjoyed the role of patron and friend as well as that of lover. It may still be prostitution of a sort, but more like that of heterosexual marriage than that of the sinister call-boy business. Because the dancer lived in a distant city, Gordon Golden more often slept alone, which brought him closer to his icebox, though a faithful dog helped to keep him in bed asleep.

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By then, I had discovered the power of suggestion to influence unwanted sleep behavior. At Psychiatry Grand Rounds at Johns Hopkins Hospital, I hypnotized a Baltimore fireman who was worried about sleep-walking while on duty because he feared falling through the brass pole hole in the floor of his firehouse dorm. Maybe the fireman just said he was cured in order to make me feel better, but my feeling of kinship with Jean-Martin Charcot, the French neurologist who taught Freud about the hysteria and hypnotizability of his female patients, was nonetheless pleasing. The case of Gordon Golden makes several points clear: One is the clinical point that a patient’s history is never so much out of line with his problems as the New York psychoanalyst assumed. The second is that a so-called sleep disorder may be a mask for a more serious problem that only tuned but non-invasive listening will reveal. The third is that hypnosis works and can greatly ameliorate early night sleep disorders like sleep-walking and nocturnal eating. The fourth is that a protective warning may be necessary and effective in reducing risk. A modern psychotherapist can, should, and must be more active and direct than I was trained to be. To these ends, the myth of therapeutic neutrality and the supposed value of symbol interpretation are unaffordable luxuries. My experience in groups strongly supports this claim, as I will now relate.

Group Psychology and the Analysis of the Ego Group Psychology and the Analysis of the Ego (1921c) is the title of Sigmund Freud’s book that was recommended to me when I reported to my supervisor for the outpatient group psychotherapy that was required of all second-year psychiatric residents at Harvard in the early 1960s. I was quite frightened by the idea of taking on a group of mentally ill persons and so sought comfort within the pages of Freud’s 1921 work. Rereading the book, which I had failed to understand when I first opened it in college at Wesleyan University in the early 1950s, did not really quiet my fears but I ascribed this failure to my own lack of sophistication, which I hoped the group psychotherapy experience would help me to overcome. My experience with group psychotherapy was not only not helped by Freud’s book, but was, in my opinion, positively hindered.

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The book was, however, relevant to understanding the Group Dynamics Seminar that we had all been required to take as Massachusetts Mental Health Center first-year residents. In particular, it helped to explain the otherwise baffling and infuriating behavior of our mentor in that seminar, Dr. Black Knight, a practicing psychoanalyst who stone-walled all inquiry from us trainees concerning his educational goals. The model was clear: a psychoanalytically oriented group leader was supposed to help his patients discover the truth for themselves and not succumb to appeals for support and knowledge from the group leader. People are strongly influenced by authoritative pronouncements and these interfere with efficacious self-knowledge. Of course, Dr. Black Knight knew what the truth that we should discover on our own really was. So much for self-reliance à la Sigmund Freud!

Dr. Black Knight: Did his stone wall crumble? I must admit that the stone-walling technique of Dr. Knight in our first-year Group Dynamics Seminar at Massachusetts Mental Health Center was somewhat helpful. But stone-walling was not as helpful in achieving insight via interpretation as it was in promoting communication among the group members and, thereby, increasing the self-esteem and self-reliance of each member. I was astonished by the vigor, passion, and astuteness of my psychotherapy group members. I offer below some memorable interactions that convinced me of the unusual power of this modality for social adjustment to the handicap of mental illness. When I treated patients in groups of my own, I quickly realized that members were more psychologically challenging to each other and more psychologically accurate than I could ever hope to be, especially with my head full of irrelevant Freud–Bion discourse about the hypothetical unconscious forces that ruled the group mind. I was scared, it is true, but I very much doubt that I feared the cannibalistic destruction that Freud thought might lurk in the depths of my group members’ psyches. Even if the cannibalism theory of Freud’s Totem and Taboo (1912–1913) was correct, I needed more practical guidelines than were offered either by Dr. Black Knight or my clinical supervisors. As students, we quickly realized that we needed each other more than we needed our so-called teachers. We actually met in a secret

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group to support our need for cohesion and for neurobiologically informed education. In our therapy groups were sick people who needed the active and direct help that they offered each other. My job was to help them see that. Why this obvious point was never made explicit by my teachers is beyond me. My group members taught me an inspiring ideal. Armed with the face validity that stemmed from their own experience and their candor in communicating accounts of that experience, they were far more useful to each other than the abstractions that I was advised to bring to their table (or get them to appreciate). Armed with Dr. Black Knight’s strong message, I went to my first group therapy session disguised as a young Sigmund Freud about to take a daring dive into the murky waters of the group’s unconscious.

Soren Tooks: Did he ever get a real job? Of the six patients that had been assigned to my first clinic group, only one showed up at the first scheduled meeting. He was a mentally handicapped, chronic schizophrenic man named Soren Tooks. Soren was on welfare, officially disabled, and lived at home. He was not actively psychotic and wondered why he had been assigned to my group. I supposed that he was in a double-bind with his mother and, hoping that his self-discovery might prove enlightening, responded to him as noncommitally as I had been advised to do with any individual patient. In retrospect, I should have told him that, despite his appreciable handicap, he might be able to get more from life if he practiced socialization skills in my group. When I recounted my disappointment at the poor turnout, my psychoanalyst supervisor said that my job was to explore my own unconscious for reasons for the anxiety I felt when I was alone in group therapy with Soren Tooks. My insight now tells me that the five patients who had been assigned to my group stayed away because they were even more frightened of the group than Soren or I was! In those early training days, things were tough in my group because so many of the patients were so severely handicapped. As a rule, my group members were of relatively low social class. Because they were poorly educated they tended to be nonverbal and they were not therefore considered to be good candidates for our first class individual treatment. They had, thus, been assigned to groups

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irrationally and decidedly against the principle of our young president, John F. Kennedy, “From each according to his ability to each according to his need.” Our principle seemed instead to be to offer the most needy patients the least desirable treatment. That helped me to understand why Soren Tooks had turned up, alone, at my first group meeting. He was just earning the right to be disabled! What did the group that gradually coalesced do with Soren Tooks and his double-binding mother? They confronted him with their recognition that, despite his handicap, he was employable. They taught him to invent a work history and they insisted that he attend a workshop to hone his occupational skills. Soren was very set in his ways and came out of early retirement grudgingly. However, under pressure from his peers, out of early retirement he came, with my enthusiastic endorsement and his ultimate satisfaction. Not all of the patients were as tranquil as Soren Tooks. In fact, the threat of violence from the desperate and troubled men in my groups was constant, a threat with which I only slowly learned to deal. As you might imagine, interpretation, therapeutic neutrality, and blank screen passivity were not at all helpful. Instead, it was honest and open communication and upbeat confidence that helped me and the group members to work together effectively.

Zack Seidler: Does he now hug his father? One of my most aggressive group members was Zack Seidler, the son of an Eastern Airlines pilot who came home in the evening exhausted by the overwork of long and frequent flights. He and my patient, Zack, lived together. Zack’s mother, who was disappointed by both of them, had long since been driven out. To unwind of an evening, Zack’s pilot father insisted on sitting at the kitchen table with his son, consuming a bottle of whiskey and arm wrestling drunkenly until one or the other—or both of them—passed out. Zack frightened me by stalking me outside the hospital after group meetings. Since we met in the evenings, after work, it was often dark, especially in wintertime. The darkness magnified my fear. I finally had the good sense to tell Zack, in the group, that he scared me so much by his stalking, that I could not think straight enough to be of much use to him. I never made an interpretation. I just spoke honestly. To my amazement, the stalking immediately stopped.

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Zack also gave up arm-wrestling with his dad as he became a valuable member of the group. He was useful because he demonstrated how even apparently irresistible violent behavior could change as a consequence of a change in social communication. My admission of fear relieved him of the need to threaten me and allowed Zack to be involved and supportive rather than aloof and menacing in the group. I interpreted nothing and I did not need to be didactic either. The thing spoke for itself. None of us functions well if we are scared and menaced.

Jane Hudson: Is her art enough for her? Nearly paralyzed with anxiety but exceedingly beautiful, Jane Hudson made me eager to attend the group because of her physical and psychological appeal. She was an artist who extolled Carl Jung and his ideas. I was as skeptical of Carl Jung as I was of Sigmund Freud, but Jane Hudson helped me to understand why Freud’s Swiss rival was so attractive to artists. I even read Jung’s book, Memories, Dreams, Reflections (1961), on her recommendation. This understanding prepared me for my later meeting with the Italian film director, Federico Fellini, who was also a Carl Jung fan and the patient of a Jungian analyst. As a frustrated artist myself, I felt lucky to know Jane Hudson and she was aware of my affection and respect. For Jane, the group provided a mirror of sorts. So many of the patients were so much more disabled than she was that she felt better about herself and profited from her sympathetic helpfulness. She was anxious, yes, and, in retrospect, probably should have been offered medication, but in those early days, medication was as off-limits in psychiatry at Harvard Medical School, as was Carl Jung and hypnosis. I heard several senior staff members derisively refer to pills as “chemical straitjackets.” Nonetheless, Jane inspired other group members, especially Rosella Campobello, an individual therapy patient whose story I have already told. As she became more comfortable in the group, Rosella became more artistic and as Jane’s anxiety diminished, she recounted more success in her social life, especially in her intimate life with men. This revelation was not wasted on Rosella. Jane’s commitment to art was strengthened as her identity as an artist gelled. She brought to the group convincing evidence of creativity, a trait that I tried hard to inculcate as a pleasure in itself as well as

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a self-esteem booster. Through my group work with people like Jane Hudson, I was able to shake off the Freudian view of art as psychopathology and embrace the alternative view that art is as healthy and important an activity as love and work. I still believe that this is true and I treasure the Pegasus flying horse mobile that Jane Hudson gave to me when she said goodbye to me and the group. That horse flies aloft above the picture of Freud’s famous couch in the studio office of my Vermont dream museum. Jane honored our work together by saying that I had helped her learn to fly.

Gerald Green: Has he now lost all his fingers? I was not the only one in the group who was seized by the terror of violence. The women were, too. Gerald Green was a group member who recounted his sexual exploits, frightening the women in the group more than me. It was Gerald Green’s wont to pick up ladies in bars and, if they had sex with him, he concluded that they were obviously prostitutes whom he then had to chastise. He punished them by throwing them down the stairs of his apartment house before he slammed his bedroom door shut. Sad to say, Gerald Green was not only a sadist, but a masochist, too. As a machine-tool operator by day, he had thrice suffered injury to his hands, wounds which he admitted to the group were intentionally self-inflicted. Gerald voluntarily let his fingers be caught in the rapidly spinning machine lathe that he operated. His employer was led to believe these bloody mishaps were accidents that justified his workman’s compensation claims. As he told this story in a group therapy session, Gerald clasped and unclasped the blade of a jackknife so that it all but cut off his fingers before our eyes. The group members and I told Gerald that the knife should stay at home and that he should use the group to explore new, more trusting and non-threatening ways of interacting, especially with women. To my astonishment, he responded well to this direct appeal, which was never recommended by either Sigmund Freud or Wilfred Bion and was never demonstrated by Dr. Black Knight in our group dynamics seminar. Of course, none of us residents was a Gerald Green type sadomasochist but, in the Harvard group dynamics seminar, we were never taught anything of relevance to the management of patients as threatening as Gerald was!

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Max Truman: Can he now pet his cats? The group had to forbid Max Truman from laughing while talking about his penchant for torturing cats. It made them too uncomfortable. Max was a well-heeled and well-educated young man who had planned to go to medical school and to become a doctor before paranoid schizophrenia got in his way. He accepted the suggestion that the subject of his cat sadism might be more appropriately broached with his individual therapist. What the group perhaps could do was to help him to find a career alternative and to keep unsavory and unacceptable tidbits, like cat torture, to himself. The group helped Max Truman see that by scandalizing and terrorizing them with his stories of cat torture, he was avoiding the unwelcome downward social drift of all handicapped persons. He had to learn to be something like a doctor if he was to regain any semblance of self-esteem. This was a tough sell, but Max’s group peers were more easily able to close the deal than I was. They were better doctors because they had all overcome more severe hardships than I. When I last saw Max, he accosted me by loudly and mockingly shouting “Doctor Hobson” in the hospital lobby. He was then still an inpatient and he was still hoping to go to medical school. In fifteen years, no kind of therapy had really helped him at all significantly. With the closure of the hospitals, he must have gravitated to day treatment in a clinic and perhaps to a halfway house. Recognizing the half in halfway to be a euphemism, patients like Max Truman were more likely to end up in quarter-way domiciles. Even this pessimistic label might be too optimistic for the likes of Max. Deinstitutionalization has not helped patients to master schizophrenia.

Edward George: Does he teach the law of behavior? Mr. George was a diabolically intelligent thirty-five-year-old man who stayed forever in law school, which he loved almost as much as he loved legalistic argumentation itself. Edward lived with his aging mother, upon whom he was entirely dependent. He was chronically angry, paranoid, and menacing. I surprised him by admitting that he obviously knew more about psychology than I did and declared, honestly, that he was clearly a far more gifted manipulator than I was. Edward was convinced that only political power mattered, an assumption that I openly doubted. I claimed that artistic imagination,

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scientific scepticism, and good will mattered, too, and that he was more gifted with all three of these powers than with legal expertise and political sagacity. These direct, sincere, and supportive communications seemed to make Edward an ally rather than a foe in the group. Although the group did not succeed in separating him from either law school or his mother, he reported feeling better about himself because he began to see himself as socially useful. I kept in touch with him for ten years after the group ended its work and his functioning, while still limited, was at least satisfying. He even took pleasure in my success as a scientist because it reinforced his own keen skepticism. He was as critical of the repressed unconscious wish paradigm as I was and his belligerent character delighted in the Freud-baiting that generated my notoriety.

Xavier Theodorus: Can he now go over the bridge? Another very bright, equally paranoid man who joined my group was Xavier Theodorus, a Greek mama’s boy who spent most of his time reading obscure Byzantine texts in the stacks of Harvard’s Widener Library. I guess it is not surprising that the Harvard library collects bright, paranoid men in search of obscure texts! In the group, Mr. Theodorus was helped to pursue more realistic social goals, to stay out of the Harvard stacks, and to cease threatening suicide by jumping from the middle of the George Washington Bridge in New York City. He had often threatened to leap into the Hudson River clothed in an overcoat from which he had cut the labels to obscure their origin and make his identity a mystery! Come to think of it, Xavier, like many of the men in my group, had mothers with whom they lived in symbiotic interdependence. At first glance, they might have been thought to confirm the double-bind hypothesis and it was hard to see that they, like Derrick Sutter, were still at home because of their own unexplained difficulties. Beside the real possibility that their mothers were loath to let them go are a host of more damaging blows to their egos, including developmental insults and genetically determined defects. Men like Xavier Theodorus and Edward George make me glad to be neither psychotic nor overly bright. When madness is combined with genius, the mixture is as awesome as it is obdurate. It is hard for me to imagine that these very bright men are not genetically

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predestined to suffer. Their brains were elaborate and their social interfaces so unconventional that life in the conventional world was intolerably painful to them. Nor were they able to use their exceptional intelligence to see themselves clearly or to contribute to collective knowledge about the mind through scientific or humanistic scholarship.

Sylvia Gates: Is she able to stop shaking? I was surprised to see the safety-in-numbers principle work for patients like Sylvia Gates, whose ego was so unstable that it (she) tended to dissolve in any one-to-one encounter. Sylvia was so fraught with anxiety that she avoided people because they invariably made her already intolerable fear much worse. Her anxiety was so severe that she trembled visibly. Sylvia lived alone and had all but given up any hope of a permanent romantic attachment. Sylvia used the group to help her feel more comfortable with friends and co-workers. At the same time, she was able to see her own strengths and even believe in them. Sylvia was by no means cured, but she learned to live more comfortably with her limitations. I do not know why Sylvia’s ego was so compromised, but my private suspicion is that her primary consciousness anxiety was not quieted by proximity to a soothing mother (or mother surrogate). I suspect this theory because it smacks of “blame the mother”, but I can not deny that I still take this idea seriously. I have seen, at close hand, several cases that made me think that anxiety is normal and that only a comforting and reassuring other can keep this normal emotion from being too much of a good thing. At least, this variation on the theme of double-binding mother is a testable hypothesis. I return to this theme in discussing the case of Chiara Perugino in Part III. Another idea that comes to mind in connection with people like Sylvia Gates is the late Ernest Hartmann’s paradigm of thick and thin ego boundaries. For Hartmann, Sylvia Gates was fragile and retreated from social contact because she was not a discrete self and so tended to feel both hypersensitive to, and in danger of being taken over, by others and, thereby, losing herself to them. Sylvia Gates had some traits of a borderline personality disorder. It is difficult to model ego boundaries but it is not hard to imagine that some people are unable to contain the thoughts and emotions that

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arise spontaneously within them because they are genetically prone to generate negative affects such as anxiety and related thoughts. This is exactly what happens in normal dreams and it is possible that, awake, Sylvia Gates could not block out dream anxiety. In this formulation, the boundary of the ego is not so much thin between self and other as between the dreaming self and the waking self. I come back to this idea in Parts III and IV. Hyper-anxiety leads to hyper-vigilance (and possibly insomnia) because of a low set point for arousal. According to this reframing of the problem, it is not so much that ego boundaries are thin as that internal signals are unusually strong. These strong internal signals make the processing of external data more than usually difficult. Thus, people like Sylvia Gates may be at the high end of a continuum for the normal emotion of anxiety. I wish I had had this normative view when I met Sylvia. It would have saved me from the fruitless quest for childhood trauma and allowed me to be more forthcoming with suggestions about coping with discomfort. The genetic and environmental models are not mutually exclusive, of course, but the desired balance between them is as difficult to achieve as it is to think about brain and mind in a fair-minded and balanced way.

Eliana Gergius: Does she still see her mother’s face? Sylvia Gates’ borderline meltdown of ego boundaries was even more pronounced in Eliana Gergius. Eliana told the group that she saw her mother’s disapproving face whenever she made love. By talking about this painful truth to the other women in the group, she was able to understand and moderate it better. Maternal disapproval of extramarital sex was a force they all had to contend with even if they did not all hallucinate their mother’s face when they had sex. This was not a subject that Eliana could easily share with a man, especially if she was alone with him, as she would have been in individual therapy, but she was able to enlighten the men who heard her story in the group setting. Eliana’s account made them more aware of what might be going on in the heads of their intimate partners. A psychoanalyst might say that her transference was diluted to a comfortable degree in the group.

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In Eliana’s case, the mother was not double-binding but she was intrusively present. Instead of receiving quiet and reassuring soothing from her mother when she was a young woman, she was enjoined to avoid sex, to suspect men, and to deny her own sexual impulses. Whether these dynamics could be exposed and specifically redressed in individual therapy is doubtful but, if I were to try, I would be active, transparent, and supportive rather than passive, opaque, and interpretive. As in the case of Sylvia Gates, Eliana Gergius was flooded with unwelcome internal signals. In her case, these signals were not so much anxious as sexual, but she had been taught to regard her normal sexual emotions as abnormal, and the mother who scolded her for having them appeared whenever she succumbed to passion. As with the nightmares of Glen Just, described in Part IV of this book, Eliana Gergius should have been coached in the voluntary control of her waking dreams instead of assuming that her sexual impulses were unconscious and that her hallucinations would cease once she had uncovered their source.

Dr. Irvin Yalom: Did science help him see straight? After my first two years of group work, I realized that I had been reading the wrong bible. I do not recall how I became aware of Irvin Yalom’s book on Group Psychotherapy, but I do remember feeling jealous. As soon as I began to read it, I wished I had written it myself! At least I no longer felt like an oddball in my disdain for Freud and Bion. Like my supervisors, Freud and Bion must never have done group psychotherapy with patients of the sort that came for help to an inner city psychiatric outpatient department such as Harvard’s. The sad truth is not just that the theoretical books about group dynamics are useless. It is sad that so many therapists do not recognize that group psychotherapy is every bit as good, and sometimes better, than the vaunted individual kind. I felt that I had discovered something solid in my groups and might well have founded my career upon this rock if I had not already committed myself to brain research. It might not be entirely coincidental that Irvin Yalom, a Professor of Psychiatry at Stanford Medical School, is a trained psychological scientist. Scientific perspective can be helpful when it comes to correcting error or replacing theory and practice with more realistic

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alternatives. I feel that Irvin Yalom’s reform of group psychotherapy was formally akin to my own reform of dream theory, except that he remained much more respectful of Freud than I was able to do. Although my work was, at first, more scientifically oriented than Yalom’s, I would now go much further than he did in rejection of Freud. He may be less shocked than I am at the error and inapplicability of psychoanalytic theory. In any case, I applaud that part of Yalom’s work that has helped group psychotherapy to be more widely understood and more wisely used. What I attempt here is the integration of basic and clinical science that most of my colleagues, possibly including Yalom, regard as premature or impossible. They prefer Freud’s leaky boat to my life preserver. Besides watchful waiting, another principle that psychodynamically inclined therapists rightly emphasize is the relative comfort offered by groups to patients made uncomfortable by the intimacy of individual treatment. There is safety in numbers in groups as well as a social learning and support opportunity. I wish I had had protoconsciousness theory and the state stabilization idea when I led my groups, but I am grateful to all of my patients—and to neurobiology— for leading me to it. I needed to give up the confusion of correlation with cause that the double-bind hypothesis embodied and both to challenge and dismiss the arrogance that went with it. Clinical and experimental work collaborated in freeing me from dogmatic faith in the Freudian unconscious so that I could live more happily in ignorance and to try to help others live with humility and dignity despite feeling hopelessly inadequate to the deep understanding of the mind and its ills.

General considerations and conclusions: group or individual therapy? The educational advice of my group therapy supervisors struck me as just as patently absurd as the group leadership model offered by Dr. Black Knight. I decided, therefore, that I would try to learn from the group itself what value, if any, such psychotherapy might have. I went along with the assignment to form and lead a group whether Freud was there or not. The other guru that we were told to follow was Wilfred Bion, an English neo-Freudian, whose writing was even more

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convoluted and as completely unhelpful to me in confronting a real group of real patients as the ego analysis book written by Sigmund Freud himself. Over the course of my two years as a half-time second-year resident in psychiatry, I learned a lot from the group that I finally scraped together. Thereafter, I practiced group psychotherapy privately for about ten years until my scientific career took off and I began to travel too much to continue group work conscionably. An obvious advantage to group therapy is economic efficiency. Many patients can be seen in a given hour and I found that I could even prescribe drugs in the context of my group meetings. After all, it was the patients, not me, who took the pills and they were extremely forthcoming about unrealistic expectations and inevitable and unwelcome side effects. As detailed above, group members were also as good or better than me at imparting helpful feedback and offering support for social adaptation. In my years as a resident, I prided myself on keeping patients out of hospitals and feel that, thanks mainly to common sense, I got to be very good at that cost- and facesaving effort in my first fifteen post-graduate years. In my opinion, the insurance industry and federal health programs have still not taken adequate account of the economic power of group work. This argument extends to many fields of medicine besides psychiatry, but that argument needs a separate airing. Restricting my attention to psychotherapy, I will try now to offer a semi-quantitative analysis. If I am allowed ten minutes per patient individually but can see nine in an hour and a half of group work, I can spend nine times the amount of time with each patient at no more than a quarter of the cost. This leads to something like a nearly thirty-sixfold increase in efficiency. This quantitative analysis leaves out of account the face validity of peer communication and the obvious benefit of learning that no one is alone in coping with hardship. There is also the boost in self-esteem obtained by being useful to others. The psychological principles of self-reliance in direct, do-it-yourself treatment are easily folded into this procedural mix, as I try to make clear in what follows. In summary, I brought an inappropriate leadership style that I call stone-walling and a useless model of group dynamics interpretation with me from my psychoanalytically inspired preparation for group psychotherapy. What group work taught me was faith in the power of

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the open and non-judgmental communicative process to bolster the self-reliance of group members. I also learned the value of a more direct expression of feeling, support, and demand for compliance than my previous personal or clinical experience had ever exposed. Very impaired patients can do very well when this treatment modality is shaped to their needs. Freud was certainly correct when he emphasized the importance of love and work. In my individual therapy experience, I was constantly reminded of the importance of love and, in my group experience, the importance of work. In both settings, love and work were best fostered by a more transparent and involved position than theory dictated was essential to success. Loving and working were not just goals. They were also the means of achieving the goals.

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PART II

The brain basis of normal and abnormal ego states

Introduction s I did my clinical work on half-day mornings, I began to work each afternoon, many evenings, and most weekends on the neurophysiology of sleep in the laboratory of Professor Elwood Henneman in Harvard Medical School’s basic science quadrangle near the hospital. This work was a continuation of studies first initiated at the National Institute of Mental Health (NIMH) (1961–1963) and during my year with Michel Jouvet in Lyon, France (1963–1964). This line of research was later pursued in collaboration with Dr. Robert McCarley, my fellow resident, and led, by 1975, to the development of the reciprocal action theory of sleep cycle control. By 1977, this physiological model had morphed into the activation synthesis hypothesis of dreaming. A detailed account of this intellectual adventure is given in Dream Life, my scientific autobiography published by MIT Press in 2011. In the subsequent two and a half decades since 1977, the two original models have evolved into my current protoconsciousness theory. These findings thus inform the general concept that is at the heart of Ego Damage and Repair. Those two models suggest that many of the

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symptoms of so-called mental illness might be due to inadequate inhibition of the virtual reality generator in the brain that is responsible for normal dreaming. Dreaming is in the service of waking consciousness but, when it gets too far out of its sleep box, it can create havoc in waking. Emphasis on dreaming does not deny the importance of waking experience but it does suggest that final common path of interactional trauma and genetic imbalance may be via those basic homeostatic brain mechanisms that regulate waking, sleep, and dreaming, among many other things (including consciousness and the ego). To help make this point clear and clearly solid, a summary review of the basic science of brain–mind state control is in order. Oversimplifying in the interest of clarity, it is now apparent that alert, mood-stable, compulsion-free, and anxiety-free waking depends upon maximal inhibitory efficacy of brain stem aminergic neurons. These neurons inhibit, and, thereby, hold in check, the cholinergic neurons that mediate sleep and dreaming. Any decrease in the efficacy of the aminergic waking system results in release from inhibition of the cholinergic dream system. Since experiential trauma overdrives the aminergic system, it plausibly disturbs the balance of the state control system with resulting ego dysfunction, as will be made clear in Parts III and IV. Before going further with this story, in which I emphasize REM, let me point out that NREM sleep is also capable of supporting dreaming but, because this capability is less impressive than that of REM, I focus here on the physiology of the REM state. When the cholinergic dream system is released from inhibition, dreamlike symptoms are more likely to be released into waking. These symptoms are most disabling as psychotic hallucinations and delusions, but they also include anxiety, bizarre thinking, and compulsive drives, as I will presently illustrate with recent case material. This model is formally similar to Freud’s dynamically repressed unconscious as the demon of the mind, but it is far more specific and considerably simpler. It is, therefore, more amenable to physical interventions and those physical interventions are logically understandable as well as inexpensive and efficacious. They inspire and inform an easily understood and straightforward approach to treatment which results in state stabilization via psychopharmacology in tandem with active and directive psychotherapy of the sort that I was taught by my patients to exercise (against the advice of my teachers).

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Exaggerating only slightly, it is clear that the new model, even if only partially correct, is a huge advance over current knowledge because it not only closes the embarrassing gap between mind and body, but also because it promises to integrate psychiatry and neurology. Such integration may even help to merge the humanities with science via the shared construct of creative imagination. I am proposing nothing less than a truly scientific model of the brain–mind. My approach may strike many of my peers as overly simplistic but it is my goal to simplify in the interest of theoretical accuracy and practical efficacy. Furthermore, while it is quite possible that psychiatric disorders are best thought of as medical diseases, we have limited but solid data that indicates that since the medical model is primarily physiological, it ignores the important two-way causal effects implicit in dual aspect monism, the philosophical basis of my approach. This theory might also be quite useful in the reform of clinical medicine. Readers who are interested in a more detailed treatment of dualaspect monism than is offered below should consult the two papers written with Karl Friston (Hobson & Friston, 2012, 2014).

Chemical intervention and the brain The usefulness of drugs that enhance aminergic inhibition unites a spectrum of symptomatic disorders as if these conditions were not so much specific diseases, each with its own particular cause, as manifestations of a shared process common to all of them. I call that process state instability. By state instability, I mean that the boundary between waking and dreaming has become less than normally distinct. The boundary is crossed primarily in the dreaming-towaking direction in the genesis of many clinical conditions. It is my contention that many drugs work—and psychotherapy works— because they both help to re-establish state stability. This proposal will be considered heretical not only by psychoanalysis, which it is designed to replace, but will also be rejected by my more sober medical colleagues who advocate application of the disease model to psychiatry. Nothing would please me more than an insertion of psychiatry into the mainstream of clinical medicine. But where should we put it? I have emphasized the possible development

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of a psychodynamic neurology, but have expressed skepticism about the political prospects of a reunion of psychiatry with neurology. In addition, the state stability paradigm goes far beyond anything accounted for by the medical model of today. It may, therefore, just be that dual-aspect monism is more important than the medical model itself in accounting not only for those disorders thought to be psychiatric, but also for a host of so-called psychosomatic diseases. Neurology is grudgingly becoming more functional but remains stubbornly structural at its core. Psychiatry sticks out like an untreated sore thumb which some would amputate to stem the further spread of dysfunction to the field and to avoid professional embarrassment. To my colleagues and our patients, I say, “Please be patient. We are only beginning to come to grips with the brain-mind and its disorders.” A deeper issue is at the philosophical level. Neurology is reductionistic. There is nothing but the brain. Mind is an illusion, an ephemeral phenomenon at best. Psychiatry remains stubbornly dualistic. The mind and the brain are two separate entities. Neither neurology nor psychiatry has yet comfortably accepted the dualaspect monism that I espouse. The adoption of dual-aspect monism is necessary for the genuine fusion that I envisage to occur. Dual-aspect monism asserts that the brain and mind are two sides of the same coin and that a true science of psychology cannot be realized until this philosophical bridge is crossed. The philosophical bridge will not be crossed until it is recognized that it is solidly founded and that both sides stand to gain more from unity than either would lose. We are not there yet. This book tries to move us one step closer. Let me now show you how I think that this might work.

Aminergic neuronal systems From the time of their initial description, in the early 1970s, of the aminergic systems of the pontine brain stem by the Swedish neuroanatomists, Kjell Fuxe and his co-worker, Anica Dahlstrom, the attention of sleep and dream researchers was excited. The reason for this excitement was related to the position (very central) and the connectivity (very widespread) of these chemically distinctive neurons. The aminergic neuronal systems were clearly not part of the more specific input–output reflex system identified by Charles Sherrington. Instead,

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these brain stem neurons are very centrally placed, and they are connected to a vast number of other brain cells including those that mediate Sherringtonian reflex activity. Their location, connectivity, and, especially, the chemical specificity that led to their discovery constituted three prime desiderata of a state control system. Consciousness is a global state dependent function in search of just such a versatile neuronal substrate.

Sleep and dreaming The earliest work on aminergic neurons in relation to sleep and dreaming was conducted by Michel Jouvet at the University of Lyon School of Medicine in France in the early 1960s. Jouvet proved that the biogenic amine-containing neurons of the brain stem were indeed important to conscious state control, but exactly how was not made at all clear by his pharmacological experiments. Jouvet had good reason to suppose that aminergic neurons might be playing an important role because their central location was in the very same pontine tegmentum that his earlier experiments using lesion and electrical stimulation techniques had already shown to be critical for the generation of REM sleep. Beyond that, Jouvet could not go with scientific confidence, but he tried nonetheless. Jouvet made crucial interpretive errors because systemic pharmacology was not up to the task of determining what specific role these intriguing cells might play. Based upon very messy drug studies and a flawed conceptual model, Jouvet incorrectly concluded that norepinephrine was responsible for REM sleep, serotonin for NREM sleep, while responsibility for waking was left to dopamine. According to Jouvet, each neuromodulator was responsible for one and only one state! If only it were that simple (or even partially true). For starters there are four, not just three, aminergic neuromodulators. Histamine was left out of the Jouvet triptych, in part because its cells of origin are located in the infundibular region of the diencephalic brain stem, anterior to the pons. The histamine neurons project to the cortex and fire in the same wake state-dependent way as their norepinephrine and serotonin containing pontine cousins. All three neuronal groups are, in fact, REM off cells, an important feature that Jouvet could not detect because his methods were too crude. Thus, none of the three aminergic brainstem cell groups could

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actively support REM and were more reasonably assumed to be crucial to waking.

Containing dreaming in REM In terms of the thesis of this book, norepinephrine, serotonin, and histamine enhance waking by inhibiting REM. In doing so, they keep dreaming in its place so that the brain can focus on what really is out there in external world instead of projecting internal expectations on reality. In other words, the real world takes precedence over virtual reality in waking. In dreaming, just the opposite is the case. Precedence is the word to emphasize as we point out that both waking and dreaming use both the external analysis of ongoing events and the experience of previous experience that is stored in memory (mediated by the aminergic systems) and the virtual reality expectations of the brain–mind (mediated by the cholinergic system). In other words, both waking and dreaming states of consciousness are composite and complementary at the psychological and physiological levels. It was only when individual brain cells were recorded with microelectrodes that it became clear that it was waking, not REM or NREM sleep, that was associated with maximal activity of the norepinephrine containing neurons of the locus coeruleus and the serotonin containing neurons of the raphé nuclei. The histamine system of the infundibulum also turned out to be involved in promoting waking. That implied that, in order for the brain to be awake, and for us to be conscious in the way that we normally are in that state, these three groups of aminergic neurons all had to be active. Conversely, in order to be asleep, these same aminergic neurones had to become inactive. As it later turned out, the sleep facilitating silencing of these three groups of brain cells was caused by active inhibition emanating from the hypothalamic seat of the master biological clock for diurnal rhythmicity. Jumping rapidly ahead, these findings implied that any drug which increased either the firing rate or the synaptic efficacy of aminergic neurons would enhance waking, while any drug that interfered with their function would increase the probability of sleep and dreaming. The role of dopamine remains a bit murky to this day because dopamine neurons are active in both waking and REM sleep; as Jouvet

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predicted, dopamine is, thus, likely to participate in the mediation of waking consciousness. However, dopamine may also mediate dream consciousness. What both waking and dreaming have in common, besides dopamine availability, is a high level of general neuronal activation and a high level of overlap between internal expectation and external perception. In the case of waking, external percepts predominate, whereas, in REM, the balance shifts to internal perception. This is the essential difference between waking and dreaming. The same distinction also differentiates sanity and mental illness. We are sane to the extent that we perceive the outside world to be distinct from our minds. We become mentally ill when that distinction is lost. Jouvet had initially proposed that the probability of dreaming was determined by the excitatory activity of still another brain stem neuronal system, the acetylcholine containing cells. This turned out to be correct. Not surprisingly, it was learned from microelectrode studies that the aminergic and the cholinergic neurons were reciprocally interactive: if aminergic activity was high, then cholinergic activity was suppressed and vice versa. In REM sleep, the aminergic cells stopped firing altogether, while the cholinergic cells became spontaneously active and fired rapidly. Whether the brain was awake or in REM sleep, dreaming thus appeared to obey a simple law of reciprocal interaction. It is now some thirty-eight years since Robert McCarley and I first proposed this model and our original findings have since been amply confirmed and extended (Hobson & McCarley, 1977). The clinical significance of the reciprocal interaction model is simply stated: the greater the efficacy of the aminergic system, the more efficient the waking. On the contrary, a deficient aminergic system and/or a hyperactive cholinergic system leads to insomnia and to a waking state of consciousness which is prone to invasion by cognitive and emotional dream elements. When this imbalance becomes extreme and fixed, mental illness is the result. The first and most dramatic instantiation of this theory was made clear by the modern pathophysiological model of depression. In depression, it was shown that aminergic weakness mediated the clinical disorder and that the disorder was further worsened by cholinergic overdrive. I return to this important finding in subsequent discussion of clinical case material later in this part of the book.

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I now ask you to consider with me what might be going on in obsessive–compulsive disorder (OCD) and in eating disorders. By examining these apparently disparate conditions, we will find more good reason to take seriously the general applicability of the reciprocal interaction model. That model has already proven quite useful in the understanding of two clinically distinctive sleep disorders, narcolepsy and REM sleep behavior disorder (RBD), which I will discuss shortly. Before turning to sleep disorder, let us first question other orderly functions such as those already discussed in my paper, “Ego ergo sum” (2013). Is the ego controlled by the activity levels of aminergic and cholinergic neurons? Does the writing of a book like this one depend on the integrity of the aminergic and cholinergic neuronal system? Is the imagination that makes a book more readable a function of cholinergic dreaming? To all these provocative questions, I would answer, yes, those are all clear implications of the theory. Am I, then, my ego, my very self, my aminergic–cholinergic reciprocally interactive system? Do I wake, sleep, and dream according to the dictates of these neurons? The answer, again, is a tentative yes. The clinical and philosophical implications of this answer are far reaching.

The heart of the brain One purpose of this thought experiment is to induce you to take these arguments more seriously. This is not mere technical talk that you can afford to ignore. You certainly want to wake and sleep and dream in an intelligent and healthy way. You, too, might want to write a book. Who knows, some day you may even become depressed yourself and you, your spouse, and your children may all fall foul of problems with this system. Therefore, it behooves you to heed what I say about the self-reliant maintenance of your brain and to consider aspects of your lifestyle which may endanger its health by interfering with your brainstem aminergic self. Your brain is at least as important as your heart and you have been lectured extensively about the care and maintenance of that relatively humble organ. My best friend in medical school, the late Robert Earl Hayes, asked, “What is the function of the heart?” After a pause, he quipped, “To pump blood to the brain.”

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Two ideas come to mind in that connection. One is that an important function of the heart is indeed to pump blood to the brain. The other is that the heart and the brain operate in basically similar ways. Aminergic inputs speed the heart, making it capable of supporting vigorous physical and mental activity just as aminergic activity speeds the brain. Cholinergic activity slows the heart, just as it does the brain. So far, the analogy is perfect, but now we must recognize and understand an important difference.

The emotional brain The difference is dreaming. The brain dreams but the heart does not. Our popular sayings imputing feeling to the heart are based on a tradition begun by Aristotle, who erroneously regarded the heart as the center of emotion. This misconception is not only antique: William James and Carl Lange proposed, as recently as the turn of the twentieth century, that emotion was nothing but the perception of the bodily changes associated with it. Those emotion-associated bodily changes included a racing heart. An increase in heart rate is indeed commonly correlated with emotion in both waking and dreaming, but we are totally unaware of heart action when we experience dream emotion. That means that the perception of heart action has nothing critical to do with the subjective experience of emotion. Sigmund Freud made matters worse when he conceptualized emotion without regard to any specific physical system. We now can assert that emotion is a brain function, a point which anxious dreaming underlines. In REM sleep dreams, feedback from the sensory periphery is actively blocked. Dream emotion cannot possibly be other than central. Aristotle’s error can now be corrected (it is the brain, not the heart, that is center for emotion). Correction of this error is complemented by the recognition that it is the brain, too, which mediates dreaming. Dreams come from within the brain, not from without, as was erroneously assumed for centuries. The heart may speed up when we experience dream anxiety, but we are not aware of heart action in our sleep and in our anxious dreams. The brain mediation of dreaming underlines an important detail in the analogy linking heart and brain functions. In order to dream, the activated brain must be made as functionally different as possible from waking. This is done by reducing

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aminergic activity to a minimum, and even annihilating it altogether. Of course, external sensory inputs and motor outputs must be blocked (and we now know precisely how this is done physiologically) but it is the change in aminergic neuronal activity that I emphasize here. The brain changes state and the mind changes state for both chemical and psychological reasons. The dreaming brain is an aminergically inactive brain. The activation of the brain and the mind in REM sleep is cholinergic. These two changes render us different as wakers and dreamers. We are governed by brain chemistry and have no say in this matter. This physiology is exigent for reasons that we are beginning to understand. At stake are temperature control and consciousness itself. The clinical control of consciousness is a major beneficiary of dream science. Acetylcholine-like drugs turn off the aminergic system just as they turn on REM and the physiologic mediators of the dream! When we say that a dream is a wish the heart makes we combine the errors of Aristotle with those of Freud. The heart may beat fast when emotion is felt but the emotion felt is primarily in the brain, not in the heart as Aristotle thought. And since dream emotion is so often unpleasant, dreams cannot be driven by wishes, as Freud should have realized. His followers, my teachers, wriggled out of such important errors by mouthing such idiotic platitudes as, “Its either the same or its opposite in the unconscious.” In other words, any and all evidence confirms Freud’s theory. This is not science. It is the authoritarian thought control typical of religion. The heart does not dream because it cannot. It lacks the number and diversity of constituent cells and it cannot afford the radical shift from aminergic dominance in waking to cholinergic dominance in REM. If the heart were to undergo simultaneous aminergic demodulation and cholinergic hyper-modulation, it would slow and possibly stop altogether. Such heart stoppage might be the basis of voodoo death, an hypnosis-like phenomenon which has fascinated scientists since Walter Cannon first called the intellectual world’s attention to it in about 1930 (see Cannon, 1942). I, for one, certainly do not wish for voodoo death any more than I welcome a nightmare to my bed. In order for the brain to enter REM and for us to dream, the heart must increase, not decrease, its output of blood because the dreaming brain requires, calls for, and gets an increase in blood flow that, for most brain regions, equals and in some cases, actually exceeds that of

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waking. The areas that require less oxygen in REM sleep than in waking are too small to be measured with one important exception. That exception is the dorsolateral prefrontal cortex, the seat of executive ego function. Dreaming, then, is a mild form of ego damage, and many of our higher cognitive functions suffer from it. The reason for this is that the frontal cortical brain region responsible for executive ego function is deactivated in REM sleep. We lose a great deal of cognitive control when we dream. That is why the subjective experience of dreaming is so often intense and bizarre. We see things that are not there. We believe things that could not possibly be true. And, unless we wake up promptly and without moving, we have no recollection of our vivid but entirely virtual dream experience. Why are dreams so often forgotten? Because in order to form a memory, as well as to think straight, the brain requires a goodly supply of aminergic chemicals and it gets much less than a goodly supply of them in REM sleep. The heart–brain analogy has another theme that probably reflects just how important the two organs really are. Whatever the environmental conditions may be, rest for both the heart and the brain is possible, but a total surcease of activity would cause death. So, the heart and the brain both remain active in sleep. This reliable and stateindependent nature of both heart and brain function is guaranteed by pacemaker cell activity. A pacemaker cell is one that fires automatically and spontaneously. This capacity to override input is given by what would appear to be a design error in the construction of the neuron, a leaky membrane. The membrane leak results in continuous, spontaneous, and reliable action potential generation by pacemaker cells. In waking, both heart and brain pacemakers fire. In sleep, they both slow down, but in REM, the pacemaker cells of the heart continue to function while those of the brain stop firing. This arrest of pacemaker cell firing is a function of active inhibition from another part of the brain. Fortunately for us, the heart does not stop beating unless we are the target of a voodoo witch-doctor whose magical power we respect. Witch-doctors are masterful hypnotists. Belief in them can be fatal.

Aminergic–cholinergic balance The balance between aminergic and cholinergic forces is a crucial concept relating to brain–mind health. In uniting a wide range of

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psychopathological conditions, we will be impressed to see that they all have in common the relative weakness of the aminergic system. That could be why they are all helped by the administration of drugs that increase the efficacy of that system. This is the mechanism of the benefits of all the chemicals that are prescribed by physicians as “antidepressants” and those “stimulants “ that are sought on the streets. In the case of Francine Poppy, which I summarized in Part I, the streets ran through a Harvard mental hospital’s cafeteria. Francine claimed that the drugs she bought illegally helped her by reducing stress.

The muddy notion of stress The muddy notion of stress can now be clarified. Any condition that produces discomfort and/or dysfunction may be said to be stressful. The word stress may refer to the environmental conditions that cause discomfort and dysfunction or it may refer to the dysfunctional response of the individual to those conditions. In my opinion, it is more exact to cite the problematic environmental conditions as stressful and to view the stress response as the result. The stress response is always mediated by an overactivity of aminergic cells both peripherally (as has long been known) and centrally (as we have recently discovered). The aminergic cells, sometimes cited as belonging to the sympathetic branch of the autonomic nervous system, mediate their effects via the central and peripheral excretion of the biogenic amine, norepinephrine. The sympathetic branch of the autonomic nervous system is responsible for the mediation of fight or flight reactions to threat in waking. The peripheral components of that system are also activated in REM when anxiety and escape dreams may be their subjective concomitants. Antti Revonsuo has emphasized this very point in articulating his theory of dreaming as a rehearsal of escape from threat (Revonsuo, 2000; Revonsuo & Valli, 2008). From the vantage point of sleep science, all stressful conditions conspire to produce too much or the wrong kind of waking. Hence insomnia, like that of Sybil Newhouse, is often part of the picture in a wide variety of clinical conditions, and no wonder, because norepinephrine, serotonin, and histamine all potentiate waking and delay or interrupt sleep. Insomnia is the leading complaint of patients who consult physicians, indicating that we are not talking only about psychiatric conditions and their neurological underpinnings, but

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about widely prevalent discomfort that affects a wide gamut of the clinical population.

Ego suicide An upshot of this principle is that there is no way that one can control for stress in sleep deprivation experiments. Sleep deprivation is an intrinsic part of stress induction and stress always includes sleep deprivation. An unfortunate consequence of the unity of sleep deprivation and stress is that the cholinergic system, which is at first suppressed, later becomes hyperactive as the adrenergic system nears exhaustion. By then the stressed individual is functioning very poorly indeed. It is little wonder that people like Francine Poppy, Derrick Sutter, Sarah Sage, and Glen Just consider, try, and sometimes succeed in committing suicide. This is ego death in the most literal sense of those words. To kill one’s own ego, when that ego is in agony, is not irrational, but it is unfortunate because the autonomic nervous system can be pulled or pushed back into balance making a depressed individual feel better again. Because they were so often convinced that they would never feel better, I often asked my depressed patients to write themselves a letter when they felt good, to be opened and read if and when they felt bad again. Francine Poppy was one such patient. Unfortunately, Francine never really felt good about anything but she did sometimes feel significantly less bad and wrote herself reminders of that fact. None of us can predict the future and I myself have had the experience of entirely unexpected mood-lifting encounters that I would have missed if I were dead!

Restoring autonomic balance the easy way It must already be clear that the appropriate chemical intervention for conditions traditionally considered psychiatric can now be rationally determined. We can measure aminergic and cholinergic strength indirectly because we know so much about sleep and dreaming. A person can be studied in a sleep lab and, from the myriad measures obtained, be confidently subjected to one or another pharmacological regime. Instead of reporting the many important details, which argue for one drug or the other, I shall try to explain why so many apparently

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diverse conditions respond so favorably to drugs which enhance aminergic efficacy. Of the many drugs which increase aminergic efficacy, I will focus on one class of such agents, the amine reuptake blockers. The best known example of this class of drug is fluoxetine (better known as Prozac). When an aminergic neuron depolarizes and its action potential reaches the synaptic endings of that cell, a neuromodulatory transmitter is released. Thus are norepinephrine, serotonin, histamine, or dopamine constantly spewed forth in waking. They can, thereby, affect the excitability of post-synaptic cells and, thus, influence energy metabolism. This twin set of actions helps to explain why so many of the effects of these drugs upon mood are so potent and why sleep itself is so strongly tied to mood regulation. In this section, I restrict my attention to norepinephrine and serotonin, the two biogenic amines secreted by the neurons of the pontine tegmentum and the cells most confidently known to mediate the differences between the brain states of waking, sleep, and dreaming. Both of these aminergic cell populations discharge most frequently in waking, reduce their output by about half in NREM sleep, and slow down significantly or stop firing altogether in REM sleep. Their state specificity is so highly reliable as to suggest that a person cannot be awake in the absence of aminergic neuronal discharge and cannot be dreaming in its presence. As Glen Just’s story will clearly illustrate in Part IV, hybrid clinical states do exist. By hybrid, I mean, for example, the normal phenomenon of lucid dreaming, which combines features of both waking and dreaming. The lucid dreamer knows that he is dreaming instead of erroneously assuming that he is awake. A shift in neuromodulatory balance may be all that is required to change us from one state to another and to help us eliminate hybrid states when these are unwanted. State stabilization is also a possible benefit of aminergic tone enhancement. By state stabilization, I mean a more firm difference between waking and dreaming. Both waking and dreaming will continue to exist but their differential compartmentalization will be strengthened. A true prophet might have been able to intuit the existence of such a remarkable system as the brainstem aminergic complex but, as far as I know, no such prophet ever existed. Prophets of heaven abound; prophets of earth are rare. It certainly was not an idea that I myself

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contemplated when I began my experiments in 1968. Our awareness of consciousness conveys no inkling about how it is physically affected and we obviously have a long way to go before we can paint an adequate picture of this complex process. There is no substitute for expensive, time-consuming, and difficult experimentation if we hope to understand our consciousness in physical terms. The story is already so complicated that most people do not want even to hear, much less read, about it. They much prefer to read fiction and, on the weekend, they prefer to go to the movies to indulge in science fiction or to church to pray to the supposed architect of their wonder. As for the suggestion that aminergic neurons occurred by genetic chance, I hardly dare mention it for fear of immediate and total rejection as politically incorrect hogwash.

Working full time A system such as that comprising the aminergic neurons of the pontine brain stem must not only be ubiquitous in brain space and coordinated in brain time, but it must also be constantly active, twenty-four hours a day, seven days a week, 365 days a year for, in my case, eighty years. If we assume a mean firing rate of about 2 per second (aminergic neurons fire very slowly but they fire all day long) by my probably inaccurate calculation, that comes to something like 21 billion neuronal firings for each cell in my locus coeruleus, and each of those firings is silent and unperceived by my observing ego. Multiply this by a factor of 3,000, the approximate number of noradrenergic neurons in our brainstem, and we reach the astronomical number of trillions of noradrenergic neuronal discharges over a lifetime. That number approaches the magnitude of the US national debt. No wonder I so often feel tired. In this little thought experiment, I ignore these hard-working neurons’ brief time off in REM sleep when I dream. The unimaginable reliability of my brain demands efficiency as well as constancy. To achieve efficiency, my aminergic neurons use the same molecules of norepinephrine and serotonin over and over again. This spares them both structural and energetic waste. Instead of breaking down a molecule of norepinephrine or serotonin and throwing away the pieces, thus necessitating manufacturing a replacement molecule, norepinephrine and serotonin secreting cells reabsorb

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and reuse the molecules. This is done by an active physiological process called reuptake. Aminergic neurons just suck up their own juice and squirt it out again. Of course, even this recycling needs energy, but the energy required is much less that that needed for starting over from synthesis scratch. A drug which potentiates the aminergic neuromodulatory system is called a reuptake blocker. With amine reuptake blocked, the molecules of norepinephrine that have been emitted hang around in the synaptic cleft longer, continuing to exert their energizing effects on postsynaptic cells. To put it bluntly, one gets more bang for the aminergic buck this way. Because aminergic reuptake blockade is so often helpful, there are numerous drugs in existence that exert their effects on one or both pontine brain stem aminergic brain stem cell populations. There are relatively selective serotonin reuptake inhibitors like fluoxetine (Prozac), relatively selective norepinephrine reuptake inhibitors (like reboxetine) and purposefully mixed norepinephrine and serotonin reuptake blockers (like venlafaxine and duloxetine). The differences between these drugs may benefit one condition more than another but they all act in the same general way: they promote waking and demote REM sleep.

The joyous effects of amine reuptake blockade The relatively selective serotonin reuptake inhibitor (SSRI) fluoxetine (Prozac) makes normal people feel more optimistic, more outgoing, and more energetic. Soon after the Prozac craze began, it was said that you were at a competitive disadvantage in New York City if you were not on the drug. Normal Prozac freaks are like those naturally hypomanic New Yorkers with whom we relatively lethargic normals must interact and compete. Prozac makes them equal to their genetically upbeat peers. New York City certainly promotes and selects for highenergy folk. Prozac does not make you as high as amphetamine does, and neither does it make you as horny as cocaine made Sigmund Freud. The good news is that you do not get pharmacologically hooked on Prozac and you do not crash as hard when you stop taking it as you do with most popular street uppers. My colleague, whom I call Mr. Bibliography because he carried all his reprints in a backpack, could not leave home without Prozac. Off medication, he could not stop checking to see that his front door was

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securely locked. Amine reuptake blockers like Prozac are thought to help obsessionals by reducing their anxiety, but I suggest that, by suppressing sleep, they reduce the probability that anxiety and obsessional thought (two formal features normal to sleep), will emerge in waking. Amine reuptake blockers have also helped several young people of my acquaintance who were otherwise crippled by obsession and anxiety. Unfortunately, Rosella Campobello could not tolerate these drugs, so we had to rely on Catholic priests and psychotherapeutic romance to help her to stabilize her states and to function a bit more normally. Derrick Sutter, the man who tried to fly through the fire door window at Mass Mental Health Center, came along before Prozac was invented, and Francine Poppy bought her own amphetamine in the hospital cafeteria despite my objections. When I was younger, I was even more uptight than I am today. Like most doctors, I was a control freak, a socially successful obsessional who thought that each diagnostic category was a distinct disease that should be treated with one, and only one, drug. Now, in my dotage, I am more liberal and less critical but, I hope, more imaginative. I now believe that all psychiatric disorders are, in some way, neurological and that they all are characterized by a significant degree of state instability. Therefore, they can be treated by stabilizing state. I will re-echo this mantra in Part V.

Epilepsy and neuronal excitability Aminergic enhancement, whether it be by mimetic stimulation or by reuptake blockade, favors wake state functions and impedes sleep state functions, including dreaming. The brain–mind is, thus, “clamped” by the amines in a mode that favors conventional behavior. A similar way of thinking is involved in the prescription of antiepileptic drugs for mental illness. Antiepileptic drugs clamp the brain–mind by damping excessive neuronal excitability. A fundamental process that is enhanced in REM sleep is the epileptiform cell discharge associated with PGO waves and with eye movement related bursts of neuronal activity in REM sleep. On this view, REM sleep is a normally modified seizure, which may help to explain its normal protective function as well as the potentiation of epilepsy by sleep.

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Psychodynamic neurology can help us understand that epilepsy, as clinically defined, might simply be an extreme on a normal continuum of focal neuronal excitability variation. To help make this heretical assumption clear, consider the robust fact that normal REM sleep is caused by focal excitation in the pontine brain stem resulting in seizure-like discharges, which are transmitted to the temporal lobe. There, they ignite seizure-like firing of which the subjective concomitant is the dream. At this level of containment, epilepsy is normal. In fact, it is healthy and possibly indispensible. Why do antiepileptic drugs such as carbamazepine so often help psychosis? Because they reduce the seizure-like neuronal activity that drives the psychosis. The arbitrary line between neurology and psychiatry is, thus, seen to be imaginary, artificial, and undesirable. Epilepsy, like dreaming and schizophrenia, does not belong to any one field. All these conditions belong to all of us, and integrative considerations can help us to see this and, in doing so, also help us understand ourselves better. Mental illness and epilepsy are positively correlated with each other, another robust fact bearing on my presumed commonality of state instability in these disorders.

Narcolepsy and REM sleep behavior disorder Two conditions that make this state stabilization/anti-seizure point most specifically are narcolepsy and REM sleep behavior disorder (RBD). Both are disorders of sleep that result from the direct release of REM sleep phenomena into waking. They help to substantiate the idea that state boundaries are not impermeable. Until now, I have been discussing more subtle forms of state boundary crossing, but now turn my attention to these clear-cut flagrant examples. Both narcolepsy and RBD are seizure-like releases from inhibition of perfectly normal REM sleep processes. Narcoleptics complain of excessive daytime sleepiness, and, during waking, they are prone to sleep attacks accompanied by dreamlike mentation. These daytime sleep attacks are sometimes associated with a sudden loss of muscle tone called cataplexy, but cataplexy may also occur alone, indicating that disorders can be partial and very specifically linked to brain anatomy and physiology.

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The nocturnal sleep of narcoleptic persons is often disturbed by nightmares at sleep onset, by the interruption of sleep by waking with hallucinations, and by sleep paralysis (when affected individuals awaken from dreams). In narcolepsy, state boundary crossing, from sleep to waking and from waking to sleep, is prominent and self evident, not subtle and controversial. Narcolepsy underlines the points I am making by the flagrant crossing of state boundaries. In the hypnopompic hallucinations that occur on awakening from narcoleptic sleep, the upper brain REM dream process continues in waking. Mark Mahowald, the neurologist who, with psychiatrist Carlos Schenck, pioneered the study of RBD, has astutely characterized these frightening visions as dissociations. Putting a chemical clamp on REM and/or enhancing waking is essential to reducing dissociation in these cases. Amine enhancers do just that. Instead of the narcoleptic’s sleep attacks in waking, RBD sufferers lose the normal motor inhibition of REM sleep. They then may act out their dreams motorically with comical, but not always amusing, consequences. One RBD patient dove off his bed thinking that his bedroom floor was a swimming pool full of water. Another walloped his wife thinking he must swerve to avoid a dream car crash. Here, too, an aminergic boost can be life, or at least, wife saving. When I was growing up, we asked the incriminating question “Have you stopped beating your wife?” An RBD pugilist can only innocently answer “yes” after he has been cured of his sleep disorder. Dreams are often pugnacious (as well as anxious), so shutting down the fisticuffs, or at least confining them to dream imagery, may be a very welcome intervention. Keeping narcoleptic anger under control is especially welcomed by family members. Other people also appreciate the restraint of violence. Individuals hoping to achieve anger management from whatever cause should all have a trial on Prozac. I wish that that drug had been available when I struggled to hold my violence-prone psychotherapy groups together. Glen Just will advocate the direct psychological manipulating of one’s own dreams when I let him speak for himself in Part IV. By using self-hypnosis, Glen claims to have cured himself of nightmares (see Dreams, Creativity, and Mental Health, Just, 2012). Pre-sleep autosuggestion could, thus, be used to reduce the prevalence of dream fighting and inadvertent wife beating in RBD. As far as I know, this simple intervention has never been tried.

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Anger management The inverse of this approach was spearheaded by the psychologistturned-sleep-and-dream-scientist, Rosalind Cartwright, who published a series of studies showing that people undergoing divorce could lessen their negative affect by attending to its representation in their dreams (Cartwright, Agargun, Kirkby, & Friedman, 2006). As their dreams got better, they felt better, indicating a two-way street between the waking and the dreaming mind. Recently, the University of Manchester sociologist, Sue Llewellyn, is pursuing this idea with her theory of elaborative encoding (2013), according to which emotionally salient memories are reorganized in dreams. Scholars such as Cartwright and Llewellyn are convinced that Freud was right in postulating a meaningful rapport between waking and dreaming, although their models have dropped the disguise-censorship hypothesis that was at the heart of Freud’s theory. How can these interesting ideas be explored within the context of basic dream science? The similarities between REM sleep and waking at the physiological level are striking. The brain activation and self-stimulation of both states is enough to warrant the hypothesis that dreaming is a simulation of waking. The shift in emphasis from replay to rehearsal does not take away from the notion of continuity. It only changes the directional arrow from the one-way street of Waking to Dreaming to a twoway signpost that includes Dreaming to Waking. Highly specific evidence for the simulation of waking by REM has been studied and reported by Charles Hong, a scientifically sophisticated psychiatrist at Johns Hopkins University Medical School. A full discussion of Hong’s results can be found in Hobson, Friston, and Hong (2014).

Lucid dreaming Instead of firmly and sincerely believing myself to be awake, I can sometimes correctly assess my bizarre subjective experiences in sleep as dreaming. In what is then called “lucid dreaming” we have good reason to think that an increase in frontal lobe power might be the cause of our enlightenment. Or, put the other way around, our delusional belief that we are awake when we are actually dreaming is

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probably due to a decrease in frontal lobe power. This explanation is deeply satisfying because it is so specific and so plausible. The data are presented in more detail in “Ego ergo sum” (Hobson, 2013). For decades we have known that the frontal lobes are the locus of executive ego function. We need to activate our frontal lobes to exercise volition, to enhance self-reflective awareness, and to facilitate working memory, to list but three of our waking cognitive talents. Our frontal lobes are huge compared to those animals that we suppose are only capable of primary consciousness. Thanks to the work of scientists such as Ursula Voss, we now know that we do activate our frontal lobes whenever dreaming becomes insightful, that is to say, “lucid.” It seems likely to me that the benefits that Rosalind Cartwright observed in the dreams of divorcees were mediated by changes in the frontal lobes of her patients. In fact, it could be argued that the occurrence of lucid dreaming and its association with frontal lobe activation is a brain mechanism for insight generally. This brings common sense back into the psychotherapeutic picture at the same time that it recognizes the irrational impulses of dreaming. All dreams are a mixture of sense and nonsense, and lucidity just shifts the ratio in the direction of the sensible. Glen Just had never heard of the frontal lobes when, as a threeyear-old child, he spontaneously discovered that he could become lucid. It seems to me plausible to assume that Glen’s lifelong ability to enter hybrid states was a function of subclinical epilepsy. He was hyper-suggestible because his frontal lobes were hyper-excitable, just as the brain of epileptics is hyper-excitable. Come to think of it, epileptics are hyper-suggestible. Consider the famous case of the great Russian novelist, Fyodor Dostoevski: he was hyper-imaginative and hyper-graphic, perhaps because of temporal lobe epilepsy. We have known for more than a century that telling yourself to become lucid when you are awake and about to fall asleep helps you to become lucid when you later dream. In other words, it is not only chance that triggers this remarkable change. It is also waking volition that operates here. The trigger can be anything that makes lucidity more useful or more enjoyable, like wishing to alter dream emotion from negative to positive or anything making it easier to wake up, which always involves activation of the frontal lobes. In Part IV, I will give a detailed account of Glen Just’s selfdiscoveries and self-treatment. Now I turn to my own experience of a

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variant of dream lucidity to emphasize the extraordinary plasticity and dynamics of the waking and dreaming mind.

Flying dreams When I was enjoying a jet-lagged lunch with my host in a foreign city, I suddenly realized that my own flying dreams were evidence that my REM sleep brain activation was capable of inducing a completely convincing, but entirely fictive, sensorimotor experience. Furthermore, I noted that I had learned to fly in my dreams even though I had never really flown in waking. This insight is relevant to the skepticism, my own included, that the blind, deaf, and paralyzed subjects who claim to see, hear, and move in their dreams needs to be taken seriously. Their motivation, like my desire to fly, is fueled by wake-state observations. REM sleep dreams may be enough to support the vivid experience of performing those seemingly impossible acts. How could this be? My answer is that REM sleep dreaming is an extremely plastic brain–mind state capable of creating intense and vivid mental experiences. This reading of the subjective data goes a long way to reinforcing the basic idea that dream consciousness is a powerful preparation for wake state consciousness as well as a reaction to it. Dream consciousness is capable of generating fictions that cannot be experienced in waking. As such, it generates the subjective experience of behaviors which are generally useful, such as seeing, hearing, and moving as well as generating exotic experiences, such as flying, which are pleasurable but entirely imaginary. From these considerations flows a new theory of human imagination and creativity in the production of a wide range of things including works of art, inspiring visions, and, of course, mental illness. It was not a good idea for Derrick Sutter to assume that he really could fly even if his impulse to get away from me and the mother from whom I was trying to separate him was understandable. He was anxious, intolerably so, because I was threatening to cut him off from his ego life-support system. His dream world was suddenly there with him in waking. Of course, when he hit the wall of reality in the solidity of a fire door, he had a rude interruption of his waking dream. This cruel blow may also have contributed to his subsequent suicide,

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two weeks later, by hanging. I wish I had been able to give him carbamazepine as well as naïve and entirely unsupported advice about leaving home. After fifty years, I still suffer from remorse and guilt about this tragic event. Perhaps Derrick Sutter was doomed to a life of misery by factors far beyond my control. I am conceited enough to think that I could have been more helpful to him if I knew then what I know now. I would at least have been modest enough to do less harm. Jane Hitchens, already an artist when she joined my group, said she learned to fly higher with my encouragement. Every one needs to learn flights of imagination and dream awareness is a great instructor. This view of the healthiness of creativity is inspired by neurophysiology. Generally thought to be reductionistic and stuffily demystifying, brain science may be every bit as liberating as insight oriented therapy is popularly supposed to be. Indeed, insight itself may be a function of altered neuronal excitability. I wanted to learn to fly in my dreams because I have always envied birds. They soar in the sky, apparently weightless, high over the trees and the fields that I enjoy walking through when I am awake. I have climbed trees and many mountains, but the closest I ever came to flying was doing running front somersaults in the air or diving from a springboard into a swimming pool. Those activities were rewarding but my brief flights were nothing compared to those of birds. Furthermore, my flights were always risky and never even apparently weightless. Awake, I always landed with a thud on the ground or hit the water with a painful slap. Birds never did either of those things. Oh, to be a bird, if only in my dreams! My own early experiments with dream flying were fraught with unnecessary effort and unwarranted peril. I first dreamt that I had to run along the ground, slowly gathering speed like an airplane taking off from a runway, and flapping my arms up and down, like a bird leaving its perch. When, to my amazement, I did ultimately become airborne, I worried about hitting the electrical wires around my dream field and becoming entangled in them, or worse, electrocuted. I hardly need point out that during these practice dream flights, I thought I was awake. It was not until much later that I became aware that I was dreaming when I was dreaming, a state of consciousness called lucidity or lucid dreaming. Nonetheless, I was quite pleased, not to say exhilarated, by my modest success.

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Gradually, I learned to fly fearlessly in my dreams and without unnecessary exertion on my part. In my dreams, I became a bird, sailing through the dream air without a care in the world. I was like a blind person to whom sight is restored, or a deaf mute who can miraculously hear. Most obviously, I was like the paraplegic who was able to move without having previously been able to do so. I say “most obviously” because I did already move (as well as see and hear) in my dreams even though I was lying quite still asleep in my bed. In other words, I was simply gaining recognition that my dreams were capable of simulating and even of surpassing my waking experience. Why then not exceed simulation and move beyond waking reality into the territory of imaginative fiction? My acquisition of fearlessness and effortlessness in dream flying did involve something like lucidity. In my flying dreams, while still considering myself to be awake, I would say “forget about those wires” or “try to take off without flapping your arms” and, lo and behold, the wires and the arm-flaps simply disappeared. Then my flight was actually better than that of a bird. I flew genuinely weightlessly. It was a wonderful feeling. When I later learned about lucid dreaming and became able to induce flying dreams voluntarily as well as incidentally, I naturally perfected and indulged my penchant for dream flying. The point here is to agree with my colleagues, Stephen LaBerge and Tracy Kahan (1996), that non-lucid dreaming is never entirely non-lucid. Some degree of wake-like conscious awareness is present in all dreams. This is the corollary of the recognition that some degree of dream consciousness is always present in waking. Where would we be without fantasy and imagination? From a scientific point of view, this means that we are not only capable of manipulating the several states of consciousness, but we are also capable of investigating the brain mechanisms underlying those states and their voluntary control.

The ego and the frontal lobes Ursula Voss has recently done a factor analytic study of dream lucidity in 600 German school children. The factors that are most prominent are all frontal lobe mediated, executive ego functions such as reality assessment, logic, and abstract thinking. These are the same functions

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that we aim to bolster in ourselves and in our patients. My Munich psychiatrist colleague, Martin Dresler, has argued that the frontal lobes may be the seat of insight, a bold hypothesis of the new psychodynamic neurology. The association of dream lucidity with a wide variety of enviable mental states is an important aspect of the treatment story that I have emphasized throughout this book. For the purposes of a focused formulation, I will restrict myself to a discussion of the apparent capacity of REM sleep dreaming to instill a convincing simulation of those skills that subjects wish to enhance in waking. There is no reason to suppose that their REM sleep dreaming is any more or less plastic than my own, or of any other lucid and non-lucid dreamer. In fact, these handicapped persons are no different from all of us in possessing a pluripotential brain–mind capacity. Most blind, deaf, and paralyzed subjects have what we might call “end organ” defects. Most blind cannot see because there is something wrong with their eyes. Most deaf cannot hear because there is something wrong with their ears. And most paraplegics cannot move because there is something wrong with their spinal cords. But they all probably have perfectly intact brain stems and perfectly intact thalamocortical brain systems, so they could, on those grounds alone, see, hear, and move fictively in their dreams if not in reality (in the waking sense of the word “reality”). In other words, many handicapped persons have input–output defects but no problem with the central brain activation or modulation mechanisms that are known to be crucial to brain–mind state control and to dreaming. The fact that most blind, deaf, and paralyzed claim to see, hear, and move in their dreams is nonetheless surprising and informative. If we take these subjects’ word for it, and we have no reason beyond our own ignorance not to do so, we are faced with the necessity to change our neuropsychological theories very dramatically. Dreaming is not simply the replay of waking experience, it is also the pre-play of anticipated waking experience. Part of the expectation is probably genetic and part is probably environmental, but, whatever that mix might be, there is in dreaming a very impressive talent for a synthetic simulation of waking. But how are the images actually realized if the subjects have no veridical sense experience? Might they not translate the nature of vision

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from the auditory reports of normally sighted persons? This possibility is supported by the emphasis placed by Helen Keller on the sensations of wetness and coolness when her teacher immersed her hand in ice water. The word “water” was suddenly endowed with “wetness” meaning. Blind persons may see in their dreams via a similar transformation from one sense modality to another. The blind person’s brain has heard others describe seeing in waking. Thus, they know that vision exists and they know how it is described. Might they not match the activation of virtual vision with their hearsay knowledge of seeing? With respect to what brain mechanisms might be driving this process, I remind you of my theoretical characterization of dreaming as a product of brain activation and synthesis. The germs of this idea were two: by activation was meant the turning on of the brain in REM sleep; by synthesis was meant generation by the activated brain of its own information and the integration of that information into a story using experiential data as well as the internal stimuli. In 1977, when the activation–synthesis theory was first put forth, emphasis was placed on the relatively random or chaotic nature of the activation process. The main point of the random-chaos principle was to contrast the new theory with the disguise-censorship hypothesis of Freud. According to Freud, the dream was a transformation of unconscious infantile wishes into the only apparently meaningless story that might later be recalled and recounted in a dream report. Activation– synthesis theory also challenged the Freudian claims that the analysis of dreams was scientific and that their interpretation could lead to the resolution of neurosis. Since 1977, abundant new evidence about conscious state generation has accumulated. It has become clear that REM sleep generation is not so much a random process as a chaotic one that reflects the activation of a brain stem neuronal network that is essential to the sensorimotor integrity of consciousness in both dreaming and in waking. It is not random because it is not entirely due to chance. It is chaotic because of its predictable unpredictability. This difference in meaning between randomness and chaos is important here. Edward Lorenz summed up the chaos theory in a safer way by defining it as “when the present determines the future but the approximate present does not approximately determine the future.” All perceptual possibilities are taken into account by envisaging scenarios in dreams that never took place and might never take place. Chaos

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is, thus, our friend and ally, not our enemy or nemesis. It gives us versatility and creativity at the same time that sensation gives us accuracy. The concept of dreaming as a state of protoconsciousness reinforces this view by insisting that the activation, in sleep, of brain stem sensorimotor circuitry is a chaotic (and meaningful) rather than a random (and meaningless) event. The system might have evolved by chance and is, in this sense, random, but the intrinsic chaos is purposeful in that it guarantees reliability and redundancy. Every possible movement and every possible sensory stimulus set in the virtual reality array has an equal chance of activation within the constraints of epigenetic possibility. A further constraint is imposed by experience but dreaming can be considered as a variation on the theme of the virtually possible. Whether the generator is random or chaotic hardly matters to the dream interpreter. He wants to suppose that all dream content is meaningful in the emotional sense of the word. I would assert that it is the job of the brain to attribute meaning even to chaotic or random stimuli and that the dream, as it is reported, may, therefore, be of considerable interest as a mental product. However, I would insist that, at its root, REM sleep is not driven by neurons that are much concerned with hermeneutic meaning. Far from being meaningless, dreaming is our subjective awareness of a more important and basic brain function than literature or poetry could ever imagine: sensorimotor integration. The consequences for dream theory are that instead of the unconscious wishes of Freud, we now specify the activation of neuronal systems underlying sensorimotor integration as the dream stimuli. Of course, the synthesis part proceeds at a much higher level of the brain than the brainstem generator: the thalamocortical system creates a meaningful integration of the brainstem signals with the neuronal representations of perception, cognition and emotion. This restores to the dream its attraction to psychologists who may wish to examine dream content for evidence of the ways that people have of synthesizing stories about themselves. We are, thus, enabled to do away with the questionable Freudian distinction between latent and manifest content and the equally dubious suggestion that dream symbolism was gotten up in the mistaken assumption of a need for disguise. Clearly, activation-synthesis, as amended, is every bit as opposed as it ever was to Freud’s disguise-censorship hypothesis.

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To credit Freud with the discovery that all mental processes are integrative is to miss the point entirely. For Freud, the essential point was embodied in the notion of defense. In this respect, he likened dreaming to neurosis, the function of which was also to disguise true meaning. For activation-synthesis and its updated AIM hypothesis, what you see in the dream report is what you get. The dream, as a subjective experience, reveals rather than conceals the dreamer’s motives. The dream is the undisguised readout of brain activation and synthesis in sleep. That activation and that synthesis are similar to those of waking, while the important differences between waking and dreaming are best understood by neurophysiology working handin-hand with psychology. Neither brain science nor introspection can do the job alone; both are needed if dreaming is to be properly understood. Surely no one, not even Sigmund Freud, would assume that the blind see, the deaf hear, and the paralyzed move in their dreams because they have concealed infantile wishes or that they harbor concealed adult wishes to perform those activities of which their handicaps deprive them. Of course, the handicapped want to see, to hear, and to move, at least as much as I want to fly—and very probably more. The point here is that we all possess the latent capacity to generate those experiences. That capacity, like dream motivation itself, is revealed, not concealed, by REM sleep dreaming. We know these things thanks to experimental research on the brain and not to speculative philosophy.

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PART III

Psychodynamic neurology: sample cases

here are three major clinical conditions, obsessive-compulsive disorder (OCD), major affective disorder, and anorexia nervosa, all of which may respond favorably to biogenic amine reuptake blockade. This does not mean that these three psychiatric conditions are the same, but it does imply that even very different conditions may share a propensity that makes each of them worse. I suggest that that propensity is state destabilization. I go on to entertain the hypothesis that state destabilization not only makes each of these conditions worse, but that state destabilization may well be a critical aspect of their pathogenesis. According to this view, the tendency for dream elements to enter waking is common to many, if not most, psychiatric disorders. This hypothesis is consonant with the assumption that waking and dreaming are two mutually enhancing states of the brain–mind the differentiation and separation of which is never complete or even easy to achieve. Thus, this view is in keeping with Freud’s conviction that all of consciousness is a compromise between consciousness and what he called the unconscious (implying, for Freud, the dynamic repression of infantile wishes). A failure of compromise was so probable as to be essentially universal. Dreaming is universal and it is universally

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psychotic, but it is not so much a compromise as a necessary component of consciousness which must be confined to sleep and that is not always possible. I now consider three common psychiatric problems in terms of this state instability concept.

Obsessive–compulsive disorder (OCD) This condition is entirely compatible with protoconsciousness theory and with psychodynamic neurology. Indeed, there are many reasons for liking the idea that OCD is a very good exemplar of protoconsciousness theory. The first reason is the virtually ubiquitous love of order that may be better considered a universal and serviceable habit than as a pathological symptom. Like anxiety, the love of order can get out of hand and, when it does, it can become crippling, as in the case of Rosella Campobello. Glen Just, whose story will be told in detail in Part IV, recounts his adolescent encounter with OCD, and, using principles akin to my behavioral treatment of OCD victim Rosella Campobello, mounted a rationalistic counterattack by which he mastered OCD via conceptual override. When I was eleven years old, I became convinced that I must not step on a sidewalk crack. The more I walked the streets of Island City in the summer the harder it became to proceed without fear. The cracks in the sidewalk gradually took control of my mind. It got to a point where I couldn’t step on them; I had to carefully step over each separate crack. Head lowered, and walking gingerly, I slowly made my way down the street. Before the summer was over, I looked like a kid playing hopscotch. The cracks had total control, and no matter how hard I tried I couldn’t get free. Every time I approached the sidewalk, my gaze would be forced downward searching for the first crack. Each succeeding crack held my undivided attention until I was able to exit on nearby grass or gravel.

Glen Just comments, By age 11, I had considerable experience separating mind and body. My 11 year old body was controlling my behavior and my Controller resented it. In these early years, behaviors just seemed to come out of the “Black Box” on their own. But, I was learning to use my mind and

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body to overcome these obstacles. Initially, behavioral conditioning seemed inevitable, using my adult language that is, but becoming a slave to environmental forces was not acceptable.

It makes sense to design a brain–mind that is orderly. The patterns of thought, feeling, and behavior that emerge in development must, therefore, be stereotyped, predictable, and normally reliable. Our early intrauterine brain calisthenics are, thus, likely to be reliably repetitive and even unimaginatively iterative. Indeed, the mindless repetition of motor acts is the flip side of imaginativeness, originality, and creativity; order and disorder are equally important, although deeply contradictory. We set ourselves the impossible task of being both reliable (automatons like Rosella Campobello) and innovative (artists like Jane Hitchens, and scientists like Mr. Bibliography and me). No wonder we sometimes get into trouble. A young man I know named Martin Hoskins was in deep trouble because he felt obliged (read compelled) to break all the rules in order to realize his individuality. He said he wanted to be an artist but he behaved more like a nascent criminal. He was so preoccupied with originality that he could not produce even a self-serving degree of orderliness. My decision to focus on this topic now is related to my surprise and delight at hearing my neurologist wife discourse so eloquently about a condition that she regards as psychiatric. I say to myself that OCD is actually a neurological condition that is arbitrarily and irrationally assigned to psychiatry. Why do I say that? Because Sigmund Freud made such a grandstand move in adopting it and fitting it out in unconscious garb in the heyday of psychoanalysis. I refer to his assumption that obsessive-compulsive symptoms were always the expression of incomplete repression of aggressive impulses. Sure enough, Glen Just was rebellious; Martin Hoskins, whose case is described below, has severe anger management problems and so did his father, his uncle, and his grandfather, but none of the other Hoskins men is bothered by OCD. There must be more to this story than repressed anger.

Martin Hoskins Martin Hoskins was the sixteen-year-old son of Italo-American colleagues of mine. Martin was one of a pair of fraternal twins who

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were born when his parents were living in America. Besides the usual problem of tension between an adolescent and his parents, he was in conflict because he was torn between two cultures, liberal America and conservative Italy. Martin was troubled by these conflicts and his distress was not helped by the relative authoritarianism of his liberal American father and the permissiveness of his more deeply conservative Italian mother. In an important way, his was a hybrid personality, which hovered uneasily between the poles of anxious fear and explosive rage. Martin’s mother stunned me by saying that she herself had the OCD trait but not the state (as if she had contributed the OCD trait gene and her husband contributed the anger management gene), a fatal one-two punch for Martin. I wondered about Chiara Perugino, who also got all her genes from her mother and her father. Her father was an Italian colleague who warned me about the untrustworthiness of intellectuals in a Sicilian café one day long ago. He was as paranoid as he was obsessional. It occurs to me that many people have the OCD trait on genetic grounds, but its development into a state depends upon environmental conditions. On that view, Chiara Perugino, whose case I present below, only became clinically anxious because her mother was never there to reassure her. Maternal soothing was also denied to both Rosella Campobello and Martin Hoskins. They express the OCD trait (which we all share), as a state (which most of us are spared because we were adequately reassured and soothed as children). OCD folk have the state and the trait, whereas the rest of us have only the trait. The trait, if such exists, was waiting for Martin’s father’s inevitable sex education talk, which backfired badly. Martin’s dad was well meaning; he mainly wanted both to protect Martin from Madonna worshipping Italian women and to instill a sense of paternal responsibility. Like Rosella Campobello, Martin reacted with concreteness and panic. He fixated on the fearsome stories of homosexual practice that his father had been told by a frequenter of New York bath houses, stories for which Martin was totally unprepared. Poor Martin couldn’t stop thinking that he himself was gay and that he was doomed to a life of mad and abusive homosexuality. In point of fact, Martin Hoskins was extremely manly and the darling of both his female schoolmates and their mothers. In that sense, his father had been right to be concerned about Italian women, but the fear of homosexuality

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was completely unfounded. Significantly, Martin’s symptoms were much relieved by his sexual intimacy with a girlfriend. At first, Martin could think of nothing but his imagined gay calling. He was truly obsessed and could not concentrate in school or do his homework in the evening. In addition to his paralysis by his homosexual obsessions, he became compulsively aggressive, an aggravation of an anger management difficulty that he had evinced since childhood. It was as if he needed to assert himself vociferously and provocatively to reassure himself and others that he really was a man. That there was a strong constitutional factor in Martin’s case was evidenced by his fraternal twin brother’s relative immunity to all of this sturm und drang. Instead of reacting with agitation and disruption, his twin brother was both calm and hyper-responsible. He was truly his obsessive brother’s keeper. Martin was made less anxious and less obsessive by the antipsychotic tranquillizer, Abilify. Unfortunately, this medication also made him lethargic, but he could not tolerate Prozac so his state had to be stabilized in a chemically more powerful way. The exact mechanism of action of Abilify is unknown but there is speculation that it interacts with dopamine and serotonin. Martin’s psychotherapy was helpful by enabling him to come to grips with his deep fear of his well-meaning but inept father, with whom he was finally able to make an alliance when both promised to be more affectionate to, and supportive of, each other. Martin and his father agreed to a set of guidelines for civility. Reward was tied to civility and restriction of freedom was tied to rudeness and loss of temper. A sports program was put in place to siphon off anxiety and aggression. In Martin’s case, as in so many others, state stabilization was achieved via a combination of chemical and psychological restraint. Unfortunately, Martin’s social world tempts him to break rules as obsessively as to obey them. The Glen Just story, told more fully in Part IV, is supportive of this concept. Glen Just might well have had an innate propensity for compulsive behavior as well as for dream and conscious state plasticity. But his major symptoms, including the ghost hallucinatory apparition, the nature mysticism, and all his sleep-dream alterations needed maternal negligence to bring them out into the open. I realize, as I write, that I risk creating a new Good Mother/Bad Mother myth or paradigm. I regret this echo of the double-bind theory

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of schizophrenia, and I hasten to point out that I am aware that my own model is based on far too little clinical evidence. I present it only as a theory that unites my scientific discoveries and my personal and clinical observations. The scientific evidence for the theory includes the psychotic nature of protoconsciousness and of dreaming. I have written, with my tongue in my cheek, that you have to have a mind in order to go out of it. In other words, you can’t go crazy unless you have the big, complex brain that we humans carry around in our heads. In other words, psychosis requires the sort of mind that goes with big, complex brains like ours. Our pets may be made neurotic but they do not appear to be troubled by psychosis. To this maxim I now add the idea that in order to have a mind you need the propensity to go out of it. I know that sounds like a pair of linked truths and a paradox to boot. Let me try to unpack it for you, this time from the protoconsciousness side up. The concept of virtual reality is crucial to appreciate and understand here. 1.

2.

3.

4.

To perceive, you must be able to anticipate what you might see. Hence, much of vision is internal and antecedent to seeing. This is an element of protoconsciousness and it is clearly instantiated in dreaming. This last statement follows all of the following principles and will not be repeated. To perceive an external object and identify it as such, you must also be able to think. To think, or to believe, you must be equipped with logic, language, and myth-making propensities. These, too, are built-in skills and they function to organize experience, but they are not created entirely by experience as we have tended to assume. Dreams are powerful examples of our myth-making talent, but dreams are relatively weak in logic and language. To feel emotion, you must be equipped with a set of primordial feeling states. Dreaming clearly elucidates the importance of anxiety (fear), aggression (anger), and joy (elation). We learn the environmental situations in which one or another of these preconditioned skills is appropriate, but those situations do not teach us to have those feelings. We know them a priori. Immanuel Kant, please take notice. The three cognitive factors listed above (and others) must be integrated for the brain–mind to function as a unified whole. This

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is a challenging task, sometimes referred to as “binding”, meaning tying together. The brain is genetically and epigenetically equipped to perform this integration. It would appear that nature outfits the emerging brain-mind with a state control system by which it can vary these functions in intensity and relationship to one another. This variability is seen as the states of waking, sleeping, and dreaming. By studying sleep and dreaming, we hope to gain insight into the nature of intrinsic brain-mind processes such as those few outlined above. By studying function and dysfunction, we may be able to better understand and treat so-called mental illness. (So called because by now it must be clear to you that every mental illness is also a brain illness.) We need a new word for brain–mind but, until it evolves, our use of the word mind always includes its embodiment in a brain. I personally believe that while most persons accept the concept of brain-mind integration, they still harbor a profound dualism. I hear this all the time when I watch sports events on television. The commentators repeatedly refer to the mental aspects of behavior as if they were somehow disembodied instead of the subjective aspect of an integrated process. The belief in the causality of consciousness is near universal. The brain substrate of consciousness is reasonably considered to be causal but consciousness is never as disembodied as many people are prone to believe.

OCD and protoconsciousness In order to guarantee that certain desirable behaviors will occur, it makes sense to over-program them early in development and then, later, to limit their occurrence via selective inhibition. A strong example is the desirability of checking to be sure that all is in order before leaving any place, especially one’s house. I ask myself, “Do I have my keys? Is the door locked?” If I am about to take trip, “Do I have my train or plane ticket?” If I am going abroad, “Do I have my passport? Do I have enough money? Do I have my slides (or my Powerpoint AV programs)?” These are all important questions, and it may be wise to ask them two or three times, even though it might seem a bit silly to be so cautious. But a person with OCD may need to check twenty times and

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still feel anxious. This is so time-consuming and attention demanding that it is virtually impossible to do anything else. We like to have clean hands, so we wash them several times a day, whereas the OCD victim can never leave the bathroom because the hands may not be really clean. Chiara Perugino had to vacuum her room, as I will detail when I describe her case of anorexia; Rosella Campobello needed to go to confession; Glen Just could not step on sidewalk cracks; and Martin Hoskins needed to disfigure himself, all to ward off the anxiety that raged out of control for want of soothing, the reassurance by his rarely present mother. He needed to think that everything was all right (even if it really wasn’t). Soothing is a very hard act to imitate for one’s self, but it can be done, as I will explain anon. Let us first consider dreams. Dreams can serve as reminders of our earliest protoconscious experiences. The common dream genre that I call “incomplete arrangements” is a proto-OCD phenomenon. In my incomplete arrangement dreams, I am often unprepared for my exam, in the wrong room, inadequately dressed (or even naked). I might dream that I will miss my train, boat, or plane because I am afraid that I left my passport at home or because I am disoriented and don’t really know where I am, why I am there, or who is with me. All too rarely, my dream companion is my mother holding my hand. In dreams, anxiety and disorientation conspire to produce OCD-like attacks. These attacks do not usually assume nightmarish proportions with panic anxiety but they sometimes can. The point here is that a perfectly normal experience, dreaming, can assume the quality of a condition like OCD. We consider OCD to be abnormal when it occurs in waking. Dreams are normally disoriented, an intrinsically unpleasant feeling. Dreams are normally anxious, which most people do not enjoy either. We soothe ourselves when we say, with relief, “it was only a dream.” But why can’t dreams sometimes occur in waking? They can, and dream-like features often do. An intrinsic obsessionalism is even more evident in sleep when sleep is associated with EEG slow waves and fewer eye movements than in the brain-activated state of REM sleep (the brain state that is associated with the most vivid dreams). The fact is that mental activity in EEG slow wave (or non-REM) sleep is classically perseverative, non-progressive and ruminative. Ideas go on and on,

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accompanied by the conviction that they are important and demand action. On awakening, these sleep ideas seem fanciful, useless, or even embarrassing (if they are remembered at all). This double-take is also made in waking when we suppose, illogically, that we really must do something. We are behaviorally compelled, resulting in compulsions, and our obsessive thoughts participate in the compelling. When we have insight, our obsessive–compulsive exigencies seem altogether silly, embarrassing, and may be easily and rationally discarded. It is not far from sleep obsession to the waking conviction that one’s hands need washing (again), that one’s dorm room needs vacuuming (again), that one must go to confession (again), or that I must not, repeat, must not step on a sidewalk crack. It is true that each of the wake state examples cited here is associated with other thoughts or feelings of unacceptability, anger, or social opprobrium but not all obsessions obey this rule. One of my colleagues feels obliged to carry two large shoulder bags full of reprints wherever he goes, as if he wished to be prepared to answer demands for documentation. He is the Mr. Bibliography whom you have already met and his propensity to carry data on his back is very useful, up to a point. Coupled with superior intelligence, he would seem to have a bright scientific future, but his compulsiveness gets in his way. He tells me that without Prozac (see below) he could not function at all. If he were not so open with me, I would never guess that he was handicapped at all! The excessive invasion of waking by traits that are incubated in sleep is, as with so many other psychiatric problems, the theme of OCD. In every case, the person is faced with too much of a good thing: the hands are clean, the room is vacuumed, the sins are confessed, and the irregular junctions between sidewalk blocks are avoided, but these behaviors, however useful in moderation, take over and make life difficult for the OCD patient, his family, and his friends. It is difficult here, as elsewhere in constructing new theories of psychopathology, to determine which is cart and which is horse or whether there is any causal connection between the shared formal features of waking and dreaming or any other pair of states. Nonetheless, the occurrence of shared formal features must be noticed, dynamic models must be articulated, and evidence for and against such models sought.

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Treatment results as they bear on causal models in OCD The most clear and concise causal model in OCD is that a propensity to obsession and compulsion is natural and universal. This normal “trait” is manifest in the obsessive and compulsive phenomena of sleep. The trait is held in check by reducing the drives of anxiety and aggression (two of the three leading affects in REM sleep dreams). The best way to reduce anxiety and aggression is by soothing during early life. The most effective agent of such soothing is the mother or some other, preferably female, caregiver. A male can serve as an effective caregiver but males are not naturally soothing and must be trained, against their nature, to be effective caregivers in this soothing sense. Men and women are hormonally different in ways to which political correctness is not sensitive. A problem today is that politically liberated women are more inclined to need soothing themselves rather than to offer it to their loved ones. When soothing is inadequate, there is a tendency for excessive obsessions and compulsions to emerge in waking life (along with anxiety and aggression). Of course, the strength of these traits and their countervailing forces are not exclusively environmental. Genetic and epigenetic factors are at work here, too. Nevertheless, the stronger the organic force from within, the greater the demand on the environmental system to inhibit or compensate for symptom formation. A symptom is defined as a behavior or a subjective experience which exceeds the level normally tolerated by societies or individuals. Families are the first line of defense against symptom formation and mothers carry the heaviest defensive burden against symptom formation within families. This is the inverse of the double-binding mother: now, if she is politically liberated, the mother herself is in a double bind: how can she leave her child and be with him at the same time? The answer is that she can not. Once symptoms emerge, professionals are usually consulted. Professionals tend to be of two types: pill-pushers and psychotherapists. For legal reasons which make good sense, pill-pushers tend to be MD psychiatrists; they have a wide variety of chemical agents at their disposal and we will focus below on one class of chemical, the biogenic amine reuptake blockers, which have known and pronounced effects upon the brain–mind and its conscious states. Consideration of chemical remedies helps me make my point about the causative role

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of brain–mind state imbalance in symptom formation and rebalancing in remediation. Psychotherapists tend, increasingly, to be young females who have a natural propensity for maternal soothing. That is good news for the patients but not such good news for the natural children of a female psychotherapist. This is because she can not be at home and at work at the same time. Even if she has her office in her home, access to her is compromised. To compensate for her absence, she may try to spend “quality time” with her offspring, but instead of being a calm and reassuring presence she is naturally prone to overdo her mothering and, instead, perform smothering. Smothering is, in this case, metaphorical but, when driven by rage, it may become literal, as Glen Just attests in Part IV.

Depression Compared to our most ecstatic states (such as our youth, our social success, and our sexual delight), we are all a little bit depressed—and tired. As life goes on, this process increases. So, depression is universal and the energizing effect of Prozac on the catcher-upper New Yorker is understandable. What does not quite make sense is that amine reuptake blockers like Prozac are marketed as “antidepressants.” They are antidepressants and that is why the Federal Drug Administration insists on labeling them as such. The FDA is like the medical student me: there are specific diseases and each of them requires specific treatment. This is laudable enough, but it is also conceptually misleading. In order for you to get Prozac from a physician (because psychologists, by law, cannot prescribe drugs) you must be labeled as depressed. Not just a bit over the biological hill and tired, but clinically depressed. Innocent, well-meaning doctors thus fall into the trap of over diagnosing depression and make a mistake in doing so in order to prescribe a drug that the doctor supposes may help the patient (who might really just be a tired person). Clinical depression is properly diagnosed when energy is at such a low ebb that affected persons are functionally disabled. They complain of feeling sad, hopeless, and helpless; they have insomnia but can not get out of bed; they have lost their appetite and do not eat

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enough to maintain body weight. They often are convinced that they have a somatic disease (like cancer), say that they want to die, and are tempted to take their own lives. Many are paradoxically agitated, pace relentlessly, and experience intolerable anxiety. Now I ask you: how many persons now on Prozac have five or more of these symptoms? Very few! The result of drug availability is a massive increase in the diagnosis of depression leading naïve journalists to report that modern life is depressing; just look at how many people are diagnosed as depressed. My alternative view is that the diagnosis of depression is over-applied in order to justify the provision of the pills to people who are tired and a bit down in the mouth but not clinically depressed. In other words the experiential cart is placed before the pharmaceutical horse. If you doubt my theory, please consider the following evidence. At Harvard’s Massachusetts Mental Health Center in 1928, the percentage of psychotic patients diagnosed as manic depressive (now called major affective disorder) was about fifty. After the introduction of Thorazine for the treatment of schizophrenia in 1955, the percentage of people diagnosed as depressed plummeted to about ten while the percentage of those said to be schizophrenic soared to ninety. Why? You know the answer: Thorazine was thought to benefit schizophrenia. In order to get Thorazine, you had better be labeled schizophrenic. Today, it is just the reverse: patients are seen as depressed. Why? The answer is Prozac. The moral of this story is that treatment drives diagnosis and the availability of a new drug can be a powerful force in the way that we perceive psychiatric conditions. But are we all depressed? Can we not simply be old and tired? I feel old and tired but I am not more than a little bit depressed. The universality of traits such as tiredness should not allow us to pathologize ourselves, to commit ego murder or ego suicide in order to get a pill. The social, moral, and philosophical implications of the current psychopharmacology debate are profound. In what follows, I will shamefacedly walk both sides of the street: I will continue to explain why amine enhancers are so effective and, at the same time, I will counsel restraint in their use. Maybe it is the old conventionalism of my youth popping out again in my old age; I hope not. I hope it is a more sophisticated form of naturalism that has been inspired by years of clinical experience, personal adventure, and maybe even a bit of reflective wisdom. Yes,

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you are at a competitive disadvantage if you are a New Yorker who is not on Prozac, but have you stopped to think about the ego murder of competition and the ego life of self-reliance? Are you Lance Armstrong or are you Henry David Thoreau? With care, you can be a little bit of both. Cycle fast (but not too fast) and walk slowly (but never stop!). Listen to Glen Just, who speaks loud and clear in Part IV. By blocking the reuptake of norepinephrine and/or serotonin, Prozac and its cousins drive the brainstem sleep–wake system in the direction of waking. After about two or three weeks on the drug, depression ratings may begin to improve. Right away, and as a necessary consequence of the aminergic enhancement, REM propensity is decreased. When we gave drugs like this to human subjects, they soon reported a decreased incidence of dreaming, but, already the intensity of the dreams they did report was increasing (as if the system was fighting back to maintain its important functions). I need to REM and, if a drug tells me to REM less, then I will REM more intensely. The set points of the aminergic and cholinergic systems may change significantly but reciprocal interaction cannot be entirely eliminated without killing the individual. In our studies, we recorded subjects sleeping at home. In the laboratory, more precise and more extensive physiological measurements can be obtained. Sleep lab studies have shown that untreated depressed people sleep poorly. They evince less deep early night NREM sleep and an earlier than usual time of onset of REM sleep. This early first REM period might be longer and stronger that usual. Subjects with this profile were likely to have a good mood response to amine reuptake treatment, which reinforces the idea that sleep profile and mood are closely linked processes. With sustained treatment, however, it was often observed that depressed subjects had more than the usual number of eye movements in so-called NREM sleep. These subjects often complained of “epic dreaming”, intense oniric activity that went on and on, all night long. These epic dreams could be unpleasant and the sleep associated with them was less restful than usual. The link between REM, dreaming, and mood was, thus, clearly mediated by the amines. Amine-sogged folk often begged their doctors to turn off the dream machine so that they could get a good night of sleep. I emphasize all these points to assure the reader that my theoretical musings might not be simply pipe dreams but are instead based upon a solid physiological foundation. There is no philosophic

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speculation involved here. For a variety of good moral and technical reasons most direct tests of my protoconsciousness theory are currently impossible. With expected technological innovation, however, direct tests in human animals may become possible. I will probably be dead before an electronic microelectrode or a high spatial resolution imaging apparatus is invented, but I confidently predict that such new tools will emerge before the end of the twenty-first century. Many of my colleagues insist on my testing the theory now to justify my scientific claims. Since I no longer compete with them for grants, I can afford to blue-sky a bit and hope to infect younger people and non-scientists with my ideas. One doable experiment would be to give a wide variety of normal subjects low doses of amine reuptake blockers and track their sleep, their waking cognitive skills, their dreams, and their mood over time, say six weeks or even three months. I would predict that such subjects would soon know whether they were on a drug vs. a placebo because those on a drug would feel more alert and more energetic by day. Because of the known changes in sleep and mood over time in depressed subjects, such a study might most easily be pursued in New York City, where competition for inflated bonuses is still keen. Such a study would be useful in establishing the time course of changes in the various measures of brain-mind state. Time course of the drug effects is of more than academic interest for reasons hinted at above. There is a time lag between the sleep effects and the beneficial effects on mood when the drugs are used clinically. I have discussed possible mechanisms of this fascinating time lag in previous writings. Suffice it to say here that, in line with protoconsciousness theory, the changes in sleep precede the changes in mood. We sleep to prepare for tomorrow as much as to recover from today. More boldly, I would hypothesize that we sleep more for our future than for our past and that, until now, we have mistakenly believed just the opposite. Another reason for needing to know about the time course of amine reuptake blockade is to be able to evaluate and respond to changes in subjective experience as the brain adapts to such a major intervention as clamping its state control system with drugs. Patients are understandably reassured when side effects are understood and explained physiologically. They can decide for themselves whether any given course of treatment is tolerable as well as beneficial. Rosella

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Campobello could not take SSRIs at all. She claimed that medicine made her worse. Other patients, like Mr. Bibliography, stay on Prozac for years and will not leave home without it. Obviously, genetic diversity plays a role in determining response to a treatment that matches its contribution to health with its propensity for fostering dysfunction. We know almost nothing about the basis of the enormous individual differences that are observed in these studies. The good news is that because of Prozac, Mr. Bibliography can function well and remain a productive member of society. The bad news is that Rosella Campobello could not tolerate drugs that might have been expected to help her. Another easily doable experiment would be to correlate normal sleep measures with estimates of mood. If my theory is correct, good sleepers should feel better. This result is to be expected because poor sleep is a robust predictor of ill heath. More specifically, if REM sleep percentage and/or intensity correlates with good mood, then we can feel more sure that our mothers’ advice about getting a good night’s sleep was sound and that the reason could be that good sleep confers the power of the aminergic system to mediate good waking. Good waking includes a predominance of positive feeling, a sense of optimism, and peaceful social relations.

Lieta Siciliano Lieta Siciliano was not very depressed. In fact, she was not really depressed at all—with respect to her energy availability. Even at age fifty, she could keep pace with much younger people. If anything, she was hyper-energetic, but she was not the least bit manic; in fact she was a very dignified and low-key person. However, because of her strong sense of responsibility, she was always on the move with a list of chores that grew longer as fast as it grew shorter. Her family and friends admired her for her industry and her generosity but they all felt somewhat neglected because she found it impossible to stop running and just be with her loved ones. She was blessed and cursed by what the French call “La fuite en avant” translated as “the escape into the future.” The word “depression” was, however, used by Lieta Siciliano to describe her “down” states. When down, she felt sad, even to the point of tears; she was withdrawn, with a sense of rejection, and

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extremely tired. But she could not sleep, even when she tried. Instead she got up, sleep deprived, but immediately relieved of her “depression” by the mad rush of domestic activity in which she engaged, for hours, during the night. Much of her nocturnal work was the performance of unnecessary household chores. This work was unnecessary because Lieta already employed two persons to do that work for her by day, and neither of them was lazy. Her house was impeccably neat and clean but seemed to her to be completely messy and out of order. She was certainly compulsively clean and orderly. There was, thus, an obsessive–compulsive side to Lieta Siciliano which masqueraded as depression. The point here is not to quibble over the accuracy of her diagnosis as much as it is to notice the antidepressant effect of her self-induced sleep deprivation. Lieta was a short sleeper to start with. Like her father, Vittorio Siciliano, she had a very high set point for sleep. Both Lieta and her father agreed: if one is slow to eat, he will be slow at work. In other words “get a move on” and don’t ever relax, even at the table. A corollary commandment is: sleep as little as possible. Yet there is more than just that to Lieta’s story: when she felt “depressed”, the less sleep she got, the better she felt! This is just the opposite of what common sense would predict. In this sense, Lieta was like those official depressives who felt better after a night of sleep deprivation. These patients felt better, moreover, when their sleep deprivation was selectively geared to REM sleep curtailment. The antidepressant effect of REM deprivation has been interpreted by Matthias Berger and his research group at the University of Freiburg in Germany as a reduction in the power of the cholinergic system. Remember that it is the cholinergic system that normally drives REM. Abundant clinical evidence supports the idea that depression is also driven by the cholinergic system. According to the reciprocal interaction model, REM is associated with cholinergic selfstimulation and it might be just this cholinergic self-stimulation that Lieta Siciliano avoided by staying up at night and working. Lieta’s set point was already hyper-aminergic. This accounts for her high energy level and her short sleep. Pessimistic by nature, she was possibly naturally too cholinergic for comfort. Sleep made her more so. Hers was a classic case of state control system imbalance. It is interesting to speculate about a possible relationship between sleep deprivation and delirious or frankly psychotic thinking in

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waking. If a person, like Lieta Siciliano, believes that eating is a waste of time and that sleep must, on the same grounds, be short, does dreamlike mentation alter waking consciousness? The fact is that sleep deprivation, whether experimental or self-induced, produces temperature dyscontrol and hypersensivity to cold makes this hypothesis plausible. In any case, it raises a red flag about the popular misconceptions about the unimportance of sleep and cautions against exerting excessive frontal lobe force upon the brain stem. The brain stem is older and wiser than the cortex.

Anorexia nervosa What do depression and anorexia nervosa have in common and why do people who suffer from eating disorders so often benefit from amine enhancement therapy? One answer is that anorexia nervosa patients are depressed and that is all we need to know. But a more interesting possibility is that both depression and anorexia nervosa share a disinhibition of sleep-related symptoms. According to protoconsciousness theory, it is these symptoms that are released from REM and are, thus, responsive to the wake state enhancement and REM suppressant effects of brain biogenic amine enhancement. Another reason for questioning the exclusivity of the shared depression idea is that mood is not synchronized with state control set-point level. This lack of tight linkage is important and is brought home by the surprising finding that the affect spectrum of REM sleep dreams does not include depressive emotion despite the fact that aminergic force is at its lowest daily ebb at night. Dreams are anxious and aggressive, but the third leading dream emotion is joy–elation. Joy–elation is the exact opposite of sadness, despair, preoccupation with bodily functions, and other depressive emotions. These depressive emotions are rarely experienced in normal dreams. Acute reductions of aminergic efficacy, as normally occur in REM sleep, do not trigger depressive emotion. The aminergic system must be weak for many days before mood in waking is impaired. Acute REM deprivation sometimes relieves depression. At first glance, theory would predict that REM sleep deprivation should make depression worse via the prevention of presumably useful aminergic inhibition. An inescapable conclusion is that the theory is wrong and

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that REM deprivation is more than anticholinergic, as pointed out above in the case of Lieta Siciliano. However, we must consider the possibility that REM deprivation actually enhances aminergic efficacy just as the drugs do. In this instance, the mood elevation must be via enhanced release rather than uptake blockade. What about anorexia? Anorexia nervosa is a disorder of adolescent females who seem determined to refuse the maturation of their femininity. They stop eating not so much because they lose appetite but because they want to impede the physiological bodily changes that will prepare them for motherhood. They would prefer to remain babies and resent their mothers for not having better prepared them for this challenge. Rosella Campobello and Chiara Perugino both refused to eat and they both had domineering, controlling, invasive mothers against whom they rebelled. But while Chiara refused food to blackmail her mother, Rosella consumed garbage to embarrass hers. Both indulged in other weight loss rituals such as purging, forced vomiting, and starvation especially to counteract the weight gains incurred by their occasional food binges. When their brains were conditioned by their anorexic behaviors to expect inadequate caloric input, Rosella and Chiara both shut down menstruation as their body weights fell to life-threateningly low levels. It would obviously not make sense to become pregnant without sufficient calories to maintain a healthy fetus. Anorexia is, thus, a very effective method of birth control. So is the suppression of libido, which occurs in both depression and anorexia. Both Chiara and Rosella slept poorly; they both tended to go to bed late and therefore had trouble getting up in the morning. This trait is shared with normal adolescents but sleep lab studies of the patients reveal an abnormally low level of early night deep NREM sleep, a signature of depression manifesting itself in a quite different clinical condition.

Chiara Perugino Chiara Perugino was a twenty-one-year-old single, Italian-born woman who tried very hard, but failed, to transplant her life to the United States. Her transplantation failure was precipitated by excessive room cleaning and by unbearable anxiety that made continuation of US college work impossible. Prior to this crisis, Chiara had become physiologically anorexic after embarking on a voluntary hunger strike

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that was successful in persuading her mother to allow her to go to college in America. Her case, like those of Rosella Campobello and Lieta Siciliano, illustrates that mix of diagnostic features that scramble obsessiveness, mood fluctuation, and appetite. Rosella and Chiara also illustrate the common use of state stabilization via drugs and psychotherapy in righting the imbalance caused by conflict about identity, independence, and work. Chiara was actually forced by her mother, against her emergent will, to go to America when she was only five years old. At that tender age she made a spectacular adjustment: she learned English quickly and well; she made friends easily, although these were often marginal young women and, like her, usually immigrants, never mainstream Americans. Nonetheless, she admired the culture of fair play and honest, open competition that makes the new world so different from the old one. In a word, she thrived in America. When her physician mother decided to return to Europe, for strong career and family reasons, Chiara was fifteen and did everything she could do stay in the US. Her mother insisted that she go back to Italy and prevailed over Chiara and her American stepfather who supported Chiara’s rebellion. It was this conflict that led to her hunger strike. Chiara vowed “to bring my mother to her knees” and did so by dropping her weight from a fashion model level 110 pounds to a Dachau survivor weight of eighty pounds. In the course of this blitzkrieg on herself and her mother, Chiara stopped menstruating and evinced all of the other physiological and psychological features of anorexia nervosa. Her case makes clear that it is possible to become sick, just as it is possible to become well, by the strong exercise of will. Chiara’s mother agreed to her request to attend college in the US. She then began eating again and returned within six months to her fashion model figure and weight level. A scrupulous and highly motivated student, Chiara had little difficulty in gaining admission to a choice US college. At first things went well in college, but Chiara’s anxiety and obsessional behavior steadily increased. I am not sure why this happened, but it seems possible that Chiara, for all her rebelliousness, was feeling the heat of competition and missing the protection and nurturance of her home in Italy. She was discouraged by feedback about her chances for admission to prestigious US medical schools. She kept postponing the scientific high hurdle courses that were required by them. These demanding science

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courses seemed too difficult for Chiara to excel at the high level that was expected of those few who would gain places at the very competitive doctors’ table. This took a toll on Chiara’s ego as she committed herself, against all odds, on her mother’s profession. But her mother’s profession was Italian medicine, not American, and it was clinical medicine rather than scientific medicine. In Italy, where the competition for admission to medical school is far less keen (especially if one is well connected), the attraction of a career in medicine has also declined. All Italian doctors, Chiara’s mother included, are civil servants who may not be paid a third of the expenses of their aristocratic lifestyle. Late in the summer of 2010, Chiara took an overdose of her stepfather’s sleeping pills and barely survived five days in coma. State stabilization was very slowly achieved. Chiara’s anxiety and obsessions were greatly helped, if not entirely eliminated, by amine reuptake blockade. Her leg did not stop twitching, indicating persistent physiological anxiety. Chiara’s anxiety has recently been diminished by moving out of her mother’s house and out of her intrusive control. In this sense, she echoes the beneficial effects of the “motherectomy” I effected with Rosella Campobello. The restructuring of Chiara’s career goals and a dignified modus operandi was effected in psychotherapy. Her prognosis, now that she has come to terms with a lifestyle that she had earlier rejected, seems good. She applies as much will to her current life plan in Italy as the one that got away from her in America. She may well do better in the bosom of her family than in the cold and lonely fields of praise that are American academic medicine. However, she has recently discovered that the best anxiolytic is physical separation from her mother! Chiara Perugino is a mixed diagnostic bag. Yes, there is some depression, but not so much as to warrant treating her with a drug labeled “antidepressant.” Martin Hoskins has a complex picture, too, but his obsessional and aggressive symptoms respond well to a so-called antipsychotic. Lieta Siciliano treats herself with sleep deprivation. No psychotherapy for her, just sleep curtailment. It is anomalous findings like these that prompt my question: what do all these conditions have in common? My intuitive answer is that what they have in common is more than obsessiveness and anxiety and more than those features plus depressed mood. What, then, do all psychiatric patients have in

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common? I argue that they all show evidence that the boundary between waking and sleep has become blurred such that sleep and dream features emerge in waking. When waking is enhanced and sleep is suppressed by treatment, this boundary is sharpened allowing a resumption of normal social functioning. What are some features of sleep that could emerge in anorexia nervosa? Appetite is suspended during sleep. As a rule, we do not get hungry during the night, indicating that the brain mechanisms leading to food ingestion are turned off. Remember the case of Gordon Golden, who woke up to eat. Sleep, like anorexia, is not only food aversive, but also relatively unresponsive to changes in body temperature. REM sleep actually abolishes temperature control and there is no doubt that sleep is a thermally conservative behavior that somehow guarantees thermoregulation. This important mechanism remains obscure, but that there is a robust interaction between sleep and energy control, including thermoregulation, there can be no longer any doubt.

Hypochondriasis Luciano Ferri is a typical Italian “mammone”, meaning big mamma’s boy. Mamma’s boys like Luciano rarely leave home before age forty, if they ever do. Wives, especially modern wives who go out to work, cannot be expected to care for a husband the way a mother cares for a son! Old-fashioned Italian mothers cook, do the laundry, make the beds, and dote on their wayward sons, who often take the place of discarded or disenchanted husbands. Luciano, who is now thirty, is thinking of leaving home, but leaving home is not an attractive thought because self-reliance doesn’t do the cooking or the laundry as well as Mamma does. The fact of the matter is that Luciano is still hopeful that his Mamma will really care for him instead of just pretending to do so. His grandmother–mother surrogate was his mother’s mother. Other lesser surrogate roles have been played by his mother’s housekeepers! His mother’s parents also contributed to Luciano’s mammone status. Luciano’s mother was an only child. Until Luciano came under their care, they had never had a son. Luciano, who was handsome and intelligent, was treated as a prince by his grandparents.

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When he spent the night in their apartment, he was dressed in the morning by maids who served him like a king who had many ladiesin-waiting. Thus, Luciano is a mammone in spite of himself. He is a double mammone and angry about it as well. Because his mother was determined to cut her own ties to her controlling parents, she married to escape them, but she was determined to have lots of children. She never really loved the man she first married. Instead, she fell in love with her boss, conceived Luciano with him, but led him to believe that her legitimate husband was really his father. Ridiculed by his schoolmates as a bastard, Luciano found out about this deception the hard way and developed an understandable grudge against his mother on whom he is now dependent. Her parents (who are, of course, Luciano’s grandparents) are now dead, leaving behind the royalist, nepotistic, and feudal attitudes that they imparted to poor Luciano. His reaction to his situation, besides his smoldering rage, is not depression, anorexia, or even OCD, but, rather, hypochondriasis. How, after all, can a person as ill as he is be expected to care for himself? So Luciano, like John Cabot in Part I, sleeps late, gets up long after his mother has gone to work, speaks little to anyone but the maids while he gobbles pills, spreads ointments all over his body, and breathes through a vaporizer. His good looks and superior intelligence are, so far, lost to the world. Only leaving home and finding a surrogate mother will help him. He is working on that solution now.

Anorexia revisited I have already expressed, in Part I, my wonder at the apparent effects of my initial contact with Rosella Campobello. Her resumption of menstruation (after a ten-year hiatus) was said to be a transference cure by my psychoanalytic supervisors. I was advised to take inventory of my own unconscious impulses, especially in the sexual domain. This advice brought me up short because, at that point in my life, I was thirty-two years old, had been married for nine years, was a young father of a two-year-old son with another son on the way. Like many other men in the US in the 1960s, I was very sexually active and not just at home. I was probably living out an autosuggestion about my own attractiveness.

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Although nothing sexual was explicit between us, maybe Rosella picked up this grandiosity of mine: who knows? At any rate, she changed dramatically after only one brief session in which I gave her explicit instructions: “Just tell me what you did for pleasure this month; no talk about symptoms will be permitted. You have five minutes. Use them well.” By “transference cure,” I would now understand something quite different from psychoanalysis. Instead of an unconscious desire for sex with me or her dear dead father, Rosella actually heard what I said (no symptoms, just pleasure) and felt pleasure in my presence. I was a young, sexually active male. Although she didn’t know it, she was in the hunt for someone like me. Perhaps some of our pleasure was unconscious, but a lot of it was not. She wanted a man. Her brain said, “Lay an egg,” and she did lay an egg. Perhaps if I had talked with her about tapioca pudding (which is white = mother) and its symbolic relationship to her domineering mother, as her psychoanalyst therapist had already done for ten dreary years, I could have avoided this psychic blitzkrieg and Rosella would have died, probably earlier, as a spinster freak rather than as a bizarre adventurer, compulsive artist, and lifelong packrat. I do not tell the Rosella story to claim that I cured her, only that direct intervention using suggestion resulted in turning on her sex life. I did not mean to do this and probably would have been embarrassed then to think about this encounter in such frank terms as I do now. In any case, she had a chance, and for twenty years she lived instead of waiting, as I had done, in vain, for the psychoanalytic penny to fall. I regret that I was not well enough trained to follow up on my discoveries with Rosella and to apply direct and positive suggestion to other patients. It is to encourage discontent with the status quo and to foster scientific experimentalism in clinical research that I share these remarkable anecdotes. Cognitive behavior therapy is a step in the right direction, and perhaps my experience with Rosella was a harbinger of things to come. If this is so, so be it. From my limited vantage point, I do not yet behold the psychodynamic neurology that I aim to foster. The Rosella story would seem to lend itself to an understanding of Rosella’s brain and mind acting as a unified whole to determine her behavior. My new story goes as follows: the Catholic Church and Rosella’s psychologically illiterate parents collaborated with her

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constitutional obsessive–compulsive guilt to produce a travesty of symptomatic effects: anorexia, amenorrhea, and an addiction to confession. Psychoanalysis, with its penchant for coolness, self doubt, and symbolic decoding was just what Rosella did not need. She was a concrete thinker and not intellectually sophisticated or capable of intellectual abstraction. She didn’t know a symbol from a thimble. Instead of free association, she needed support, encouragement, firm direction, and release from all these bonds. When she met me, I spoke directly to her brain or, rather, my body spoke directly to her body. This produced explosive release but, over the years, she had trouble accepting and maintaining the gains of her relationship with me. In retrospect, perhaps I should have put her in the hands of another therapist when it became clear that, at about age fifty, she was stalling out. My intuition now is that an older woman might have been better able to help her manage her menopause and organize her life around a different set of values from mine. She then needed a grandmother, not a middle-aged man who was chasing his own butterflies around the world. She was not only missing the family that gives many of us supportive solace in later years, but the family which provides us with youth in the form of nieces and nephews, grandchildren and great grandchildren. It was not my fault that Rosella was an only child of older parents but a surrogate family, or some such entity, might have been helpful. I regret, too, that I was never able to help Rosella to better manage her own brain. Yes, she stopped eating garbage, but she never learned really to enjoy food. Even when she was employed, she gravitated toward night shifts that allowed her to sleep in the daytime. I was sure this was a bad idea because it abetted her social isolation. As for the cigarettes, I failed utterly to curtail her smoking. For Rosella, nicotine was like a pill, but the excessive cholinergic stimulation of nicotine must have destabilized her basic rest activity cycle and pushed her in exactly the wrong direction: toward sleep and lassitude, compulsion and anxiety. Why was she so intolerant of SSRIs? I don’t know the answer to this question but I do know that neither my eldest son nor I can tolerate stimulants, even when they might be helpful to us. Now that I write about it, I realize that what Rosella might have needed, especially in the last third of her life, is the sort of halfway house or group home that is so helpful to other handicapped people,

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especially those who suffer from even more obvious brain deficiencies than Rosella. Think of it: a halfway house for people who need the social and structural stability of a surrogate family. Such houses do exist for very handicapped patients but not for the walking wounded Rosellas of the world; her name is, sadly, legion. Anorexics show a variety of symptoms that suggest that their brains are partially asleep: they often feel cold; menstruation may cease; lethargy and tiredness prevail. Even if, like Chiara Perugino, they begin their self-starvation campaigns voluntarily with clear conscious motives, their brains soon become caught in an automatic reflex response. The mental state of wanting to be thin and of wanting to frustrate mother appears to cause the syndrome of anorexia. However, overt mental prodrome is a brain prodrome too, and it seems possible that subjective experience may not really cause anything except insofar as it is linked to physical instantiation. With Karl Friston, I have recently suggested that consciousness is causal, which means that first-person subjectivity can alter thirdperson brain activity. If this is true, the elusive brain-mind problem is solved. The brain and its mind are causally linked in both directions: brain causes mind and mind causes brain. Dual aspect monism triumphs over Cartesian dualism.

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PART IV

Self-reliance and psychotherapy

very human infant is born dependent on the care of its parents. The power exerted by parents over children is virtually absolute and the detection of even severe abuse is difficult. Just as it is difficult to establish the veridicality of memory, so it is difficult to know the degree of abuse that any given child has suffered. Some degree of abuse may well enter into every parent–child interaction.

E

Can you be your own psychotherapist? We need to learn to be more like soothing mothers to ourselves. We need not so much a list of things that must be done as a carte blanche to relax, have fun, and even imagine something preposterous such as sharing a bed with a lover. We need to learn to let ourselves go and to have obsessions in our sleep and dreams with the hope that these odd mental gymnastics have a role in the greater satisfactions and achievements of our waking life. At the same time that we learn to be soothing mothers to ourselves, we need to listen to the stern father who lives within us. Glen Just is very clear on this point. He credits his father with his firm 95

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commitment to self-reliance. His writings make clear his heed of his father’s admonitions to make up his own mind about decisions in the face of conflict. He overcame his obsession not to step on sidewalk cracks, his fear of normal dreaming, and his terrifying nightmares by a sort of self-hypnosis that bears a striking resemblance to the power of positive thinking. Here is Just’s summary of this process: The development of self-reliance has been critical in my life. Enhancing capacities has also been fundamental—i.e., learning to control all altered states as well as attention and feelings. Expanding one’s mind into the universe is a gradual process of learning, which permits both body and mind to travel at will. I haven’t said much about pre-sleep imagery, but I believe there is a level of brain activity that goes on continuously. When I took my cosmic journey, for example, I just focused on this channel and let my Executive-self do the work.

Not everyone can or should try to reach the level of state control that Glen Just claims to have achieved, but it is already evident that we all do something like this all the time. Our fantasy life is full of what I call review and rehearsal. We review what has happened to us in our interactive life and we lay plans for the future based upon our analysis of what worked and did not work so well for us. The main point here is that we are all, already, our own psychotherapists. Armed with a basic set of neurological considerations, we can be much more systematic in our rehearsals, and we can be more determined in carrying out our strategies. A behaviorally oriented cognitive therapist can serve as a very useful ally–coach in helping us set and achieve our goals. The evidence is overwhelmingly strong that this approach is far more effective than the reliving of childhood trauma with its assumption of anxiety release via recollection. As for the analysis of the transference, there is no evidence that it is accurate, much less helpful, in the relief of symptoms.

The self-treatment of Glen Just An extensive and intensive use of modern sleep and dream principles in treatment has recently come to my attention via the books and

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letters of Glen Just. Three books, of exceptional interest, have recently been privately published by Glen. Although privately printed, they are available in electronic form on Amazon.com. They are: The Autobiography of a Ghost (2009); Mind of the Mystic (2011); Dreams, Creativity and Mental Heath (2012). All three books are characterized by vivid accounts of the author’s experience as an abused child and of his ingenious, persistent, and impressively successful efforts to overcome the presumed resulting handicaps. Their greatest import is their use of modern cognitive science theory and data to create a novel integration of subjective and objective viewpoints in support of a new paradigm of psychiatric case formulation and of the amelioration of psychopathology via selftreatment. Although Glen Just has read extensively in the current cognitive science literature, and writes so vividly as to create a sense of his life as if it were fiction, his descriptions of subjective experience have a face validity that go a long way to counter my concerns about false memory and confabulation. At my urging, Dr. Just has sought corroboration from his siblings and, in the main, they confirm his memories. Even if his recollections were all fabricated, I would, nonetheless, consider his writings to be of great interest: it is, to my mind, unlikely that this story is entirely made up: it is too elaborate for that. The fit with experimental science is too tight for Just’s witness to be dismissible as confabulation. That his unusual psychological experiences may have been neurologically engendered is possible, but whether or not Glen Just was brain damaged as a child is also irrelevant to our appreciation of his career of self-reliance. I will come back to this point later but, for now, I ask, “Are we not all just a little bit brain damaged?” Having had a stroke ten years ago and now being as forgetful as many octogenarians, I know that I am more than a little bit brain damaged. The success of Glen Just’s therapeutic self-help efforts is evident in his educational achievements. He received a Ph.D. degree and then devoted his career to enlightened reform of the criminal justice system. In this career, Dr. Just has administered complex treatment, educational and research programs while still subject to very major psychiatric symptoms.

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Glen Just’s three books are, from both a clinical and a scientific standpoint, a remarkable combination of travail and triumph. Without the subjective details of the sort that Just supplies, the objective resort to ego theory and science would not be cogent. There may be better books in all of these three domains, but I have never before encountered a personal account that bridged the mind–brain gap more effectively and which succeeded in integrating traumatic childhood experience, symptom formation, and relief in a credible neurocognitive paradigm. The early history of Dr. Just’s difficulties clearly documents extreme neglect by his ambivalent mother and unyielding demands by his alcoholic father. Two of his sisters, Donna and Carol, died of maternal neglect before the age of six months. Two other sisters, Lavonne and June, suffered from severe anxiety throughout their lives. Glen’s older brother, Bud, was “placed out” of the Just household when he was fourteen and, thus, both banished and protected from the family. (In this book, I use their real names, with permission, in the interest of authenticity and to facilitate communication by others with Glen Just.) By the time that he was three years old, Glen Just claims to have had dissociative and hallucinatory experiences that have been with him throughout his life. These include his “ghost,” the guardian angel Moses, animals, and malevolent attackers in recurrent nightmares. He suffered from a host of lesser but problematical post traumatic anxiety symptoms which interfered with his social adaptation. Despite concerns about the possible invention of these stories, the extreme instability of his family of origin is embodied in his school attendance. Dr. Just went to no less than fifteen schools in the twelve grades of his elementary education. This is environmental instability in the extreme. Over his father’s objections, Glen Just insisted on going to college. He benefited from a stint in the army, obtained a Ph.D. degree, and thereafter ran state-sponsored programs in the prison system of Minnesota. During all this time he was intermittently beset by severe symptomatology, which was shared by his siblings. It is only during his mature years that he has enjoyed relative freedom from anxiety, hallucinations, nightmares, and compulsive thoughts. His adaptation must be considered remarkable, and meeting him today gives no hint of this often disabling mental experience. Glen Just is a remarkably

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calm, thoughtful, and intellectually sophisticated gentleman, eminently worthy of trust, affection, and respect. To counteract the negative effects of his symptoms, Dr. Just developed a variety of self-control measures, including out-of-body experience, astral travel, dream plot control (via lucid dreaming), self-hypnosis, and voluntary mind control. Remarkably, he consulted a professional psychotherapist only once in his lifetime. His independent discovery of the power of self-help approaches corroborates and extends the strategy of cognitive-behavior therapy while his aggressive intervention is contrary to the dictates of Freudian psychoanalysis. In fact, Dr. Just’s story counters all of the Freudian rules of how therapy should work, but is manifestly effective and surprisingly consistent with the findings of modern sleep and dream science. His story complements the scientific findings that have so dramatically challenged Freud’s disguise censorship model of the dreaming and psychoneurotic mind. Glen Just began by using dream lucidity to change nightmares into tolerable and even pleasant dreams. Not every one will find lucidity as easy to achieve as he did and, for some, it may be impossible. However, the point that matters is that it is not the specifics of the mental calisthenics that Just used to achieve mind control that matters, it is the creative, persistent, and determined effort that he made to help himself that I find inspiring and that I hope will inspire others. At last we have a voice that speaks to the psychiatrically afflicted about the power of cure that lies within. Outside us, in the world, there are crutches, miracles, and a few good doctors, but also a host of quacks hoping to enrich themselves and prescribe thousands of dangerous medicines that are longing to jump into your mouth. Read Glen Just’s books before you go into therapy or take a pill. If you do decide to consult a helper, lend him your Just books and ask him to call you in the morning. My book, Ego Ergo Sum, now titled Psychodynamic Neurology, has detailed the many faulty psychodynamic principles that constitute psychoanalytic theory and replaced them with new ideas based upon modern sleep and dream science. I hold that psychiatry and neurology, like the mind and the brain, must be studied together and that the separation of the two fields institutionalizes the dualism that is at the heart of the mind–brain problem. I call my new approach psychodynamic neurology.

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In this context, Glen Just’s three books appeal to me for several reasons: 1. 2. 3.

4.

They are the most detailed descriptions of exceptional mental states that I have ever read. The descriptions are related in a clear and precise way to modern sleep and dream science. The mastery of handicaps resulting from early life trauma is driven by common sense. Just relies on the same sort of behavioral approaches that I have found helpful in treating patients. The “treatments” invented by Glen Just are not only driven by common sense, but often emerge directly from modern sleep and dream science.

For example, when Glen Just wanted to escape smothering by his mother, he resorted to out-of-body transformation. This reduced his fear even if it did not really protect him from his mother. Similarly, when he suffered from nightmares, he used self-hypnosis to induce dream plot control, often in the context of lucid dreaming. This gave him a sense of control over his unpleasant dreams. Astral travel enabled him to hide a part of his ego in outer space for safekeeping until it was possible to reintegrate himself. Again, this trick was not only psychologically empowering, but it bought him anxietyfree time. While it all sounds too good to be true, his accounts have a face validity that makes me inclined to take him seriously. I therefore suggested that he come from Kennewick, Washington to Boston so we could get to know one another better. We spent five satisfying days together in May 2012. To help the reader gain a sense of Glen Just’s life, I asked him to provide us with a timeline of his experiences. His history is organized chronologically in the Appendix. My purpose now is to discuss a number of general themes and say how the Just data fits, or does not quite fit with new scientific concepts. Dr. Glen Just’s terrifying dreams, his hallucinated ghost, and his mystical states are seen by him and by me as neurodynamically linked and altered expressions of consciousness control systems of his brain, the further understanding of which could lead us to the long-sought understanding of the unity of brain and mind. This is the unity that Freud sought, but could not achieve in 1895. The emerging virtual reality model is, thus, important not only to psychology

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and psychiatry, but, as Dr. Just emphasizes, to a genuinely human philosophy as well. The attribution to the brain of mental phenomena such as religious beliefs of all kinds, mystical and other transcendent states, as well as dissociative phenomena that are so central to psychopathology, is a detailed demonstration of the central idea of William James’ 1902 book, Varieties of Religious Experience. As we further investigate the still mysterious phenomenon of human consciousness a century later, Glen Just’s story inspires hope for a general science of subjectivity in relation to our growing scientific understanding of consciousness. It is now clear that the states of consciousness (waking, sleeping, and dreaming) are meaningfully related to physiological states of the brain. The incorporation of the specific findings of modern sleep and dream science gives Glen Just’s books much more than an appreciative echo of the Jamesian past. They go far beyond James, who, inexplicably, said very little about sleep and dreaming. This is because the phenomena of sleep and dreaming are presented as both pathogenic and therapeutic; they are at once the problem and the hope for its solution. Glen Just is required reading for those who share my dream of a truly scientific psychology. With respect to the unity of mind and brain, Glen Just writes, Between the ages of two and five, out of body was experienced repeatedly. I did not distinguish between mind and body; I did not assume that my body and spirit traveled together until sometime after eight years of age.

I maintain that modern psychiatry has just reached the mental age of about eight. If Glen Just’s evolution is a harbinger of things to come (and I think that it is) we will have a long and happy life.

Out-of-body experiences Out-of-body experiences are usually not as frequent as those described by Glen Just but neither are they always associated with claims of abuse. Hence, it is considered by sleep scientists to be an unusual, but not necessarily pathological, condition. The interested reader is referred to Thomas Metzinger’s book, Being No One (2003), for a philosophically oriented analysis of this experience. I particularly applaud Metzinger’s insistence that self (or ego) is a process, not a

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structure. Self is a plastic process and, as such, subject to renewal and revision. Metzinger has admitted to me that he himself is able to go out of his body. Neither Just nor Metzinger really believe that their selves, or souls, float overhead as they lie in bed. Rather, they agree that out-ofbody is an illusion, but a very powerful and sometimes useful illusion. It is in that sense that I cite their claims. If this illusion is strong, then the basic idea of dualism, which underlies our culture, is not surprising. It is, rather, natural and normal to think that the body and soul are separable. They really are separable in convincing illusions such as out-of-body experience. Thomas Metzinger takes advantage of the illusion of mind–body separation to design experiments that clearly show that normal selfconstruction is dynamic and universal, not the quirk of a lunatic fringe of society as convention might suppose. In other words, we all create the illusion of integration all of the time as a way of reassuring ourselves that we are all of a piece, whereas we are all really a set of pieces kluged together into an apparent whole. Given this degree of fluidity, it is not surprising that we often have the feeling of being two or more selves, each with an agenda sometimes at odds with the other or others. Far from being a psychopathic performance, as psychoanalysis asserts, multiple personality is both understandable and, to a degree, inevitable. Multiple personality may not be exactly normal in a statistical sense, but it is normal phenomenologically speaking. Out-of-body subjects typically report that their mind (or soul) slips out of their body and hovers over their bed on which lies their inert body. After floating aloft for a while, a reunion with the body may be actively affected. Here is a vivid account by Glen Just of one such episode, which occurred in a hospital: I was standing shoulder to shoulder between my father and the nurse. Or was I floating shoulder to shoulder between my father and the nurse? We were looking down at my corpse. As I contemplated my dead body and wondered how I could be this tall, a series of lights appeared in the distance, grew brighter, and moved toward me. The view of the hospital room and my bed faded away, and my total world consisted of approaching twinkling lights.

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The illusion of a separable body and mind is deeply built into our conviction whether or not we have ever had an out-of-body experience in sleep. I, for one, have never had such an experience, which might be one reason why I am a scientist and not a shaman, a priest, or a pastor! Out-of-body experiences are too rare to be studied in a sleep lab but numerous laboratory observations have been made of closely related phenomena. Lucid dreaming is a good example. A reasonable scientific guess is that out-of-body experiences, like lucid dreaming, occur at the margins of REM sleep and waking. This is the never-never land of hybrid states. The brain is at once partially awake and partially asleep, which facilitates the anything-goes aspect to consciousness. Glen Just used spontaneous and deliberate techniques to save himself from his parents’ wounds to his ego. Among the spontaneous techniques are the set of manipulations of his conscious state control system that relate directly to sleep and dream science. They are, therefore, of the greatest theoretical and practical interest. In this catalog, I briefly return to the longer description of these phenomena given above. Some people, and Glen Just claims to be one of them, are able to separate themselves (their ego) virtually from their body. This capacity, however rare, serves to support the idea that an ego “in body” is an artificial construct and this idea raises fundamental questions in “self” theory.

Dream plot control The very best use that can be made of lucidity is dream plot control. In this case, you not only know you are dreaming when you are dreaming but you know that you are dreaming about something that you want to dream about, such as flying, or making love, or feeling safe instead of feeling threatened or insecure as you are likely to feel when you are not lucid. This is nothing more or less than the power of positive thinking and now we know, to a first approximation, how to induce dream lucidity. Glen Just learned this skill at an early age. Perhaps he was genetically predisposed. Perhaps he suffered brain anoxia at his mother’s hands. He says he had petit mal epileptic fits. I think that some such unusual circumstances primed his discovery. I speculate that he slept lightly because, fearing attack, he was always on the qui vive. And,

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because his waking life was so fraught with danger, his dreams needed the doctoring that lucidity could provide. By the time he was a nightmare sufferer, at age fifteen, he had learned that systematic self-hypnosis could increase his capacity for dream plot control. His father, Augie, was part of the problem because he was so arbitrarily authoritarian. Yet, he was also part of its relief because he so loudly preached the gospel of autosuggestion, otherwise known as self-hypnosis. In any case, if we are to believe him, and I do, Glen Just learned dream lucidity at an early age and used dream plot control to moderate his predisposition to nightmares throughout his life. It may be an exaggeration to call the atmosphere in the Just family of 1938 traumatic. Rosella Campobello was raised at about the same time, albeit in a very different place and cultural context. For that time and place, the relative normality of the authoritarianism and chaos makes the modern world of Chiara Perugino, Martin Hoskins, and Lieta Siciliano seem over-privileged. But all patients see themselves as victims and act out their complaints in various maladaptive ways. I have included this modern trio in order to explore parental neglect as abuse and to demonstrate that even in relatively well-regulated households, there is often a smoking gun. It is very likely that accounts of alien abduction, described in the late John Mack’s book, Abduction: Human Encounters with Aliens (1994), have a similar explanation. Authors such as Mack and Just strain our credibility with their claims that such subjective experiences really occurred and push us over the edge when they insist that their experience was veridical, not illusory. Without taking a hard stand on that difficult issue, we can all agree that the unity of brain and mind (that is the central tenet of cognitive neuroscience) is not a widely shared conviction. By coming aboard our own extraterrestrial vehicle, Glen Just is trying to help those of us who are convinced of brain–mind unity, but such unity is not obvious in our daytime, and even less in our nighttime, consciousness. The problem is that we have no direct access to our brains. Subjectivity is a slippery slope and experimentalism is elite and costly. No wonder that science has been so incapable of holding the fields of psychiatry and neurology together. Whether we have out-of-body experiences or not, we all have difficulty believing that our minds are functions of our brains. It just doesn’t feel that way. No wonder that René Descartes, who saw mind

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and brain as two watches perfectly synchronized by God, formulated philosophical dualism and no wonder that even determined atheists like Sigmund Freud inadvertently fell afoul of mind–brain dualism. As already noted, eight years old seems about right to me as a guess at our current mental age with respect to this thorny question. I estimate that we need another five hundred years and many more Glen Justs to make our views more palatable to others.

Post traumatic stress disorder (PTSD) An impulse to unity has been provided by unfortunate developments in the homes of people like Glen Just and by the domestic misadventures of many other people. Since the US involvement in the wars of Vietnam, Iraq, and Afghanistan, the concept of post traumatic stress disorder (PTSD), which has a long and checkered history, has become more widely recognized and at least partially understood. Dr. Just’s story indicates that a person does not have to go to war, or even to leave home, to be subject to the lifelong wounds of terror at the hands of well-meaning but negligent or sadistic parents. There is no question that the most blatant signs of PTSD described by Milton Kramer, flashback re-enactments of witnessed atrocities, are correlated with objective disturbances of sleep, making it all but certain that laboratory studies will soon yield evidence of sleep disruption in victims of domestic violence. PTSD is the modern equivalent of the childhood trauma that Freud supposed engendered every dream and every neurosis. But in Glen Just’s case, the trauma was more violent and more persistent than the Viennese sexual peccadillos presumed to be disruptive to Freud’s patients’ psyches. To explain the ubiquity of dreams and individual behavioral idiosyncrasies, it was asserted by psychoanalysts that a trauma needed only to be fantasized to work its mischief on the psyche. This assertion is as unfortunate as the double-bind hypothesis of the schizophrenogenic mother lampooned by me in Part I of this book. Nonetheless, the epidemic of modern sex scandals shows that abuse trauma can cause embarrassment and disability when trusted adults (such as athletic coaches and priests) take advantage of younger persons, often young boys like Glen Just. When careful witnesses follow Glen Just out of the parental abuse closet, psychiatry will have another chance to prove itself, this time

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armed not only with physiological weapons to silence the skepticism of doubting Thomases, but also a more robust set of objective thirdperson phenomena to work with scientifically. Among the most potent weapons are those of sleep and dream research. For example, the flying dreams of Glen Just can be explained in terms of welldocumented alterations in the physiology of sensorimotor systems during REM sleep. I am thinking of the auto-activation of the brain stem vestibular system, an integral part of the brain that positions the body in space. A more direct explanation of lucid dreams, of which flying is often a cherished part, has already been discussed and I have hinted at the desirability of flying in the out-of-body escapism of post traumatic sleep.

Glen Just’s flying dreams In the case of flying dreams, the body image and the mind fly away together. Here is the account of an early dream flight by Just: I was afraid to fly high in case I might fall. I didn’t know how I stayed up in the air and this made me fearful of flying above the clouds. I practiced flying close to the ground, and never too far from the house, or out over the water.

As I pointed out earlier, my own early attempts at dream flight were similarly cautious. I was at pains to avoid high-tension wires for fear of electrocution. After a while, I was able to tell myself that my fear was groundless and, at the same time, I was able to give up my arm-flapping imitation of birds since I was weightless and flying without effort. For me, as for Glen Just, this was a blissful illusion. For Just, it was the more desirable because he was not only weightless, but also fatherless and motherless. Perhaps because of his motivation, he went much farther than I did when he learned to experience flying while awake. At age seven, he was returning to Wisconsin from the state of Washington in a car with his parents: Sitting on the outside seat, I floated above the edge of this two lane highway. I loved the feeling. I moved with the clouds, swept across the mountainsides with the wind, and glided effortlessly down into the distant valleys. I was flying above and through the clouds, not just levitating over houses and trees; a new dimension was added to my

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being out-of-body; a fearless dimension that let me rise to new heights as I conquered the Rockies. I was learning to master new spaces in my mind; the space for altered realities grew larger.

To a first approximation, flying dreams are easily enough explained by REM sleep physiology: there is brain activation, there is muscle inhibition, there is activation of motor pattern generators, and there is abatement of the aminergic modulation of the brain that keeps us awake. But how are we to explain the sensation of flying when awake? Here, a degree of hand-waving is necessary. We suppose that the REM sleep system responsible for flying dreams is damped but not completely shut down in waking. People like Glen Just, for genetic and experiential reasons, can more easily access this relatively inhibited but still operative system during waking. If one can be awake while dreaming, why cannot one be dreaming while awake? There are many other reasons for taking this hypothesis seriously and I will return to this point in subsequent discussion. For now, let me only boast that, at last, we have a testable hypothesis. We do not need to label the Glen Justs of the world as mentally ill. Now we have only to get eight-year-old waking dreamers into the sleep lab. If you fly in a car, and your parents don’t abuse you, please get in touch with me by email: [email protected]. Harry Potter need not apply!

Dream emotion Anxiety is the predominant affect in normal dreams and sometimes assumes nightmarish proportions, as Glen Just attests in a letter to me: By the time I was five years old I had continuous nightmares as I thought about the Japs coming to get me. The nightmares were always the same. They would catch me. I’m on their submarine being held face down as they start to make preparations to make me into a flag stand. I never knew why they needed a five year old boy for a flag stand but it didn’t matter. They would start drilling a hole in my lower back, the pressure would become intense, and just at the point of my spine snapping I would escape.

As a person of about the same age as Glen Just, I can easily appreciate the villainizing of the dream Japanese. In the endless war

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propaganda to which Glen and I were exposed in the early 1940s, the Japanese were stigmatized as monsters whose tortures were horrific. I thought a lot about them when I was awake but I do not recall dreaming about them. To my knowledge, I never had nightmares. And I was not abused by my parents. I do, however, recall my eightyear-old preoccupation with Bruno Hauptman, the convicted kidnapper of Charles Lindbergh’s son. As I lay awake, unable to sleep, I was sure I heard a ladder being placed outside my bedroom window by a Hauptman-type thug bent on snatching me away. The fact that my parents were not as rich and not as famous as Lindbergh did nothing to reduce my fear. Dr. Just’s account of his anxiety dreams gives them a distinctly PTSD-like character. His nightmare dreams are repetitive and stereotyped, like the flashbacks of Vietnam veterans. In his only experience in psychotherapy, he was told that the Japs represented his mother, but why he would need to symbolize her tortures, of which he was already consciously aware, was never explained to him. If we had been able to study Glen Just in a sleep lab, we would not have been surprised to observe his nightmares occurred in NREM sleep where perseveration and stereotypy are common. Young subjects often awaken in terror from Stages III and IV of NREM sleep. Confirming this hypothesis is the following note: I escaped to the “hole” in their submarine (later understood as hold) and suspended myself with thought. Unknowingly I taught myself to alter this nightmare dream with suggestion. I would fall asleep and wake up next morning in my bed.

The thought-like, non-progressive nature of NREM sleep “dreams” has been recognized since the early work of David Foulkes made it clear that mentation in sleep was not the exclusive product of REM. REM sleep dreams may be frightening but they are often more animated, more variable, and more bizarre than this one. When he was twenty-one and a student at the University of Minnesota, Just wrote, The nightmares returned with glorious intensity and frequency after I returned to the university. My attention span shrank in proportion to my increasing level of anxiety.

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Glen Just goes on to explain how he used self-hypnosis to increase his attention span and added, Mental health progress is not linear as recycling commonly occurs. It is the repetitive phenomenon experienced by a majority of individuals going through chemical dependency programs.

Two points are clear: trauma may cause severe handicap, and that handicap may be long-lasting and recurrent. Anxiety, just enough and not too much, is useful. Normal dreams make it seem adaptive to be able to be anxious, up to a point. However, when environmental stress exceeds a certain limit, the system cannot damp anxiety any longer and it breaks through in both sleep and waking. Healthy child rearing and good parenting hardly need my endorsement, but the recognition and management of anxiety needs to be singled out for our creative attention. We live in a threatening world and need to be virtually psychotic to survive in it. The brain has programmed anxiety into its virtual reality generator to give us the benefit of just enough, but not too much, of this feeling.

Ego development According to protoconsciousness theory, the ego emerges early in uterine development and has little to do with sexuality, despite its pronounced dynamism. I hypothesize that a primitive sense of self is associated with the earliest sensations and movements, which the evolving ego comes to regard as its province as it becomes an imaginary agent. We can expect no direct proof of this hypothesis from the testimony of self-observers like Glen Just who, if anything, exaggerate their own role in early developmental terms. This model of automatic ego genesis resonates strongly with the relative indelibility of personality and character. I am always the same me in my dreams. This means that every night my ego is exercised and reinforced. It is indirect and suspicious evidence that characterizes Glen Just’s story. His story is suspicious because there is no evidence for veridical memory prior to age four. Yet Just claims to remember his mother’s attempts to smother him at age eighteen months. This is almost certainly a false memory, yet he writes about it with the greatest conviction and confidence. Read what he says:

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Mother was approaching me screaming, totally out of control. Her abdomen was extended, with my unborn sister June, or maybe it was just after June’s birth: she had a pillow in her hands chest high. Her face was distorted and twisted. It was the same mask that she wore four years later when my face was forced into the urine soaked sheets in the house by Lake Stevens; it was the mask she wore when her evil soul went to hell. My right ear, the one that always got earaches, was pounding and I was sobbing.

Despite the dubious nature of this report, we have three good reasons for supposing that something like this horrendous story may be true: First, Glen Just’s living younger sister, Vonna, told me that their mother was indeed very spoiled and selfish, incapable of concerned child care; Second, two younger sisters, Donna and Carol, died before the age of six months and are buried in a single grave. Third, when Dr. Just questioned the family physician about the reasons for these early deaths, the last word that the doctor spoke to any member of the family was “negligence.” Everyone that I talked to said that it was routine for Glen’s mother, Madeline, to lock the children in their room when she went off for a sexual tryst. These trysts often took place when Glen’s father (August, aka Augie) was away from the house. One day, Augie returned unexpectedly and caught his wife in flagrante. Her lover escaped by shinnying down a rainspout outside the bedroom window but Madeline was badly beaten by her angry-to-be-cuckolded husband. This saga of domestic chaos says nothing specific about what happened to Glen’s ego before he was born. Let us assume, therefore, that his prenatal ego development was normal. We know from the direct study of human and animal subjects that the third trimester of pregnancy is tumultuous with a brain dynamism that continues in sleep after birth. This is direct evidence of neurodynamic ego development. All we can say in Glen Just’s case is that even if his fetal life was relatively harmonious, his early days in life as an infant cannot have been easy. My impression is that he was genetically and epigenetically well endowed but environmentally handicapped. This formulation reconciles the apparent paradox of his handicaps and his resilience at their compensation and transcendence. To his startling history of maternal smothering, Glen Just adds recollections of mutually unsatisfying breastfeeding. Whether or not

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these stories are true, Glen Just is bereft of happy early memories of his mother. And yet he rejected the suggestion of the only psychotherapist that he ever worked with that his mother did not love him at all. I concur with Glen that his mother really did love him. The problem was that she also lusted after adult and adulterous love. Glen gives joyous accounts of the transcontinental trips he took together with his family. Mother’s explanation of the ghost, Moses, as a guardian angel (of whom he should never speak for fear of being taken for an insane person!) is charming. Something about his early life must have gone well. Otherwise, he would not be here to tell us his fascinating story.

Lucid dreaming Lucid dreaming is now well accepted and, as this book relates, relatively well studied, but at the time that Glen Just was a child, in the late 1930s and early 1940s, it was neither widely recognized nor at all understood physiologically. It is almost certain that Dr. Just could not have learned to control his dreams and other aspects of his psychic life by being taught dream lucidity by his parents or his friends. Spontaneous dream lucidity is most frequent in young children, as a large sample study of German school children by Ursula Voss has recently revealed (Voss, Frenzel, Koppehele-Gossel, & Hobson, 2012). We may conclude, therefore, that Glen Just discovered dream lucidity spontaneously, possibly due to frequent awakenings from his troubling dreams and possibly because he was naturally adept at recognizing that he was dreaming when he was dreaming. If he had temporal lobe seizures (the petit mal fits he refers to in Appendix I), his talent for hybrid state induction might have been enhanced. An ironic twist emerges from this formulation: It is the triggering of dream lucidity which at once signals Dr. Just’s disturbed early sleep and indicates the mechanism of his impressively effective control of his symptoms. He was able to admix elements of waking into his dreams and, thereby, monitor and control them. At the same time, he learned to incorporate pleasant aspects of his dream life into his waking consciousness. The plasticity of our states of consciousness has been grossly underestimated. Glen Just is teaching us to pay closer attention to the voluntary and systematic alteration of states of consciousness. In this regard, Glen Just

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is like the many New Age adherents of meditation but he cannot be easily dismissed as a mere cult spokesperson. Neither should all New Agers be ignored just because they adopt outré claims about why their practice is so effective. Like William James, our minds must remain open to the new music of the spheres (neuronal spheres that is!). The incidence of spontaneous dream lucidity is relatively low and, therefore, it seems reasonable to speculate that Glen Just hit upon this skill by chance but that he then used the skill to treat himself by changing dream plots that were disturbing to him. His use of dream lucidity fits well with other mind control devices that he practiced to reduce the intrusion of primary consciousness elements into his waking life. In practicing this maneuver, there is no doubt that he was guided by his father’s common-sense psychology. August Just was poorly educated, but he believed strongly in the power of positive thinking. He successfully imparted this principle to his son.

Self-hypnosis All of Glen Just’s spontaneously developed self-help procedures have the neurodynamic of self-hypnosis in common: systematic facilitation of frontal lobe executive ego forces is the result. It is, thus, the ego that works, overtime, to save itself from the destruction of parental negligence and abuse. It could be said that the ego is defensive in this struggle but the defense is not of a Freudian nature. This clarification testifies to the power of a waking consciousness that works better and suggests that waking consciousness is a synthetic creation of a novel reality, not an obfuscation by symbolic disguise of an unacceptable reality. It is hard for a normal person like me to believe the claims of Glen Just but I think we must take those claims very seriously, if only because they have such a powerful and credible heuristic value for scientific psychology. When Glen Just refers to his control as “total” and recounts example after example of mental content manipulation, he strains credulity. Surely there were many unremembered dreams that possessed the usual formal features: formed perceptions; false beliefs that he was awake, not asleep; bizarre incongruity and discontinuity; a wide range of emotional feelings with positive as well as negative affects; and the amnesia that helps us all forget our own robotic enslavement to virtual reality.

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Surely, too, there were some memories that were fabricated and are, hence, false. However, there can be no doubt that Glen Just’s childhood was traumatic and that his ego responded positively to his own interventions. When he was forty-two years old, he noted that: I now felt strong enough to unlock my programmed dreams. I wanted to experience all of life as I thought other people must experience it. My nightmares returned but without the psychic pain common in my younger years. I had added twenty years of study, and a modicum of insight, discarded the old Freudian and psychiatric theories of dreams, and was now analyzing them from a developmental psychological perspective. The sense of relief was almost immediate. I finally came to appreciate the amount of energy that active suppression takes. One of the wonderful changes that occurred was my gradual emotional rebirth. Robotic self control was gradually disappearing.

We wish Glen Just had kept a dream journal so we could know what he experienced in his non-lucid dreams and calculate the actual incidence and degree of lucidity in them. We wish we could have studied him in the sleep lab. We will now be alert to his contemporary counterparts and invite them cordially to come forward. The bug-a-boo of Sigmund Freud, hypnosis, turns out to be the abused child’s best friend. Far from interfering with free association and making definitive symptom relief impossible, as I was taught in that Harvard Citadel of Freudianism, the Massachusetts Mental Health Center of 1960, hypnosis is a very effective way of controlling symptoms, and when the ego has gained sufficient strength, the control can gradually be abandoned. Here is an account of how Glen Just used hypnosis to control his behavior: During the time that I had nightmares about the Japanese, I began to have a problem with stuttering. The more I tried not to stutter, the more I stut . . ., stut . . ., stuttered. Dad believed that people could just think unwanted behaviors away. Dad talked to me again, and told me to think about not stuttering before I started talking. I practiced this idea and it worked.

Having read extensively in the modern cognitive science literature, Dr. Just now offers this very consilient-with-science explanation of his victory over stuttering:

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Stopping behavioral reinforcement early interrupts neuronal patterning before it becomes set. I didn’t know this at five years of age; I just knew that thinking before speaking returned speech control to me. Unknowingly I was also learning that mind could supervene over behavior.

If Glen Just had not practiced autosuggestion at age five, he might have become a lifelong stutterer. Or he might have learned, in anamnestic psychotherapy, that his stuttering arose in response to anxiety about his helter-skelter parenting. He might even have been relieved of his stuttering symptom in this way. But he would have suffered increased embarrassment at the hands of schoolmates, which he did not need. There is no guarantee that he would have achieved complete relief of his speech impediment if he had not used autosuggestion to relieve it. It is ironic that his mentor was his demanding, demeaning father. For once, he lucked out, getting help from a person whom he feared but respected enough to apply the simple prescriptions of common sense and positive thinking. There is another point that deserves comment. It is Glen Just’s assertion that after sufficient practice his mind became supervenient over his physiology. At first glace, this claim smacks of dualism, but it is really more consonant with dual aspect monism. Dual aspect monism allows that the mind is, in fact, causal (that is to say, supervenient over brain activity) as well as being caused by the brain. These possibilities restore free will to its rightful place in cognitive science, as Karl Friston and I argue in recent articles (Hobson & Friston, 2012, 2014). By the time he was a college student, at age twenty-one, Glen Just could claim that: At first I used self-hypnosis to improve my concentration. I kept increasing my length of concentration each week. By spring quarter, I could focus on textbooks for eight straight hours without a break or interruption. I found these marathons physically exhausting and began to limit myself to four hours of unbroken concentration.

My own modest academic success was achieved in a similar way. At age fifteen, I had unqualified parental support and the passionate encouragement of a mentor who made me believe that I could excel at school. I did, with no resort to anamnesis, and I write this book in three-hour bouts of unbroken concentration.

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Dr. Just goes on to say, Self-hypnosis was then used to control test anxiety. I could study from 10:00 PM until 6:00 AM with only one break and about 98% recall. Test anxiety gone, grades improved. I went on to expand the use of selfhypnosis to control pain, heart rate, body temperature. I then learned to enter my dreams while still dreaming and change the plot and characters.

A process that began at age five was, by age twenty-one, effectively realized. In Glen Just’s case, the clinical motives for self-hypnosis were strong and although his symptoms were not gone, they were surmounted. Doesn’t Glen’s witness send a compelling message to all students? Student mental health intervention, in the United States at least, still tends to be anamnestic (that is to say, Freudian). The assumption of this model is that stress will be reduced by support, by changing courses, by dropping out of school for a while, by transferring to another college, by taking prescription and illegal drugs, by anything but buckling down and reducing anxiety via successful performance! I say, therefore, that Freudianism is more of a problem than a solution. It is a broken crutch, which should be discarded.

Energetics A function for REM sleep and dreaming has recently been advanced by Karl Friston and me by combining basic neurobiological findings with free energy theory. This is a technically sophisticated and mathematically instantiated innovation but it can be simply understood as the need of a complex system, like Glen Just’s brain–mind, to achieve energetic equilibrium and freedom from informational surprise. Glen Just has claimed that he can achieve body temperature control by self-hypnosis. Whether or not this is really true (and I am skeptical), there can be no question that his energetics in general and, his brain temperature in particular, must be in good order since he has survived to age seventy-seven. To me, this indicates that his sleep physiology is normal enough to support basic housekeeping functions (like body and brain temperature regulation) but that many of his dreams are uncontrolled. As I say to those dream lucidity wannabees who fear getting stuck in that mode, it is difficult to be more than occasionally lucid. The automatic aspects of REM sleep regulation are

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pre-emptive over voluntary ones, and will take over when vigilance is relaxed, as occasionally it must be, to prevent our all dying, like Allan Rechtschaffen’s rats, of insomnia (Rechtschaffen et al. 1989). This means that Glen Just’s brain–mind is a war zone for two kinds of survival forces: one is conscious state alternation and the other is intrinsic regulation by sleep of life-sustaining energetics. No wonder that his battle is constant, never fully won, and no wonder that Dr. Just is never completely symptom free. It is faint comfort to Glen Just to be told that he is as vulnerable as the rest of us to dysregulation and that it is normal to be a little bit crazy in our dreams. What Glen Just teaches us is that craziness needs to be jacketed, that is to say, kept in place in dreams, and modified in that place to the extent that this is possible. By this means he can experience a waking state that is symptom free, or at least symptom understood and symptom controlled. This is nothing more or less than a universal goal. We are all prone to have the dream stuffing escape from our sleep pillows. When Glen Just relaxes his vigilance, he is not so much surprised to see his dreams take a turn for the worse as he is disappointed to find himself again depressed when he is awake. For Dr. Just, the surprise that most of us successfully avoid in waking is a commonplace to be expected. We normals have nightmares and are reassured upon awakening to see that our perception was “only a dream.” For Glen Just, the waking reality was, in many ways, worse than the nightmares that he tried to diminish via his lucid dream selfmanipulations. He learned not to be surprised by the ability, rare in my clinical experience, of altering his waking in the direction of his ecstatic dreaming. He tells us clearly that this does not surprise him at all. Rather, he welcomes his power to escape from abuse even in waking. This is transcendence par excellence. We normals are glad that we are not motivated as much as Dr. Just to achieve lucidity, but we are a bit jealous of his success all the same. The capacity for invention that Dr. Just channels so well is part of our capacity to avoid surprise in our perceptions, thoughts, and actions. By being able to anticipate almost any threat to us in waking, we have a built-in virtual realty generator that normally makes our dreams so unpredictable, so anxiety ridden, and so bizarre. We are made ready for anything, or, at least, almost anything. A hard-assed father and a promiscuous mother are difficult for anyone to accept.

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They become impossible to accept if they turn sadistic, as Glen Just’s parents were alleged to have done. (We have abundant testimonial corroboration of their abuse of each other as well as of their children.) When Glen Just’s capacities for acceptance of abuse were exceeded, he took flight in his imagination. In this way, he achieved the status of shaman, mystic, Native American, astral traveler, out-of-body escape artist, and expert witness to adaptive alteration of states of consciousness. Thereby, he extended the range of prediction, but in the main not beyond known limits and not yet beyond what we can understand about our brains and our minds.

Religion The Mind of a Mystic is the title of Glen Just’s second book. In it, he describes the wide variety of his religious experiences. Although he is now inclined to favor the entirely naturalistic view that his mystical mind states are brain functions, he is loath to embrace atheism, because the absence of a god is no more ascertainable to him than the presence of one. In this sense, Glen Just is more conservative than Sigmund Freud, and more conservative than Adolf Grunbaum or me, when we react with anathema even to agnostic theism. For we atheists, tolerance of religion is entirely unscientific and a positive obstacle to moral, political, and social progress via scientific humanism. For example, we humanists hold that sexual fidelity is desirable not because it is God’s commandment but because infidelity is hurtful. Whenever, in the tolerant spirit of William James, one leaves the door open to the veridicality of religious belief, one leaves the enemy unchallenged. For me, this is akin to granting the psychoanalysts the possibility that, after all, Freud might have been right about dreams. I say that he was wrong and hold it to be religious to argue otherwise. I am irreligious but I do not expect most people to embrace atheism. I just want to promote the paradigm of science to the extent possible. Glen Just agrees with me on this last point. In Ego Ergo Sum, now titled Psychodynamic Neurology, I argue that Sigmund Freud was not only wrong about the dream theory but also mistaken in his theory of trauma, his theory of sexuality, and his theory of psychopathology. Just’s religious toleration is in the service of his respect for deviant views of all kinds. He has been stigmatized enough himself to know the pain of prejudice. A major element in his story is his own reverence

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for life (revealed in the owl-hunting episode) and the comfort he himself derived from his many mystical experiences. In that sense, it could be rightly maintained that religion is the opiate of the people. This is because life can be so painful as to put us in need of spiritual remediation. Glen Just and I would certainly agree that the brain is credulous, ready to believe the impossible. This fact is clearly demonstrated in our acceptance of the delusional belief, when dreaming, that we are actually awake. Glen Just was more successful than most of us in getting this illusion corrected (but he also had stronger reasons for doing so than most of us do). He wanted to believe that he was all right even though he was not all right. His survival, as a psychic being, depended upon his belief. Like William James, he accepted the idea of free will pragmatically: it worked for him.

Sex At age seventy-seven, Glen Just doesn’t talk much about sex except say that it is no longer very important to him. He has had a relatively normal sex life despite the fact that his mother had very porous sexual boundaries. Her alleged negligence of her children was tied to her promiscuity. The six siblings born, we suppose, to his mother and father suggest a lively marital sex life despite his father’s frequent absence. Glen’s father, Augie, was erotically frisky and, while stern about work, he was permissive about sexual play. In one poignant episode, we learn of a homosexual violation of Glen by a farmer neighbor and find him confused and outraged by a bewildering set of questions asked by a criminal investigator about his acquiescence in the encounter. Flying dreams were more satisfying in and of themselves rather than the appeasement of sexual urges that Freud imagined them to disguise. We must first survive. Then, if safe, we may procreate. In any case, we can safely conclude that little, if any, of Glen Just’s early experience is determined by repressed sexuality. Glen was raised in a family where sexual expression was open, often to an alarming degree. His promiscuous mother once tried to seduce him, but he rejected her blatant nudity out of hand. His use of flying dreams was more in the service of survival escape than seduction avoidance or displacement of a Freudian nature. He wanted to avoid marital entrapment by seductive women during his high school

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years and was, thus, unusually abstinent, but he masturbated freely. He was mostly faithful in his three marriages, all of which were normally consummated. I conclude that Glen Just is not a victim of the Oedipus complex. He is victim of maternal neglect and paternal authoritarianism.

Astral travel As the brain matures and life experience diversifies, there is at least the opportunity for transcendence. By transcendence, I do not mean elevation and entry into a literally higher world. I mean instead that virtual states of being can be cultivated which can counter the deleterious effects of early childhood experience. Glen Just offers us numerous examples of creative manipulation of his own mind. The first example is one of astral travel, a psychological phenomenon related to out-of-body experience. The strategic use of the imagination by an eight-year-old boy is remarkable: I decided to visit the man in the moon after Dad tried to chop (big brother) Bud’s head off. I flew into outer space and got halfway between the moon and the earth where each celestial body seemed to be about the same size. Suddenly I felt entirely alone in the cold, dark grip of space. The void was entirely black except for the shining moon and earth, and the earth was rapidly becoming a shrinking bell of rapidly fading colors. Was I lost, would I be able to return if I went all the way, and the extreme cold made me shiver; I physically shivered.

Glen Just then decided to leave a part of himself in outer space for safekeeping and later retrieval. This would be useful, he reasoned, if his Dad were to turn his wrath upon him. Glen’s ego/self was plastic, unfinished, and divisible—witness his astral travel powers. He returned to earth, to his farm, and to his wrathful Dad with a bit of himself left in outer space. At this point his conviction about his experience was literal. He comments, I learned that out of body experiences had no boundaries. And that the human body could pass back and forth through the roof of one’s house. I learned that Dad was right: one could control their body with their mind.

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Communing with nature Four years later, when he was twelve, Glen Just began to commune with nature. This phase of cognition increased his sensibility and made him realize that his unusual experiences might have a naturalistic explanation. He never relinquished the joy and power of subjectivity, however. In this sense, he is never a reductionist and never an eliminative materialist as so many scientifically inclined persons become. I would watch the Northern Lights until bed time; or winter’s cold would drive me indoors. The lights would pull me upward like a magnet into their magnificent celestial fold. Letting myself merge with the forces of nature was not mystical or strange. I came to understand that the reality of pre-literate peoples of the world had its own beauty; a beauty unknown to most civilized folks of the city. Being different was not pathological.

He was chastened, at age twelve, by a hunting experience that stimulated his reverence for life: On the spur of the moment, I raised the .22, aimed carefully and shot. I was surprised when the bird came flapping down, and landed on a branch just inches from my face. It looked straight into my eyes, like a demanding teacher about to reprimand a wayward pupil. I had never seen owl’s eyes up this close before and I just stared back. The owl’s gaze held me in a vice-like grip as life drained slowly from its body, its eyelids began to blink, the eyes turned upwards and the lids closed. The picture of the dying owl became permanently burned into my brain. I wished it could fly again, I wished it would hoot once more, but it just lay on the ground. I couldn’t bring myself to pick it up or even bury it. I just walked away.

A bird died and a mystic naturalist was born. Glen Just realized that the owl and he both had a similar kind of consciousness. In my terms, the owl’s consciousness was predominantly, if not exclusively, primary; Glen’s consciousness only became primary when it could not bear to be secondary. The owl never enjoyed Glen Just’s secondary kind of consciousness. By virtue of his own awareness of instinctual life, Glen made unusual contact with the dying owl. His ego transcended its boundaries.

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Psychosis For much of his life, Glen Just has communed with Moses, whom his mother called a guardian angel, and he calls his Ghost. In his own words, Moses had a magical way of talking to me. It was like his voice, more, his thoughts, were put directly into my mind, but his communication was always as clear as spoken words, and in this case accompanied by a visual aid. When I pulled back the grass in the exact spot where he directed me, I found a dime and a nickel wedged out-of-sight in the yellow clay. Ice cream was ten cents at the corner dairy, but only a nickel at Sam’s—a mile through town on the North end. I walked home, got my sisters (Vonna and June) and we all went out for ice cream. Moses was an incredible person, or angel, or whatever, to me.

This description is very much like a dream apparition rather than the hallucination of a schizophrenic, but this sort of thought insertion is also seen in hospital psychopathology. Glen Just’s mother may have been wise to advise him not to tell anyone about his Moses experience. As David Rosenhan has demonstrated in his seminal article, “On being sane in insane places” (1973), once a normal person has gained admission to a mental hospital with the claim of having heard voices, it is very difficult to get out again. Another unusual feature of Moses is his benign, even benevolent nature. To a poor farm boy, longing for ice cream, Moses is wish fulfillment in spades. But it is Moses’ uncanny prophecy that causes Just to believe he is real. A Chinese peasant wrote to me repeated letters about his dream instruction to dig for treasure in his garden. In spite of my warnings, dig my Chinese peasant correspondent did, but treasure he did not find. Glen Just never tells us that his Moses was sometimes wrong. Maybe he was not, but believers in dream prophecy are not dissuaded by prophetic failure. Like the compulsive gamblers that they are, they go right on to the next disappointment as if nothing had happened. They are the faithful of the world and the world is full of them. Was Glen Just really crazy when he was with Moses, and should his testimony be written off as the ravings of a madman? I think not. He had an imaginary benefactor who helped him find money when money was scarce. Moses was, as his mother insisted, a kind of

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guardian angel, a friend whom he needed, much as the imaginary playmates summoned by perfectly normal but socially isolated children. A problem is that ghosts seem very real. But, I remind you, so do your dreams; conviction cannot be decisive whereas the objectification of brain state can. Some people, and Glen Just is one of them, move in and out of the dream world with ease. It is not hard for me to see why, especially now that I am convinced that dreaming is a necessary prelude to waking consciousness. Dreaming is a natural, deeply embedded part of us. It is essential to life. It is impossible for me to explain the experience of the student who witnessed the Ghost in Glen Just’s sociology classroom at the University of Minnesota, Mankato. Just claims that Moses entered the classroom uninvited, sat down, said nothing, and then left. A student asked him “Who was that stranger?” She proceeded to confirm details of Moses’ appearance as if she, and only she and Glen Just, had noticed the apparition of the Ghost. Just understandably harbors doubts about the veracity of his perceptions although he would, by now, prefer to accept a scientific explanation. Against such stories, I lay down my arms and wait patiently for a rational explanation. I myself have had convincing apparitions but they were always visual and always, in my case, always associated with sleep loss. I am referring to the relatively common hypnagogic (falling asleep) and hypnopompic (waking up) hallucinations that are now quite easy to understand as REM wake state interface breakthroughs. But no apparition of mine has ever been confirmed by another person. I must admit that such a confirmatory sighting would set me to wondering and I am not sure I would do as well as Glen Just in quieting my own doubts. If Glen Just was not schizophrenic, was his psychotic experience a manifestation of a major mood disorder? No. Glen Just was not bipolar, and not even genuinely depressed, although he had every reason to be. In this regard, his sixteen-year-old’s account of a suicidal impulse is telling: I decided one warm, sunny Sunday morning after I had finished milking and eating breakfast, that I would commit suicide. I thought the silo was high enough to kill me if I jumped from the top. I started to climb the metal rungs and got halfway up. I stopped, looked out at the

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countryside, visually followed the river south a mile or so into the distance, studied the green land below, and felt the warm sun on my face. I thought it would be just my luck jumping from the silo to break both legs and be lying there when uncle Bert came back from his weekend vacation. The thing to do was dive off, head first. This would splatter my brains all over the packed road below and kill me instantly. I began to climb higher. Then I thought about my brains being splattered like broken eggs all over the yard, became nauseated, and felt like throwing up. I came down the ladder suppressing the urge to lose my breakfast, and decided I would rather live.

Sixty years later, he concluded: I think the common element that kept my sisters and me from suicide was an ingrained sense of self-responsibility acquired from our dysfunctional family.

If Glen Just was neither schizophrenic nor manic depressive, what kind of psychotic was he? Organic psychosis is the only other possibility, and to that topic I will return when I formulate the case of Glen Just in terms of psychodynamic neurology. The existence of a priori expectations of waking reality implies a kind of biological memory. Where did my expectations come from, if not from experience? I can say, without fear of contradiction, that they must have come from my genome, which is not only a memory bank but also a mnemonic record of successful strategies. As scientists, we are deeply committed to the idea that the genome, with its millions of molecules of DNA, is a reliable predictor of our fate, be it personal, social, or medical. Protoconsciousness theory is based strongly on this idea and hypothesizes that the brain is constructed automatically by both genetic and epigenetic mechanisms. The collective memories of the species are built into our bodies by our genes. Here, we are faced with the conviction that Carl Jung, the mysticist Protestant rival of the avowed atheistic Jew, Sigmund Freud, called the “collective unconscious.” Because of Jung’s mysticism, this is very uninviting territory from a scientific point of view. We can well understand Freud’s expulsion of Jung from what he still hoped would

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be a scientific psychology movement, in his words one that was “perspicacious and free from doubt.” Mysticism was not the only reason for Freud’s expulsion of Jung, a rival who contested the master’s heavy emphasis on sexuality. Freud wanted obedient disciples, not intellectual collaborators like Jung who challenged his authoritarian pronouncements. To the extent that Jung was more critical than Freud and open to more positive ideas, it is a pleasure to acknowledge the originality of Jung’s “collective unconscious” hypothesis. If we, like Freud, restrict our attention to postnatal development, we can improve our chances of accurate observation and decisive experiment. But, in doing so, we miss the obvious fact that much of importance has already transpired when we begin our observation. What does Glen Just teach us about such matters? First and foremost, he teaches us that what passes in parlance for memory is as unreliable as it is insistent about the truth. From his story and that of his siblings, we can only be sure that something was amiss in the Just household. There is no reason to suppose that Glen Just’s adventitious memories were psychopathological. An extensive family history reveals no smoking gun, no impressive overloading of mental illness. Glen Just’s mother was certainly not a schizophrenic, as he so boldly claimed in one of his books, and he was not the firstdegree relative of any schizophrenic. His genetic memory rules that out. For Glen Just, as for all of us, memory is, thus, a fiction writer who helps us to create a reasonable account of why we are the way we are, a story about a story about a story. We are in a hall of mirrors and the images that we now behold began to be flashed up on our perceptual screen before were born. Our memory of those early flashes is nonexistent but our dreams tell us a lot about how confusing it must have been to get any hold on reality in the best of situations presented by the environment. If environmental reality was not reliable or safe, as it was surely not for Glen Just, then the virtual model may have won its battle with the real model. If he is a good fiction writer, then Glen Just’s memory model may be worse than his life really was. I am not suggesting that his early life was good. I sincerely believe that it was both good and, in many important ways, bad. But I cannot prove that in any way and will not try to do so. All that I need to accept to make modern scientific sense

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out of Glen Just’s story is that he was neglected and mistreated and that he used universal and natural means to overcome his handicaps. I wish Just’s narrative memory were more accurate than it appears to be, but it does not really matter if the basic assumptions that I make about him are “perspicacious and free from doubt,” as I take them to be. There is no way that the precious account given to us by Glen Just can be dismissed as the delusions of a lunatic, the product of false memory, or a fantasy to be rejected out of hand. False memory there may well be, but the basic message is solid and intact. Glen is not a great writer. He is given to hyperbole and repetition. He is psychiatrically naïve, but he is sincere, intelligent, and he tells an important story. How can I be so sure of this conclusion? Read the books yourself, keep your tongue in your cheek, then try to meet the man, as I did. Study modern sleep and dream neuroscience as I have done all my life. It all fits together in a coherent way that would satisfy even religionists like Sigmund Freud and Carl Jung. You do not even have to give up your belief in the psychoanalytic model of the unconscious if you don’t want to, but I do not see what that buys you in understanding the story of Glen Just. If you are born sane in an insane place, as Glen Just was, you had better start working on getting out. It may take you a lifetime, but it is worth it.

The interpretation of dreaming Long before I proposed the theory of protoconsciousness that I advance here, I argued in favor of the interpretation of dreaming rather than the interpretation of dreams. By that shift in emphasis, I meant to encourage a formal rather than a content analytical approach. Unbeknown to me then was the concept of psychodynamic neurology that has emerged only recently. I wanted to know why dreams were so often visual, thinking I might be able to frame the answer to that question in terms of what I was learning about the brain. I would never have a chance of doing that if I wondered why I dreamed of so and so, unless I was an authoritarian figure like Sigmund Freud, who forced dream interpretations down the throats of his hapless patients and his reverent students. I am now more thoroughly convinced than ever that dreams are not interpretable by any systematic symbolic approach but that the interpretation of dreaming

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really is a valid and robust way to understand the mind of the brain. Glen Just’s story confirms my conviction. When he dreams, he unrolls his own set of expectations as a way of helping him deal with his challenging reality. His dreaming, like yours and mine, is psychotic by definition. He sees and hears things that are not really there, believes things that could not possibly be true, thinks in a jumbled and inconsistent way, feels strong emotion, and, were it not for his horrendous waking reality, he would probably have forgotten most of his dreams just as you and I do. But instead, Glen Just discovered that this very inventive part of himself had two functions that were not normally apparent. One was his ability to control some of his dreams by applying the canons of waking consciousness to them; the other was his ability to drag aspects of dreaming into waking so as to comfort him. In neither case did he use dreaming to disguise or conceal waking from himself. Glen Just is, thus, the quintessential non-Freudian dreamer. He says so himself. Freudian dream theory never worked for him and he made this discovery for himself long before he read any of my rebellious books. How does Glen Just do it and what can we learn from his story? Why his story is not more often told is one part of the puzzle. I suspect that there are many other Glen Justs out there but that they, like Glen, obey their mother’s injuctions not to tell anyone what they really experience for fear of being stigmatized as mentally ill or, worse, hospitalized. The stigmatization of mental illness is still pronounced. And it will be until we instill something like psychodynamic neurology in our minds. We are not two substances, one material and the other spiritual. We are creatures with brains so highly evolved as to need a model of virtual reality to help us cope with real reality. When those two models are out of synch, as they were in the Just family, all hell breaks loose. If I am correct, many others will follow Glen Just’s lead and introduce us to their own Moses while learning from Just how better to temper their two models of the world, the one virtual and the other real.

The universality of dream science If I were to chide Just and encourage his successors, I would say “take yourself more seriously as a valued member of the most ambitious

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and important team of scientists in human history, we who dare to tackle the problem of our own psychology.” I am grateful to Glen Just for taking this charge as far as he has done. But this is just the beginning. Glen Just is an unusually bold and talented lay person. I wonder how many professionals dare, as he does, take up the cause of a new psychology? The rash of books that has celebrated the new science of the mind is a step in the right direction. These books do sometimes sell well, but they are as likely to elicit the scorn of peers as they are to inspire proselytes among the laity. Try to get a grant or an academic appointment to study dreaming and you will hear Glen Just’s mother telling you to keep your bizarre ideas to yourself. Success, sadly, is conventional and for good reason. It is so easy to be wrong. So much is believed. So little is known. As I write this appeal, I realize that it is to the young that my voice must be directed. Most people as old as I am do not want to listen anymore. Their minds are made up, they have their tenure, their Nobel Prizes, and they may be quite self-satisfied although they have contributed little or nothing to the science of consciousness. It is, therefore, to the young in mind that I speak. You who have just begun your graduate studies are still full of the wonder of the great books you read in college. Now is the time to begin to read them again. Oh, you say, you have no time for that. You have nowhere near enough time even to cover the last ten years of the scientific literature in your field. Shame on you if you have not read Marcel Proust at least three times by now. What about James Joyce’s Ulysses (1922)? How about Bertrand Russell, cover to cover, all fifty books, all his letters? Immanuel Kant? William James? Don’t tell me you have not read any of these giants in the last year? If you send me an email, I will return a reading list that will keep you happily and profitably engaged for a decade and 2014–2024 promises to be quite a decade. If brilliance and poetry turn you on, take a heavy dose of Arthur Rimbaud and Charles Baudelaire. They were on to protoconsciousness in the nineteenth century. In fact, it could be argued that it is the fiction writers and poets to whom we must turn for what little we know of subjective experience. On this view, it should be remarked that C. P. Snow’s Two Cultures (1960) are but one culture that we have cut in two. An integration has begun to unite the two cultures. I am

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embarrassed to say that it is the humanists, not the scientists who have taken the initiative. For me, brain science is a liberal art and belongs at the center of philosophy and psychology, not to mention literature. If we are to study consciousness, we must, repeat must, deal with the issue of subjectivity. A science of consciousness cannot only be a science of the brain. We must map back and forth from the brain to the conscious mind. The mind part may be inspired by great literature but great literature is not enough, and neither is it now possible to account for the quality of great writing in terms of neurobiology. We need to invent new psychological measures and new paradigms for their analysis. In this book and in the forthcoming volume (2014) edited by Nicholas Tranquillo and entitled Dream Consciousness, I have detailed the formal approach to dream reports and illustrated the way that formal measures can be compared with physiologically derived data to help us understand what I call dual-aspect monism. We must recognize two sides of the same coin, the brain–mind as subjective object. I have also suggested that the states of the brain–mind are objective subjects. To join the team, try the following experiment. As you read, look into the mirror. The mentor you seek is you. The answer is in your mind, along with the question: what do I really want to know? Is Allan Hobson right? Is Glen Just really a pioneer? If I myself had it to do over again, I would talk to myself in the mirror, and say, “try hypnosis, take a few drugs, and give yourself over to meditation.” I didn’t do many of those things when I was young because I was scared and I was conventional but I did do a lot of things that I never told anyone except my journal about. If you are open about self-observation and how to systematize it, please let me know. Collaborative studies in dream science are easily managed by email communication. Speaking of reading, do you write a lot? I mean for yourself, for your mind. I am convinced that this is research, too. Do you know what you really think or are you just making up answers to please the other guy? And speaking of speaking, do you really discuss burning questions or do you just keep your end up in polite conversation? Have you ever given a scientific paper without notes and spoken to a seminar without PowerPoint visual aids? Send me an email or call me up: 802 467–3174 in the spring and summer; 011 39 090 46252 in the fall and winter. I said that only the young were likely to take me up

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on any of these outlandish proposals, but I am an equal opportunity employer. All I ask is that if you are seventy-five, like Glen Just, you keep your end up.

Waking dreaming If, in dreaming, we can insert a bit of wake, why can’t we insert a bit of dreaming into waking? This tendency is, in fact, universal when it is called “fantasy” or, more specifically “day dreaming.” The fluid boundaries that Glen Just made more porous around his mental states allowed him to achieve unusual freedom from monotony and escape from confinement. A Wesleyan student friend of mine, the late James (aka Jimmy) Steindler, worked one college summer as a welder’s assistant, erecting the steel frames of New York City skyscrapers. The welder that Jimmy was assisting was often lying on a beam, high above the street, with his eyes half-closed and a bemused smile playing on his lips. “Just having a mental” was his reply when Jimmy asked what he was doing. He was escaping from boredom and danger by experiencing sexual pleasure in his imagination. He did this by lying down, closing his eyes and rolling the pornographic film of his choice in his mind. When Glen Just, age twelve, drove with his family from Wisconsin to Washington state and back, he made the trip more interesting by flying alongside the car and cruising up and down valleys for a better look at the landscape (see p. 167 for his own account of this experience). He was a nature romantic in the making and his trick would have pleased William Wordsworth and Samuel Coleridge, who also contrived naturalistic means of increasing their sensitivity. As is well known, Coleridge experimented with opium to enter exotic, hyperimaginative states, but Glen Just’s story suggests that quite a lot of exoticism can be conjured up without chemically tinkering with the neurons. I asked Glen Just to provide a summary comment on waking dreaming and this is what he said: As noted by Dr. Hobson, out-of-body experiences began to occur after being hospitalized with a near death experience. My memory is vague, but these experiences were common by the time I was three years old. I never separated mind from body when out “flying” until sometime between eight and twelve years of age. By the time I was eight, my

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ability to pass back-and-forth through the roof from my bed bewildered me. I practiced and practiced but could not explain how this was possible. I knew that my body was physical, yet it passed easily through the roof time and again. By the time I was twelve, I played out-of-body with the Northern Lights, and projected myself into celestial play. By this age, I was fully aware that this was a capacity that I could just turn on and off. I still exercise a similar kind of projection when watching a film such as “Ghost,” or a Star Trek-type movie. It is fun and provides me with a strong sense of veridicality. I give numerous examples in my writing in an attempt to bring attention to the neuroscience behind this phenomenon. As Dr. Hobson notes, I taught myself from about three years of age on to gradually engage in experiments to overcome fear of fictive heights, flying over water, and eventually going into outer space. A point that I want to emphasize is how real these experiences feel to an adult, let alone a child who is still working on putting his sense of self together. I considered flight school when I was in the army at age 19. Never having been in an airplane, one of the army pilots took me for a spin, loops, rolls, dives, and an entirely joyous experience. Camera in hand I clicked away. I asked to take the controls, but this was denied. My pilot was impressed. The only difference between flying out-of-body and in a plane performing stunts is the pull of gravity, and this I found exhilarating.

The architecture of our brains, which permits virtual but true-tolife experiences of this nature, speaks directly to the auto-creativity that is a natural part of our virtual reality mechanisms. My hope for individuals who have not yet learned to control these mechanisms is that neuroscience and better clinical models will find a way.

The ghost Not all of Glen Just’s exceptional mental states were planned or even desired. His visitation by the ghost is one example of an unplanned intrusion and it gives evidence that Just was on the edge of psychosis and frank mental illness for a large part of his early life. He was “borderline,” in the subjective sense of that word (although I would not make the diagnosis of Borderline Personality Disorder in his case). When he entered college, he told me that he scored high on the

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Schizophrenia and Paranoia subscales of the Minnesota Multiple Personality Index (MMPI), but he is not schizophrenic and neither is he even faintly paranoid today. Glen quickly learned how to drop those scales into the normal range when he was retested in his collegiate youth. The MMPI asks a test taker to say whether or not he has experienced symptoms commonly described by mental patients carrying those diagnostic labels and is, therefore, of limited validity. As Glen Just’s mother advised, he did not tell people about his subjective experience and, thus, she helped him to reframe his subjectivity. If you talk like a nutcase, then you will be considered a nutcase, and Glen’s mother wisely counseled him to say nothing about Moses lest he get himself locked up. Unlike the uninvited guests of the minds of schizophrenics, Moses was as friendly as he was menacing. In fact, he was so friendly that his mother advised Glen to regard his ghost as a guardian angel, a common fantasy ally who is welcome and not a bit menacing or stigmatizing to many people. Having a guardian angel as benevolent as Moses is as lucky as drawing a winning ticket to the lottery jackpot and far more likely. Here is Glen Just on Moses: Mother said that children had “Guardian Angels” and I believed her. When one has a sense as a three to five year old child that some entity is nearby helping, it does not take a lot of convincing. I eventually called this “spirit” Moses. I learned as an undergraduate student in psychology that children often have imaginary friends. This awareness took away my sense of being different or potentially being stigmatized as crazy. I kept Moses as an imaginary friend most of my life, he is comforting and always available; much like a small child’s favorite blanket. Neuronal habits become habituated and feel good. Just ask any gambling addict. My life has been enriched tremendously by the comfort of such fantasies, even though I’ve known throughout my adult years that they are just fantasies. I discovered as a university professor in the 1970s that hallucinogenic drug users could collectively share their paranormal experiences. I experienced a collective sighting in a Native American honoring ceremony with a Shaman during this period as well. Expectations, perhaps a little ultra-sensitivity, or the right amount of hallucinogen, and multiple (many?) people come to believe. Neuroscience has given us the tools to finally explain these phenomena and take the mysticism out of “normal”; (they are) but altered brain states.

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Seeing Moses in my university classroom was the one experience I had most difficulty explaining. I explained collective sightings (visions) in my recent books, but failed to explain Moses. I am an ultra-sensitive person in that I cannot watch blood and gore movies. My stomach turns to knots and it becomes impossible to tell myself that this is just a movie. Put two such sensitive people together, adjust the lighting or emotional context, provide the right amount of suggestion, and like a collective drug trip, out pops a version of our expectations. Our autocreative generator never stops. It should be comforting to individuals with shared but uncontrolled hallucinations, and Moses in the classroom was one for me, that something special has happened in the present context to create a collective sighting. I understood the use of mass hypnotism by prophets and proselytizers historically, but when the actual situation enacted in my classroom, I forgot history on the spot. Many people become “True Believers,” as the sense of reality these brain state changes enact tend to be overwhelming. Just read some of the shamanic literature and you will become aware of how quickly some professional anthropologists jump on board the wagon of mysticism.

Glen Just and I have discussed the very unsettling sighting of Moses in a classroom where Just was teaching at the University of Minnesota. Only one other person saw Moses, which is good news and bad news: good news because if Moses had been real, he would have been visible to everyone; it is bad news for rationalists like me because a common sighting raises the probability of an other-worldly, spiritual interpretation. With respect to the shared Moses sighting, we are obliged to hand-wave a bit and invoke unconscious communication between Just and the sensitive student. The jury is still out on this one, but the precedent for shared visual illusions is strong. Consider the frequency of UFO sightings. I know that debate rages on this subject but no little green men have yet been photographed with even the murkiness of film images of the Loch Ness Monster or the clearly light-struck photo of a ghost that I was shown by a credulous university professor in Thailand. I guess you can tell that I am very skeptical about spiritualist explanations for these events. The delusion that I am awake when I am in fact dreaming convinces me that the human mind is all too easily fooled by brain shenanigans that we are only beginning to understand. Add to this truth the fact that the brain is designed to

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predict its sensorimotor future makes contamination by suggestion all but inevitable. We should learn, from people like Glen Just, how to take advantage of the power of positive thinking and to embrace hypnosis rather than attempting to run away from it as Freud did.

Psychopathology and the temporal lobe The timeline of Glen Just’s life (which is provided in Appendix I) reveals the fact that he was told, as a child, that he had a seizure disorder but that he was never diagnosed as suffering from temporal lobe seizures. I strongly doubt that a contemporary neurological study will reveal evidence supporting such a diagnosis today. It is, nonetheless, warranted to consider the possibility that Glen Just did have something like a temporal lobe seizure disorder that made him abnormally able to enter dreamlike states of consciousness. The reasons for taking this possibility seriously, beyond his testimony, are several. They include: the low seizure threshold of the temporal lobe revealed by the experimental effects reported by Graham Goddard; the active participation of the temporal lobe in REM sleep and the related formal similarities of dreams and seizures described by A. W. Epstein (1977); the epileptiform nature of REM sleep neurophysiology, especially the PGO waves and their interaction with the temporal lobe detailed by Zeev Elazar and me (1985); and the ability of TLE patients to alter their own state, especially if sleep deprived, as in the accounts of the behavioral neurologist, David Bear. The upshot of these considerations is to rate as strongly possible the explanation of Glen Just’s experience as due to a TLE-like brain sensitivity. This responsible speculation reconciles neurology and psychiatry in an attractive way. It does so by clearly linking a distinctive set of subjective phenomena with a distinctive set of neurological data and is, thus, a cardinal example of psychodynamic neurology. According to this formulation, Glen Just’s temporal lobe was kindled when he experienced anoxia, possibly at his mother’s hands, when he was an infant. He was never thereafter subject to frank seizures but he was susceptible to twilight states, particularly at the sleep–wake interface. Glen Just’s twilight states included out-of-body experiences, astral travel, and lucid dreaming as well as waking

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dreaming. Whether his nightmares and his daytime obsessions were a consequence of this sub-threshold seizure propensity is another question that we may ask. Closer study of the dreamy states of TLE patients is clearly warranted. At an even more speculative remove, we must consider famous literary antecedents such as Fyodor Dostoevski, who has been considered to be a TLE sufferer. Dostoevski’s seizure-like writing orgies, his compulsive gambling, and his creation of fictional characters was parricidal and bizarre; Dostoevski’s self-destructive impulses have prompted many scholars, including Sigmund Freud and me, to wonder about a connection between seizure propensity and creativity. I suspect that Glen Just may be a modern Fyodor Dostoevski who is trying to take us further in the direction of psychodynamic neurology.

Self-reliance and the frontal lobe A powerful means for shaping our own behavior is telling ourselves flattering stories. If I say to myself, you are very attractive to women, I will be more attractive to women, especially if my autosuggestion is even a little bit true and if I flatter myself with that conviction. This indicates that the power of positive thinking needs only a little bit to go on and that a form of ego embroidery can then repeat a realistic assumption and result in a comforting and aesthetically pleasing cover, an ego quilt as it were. Evidence from modern sleep and dream science promotes the idea that self-hypnosis of this kind is very real and that it may be mediated via the frontal lobe. This important possibility leads to the specification of several testable hypotheses of relevance to psychodynamic neurology in the domain of treatment. The neuropsychology of the frontal lobe’s role in executive ego function is extensive and has been meticulously reviewed. It seems reasonable to assume that frontal lobe activation is critical to the capacity of waking consciousness to be coherent, focused, and rationally abstract. The recent evidence from Ursula Voss’ laboratory studies of lucid dreaming are consistent with this theory (Voss, Holtzmann, Tuin, & Hobson, 2009). From the point of view of REM sleep and lucid dreaming, it is significant that the voluntary eye movements that are used by lucid subjects to signal their awareness of dreaming must engage neurons

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in the frontal eye fields that project directly to the pontine tegmentum of the brain stem. This allows volition to control the saccade generator that is automatically activated, for the most part, free running, in REM sleep. It is in this sense that we can assert, with confidence, that a bottom-up automatic process (resulting in dreaming) is converted to a top-down process (resulting in lucidity). Dream lucidity is, thus, evidence of a competitive interaction within our brain and this competition often results in either the interruption of sleep or the loss of lucidity. There is also good scientific evidence to suggest that the temporal lobe, which I have considered to be hyper-excitable in Glen Just’s brain, is under the inhibitory control of the frontal lobe. Ritchie Davidson, my friend and colleague at the University of Wisconsin, has demonstrated reciprocal interaction between these two structures. This renders plausible the idea that volitional thought, of the sort used by Glen Just to regulate his psychic state, was efficacious because the physiological substrate of his conscious decisions diminished his psychopathological propensities. The frontal lobes can, thus, be considered to be the top of the line in the control of waking consciousness. The frontal lobes are, therefore, worthy of consideration as the top of the top in directing “topdown” processing, the kind of processing that I am now using in writing these words and the kind of processing that you are using in reading and evaluating them. The frontal lobes are command central for waking consciousness and the understanding of exactly how they work is of the greatest interest and importance in fleshing out the brain–mind connection. Their clearly significant role in determining brain–mind state is, in turn, reason to be interested in sleep and dream science. It is the meteoric progress in this area of human clinical neuroscience that supports optimism for the solution of the mind–body problem.

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PART V

Ego repair: what every psychotherapist should know

he most important and most difficult challenge to caregivers is to recognize the extent of our ignorance without instilling despair in ourselves or those who seek our help. In other words, we therapists need to be humble, tranquil, wise, critical, and hopeful at the same time. Good luck to us! This challenge can be met only by the honest appraisal of our current state of knowledge, which is extremely limited. What little we do know is no less substantial and promising. Achieving a comfortable degree of acceptance and self-respect is possible if we realize that we are working toward a very important social and scientific goal.

T

Philosophical considerations We must put aside the suggestion of infallibility that has been a particular problem of the pseudoscientific psychoanalytic therapy practiced by the followers of Sigmund Freud. I know whereof I speak because I was educated to become one of them. Fortunately, my inability to believe the theoretical and practical claims of psychoanalysis was relieved by the kind invitation of brain science to learn and know a 137

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little of what Freud wanted and needed to know to create a scientific psychology. In the beginning (ca. 1895), he was autocritical, but by 1900 he began to take himself too seriously, with disastrous results for psychology as a science. I have already offered a theoretical critique of psychoanalytic theory in Ego Ergo Sum (now titled Psychodynamic Neurology) and I will specify the sorts of errors to which interpretive infallibility can lead in a general discussion of the cases I presented in summary form in Part I. I am now convinced that it is a huge mistake to assume a passive stance on the assumption that insight will ensue from an analysis of transference as Freud instructed. In my experience, this model is illusory and incorrect and should be discarded. Even if it is partially valid, it is entirely inappropriate to apply this theoretical mode to those who suffer from true mental illness (as against less disabling problems of living). Because they lack precisely those ego strengths that the passive treatment mode requires for benefit, the mentally ill cannot profit from the application of psychoanalytic theory, but they can and do profit from more direct and encouraging supportive interventions. Among the more direct methods are an active alliance-building stance that offers transparency, education about what we do know about the mind, and collaborative investigation in the further development of brain–mind science. The humility mentioned above must be genuine and must have face validity to avoid fostering deception and to encourage true collaboration. Every person, and especially persons with handicaps, can contribute to a collective picture of what it really means to be human, participating in reconciliation with the truth of that matter and with resolution of many obstacles to compensation and social adjustment. I am advocating what my late Harvard Medical School colleague, Leston Havens, would call the existential attitude. But I would go further than an egalitarian assessment of the way things are with my co-worker patients. My philosophy includes both an assessment and a program of self-improvement that builds upon what we have learned about ourselves in the past fifty years, particularly in the area of sleep and dream science. I want to share with all people, especially my patients, aids to adaptation that I myself have found helpful. These include the keeping of a journal (including waking observations of behavior and reports of dreams), an extensive educational program

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in both the scientific and the artistic domains, and a deliberately experimental approach to social relations. An important choice between optimism and pessimism faces every therapist and every patient. The power of positive thinking can be overdone but so can the negative thinking that has tended to shape Freudian psychoanalysis and its derivative psychodynamics. Freud himself was a pessimist and, no doubt, he had good reason to be so. Freud was a Jew in conservative Catholic Vienna who could not fulfill his scientific aspirations because of the limited number of professional opportunities in the university. His own account of his academic frustration may have exaggerated the effects of anti-Semitic prejudice, but he was, nonetheless, deterred and thereby forced to live by his wits as a practitioner of medicine. By his own account, he was an adventurer rather than a scholar, and he did much to institutionalize his own world-view, which was anything but sanguine. My own recognition of the pessimistic position of psychodynamic theory grew out of my educational encounters, first with the texts of Freud and other late nineteenth-century European intellectuals and, later, by more modern advocates of Freudian philosophy. In my residency, I was admonished by psychoanalyst supervisors for turning psychotherapy into a “tea party” (implying that I was not tough enough, not skeptical enough, and blind to the downside of life). When I gave the William James lectures on Dream Consciousness at Roehampton University in the spring of 2008, I was told by one of the five humanist critics of my theory that he admired Freud because of his pessimism. So, the battle lines are clearly drawn. Pessimists (like Freud and his followers) see the cup as half-empty. Optimists (like me) see the same cup as half full. This simple homily says it all: what we call reality is a function of the way we look at it and how we feel about what we see. I am an optimist by nature and my own experience in life reflects that disposition. So, probably, does my science and the clinical spin that I put on it. But the clinical experience which I summarize in this book tells me that optimism is every bit as important a message in psychotherapy as insight (especially if that insight is pessimistic). In fact, I suspect that insight may actually undermine the fragile trust upon which all adaptive behavior rests. My own trust may admittedly be naïvely optimistic and it is important for me to remain reserved about the motives of others. But, to the degree that suspicion is

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destructive and trust is constructive, even an arbitrary choice, like that of seeing the same cup as half full rather than half empty, will favor the positive, more optimistic choice. With respect to the importance of this fundamental philosophical consideration, I refer with unaccustomed pleasure to the neo-Freudian position of Erik Erikson, for whom basic trust is the first and foremost ego attribute. If one is fundamentally suspicious of the motives of others, then, as Erik Erikson asserted, one will have difficulty in mastering the many challenges that face us all later in development. Thus, it behooves all who would be therapists to mobilize and demonstrate their own trustworthiness so that their patients are aware of it and can avail themselves of it. I myself revel in the feelings of acceptance and love and my clinical experience tells me that my patients do, too. Optimism is such a palpable commodity that it can be engulfed and assimilated as such. We feed on the positive regard of others. The cynical analyst may mockingly call such an open display of optimism a “tea party”; an analyst might even advocate the uncovering of early distrust on the unjustified assumption that the patient’s mistrust will melt away in the heat of insight. This assumption is, in itself, unjustifiably optimistic and, to the extent that the analysis of the transference is a myth—or an unscientific and erroneous assumption—much valuable time and money, not to mention life adventure, may be wasted on it. Worse yet, the poor patient, already distrustful of himself and others, is deprived of his therapist’s positive feelings because they are suppressed by the false and misleading shibboleth of objectivity. For objectivity, we now have recourse to the findings of brain science, especially those which derive from the study of sleep and dreams, and these should be known to every practitioner of psychotherapy and to every patient. I may suffer from the bias of optimism, but that is a far more acceptable bias than that of pessimism.

Brain–mind science In Part II of this book, I have summarized the technical and experimental findings that I think everyone should know. To pave the way for the clinical application of scientific principles, several general points need to be made.

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1. The brain, on which our minds depend, is the most complex product of nature known to us. 2. Although it does not feel that way, each of us has a brain and that organ somehow determines who we are, what we feel, and what we think. 3. Millions of years of evolution have been devoted to the production of the human brain. 4. We are still largely ignorant of how the brain is genetically engineered and how it works. 5. Most brain function is, thus, beyond our understanding or control but several facts are now so well established that we can safely build on them. 6. We all wake. We all sleep. We all dream. In each of those three distinctive brain states, we experience three distinctive kinds of consciousness. 7. We can identify those three states of consciousness for ourselves and examine them with a view to better self-understanding. 8. For example, we can look at the similarities between waking and dreaming and ask ourselves what they mean. 9. Instead of interpreting dreams as distortions of waking consciousness, we can begin to view dreaming as a building block of waking. 10. The result is a positive view of dreaming as proof of our cognitive capacity, including our creativity and resourcefulness, a strength for which we should be grateful. Part II of this book has detailed what we now know about how these states are regulated by the brain. The underlying neurobiology should be known by all people because it constitutes scientifically solid and fundamental aspects of our psychological nature. I go so far as to suggest that at least this much of brain science should be seen as central to the humanities and must become a part of general education. We should no longer tolerate the artificial separation of art and science either in our minds, our homes, our schools, or our offices. We make the mistake of separating the mind from the body at our own self-divisive expense. Moreover, the neurobiological story is not only essential to self-understanding but constitutes the basis of psychological, behavioral, and pharmacological intervention. I address these three kinds of intervention again when later I introduce the

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strategy of state stabilization as a core desideratum of all psychotherapy. Summarizing Part II in terms of self-realization further defines what it means to possess, control, and be controlled by a brain. 1. The human brain can be thought of as an automatic device with volitional override. 2. The automatic functions of the brain are very old in an evolutionary sense. Many of them are situated in the brain stem. 3. The brain stem controls the alternation of brain–mind states. 4. The volitional functions are more modern in an evolutionary sense. Many of them are situated in the upper brain and are most highly developed in man. 5. The automatic and volitional parts of the brain interact at all times and in all states to the benefit and hazard of both. 6. Among the benefits are the capacity to appreciate both automatic and volitional functions, to maximize the strengths of both, and to manipulate their interaction to promote adaptation, health, and well-being. 7. Among the hazards are too much, too little, or the wrong kind of each of the states. 8. For example, too much waking (called insomnia) and too much anxiety (called neurosis) are caused by overactivity of the upper brain, resulting in underactivity of the lower brain. 9. Too much dreaming (called delirium) and too much imagination (called psychosis) are caused by overactivity of the lower brain. 10. A general principle of treatment is to redress the balance between automatic and volitional brain functions. These general points give rise to a new way of thinking about ourselves, our benefits and our hazards, and so informs treatment strategy. This theory, called protoconsciousness, organizes these principles by first postulating two very similar but distinctly different states of consciousness: waking and dreaming. The two states are mutually enhancing but their interaction is potentially problematical. The protoconsciousness theory is based on the following facts and considerations. 1. The brain stem develops before the upper brain in both evolutionary and individual history.

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2. Dreaming is caused by automatic brain stem activation of the upper brain in sleep. 3. Dreaming reflects the operation of an automatic brain function that is seen as a prelude to waking consciousness as much as a consequence thereof. 4. Normal waking depends upon dreaming, which automatically prepares the brain to represent a virtual protoself (an ego or agent), a virtual protospace (or environment), a virtual protosensibilty (or capacity for sensation), a virtual protomobility (or capacity for movement), and a protoemotionality (or capacity for feeling). 5. All of the postulated protoconscious processes are automatically engendered. 6. All of the automatically engendered protoconsciousness processes are virtual. 7. The brain is, thus, automatically provided with a virtual model of the self and its experiential and emotional world before it is called upon to process external data from the outside or real world. 8. Data from the outside world (which we call real as against virtual) is mapped onto the virtual model, creating the hybrid model that we call the psyche. The ego (or self) is established long before birth. 9. The psyche is, thus, a product of innate (genetic) and acquired (environmental) influence. 10. An as-yet unexplained feature of the psyche is how it can be aware of itself in waking, but it seems likely that self-awareness might simply be an elaboration of the upper brain’s talent for abstraction. One very surprising fact is that dreaming is not only essential to mental health (via its informational underpinning of the generic psyche), but that REM sleep, the brain state with which dreaming is most strongly associated, is essential to life itself via its as-yet unexplained utility to the maintenance of body temperature. This completely unexpected fact plays an important part in suggesting and empowering the protoconsciousness hypothesis as a vital theory. It is not only necessary to have REM sleep to dream and to experience its psychological benefits but, as mammals and birds, we must hold our

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bodies (and the body of course includes the brain) within a very narrow temperature range to survive at all! The prime beneficiary of our physiological thermostat may be the brain itself. The constancy of body–brain temperature (which we call homeothermy) is, like brain elaboration itself, both a product and a protector of the higher brain functions that in man are recognized as consciousness. If we do not keep our brains warm we suffer from the loss of efficacy of cognitive function. We cannot concentrate, we cannot elaborate, and we cannot cerebrate until our temperature returns to its elevated straight and narrow path. This is automatic housekeeping with a vengeance and it ties our new view of brain–mind state control to energy control in a fundamental way. Do not lose too much sleep because not only might you go crazy, but you might die! The details and further implications of this important link between information processing and energetics are discussed in Ego Ergo Sum (now titled Psychodynamic Neurology). Because self-awareness is lost (or greatly diminished) in dreaming, the protoconsciousness theory assigns self-awareness to the upper brain. Waking is the state in which all self–other psychotherapy is conducted and self-awareness is a critical factor in engineering changes in self-image (how we see and present ourselves to ourselves and to our world) and how we program change in volitional behavioral options. It is important for us to recognize that while dreaming may be able to tell us “who we really are” in terms of innate and acquired propensities, it is almost certainly not the repository of hidden truth about our experiential past and the revealer of compromises that we might (or might not) have made in our lives. What are some of the benefits of being constructed in this way? In addition to the privileges of automaticity (which acts as a servant which frees our consciousness from responsibility for basic housekeeping functions), dreaming is evidence of our intrinsic talent for improvisation, for imagination, and for creativity. The upper brain must function well to instantiate dream products in works of art and science, but we can depend upon dreaming to constantly remodel the information in our brains hunting for an innovative recombination of data to make unexpected sense of ideational and emotional information. Far from being the instinctual charnel house that Freud envisaged, dreaming is a cause for praise and celebration. Artists have recognized this truth for generations and now art can be appreciated without any

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implication of psychopathology. Indeed, everyone who dreams—and every one of us does so—is an artist of sorts, whether or not he has the upper brain talent or training to turn his dreams into a marketable art product. Counterbalancing these wonderful benefits is a set of menacing hazards. Nature gives nothing away for nothing. There is always a price, a risk, and a downside to our privileged possession of the kind of protective, creative brain we possess. Dreams are not always pleasant: they are sometimes anxious to the point of panic and nightmare. They are sometimes violent. This is the price we pay for carrying insurance against waking risk. Our brain–minds are ready for anything. Dreaming immunizes our minds against surprise in waking. With respect to the previous discussion of optimism and pessimism, there is solid ground for both positions in the emotional profile of normal dreams. Most dreams are emotionally unpleasant so, yes, pessimism is justified. Yet dream elation can also be ecstatic and that is good news for optimists. The best news is that the spectrum of dream emotion can be manipulated, to a limited but enlightening extent, by the inculcation of lucid dreaming. I allude to this enlightening and inspiring state in other sections of this book. Lucid dreaming is a robust kind of insight that needs no special pleading. By demonstrating that volition can influence dream content, lucid dreaming surpasses and replaces the dubious claims of Freudian dream theory and Freudian psychoanalysis. The brain stem control system for sleep and dreaming can get out of whack for genetic or environmental reasons with the undesirable effect of admixing the two states of consciousness. In the worst case, we dream when we are awake. This is what we call psychosis. In less severe cases, we lose control of energy and mood. This is what we call depression. And, as I have already noted, we may lose sleep (and with it dreaming) if we do not let go of waking when we go to bed at night. This has been called neurotic insomnia. It is probably universal and is certainly the most common complaint of patients consulting doctors.

Self-creation An ego springs from our genes via the epigenetic sleep and dream processes that arise before our birth and continue throughout our lives.

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We can do nothing about the biological determinants of our genesis. A joke says that the most important decision you can make is to choose your parents wisely! Environmental variables are as plastic as innate variables are fixed and it is, therefore, on the environmental domain that we focus here. A central hypothesis of Ego Damage and Repair is that our selves are continuously created and recreated. The cases that I have discussed illustrate the genetic and environmental forces clearly. The experimental and philosophical evidence for the hypothesis of continuous ego genesis is strong, as Thomas Metzinger claims in his book, The Ego Tunnel (2009). In this section, I consider some of the means by which we can inventory, understand, and even actively shape those forces. I begin with the assumption that we and our parents, our siblings, and our significant others adopt narrative representations of our identity. Sometimes those narratives do not fit and must be changed for others that are more realistic and more compatible with our biological destiny and social environment. This is not easy, as Luciano Ferri has discovered. We are also powerless to counter environmental contingencies over many of which we have no more control than we exert on our own genetic make-up. But that we have control over some of those forces there can be no doubt. Glen Just’s story makes clear that both innate and environmental forces can be harnessed to self-re-creation through narrative reinvention. Therefore, it behooves each of us to examine the narratives that describe, and to a significant extent shape, our identities. This is achieved clinically via the classical anamnesis, or history. Without meaning to make patients of us all, I suggest that biography and autobiography are tools that we all should use more frequently as we attempt to evaluate and change our own lives in more desirable directions. By looking at, listening to, and writing more carefully about our selves, we can actively participate in our own self-creation. This is what traditional psychotherapy has tried to do. But traditional psychotherapy has followed a misleading theory of pathogenesis and an equally misleading theory of behavioral change. Why Freud should be the only one entitled to a self-analysis was never made clear. The power of narrative is, of course, the power of fiction. When we read a good book, we suspend disbelief and enter into the lives of fictitious characters with a view to exploring narratives that may fit ourselves or narratives that we would prefer not to fit ourselves. A

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paradoxical consequence of this line of reasoning is that we must more comfortably regard our lives as works of fiction of which we ourselves are the author. If you have understood me at all, this is exactly the position fostered by my view of dreams. Dreams are works of automatically written fiction about our innate and experiential lives. Dreams, therefore, have both direct and indirect relevance to our self-creative agenda. The formal properties of dreams define the potentiality and limits of our narrative. In dreams we are all guaranteed a sense of self-asagent, a space for self-realization and the sensibility and motility to enact that realization. We are even provided with a set of informative and protective feelings for our enactments. These formal properties of dreams are not, as far as we now know, very malleable, but the specific characters, places, and behaviors in which we play out our dreams differ greatly from person to person. Thus, what we call dream content is not only personally tailored but personally adjustable, as evidenced, again, by the light of the Glen Just story and by the scientific study of lucid dreaming. These two lines of plasticity come together to form the basis of a new active approach to self-creation, to ego repair via self-reconstruction. I want to go a daring step further. Our self-assessment and selfreconstruction is itself an artistic act. By creating fictitious selves, we may succeed in creating more satisfying and satisfactory selves. This irony is more than a mind teaser. A moment’s reflection will convince you that your inner “voice” is like an actor’s lines. When my parents said that they could not oblige my request for autobiographical accounts of their lives, they were repeating what they had been told by their own parents, by their school teachers, and by their peers. Their script reads as follows: “You are two very ordinary people. There is nothing remarkable or special about you, so you have no business in indulging in narcissistic navel gazing.” I am determined to change that message to my more optimistic and self-reflective message: “You are a self with the power of reflection. That reflection can lead to a greater understanding of your self and to the possibility of change.” My credo is that you are as ordinary or as extraordinary as your life script, your narrative account of yourself, permits. My mother could well have described herself as the miraculous survivor of a traumatic childhood characterized by an abusive alcoholic father and a series of ill-advised attempts to pursue

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his delusions of grandeur. My father could have succumbed to the vision of his Cinderella Princess post-Victorian mother who collected glass slippers and took fancy steamships to Europe instead of sending him to college. Instead, both my parents overcame their limitations by dint of hard work and self-sacrifice. In asking them to write their autobiographies, I wanted them to be more appreciative of what they themselves and their children had accomplished. One reasonable rationale for not wanting to tell these autobiographical stories is that they are too painful to recount. On the other hand, the personal triumph over adversity goes unrecorded too (unless I now tell their stories myself, since my parents are long gone from this world). If I can manage to oblige my own children’s requests for accounts of my childhood, I may just have a go at a necessarily fictional account of my parents’ lives. I am aware of the resemblance of these prescriptions to what modern psychoanalysts call “narrative truth.” In so far as narrative truth is a constructive ego function, I am all for it. As a substitute for historical verification of what really happened, I deplore it. A literary vision that I believe should be instantiated in the education of elementary school aged children is the personal biography of parents. If my father and mother had thought that their stories would have helped me in school, they would have been more forthcoming and I would have known their stories at a much earlier age. It could be objected that young children lack the experience necessary to realize perspective on their parents and themselves. My answer is that even if this were partially true, that is no excuse for omitting an opportunity for relevant psychological sensitization, especially within the context of a more general effort to reconstruct a psychology of the self. Loving mothers, like mine, do often keep photograph albums of their babies. This is good, as far as it goes, but it would be helpful if mothers also kept a journal of their prenatal experience, of the birth of the child, and of the child’s infancy and childhood. As mentioned above, I tried in vain to persuade my own mother to write her autobiography but she never took my request seriously, saying that she was too ordinary a person to celebrate herself in this way. My father was equally reluctant and offered the same rationale for his refusal to write about himself. I am focusing now upon their childhood, but we have all been children and need to recognize the universality of that experience at the same time that we note its particularity.

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The act of writing about parental experience has more than a historical function. I hope to show all parents that their narratives enter directly into the personal image of their children and that their children are actively engaged in creating their own self-images. This process is slow and obscure but its presence and its importance cannot be overlooked. It is a commonplace to remark that what a child learns in school pales in comparison to what is learned at home. I am only trying to strengthen and make more explicit this obvious fact. Many critics will say that I am naïve to suppose that most parents can or will communicate in an intimate way with their children. I recognize but do not accept this objection. Rather, I want all the more to overcome it. I am also aware that many children do not share my interest in their parents. Resentment precludes identification. The last thing that a child who is resentful of his parents wants to learn is that the resentment is only partially justified. A resentful child says, “Don’t confuse me with facts, my mind is made up.” In other words, if your fiction denies mine, I reject your fiction.

The importance of subjective data Our knowledge of consciousness and its vicissitudes suffers from the scientific opprobrium of subjectivity as much as autobiography is frowned upon by some parts of the scientific culture. Ever since the excessive philosophical and psychological speculation of the nineteenth and early twentieth centuries, it has been virtually impossible for any self-respecting psychological scientist to investigate subjective experience. Yet consciousness is nothing if it is not subjective. My conviction is strong that we explain nothing if we do not try to explain subjectivity. I am also convinced that we now know enough to use subjectivity as a scientific instrument; subjectivity is, therefore, an explainer as well as an explanandum. It is a major error to assume that consciousness is unapproachable from a subjective point of view but worse, if that is possible, is the error of regarding subjective experience as an epiphenomenon of no causal significance. The free will debate and the mind–brain problem must be taken more seriously if we are to advance our science. As an antidote to the blanket prohibition of subjectivity data as measurable, I have argued that laboratory work is now sufficiently advanced to test specific hypotheses about consciousness. This new

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insight enables us simultaneously to take both a bottom-up and a topdown approach. In top-down studies of subjective experience, we can control for the imaginative bias of individuals by sampling widely. This is safety in numbers even if popular delusions are widely shared. In the case of dreaming, there is scarcely a post-Freudian person who does not believe, sometimes fervently, that dreaming is at least as meaningful as waking, if not more so. Every dreamer who bothers to record his dreams has a theory or even a dream mystique. This makes it easier to get dream interpretations than bona fide reports. By bona fide, I refer to the description of subjective experience without the prejudice of interpretive bias. Another antidote to the sterility of a brain-only strategy in the scientific study of consciousness is, thus, the formal vs. the content analysis of subjective experience. Until recently, the study of dreams focused on their content, and that is still the level that dominates interest. However, the new physiology of REM encourages a formal approach that is less subject to distortion by mystique than content analysis. Instead of asking what each individual dream might mean, we can now postpone, or even jettison, content analysis if we change our goal to understanding the universal meaning of dreaming. What is dreaming really like phenomenologically? How can we interpret the experience of dreaming whatever the individual dreams might or might not mean? The formal approach asks, for example: Is dreaming visual? What other sense modalities are represented? Are dreams animated and, if so, what movements are imagined? These somewhat plebeian questions are less likely to invoke mystique-based answers and, at the same time, lend themselves quite nicely to a third safeguard against the circularity of hidden meaning-obsessed interpretation. Once we have asked and answered questions like these, we can proceed to a higher level of question: What is the correlation of these formal aspects of subjectivity with objective, third-party observables such as brain physiology? Not even the most skeptical scientist believes that REM sleep can be feigned. REM sleep is a biological fact. It is not a philosophical construct, an enactment of ideas, or a quirky theory. Enter expert witnesses, like the Engine Man and Glen Just. The Engine Man, who was an insect specialist at the Smithsonian Institution by day, recorded his nocturnal dreams in the summer of l939, just three years after Glen Just was born. In 100 consecutive

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nights, he collected the reports of 256 dreams; he described each of them in copious and non-interpretive detail using the easily read copperplate handwriting typical of that era. The Engine Man even made drawings, sometimes to depict the dream movement trajectories that he considered to be interesting and comical. The journal has face validity, and I will be happy to share a copy with any serious colleague. It is a treasure trove. But although the Engine Man (so called by me because he loved trains) was not abused as a child, and his dreaming is rather conventional, it is formally bizarre. Glen Just did not keep a meticulous journal until he was over forty years old, but he did become fascinated by his own psychology in a way in which the Engine Man was not capable because he was not psychologically minded. The Engine Man was descriptive, as befits his scientific training. For the same reasons, he eschewed theoretical interpretation, preferring, first, to record data. He never resorted to the experimental alteration of his dreams. Glen Just, by contrast, spontaneously discovered a variety of tricks for manipulating his dreaming that have since been scientifically validated. I was quite taken by the face validity of both the Engine Man’s dream journal and of Glen Just’s biographical accounts, but I was more worried about Just’s credibility and my scientific reputation because I wanted to make more of them than I had made of the Engine Man’s dream journal. Since so much of Just’s precious witness was memory based, how could he or I be sure that the accounts were not consciously faked or unconsciously fabricated? As already emphasized, how could I be sure that his recollections were veridical memories and not false or confabulated ones? I repeat these considerations here to reassure the reader that I recognize the fallibility of recollection. This problem has been overlooked by most twentieth-century followers of Sigmund Freud, who have said that fantasy trumps veracity in reconstructing personal history. I share this conviction up to a point, but I want to go beyond that point. I want to know, as best I can, what really happened and how did Glen Just use the virtual reality of his dreams in constructing his model of his real world. To do this, I had to know what was real. My only recourse to credibility in Glen Just’s case was corroboration. Co-witnesses were few and far between but I was able to talk at length to Glen’s younger sister, Lavonne, and his older brother,

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Elwood (better known as Bud). By their accounts, the familial experience of all three of Glen’s living siblings was traumatic. Two sisters died young, perhaps victims of maternal neglect and violence. A fourth sister, June, was said to have been positively abused by her mother, who sold her into sexual slavery. I will say more about childhood trauma and abuse anon, but first I must warn the reader that I am aware that while Glen Just’s accounts make my theory more credible, they by no means prove it. Their detailed rehearsal, in Part IV, is best regarded as a heuristic demonstration project. About trauma, I am convinced that we are on to something profound about Just family life and that careful future work will reveal abundant confirmation of the validity of this concept. Whether Glen Just really experienced all the horrors he reports and whether or not he had all the psychic experiences he describes is a matter of opinion. My account of our dialogue is presented to help you see why I think his accounts are veridical. If Glen Just is right, there are many trauma victims out there whom I invite now to come forward and help me to formulate a truly scientific psychology by recounting their exceptional mental states without fear of being stigmatized or marginalized.

Personal history As Freud emphasized, the possibility of childhood trauma must be taken seriously in assessing psychiatric dysfunction. The ego of the infant inevitably clashes with the ego of the parent. “Murder” may be too strong a word for this clash. “Wound” may be a more appropriate one for the universal friction between parent and child. “Spare the rod and spoil the child,” says it all, doesn’t it? The rod, you say, incredulously? We did away with corporal punishment years ago. But did we do away with Yes or No, and I will pick you up when you cry (or I won’t) and I will criticize you when you drop a plate or fail a course in college (or I won’t)? Every schedule of reinforcement (pace B. F. Skinner) comprises rewards and/or punishments. A rewards-only schedule is preferable to a punishment-only schedule or an arbitrarily mixed schedule of reinforcement, but the inadvertent omission of a reward or the overuse of a reward can be damaging and may even incur resentment. I wish my own mother had been able to say no more easily. In her permissiveness, she was reacting to the hardships of her own childhood.

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In other words, it is impossible to be a perfect parent and efforts to correct the errors of one generation are very likely to result in errors in the next generation. Lieta Siciliano is a mother whom I know quite well, as I have already indicated in Part III. She leaves her children alone with impunity because she is ambitious for herself and because she herself could not bear what she took to be her own mother’s omnipresent, but emotionally frigid, intrusiveness. I suggest, therefore, that her mother was a model for the creation of Lieta’s own ego. In exercising her excessive ambition, Lieta Siciliano followed her successful father and repudiated her emotionally paralyzed mother. In so doing, she inadvertently damaged her children. Going out to work will always be perceived as a rejection even by children who do not contest their mother’s political right to do so. Going away on long trips, as Lieta Siciliano often does, may be even more devastating. Striking a healthy balance between intrusiveness and neglect is not easy. No parent is capable of perfection in the reconciliation of these contradictory positions, but parenthood requires that we try to do so.

Childhood trauma If trauma is defined as any parental move that is unwelcome to the child and damaging to that child’s security and self-esteem, then trauma is virtually universal and efforts to correct its deleterious effects need to be better defined and more widely applied. A good rule of thumb is to recognize the trauma that one has undergone and to correct its effects through self-reliance enhancing measures. One reason that I like the Glen Just story that I have told in Part IV is that he has always strived to pull himself up by his own bootstraps. Glen Just is a life work unto himself and, at age seventy-seven, he is still cheerfully working out the maladaptive effects of his many childhood traumata. What is the evidence that Glen Just was genuinely traumatized? Whether or not his mother really tried to smother him with a pillow hardly matters. He thought she was capable of such positive abuse and the evidence of her neglect abounds. That is enough for me to make Glen’s strategic responses understandable and laudable. He learned to escape the domestic chaos of the Just family by utilizing his native gift for changing his state of consciousness. That is the strategy that I seek better to expose and promulgate. Glen Just programmed

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his dreams, broke down the normal barrier between waking and dreaming, and, having done this, enjoyed a wide variety of exceptional conscious experiences. Since the capacity to dream is universal, Glen Just’s story can inspire others to mobilize self-reliance and, in so doing, can help me to promote scientific psychology. Perhaps Glen Just could have saved himself a lot of trouble by choosing his parents more carefully, but what he has been able to accomplish by his own wits is truly remarkable. He rose from a farm family with two parents who were eighth grade school dropouts, constantly warring with each other, and both of whom were sexually wild. He got himself a college education and then a doctorate. Armed with these hard-won skills, he then developed a constructive career in the criminal justice system. Here is an excerpt from a recent letter describing his family. On reading it, please ask yourself, does this story ring true? To me, it does: Mother was a church mouse in Dad’s presence; a vamp in his absence. She was a loving mother and dutiful in the presence of others but almost always self-centered in the absence of other adults. She performed her wifely roles under pain of punishment. Dad would impulsively decide Saturday evenings whether mother or his children deserved to go to town. He was working until 1:00 a.m. as a bartender at this time and mother was doing most of the chores with the cattle, milking, etc. Saturday nights was the carrot one looked forward to throughout the week. It was a carrot easily withdrawn and the deafening sound of silence roared on for another week. Add sleep deprivation, hangovers, immaturity, authoritarian upbringing, and God’s laws.

The traumatic criticism of children Many bright people, like Luciano Ferri, whose story I have told in Part III, may be born critical. Others, like me, also learn it from their parents. If I was not born critical, I learned it from my father. Compared to me with my own children, my Dad was critical hell on wheels. I never knew how to elicit praise from him. Instead, I knew that he would always find fault with what I had done and expect me to do better. I came to regard criticism as acceptable, understandable, and even desirable. It has stood me in good stead in academia, which, at its best, is creative and at its worst, is hypercritical.

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My father, like Glen Just’s father but unlike Luciano’s dad, taught me to work, to be self-reliant, and to leave home as soon as possible. For me, age eighteen was none too soon but, as I tried to make clear in my autobiographical book, Dream Life (2011), I had already left home effectively three years before that. Actually, there is a lot at stake in the academic search for brain–mind truth. It is so easy to be fooled—and the power of belief is so strong—that only fiercely critical analysis can save us from error. Children need to believe in themselves and that is hard to do with a critical parent like me or the Just father around. For my excessive zeal, I apologize. I feel very positive about all my children, but I am not uncritical of any of them. Why, I wonder, is that so hard to take?

The maternal bond revisited A child never really separates from its mother. Even abused children such as Glen Just and some of the people I talk about in this book are still connected to their mothers. The maternal bond was thought to be pathogenic in many of the cases discussed in Part I because it was assumed that childlike dependency was reinforced by mothers who did not really want to separate from their offspring. I claimed that this double-bind hypothesis was exaggerated and very misleading to me as a young psychiatrist. During, and for ten years after my residency in psychiatry at Harvard, I thought that the maternal double-bind was a scientifically valid concept. Instead, it was only a speculative hypothesis that should have been more clearly labeled as such. In some of my clinical cases maternal closeness was related to persistent childlike dependency, but in all cases that was probably because the mother is an integral part of the child’s ego. If that part is wounded, ego damage is the result. Perhaps Latin cultures, with their veneration of the Virgin Mary, recognize this connection better than we Anglo-Saxons, who fool ourselves into believing in post-maternal independence. As you know from reading about Derrick Sutter and Sarah Sage in Part I of this book, I learned about the vital importance of the mother–child bond the hard way: I firmly believe that I harmed them and others of my patients by insisting on their separation from their mothers when I accepted the then prevailing view of psychoanalysis:

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the mothers were the pathogenic problem and, therefore, better gotten rid of. I harmed several other patients by the persistent folly that separation from mother was desirable and possible. This does not mean that mothers are never pathogenic. Sometimes their own ego is shored up by the ministration that they make to overly dependent children. In these cases, some degree of separation is to be encouraged even if total independence is neither possible nor useful. We are stuck with our parents because they are built into us. When we consider genetics, this point is easily understood. Mothers contribute 50% of our genes, meaning that our very bodies are partially theirs. They are so much with us in our early days of life that we absorb their psychological being and build their image into our already elaborate virtual reality blueprint of the world. On genetic grounds, the other half of our substance is paternal, but we do not spend nine months in his belly. Neither do we nurse from his breasts. He may change our diapers and whisper sweet nothings in our ears, but my guess is that even in gender-equal families, it is the mother that does the lion’s share of child care. Hormones and odors play a role in all of this that politics cannot change. Try as you will, Dad, Mom will always win the battle for attachment. This fact is so widely recognized as to make the divorce case legal assignment of child care to the mother in all but the most egregious instances of maternal neglect. If Glen Just’s parents had had the good sense to separate before they damaged him and possibly killed two of his siblings, he might have won his freedom from his mother and found his grandmother earlier. But even had his parents divorced, his care would never have been awarded to his father. Maternality is not only a social construct and a myth, it is also a biological fact. On these grounds, it could even be argued that women are more important than men, but please show me the mother who is more pleased by the first-child birth of a daughter rather than a son. In our culture, the incidence of daughter preference may be as high as ten per cent, but in China, where child-bearing is limited to one, by law, daughter preference is said to be less than one per cent. In China today, the literal murder of female infants is alarmingly common. So we confront a paradox: the more important sex is not granted fair status. The cultural inflation that leads to matriarchy in places such as Italy may reflect this paradox.

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Keeping a journal When I was about age forty, I decided to keep a journal. The project began as a series of notebooks concerning my paper and book-writing efforts and was later expanded to include dream reports, photographs, and drawings. Most recently, it has taken the form of essays about my past and present life. My journal collection now runs to 166 volumes and is without a doubt my most ambitious literary project. Whether it will ever be of interest or of use to anyone else is not critical. By strengthening my interest in subjectivity, the journal has already more than served its purpose. Of course, I hope that the journal may someday be useful to someone other than me. To that end, I have appointed Nicholas Tranquillo as my literary executor. If you have a scholarly interest in my journal, please contact: [email protected] My journal is at once a self-analysis and a self-transcendence that has sensitized me to otherwise overlooked or forgotten truths that have helped me to become as scientific as I am and more artistic than I ever thought possible. My photographs and drawings are quite wonderful to behold, if I do say so myself. I know this sounds grandiose and self-congratulatory, but I want to emphasize what I believe to be universally useful about this practice and to convince you—as I tried to convince my parents—to keep a journal. It took me far too long to realize that I could learn from myself by reflection on my thought and experience in the contents of my journal. The impulse to keep a journal often begins with the trite diary of adolescence, a time in life when one is flooded with self-consciousness and one wishes to confide what one supposes to be unique, private, and even forbidden fantasies. These are usually of an erotic and romantic cast and take the form of a “Dear Diary” confessional. Most people who keep an adolescent diary later throw it away in embarrassment lest someone else discover what a romantic fool they once were. But it is my contention that we are all romantic fools of one kind or another and that our tendency not to admit this to ourselves— and to others—is lifelong, self-destructive, and sad. When I was an adolescent, I had an inspiring English teacher at the Loomis School named Norris Ely Orchard, our dearly beloved NEO. One of NEO’s memorable thought experiments was to open his desk drawer and exclaim, “Allan Hobson, I have found the book of your life. Each chapter describes a year of your experience from now until

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the time of your death.” When I had gasped in embarrassment, NEO asked if I wanted him to read it to me. I, of course, said “No” but NEO’s point had been made. The study of literature is not just about “Them.” It is also about “Us.” If NEO had said this, we would not have believed him but, of course, he was quite right. I wish I still had the earlier self-observations that I confided to my several “Dear Diary” false starts but, as I reach my eightieth year, I am glad to have resumed my confessional self-observations in my now multivolume journal. I am ashamed to admit that my initial conscious motive for what is now my splendid collection of journal volumes was to integrate my intellectual experience (which was decidedly public and dutiful) with my private interior life (which will scandalize conventional moralists). As time has gone on, I have discovered, from keeping a journal, that there are numerous more positive reasons for doing so. I now wait, with pleasure, for the opportunity to transcribe my experience and to explore my thoughts and feelings about it. The major shift in motive stems from what I take to be a transformation from the obsessive inclusiveness of the collector (who strives not to lose journalistic accounts of himself) to the far more important sense of the self as an unknown but endlessly creative entity (who cannot predict his own future except to say that he can’t wait to see how it all turns out). It is precisely this shift in emphasis that I hope to impart to you. Instead of a psychotherapy that looks mainly back toward childhood to discover the origins of today’s concerns, I want to promote an appreciation of the limitless promise of tomorrow by an exercise of the imagination about today. Instead of a psychotherapy that relies on another person who may be authoritarian and pseudoscientific (as well as time-limited and expensive), I want to encourage selfexamination and self-reliance in the context of and active collaboration with state of the art science and literary fiction. I have now made that transformation myself and can attest to the power of the mind to invent truth that may begin as fiction but has the propensity to become a novel idea that can be applied to art and to science where the lowercase letters of those two words (art and science) denote the universal and non-professional attributes of all people. That I had to become a professional scientist and a zealous amateur artist to realize a universal set of talents is an embarrassing fact. But it is my fond hope that I can inspire a creative self-reflection

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in others that will lead to a do-it-yourself variation on the theme of psychotherapy. Glen Just is my right-hand man in this endeavor. Glen’s selfanalysis and self-reinvention is far more impressive than my own. My conviction is that you are situated somewhere on the same continuum of emotional hardship to privilege as Glen and I are. You are not qualitatively different from either of us. It is true that Glen did not keep a journal, but in the past five years, he has written three books about his life experience and will undoubtedly write more. The point here is that writing, whether it be books, a journal, or both, has the power to transform a life experience into a narrative. That narrative is at once journalistic (in that it documents the past) and it is transformative (in that it shapes the future). In that sense, journalizing is dreamlike. My meeting with Glen, first in the pages of his books, and then face to face, has changed us both in ways that neither of us could have imagined. My own journal contains a wide variety of informative elements, many of which I have already mentioned. Yours will contain some of these and many others that you have not yet envisaged. I used to think that I could only do my journal justice because of the time and place discontinuities of a life of international travel. I thought I needed expensive and beautiful artist sketchbooks to pack into my ubiquitous shoulder bag as I trekked from one end of the earth to the other. Now that I am more sessile (because of physical disability) and retired, I am not only more easily able to add to my journal, but my journal has a life of its own and tells me what it needs on an almost daily basis. It does this in my bedroom as I lie awake thinking or sleeping and dreaming; the stories unfold as I “travel” from my bedroom to my bathroom and my office. In my office, I find my computer, which is now chock-a-block full of essays, journal entries, and dream reports. The mind is an infinite space, and I am happy to be able to voyage freely in it without bothering with travel agents, taxi cabs, security checkpoints, or lonely hotel rooms. Furthermore, advances in technology make it now possible to commit my thoughts and feelings, via my handy word-processor, to ordinary paper pages that pile up rapidly until they are bound in the local copy shop. Digital photography has made my camera obsolete and I am now flooded with illustrative images for my essays by gadget-happy friends and colleagues.

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Insight Religion aside, I suggest that the price of interpersonal insight is the giving up of precious delusions. Genuine conversation is as difficult as it is rare, especially with deeply distrustful people, and we may even be distrustful of ourselves. I think most people are too self-absorbed to really know what is going on, even in their own minds, much less in their futile efforts to communicate with one another. Of course, I realize that what I say includes me, and I also realize that my personal theories are probably every bit as narcissistic and self-serving as those of more doctrinaire religionists. My desire for a philosophy of psychological and somatic fusion is very likely to be akin to what many other people seek in church, at mass, or in the confessional box. I say that communication begins and, for me, ends in the head. In trying to think this through, I had the following ideas. n

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My work on dreams is an effort to comprehend the human desire for cosmic fusion. The concept of protoconsciousness is designed to deal with this desire. Our deep motivation for fusion is not so much sexual as it is preverbal and cosmic. It is in this sense that I say that I am more Freudian than Freud. Denial is not a defense against unconscious sexual desire; rather, it is part of an offense aimed at fusion. My work uses physiology to try to get at the pre-verbal sources of cosmic desire. It is an understandable mistake to regard physiology as reductionistic. Physiology asks what is the physical basis of cosmic desire. Dreams tell us about the unconscious, sure enough, but Hobson’s primary consciousness is different from Freud’s primary process. I will converse with anyone who shares my interests. A great irony is that psychoanalysis is clearly another religion. The only thing that the scientific philosopher, Adolf Grunbaum, liked about Freud was his atheism. I also admire Freud’s atheism and his ambition, but deplore his intellectual, professional, and personal methods. Most people do not share my interest in exploring. Their minds are made up.

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Psychosis is not just the privilege of the mentally ill who deserve to be in the hospitals closed by the state. Psychosis, not just neurosis, is as universal as dreaming.

State stabilization What do psychotherapy and neurobiology combine to teach us about a unified model for improved psychological functioning? To begin to answer this question, I believe that a case can be made for a process that I call state stabilization. By state stabilization, I mean the separation in consciousness of our virtual model of the world from that of the world as we experience it, our “real” reality. This is another way of saying that we should dream by night and wake by day. In its most banal instantiation, this prescription is nothing but a good mother’s good advice: get a good night’s sleep! Why get a good night’s sleep? To allow the virtual reality program full freedom to run itself out, thus decreasing the tendency for cognitive demons to appear in waking. The cognitive demons include: n n n n

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perceptual hallucinations; delusions and obsessive perseveration of thought; discontinuity and incongruity of cognitive sequence; uncontrolled or excessive emotions such as panic anxiety, manic elation, and explosive anger; memory failure and the confabulation that is its concomitant.

For reasons that we are as yet far from understanding, this system, which is given full play in our dreams, is essential to our waking if, and only if, it is kept under strict inhibitory control. We learn about our dreams by paying attention to them. We appreciate our dreams for their imaginative power at the same time that we learn to fear their unbridled force. By means of auto-suggestion, we are able to actively augment our waking powers. We suppress misperception, increase the veracity of our thoughts, stay on track and on task, damp excess emotion, and remember what we want to remember by tuning up waking and tuning down dreaming. Sometimes we intentionally destabilize the system as we learn how to control it. Sometimes the

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system goes out of balance spontaneously. Both spontaneous and voluntary destabilization can help us better understand and control ourselves. Now that we are beginning to understand how the brain controls its own states physiologically, we are in a strong position to augment the beneficial effects of psychotherapy with chemical state clamps. I theorize that the biogenic amine reuptake blockers are useful in a wide variety of disorders because they stabilize the brain and its cognitive state in all of them. Their augmentation of waking and their suppression of dreaming is the key to their action. They stabilize state by increasing the efficacy of the biogenic amines norepinephrine, serotonin, and histamine. All three of these amine neuromodulators (norepinephrine, serotonin, and histamine) are anticholinergic and, as such, are dream dampers. The role of the fourth biogenic amine, dopamine, is less categorical and less easily understood. Dopamine may provide the link between waking and dreaming by mediating effects common and essential to both. Dopamine, in the absence of the neuromodulatory effects of norepinephrine, serotonin, and histamine, may mediate the perceptual disturbances of the psychotic states (including normal dreaming). Many other drugs are available to help the brain stabilize its states. The exact mechanism of action of most of them is unknown but they all may act in the same way by creating a clamp on brain state in the service of stabilization. The concept of state stabilization will offend those who regard each disorder of the brain–mind as a discrete disease. The current controversy about the Diagnostic and Statistical Manual is an indication that the pendulum is now swinging away from a microscopic trait paradigm back in favor of state-based approach to nosology. It is physiology itself, and not just pharmacology, which prompts this change. My AIM model derives from measurable variation of a very small number of variables but, nonetheless, prefigures a virtually infinite set of possible states. To call each of them a disease rather than to regard the brain–mind as a dynamic system is foolhardy at best. The brain is not the liver, the lungs, or the heart. It requires its own special formulation, a formulation that respects its diversity and its dynamism. Neurodynamics holds not only the key to the mind, but to its disorders as well.

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Concluding remarks Neurobiology now promises to effect a meaningful integration of psychology, psychiatry, and brain science. The leading edge of this integration is the emerging science of the conscious states of waking, sleeping, and dreaming. Experimental work on REM sleep and the formal aspects of dreaming provides a specific and solid foundation for the scientific psychology that Sigmund Freud sought, but could not find, in 1900. A new theory, called protoconsciousness, proposes that REM sleep is the epigenetic platform upon which conscious states are constructed. Brain activation begins to stimulate intrinsic capacities for sensation, motor control, and for sensorimotor integration. The protoconscious agent of these intrinsic processes is the ego, or protoself. Emotion and other aspects of cognition emerge and are added to the mix as a virtual reality model of the world is elaborated by the fetal brain in utero. After birth, environmental inputs contribute experiential information to the internal model and shape that model in individually specific ways. Development, thus, consists of a dynamic interaction between the extrinsic inputs of waking and the intrinsic inputs of sleep. As waking increases in time and capacity, REM sleep dreaming declines but never disappears because it serves to renew the intrinsic model and because it subserves other functions essential to the development and maintenance of that model. These functions include temperature control, energy balance, and immune defense, all of which are in the service of survival and of the consciousness that guides the organisms that possess it. The new theory inspires a radical revision of dream theory and the psychological functions that relate to it. The psychoanalytic concepts of disguise censorship, repression, defensive transformation, and symbolization are found to be based upon either incorrect or misleading building blocks of consciousness theory. Their shortcomings demand at least revision and sometimes even rejection. A scientifically responsible treatment program can be developed in conjunction with the further development of protoconsciousness theory. Clinical intervention, combining the psychological and physiological data of sleep and dream science, can be shown to favor state stabilization via psychopharmacologic, behavioural, and psychological stratagems. This therapeutic program also promises to unite the

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currently dissociated fields of hypnosis, meditation, and related alternative modalities of support and change. The most important innovation provided by protoconsciousness theory is the imminent solution of the mind–body problem and the definitive elimination of Cartesian dualism, which has plagued our efforts to think and act about psychology in a scientifically responsible way for centuries.

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Glen Just’s altered states timeline

ltered states of consciousness have been part of my life since infancy. The following list documents the timelines of these occurrences while dreaming or awake. Note that I recall having lived in twenty different houses by the time I was fifteen years old; and, experienced my twelfth school change when I entered the seventh grade. These frequent changes act as a memory frame of reference. I have provided a minimum of background information with each entry in order to provide context. Personal examples are drawn from Autobiography of a Ghost (2009).

A

BIRTH: 28 March 1936 July/August, 1937 (16–17 months) I was hospitalized, had a near death (NDE) and out-of-body experience (OBE). The timeframe is provided by older brother Elwood Just (DOB: 3 April 1930) as being the hottest part of summer. Elwood stated that I went into convulsions, mother submerged me in water, and someone whom he does not recall drove us to the hospital. 1939 (3 years): Start of life-long OBEs and “Spirit Presence” I recall frequently flying out-of-body (OBE) around the S.E. Cumberland, WI Area. I never flew high or over water as I was afraid 165

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of falling and I didn’t know how to swim. Our residence overlooked a divided section of Beaver Damn Lake. And, like any small child of three, I only flew around the neighborhood. I made no distinction between flying in dreams or in waking states. All flying experiences are remembered as involving my physical body until about eight years of age. A “presence” appeared while living at this residence. I did not see him, but knew how he looked. Mother explained the “presence” as my “Guardian Angel” and told me that most children had them. I eventually named this “Angel” Moses. During times of stress, even as an adult, he would “appear” by sitting on my bed, or standing next to me when I was reading in the evening. As a child, he always seemed to be nearby whenever I needed comfort or support. 1941/1942 (5–6 Years): Japanese Submarine Nightmare and Active Dream Intervention Japanese bomb Pearl Harbor, Hawaii and the Puget Sound Area practices blackout drills. This is the start of my Japanese submarine nightmare. I am captured and taken to the submarine, the Japanese start drilling a hole in my back to make me into a flag stand, I escape and fly to a “hole” (later understood as hold) in their submarine, suspend myself and fall asleep. Later I wake up in my own bed and have no idea how I got back home. Mother informed me that if I ever hit bottom in the “hole” I would die. This was the beginning of active intervention in my dreams to alter outcomes. Between December, 1941 and the start of first grade, September, 1942, I was plagued by the following adjustment problems, in this order: bed-wetting, head-banging, and stuttering. Mother rubbed my face in the urine until skin came off. I managed to stop wetting the bed by banging my head hard against the floor. Mother held me to stop head-banging and I then began to stutter. These episodes occurred over a number of months. Father was adamant that I not stutter and became increasingly angry with me. I was told to think about stuttering before I spoke and applying this technique I was able to stop. All of these adjustment problems occurred before I entered the first grade. I never attended kindergarten. The Japanese nightmare appeared during this time and continued until we moved back to Wisconsin after the end of my first school year, 1943.

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1943 (7 years): Conquering Virtual Space We drove U.S. Highway #2 on our return to Wisconsin from Washington. By sitting at just the right angle as we drove through the Rocky Mountains, I could experience flying at great heights. This was my first experience overcoming fear of heights, which I later applied to all of my flying episodes. 1944 (8 years): Interstellar OBE, “Soul” Separation, and Fits My father attempted to cut off my brother Elwood’s head with an axe. I had been practicing flying back and forth through the roof of my bedroom at night, in an attempt to understand how my body could pass through solid objects. I still assumed that my actual body went out flying at this age. In retrospect, it seems that out-ofbody experiences were activated before I was fully asleep during a hypnagogic state. I decided to go sit on the moon to escape any future rages by my father. I flew through the roof, and got about half-way to the moon. It was cold and dark and I shuddered, left my soul half-way between the moon and the earth, and returned to my bed. Eight year old logic told me that my soul would be safe where my dad could not find it. I had experienced petit mal episodes intermittently from the time of my infant hospitalization. (My mother referred to them as “fits”.) I made note of them at this age as we had an outdoor pump, and it was my job to fetch water. If I pumped too rapidly, I would faint and drop to the ground, momentarily regain control and continue pumping. I associated a particular rhythm with these episodes. I have been bothered all of my life with flickering fluorescent lights, but have not had a formal diagnosis of TLE. 1947 (11 Years): Learning to Control Obsessive Behaviors; Self-confirmation of Presence We lived one-half mile east of Cumberland, Wisconsin on Highway. 48. I did not typically wear shoes in the summer, and my common attire was bib overalls. On hot summer days this meant no shirt as well. I was often sent into town by mother on grocery errands. A group of three boys repeatedly threatened me on sight. I recall being called a “hick” and other similar derogatory names. Two major events occurred that summer before I entered sixth grade:

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As I entered the town’s sidewalks, the cracks would take control of my mind. The harder I struggled, the more control the sidewalk cracks had over my mind. People asked me what I was doing as I “hopscotched” over the cracks from one end of town to the other. Finally, in an act of desperation, I started stomping them. This went on until my bare feet were throbbing, but in the end I was their master. The reader will note that such behaviors were considered crazy by my parents; their usual comment was to stop, and it was made clear that I was totally responsible for all of my actions. The second incident involved Moses. It was a hot summer day as I walked by the first store on Cumberland’s main street, an ice cream store. I wished for an ice cream and Moses’ voice directed me to the edge of the sidewalk. Pulling back the grass I discovered a nickel and a dime. Fifteen cents was enough to buy an ice cream cone for my two sisters and myself. Logically, a child would look for loose money in the area where the sidewalk meets the grass. But, when voices tell you to look there, it is confirmation of a real “presence.” At least it was to this eleven year old. Long-term accompaniment by a “presence” offers many opportunities to confirm their reality. Behavioral reinforcement patterns of this nature are well understood. I became a believer before education had a chance to catch up with experience. 1948 (12 Years): Conscious Mind–Body Separation— Virtual Self-Projection as Dual State Northern Lights were beautiful on the farm by McKinley. The farm was isolated on all four sides by trees, and there were no lights to interfere with nature’s light show. I discovered an ability to project myself into the aurora with a sense of freedom and free flight. I later discovered this same sense of “projection” if the aurora wasn’t on but the Milky Way was. This type of projection approximates what one experiences when we fly in dreams. This was my first awareness of separating mind and body consciously while enjoying the out-of-doors. I later came to experience this same sense of leaving my body, entering thunderstorms, sensing their power, and enjoying the moment. Eventually I came to understand that any combination of dual/hybrid sensory states seemed possible.

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1950 (14 years): Sexual Trauma as Nightmare Generator I was sexually molested by a pedophile farmer. Our family had moved into Cumberland once again, and I was contracting out work. The sheriff department’s interview was conducted without any adult present, was extremely traumatizing and repetitive, and the source of decades of subsequent nightmares. We moved from Cumberland, Wisconsin to Everett, Washington before the pedophile’s court hearing. Thus, the nightmares became multiple and involved scenes from Wisconsin, Washington and the mountains in between. 1951 (15 years): Long-Term Nightmares without Terminus My return to Washington State reactivated the Japanese submarine nightmare. Both nightmares were expressed occasionally until I entered the University of Minnesota in 1957, at which time they became a constant nighttime threat. It was not uncommon to have two or three variations of these two nightmares, nightly. 1952 (16 years): Suicidal Acts and Self-Projection into Thunderstorms I’m placed on uncle’s farm and separated from my two sisters and my brother. My parents went through their final divorce, and my father was busy with a new girlfriend. I’m being encouraged by my uncle to set up a milk route using the farm’s milk supply. This would mean discontinuing high school, which was only mandatory until age 16. I decide to commit suicide and climbed the farm’s silo to jump. I visually pursued the meandering river and beautiful landscape and changed my mind. It was during this summer that I discovered the ability to merge with thunderstorms. Thunderstorms, Aurora Borealis, flying through the Rocky Mountains, leaving one’s soul halfway between the moon and the earth, passing through the ceiling of my bedroom, or having a personal “Guardian Angel” were integral parts of my development. 1954 (18 years): Freud I graduated as an honor student from high school and entered the army for the G.I. Bill. I returned to the University of Minnesota in

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September, 1957 and my two most frequent nightmares reappeared nightly. I was dismayed. I was fortunate while in the army to be stationed with graduates from some of the nation’s better universities—Yale, Harvard, NYU, and Stanford as I recall. Fortunately for me, they all loved to read. I had read Freud’s major works before leaving the army and now looked at applying his methodologies. 1957/1958 (21 years): Rejecting Freud, Embracing Behaviorism, and Employing Hypnosis I attempted to use Freud’s theories for therapy and dreams, but found them useless. I also found the university’s medical library overflowing with endless works of this genre. I had experimented with hypnosis in high school and found it easy to use. I needed a quick fix for my nightmares as fatigue and anxiety were taking their toll. I adopted Behaviorism as my working model, added an active Executive-Self and assumed that I could behaviorally modify how my brain worked. I took the following steps: I practiced self-hypnosis to gain incremental control over my body. First, moving arms and legs with thought, next controlling pain to the point where fellow students could stick pins in my hands without my feeling pain, controlling heart rate, temperature of hands and feet, opening clogged sinuses, and using suggestion to stay awake while driving or studying. I decided to substitute erotic scenarios for nightmares, and was surprised that the autosuggestion worked immediately. Within days, I was sleeping through the night, in fact looking forward to sleep and my new adventures. My anxiety and depression rather quickly abated, and I felt like a new man. My attention span had declined to about 20 minutes, so, I focused on improving it in increments. In a matter of weeks, I could concentrate on text memorization for eight hours without a break, and with about 98 percent recall. My entire university experience became positive. These changes have lasted throughout my entire life. I then went on to use hypnosis for therapeutic purposes with my wife, Sister June, and a couple of friends who wanted to lose weight. I helped delivery of our second son using hypnosis. By the time I graduated with my BA I only used hypnosis for my own purposes. The medical community of my acquaintance expressed no interest in hypnosis.

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1965–1968 (29–32 years): Virtual Shamanic Projection of Self In shamanic projection of self, I assumed the persona of the bear through the use of an ethnographic film depicting a N.W. Coast shaman engaging the same self-generated processes. This was my first awareness and use of this capacity. I was a full-time lecturer at Mankato State College, as it was known at that time. 1970 (34 years): Longevity of Child Demonic “Ghost” The demonic “ghost’s” presence that started plaguing me when I was eight years old returned to my house in Skyline, Mankato, MN. The presence was strong enough to cause my immediate return to the main floor. I still did not understand its origin at that time. 1973 (37 years): Discovering Glossolalia, and Collective Drug Trips I had conducted research on the Sisseton-Wahpeton Indian Reservation in South Dakota in the late 1960s and thereafter attended their annual Pow Wow. I was dancing to the drums, began chanting and realized that an automatic speech process had been activated. I later practiced this procedure in the isolation of my living room to recorded drum music with the same effect. Much like lucid dreaming, this is a hybrid state, or perhaps I should say a partial state of speech activation. The voice mechanism is activated without it being connected to cognitive, conscious guidance. The psychic effect is almost as strong for me as visual hallucinations. No effort is put forth as the voice takes on its own “presence.” I attended a Native American Church peyote ceremony that honored one of my student’s deceased brothers. The overnight ceremony brought the deceased young man’s image back to the fire pit early that morning. Nods all around acknowledged the collective sighting. I shared this “vision” with one of my drug experimenting students at MSU, who informed me of planned, shared collective drug trips with friends. This was my first awareness of how easily collective trips could be generated: The Joan of Arc Syndrome. 1978 (42 years): Concretizing “Presence,” and Virtual Control of Physical Self The setting was at MSU during the time I was going through my first divorce. I’m walking down a long hallway from my office to the

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bathroom when I change almost instantly from a psychic three feet to my full 6 ft. 2 inch size. The effect was dramatic enough to stop me instantly and contemplate what was happening. This episode occurred during one of my summer school teaching sessions. A few months later during fall term, I entered my classroom only to find my childhood “Guardian Angel” Moses sitting in the far corner in my proctor’s chair. Moses had never occurred to me as a complete physical presence, and I was bewildered. After class a student asked me who was sitting in the corner chair at the beginning of class, and I was even more bewildered. She explained that she often had these psychic experiences. When I wrote my autobiography, I did not accept this as a stark hallucination. Later, after reviewing episodes such as that of the Native American Church ceremony, I realized hallucinations of this type were not only self-generated but how easily they were shared with others of similar mindset. 1979 (43 years): Nightmares After 20 Years of Active Suppression I decided to discontinue twenty years of dream programming after a year of emotional adjustment from my divorce. The previous 20 years had been free of nightmares as my dreaming brain automatically substituted pleasant dreams for nightmares. My two major nightmares returned almost immediately, but with lesser emotional impact. 1982 (46 years): Self-Generated Hallucinations Using Visual Media I was watching the movie Ghost with my wife when she touched my arm and asked me what I was doing. I had projected myself into the virtual body of the “Ghost” and was jumping through train walls, etc. with him. I watched the movie a couple more times by myself and enjoyed the experience each time. Experientially, the effect is similar to lucid dreaming where one is aware that they are in a dual state, and performing superhuman acts. Throughout my lifetime I have enjoyed similar virtual effects while watching TV. 1986 (50 years): Self-Generation of Waking Hallucinations Using Childhood Dogma My biological mother was dying and requested the presence of her children. My older sister and I shared 24 hour surveillance. The night

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of mother’s death I had been reading, it was about 2:00 a.m. and her restlessness continued. She gasped, her face became distorted, and moments later I realized she had breathed her last. With this realization, four ghoulish figures rose up through the hospital’s cement floor uttering guttural sounds. They reached into mother’s body and wrenched free what I understood to be her “soul.” I had an overwhelming sense that her “soul” was being taken to “Hell,” and I didn’t believe in “Hell.” I was shocked! I sat motionless absorbing the emotion for 20–30 minutes before calling the nurse. I realized that these figures were self-generated at the time, but, nevertheless the effects were startling. 1989 (53 years): Non-conscious Memory Acquisition Using Physical Posturing I was undergoing management training with a woman who was using yoga-style exercises. A dual image of mother attacking me with a pillow in my crib emerged. The training scene and that of my mother “vision” overlapped like two plastic overheads that were superimposed. The room and my trainer gradually faded and I was transported back to my infant crib. I experienced the pillow shutting out all light, breathing difficulty, and then nothingness. I’m aroused by my trainer touching me and bringing me back to the moment. The experience was dramatic and preoccupied much of my thoughts for the next few days. Later, the Japanese submarine nightmare returned, I’m captured, taken to their sub, they begin to drill a hole in the middle of my back, and the drill turns into mother’s hand. I realized almost immediately the source of this nightmare, and the feeling of relief was immense. The nightmare has never recurred. Later in therapy, I recalled other similar smothering attacks by mother. 1991 (55 years): Virtual Control of Physical Size: A Dreaming Corollary I entered therapy for the first time in my life. My therapist was aware that I had left my soul in interstellar space, half-way to the moon, when I was eight years old. She asked me to retrieve it, but I was unable to leave my body and hold conversation at the same time. After a number of minutes of concentration, I started to grow dramatically. I physically grew half-way to the moon; the earth was marble

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size at my feet; I wrapped myself around my “soul” and returned to the therapist’s office. I realized at that time that one could have a virtual size of any choosing. And, that my virtual size had often changed throughout my life. The virtual sense of being smaller than one’s actual physical size represents only one option for our virtual reality generator. Thus the reality of historical giants, sea monsters, and other scary virtual phenomena took on new meaning. 1991 (55 years): The Startle Response with New Forms of Hallucination My “Guardian Angel,” Moses, had never spoken to me throughout my entire childhood and life. I was discussing this “shortcoming” with a psychologist who worked in one of the treatment programs I had developed for adolescents and young adults in the criminal justice system. He encouraged me to speak to Moses next time he showed up. This was during a period of time when I was adjusting to my second divorce. Moses sat down on the edge of my bed, which he often did as a presence during this time period. I asked, “Moses is that you?” In a loud clear voice the answer was “yes.” I was unable to continue the conversation. I note that the first time a new type of hallucination occurs it tends to be very impactful and requires processing time. 1994 (58 years): Repression Requires Psychic Energy, Nightmares can be forever The sexual molestation nightmare repeated, I was captured and realized my captor was a sexual deviant. I’m berating myself for being stupid, and at that moment I was transported back to the isolated hay farm in N.W. Wisconsin where the molestation had occurred. This nightmare version disappeared immediately with this new awareness, but other versions of it continued to surface for a month or two and needed similar recognition for their removal. Two major awareness factors were prominent during this nightmare removal process: Trauma producing nightmares can last a lifetime, and it takes considerable psychic energy to suppress nightmares with “dream programming.”

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1998 (62 years): The Whole Body as Phantom Limb I was driving back and forth between S.E. Minnesota and N.W. Wisconsin for a number of months when my step-mother was dying of cancer. Bored, I would engage in what I called Zen driving. This meant merging my body with the car and letting my mind float freely. The effect is much like lucid dreaming where we observe our self, but do not consciously direct our dreams. It’s a pleasant experience as many joggers or motorcyclists can attest. Sometimes called road hypnosis, but in my case a controlled dual state experience. The difference in a dual state of “Zen” driving is that the tiredness of body is not experienced. Thus, the driving experience is most positive, and one can enjoy the lovely, winding roads on this particular route, Highway 63. The enjoyment is enhanced as the body’s self is in charge, thereby freeing the mind to experience a form of sensory bliss. 2000 (64 years): Controlled, Multi-Sensory Waking Hallucinations Hallucinations can involve only one of our senses, or be multi-sensory; they can be singular or narrative in the sense of our “movie-type” dreams. I had been reading some material on the Big Bang, superluminary flight (faster than light flight), and quantum entanglement. On a cold January afternoon in Minnesota I put down my book, concentrated for a minute or two, and then went to the beginning of time. I shot past the earth, moon and then the Milky Way Galaxy. Eventually, I hit the early universe’s plasma wall, observed the experience, and immediately returned to my living room easy chair as quantum entanglement permits. These self-generated dream-like visions approximate their lucid REM counterparts. They are extremely impactful and this one left me in an exhilarated state for days. Controlled or partially controlled hallucinations that are similar to what I call my Genesis Journey in Autobiography of a Ghost are discussed by Oliver Sacks in Hallucinations. 2010/2011 (74–75 years): Classifying Hypnopompia Hypnopompia are the images one shares with dreams as we pass from dreaming into waking. The varieties of hypnopomia discussed below have been with me since starting dream programming in 1957–1958. If I’m dreaming lucidly at the time I get up to use the bathroom, the dream may continue at a muted level, but at a level that still

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permits me to follow the dream narrative, while I’m out of bed; it can then return to full-REM when I return to sleep. A second version is for the dream to stop as though a VCR is put on hold, and pick up again at this point when I return to sleep. A third version is for the dream to be put on hold while I use the bathroom and then be repeated in toto when I return to sleep. A fourth version is for the dream to repeat but with a changed ending. I note that this type of dream classification is not common to dream research literature. If a dream is in process when I get up without returning to bed, variations also occur. I may finish a dream segment at a muted level, the dream may just shut off, or a jumbled version of the dream may persist as I slowly wake up on the commode. 2012 (76 years): Using Suggestion with Hypnagogia I have never found hypnagogic imagery very interesting. In my late July, 2012 visit with Allan Hobson at his home in Brookline I decided to pay more attention to it. A single long-stemmed flower appeared, I noted only one flower and it turned into a bunch of one or two dozen. I then noted no background and one appeared. I made a mental note to myself that suggestion could be employed in this early pre-sleep stage as easily as with REM dreaming.

Overview I’ve experienced various altered states since my first OBE at approximately l.5 years. I assume some brain damage at the time of this hospitalization as I had to relearn early walking and talking behaviors. By age three I recall flying around the countryside of Cumberland, Wisconsin without distinguishing between waking and dreaming states. By age five I was entering my Japanese nightmare and consciously suspending myself so I would not hit water in the “hold” of this vessel. I gradually learned to project my virtual self, experienced as real-self, into the Aurora Borealis, thunderstorms, automobiles, animals, as well as other multi-media imagery. Lucidity with control was gradually transferred over my lifetime to all the various altered states discussed. And, once I had mastered “dream programming” control of other altered states became fairly easy as well. It is from this perspective that I came to embrace much

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of Allan Hobson’s theorizing about protoconsciousness. In the context of protoconsciousness, our virtual reality generator is always on. We just need to learn how to manipulate the mechanism’s on-off switches. Lucidity in dreams led to programming complete dream scenarios, and the ability to enter ongoing dreams and alter them. Lucidity and accompanying control was then transferred to other altered states. The sense of helplessness that tends to accompany a startle response activated by hallucinations is greatly moderated once anxiety is removed from the process. If an unwilled hallucination occurs, I may choose to suppress it, go with it, or elaborate it. I may also choose to create movie like hallucinations in toto for personal enjoyment. These are not virtual creations that I commonly employ as I prefer and enjoy normal consciousness. The reader will have noticed that the above examples include multi-sensory dreams and multi-sensory waking hallucinations, singular sensory hallucinations with touch and related sense of presence, sight, sound, as well as one’s relationship to gravity, but not taste. I have occasional taste hallucinations but have excluded them; they are difficult to localize and confirm with any degree of objectivity. In other words, one’s entire sensorium can be involved in hallucinations, as it can be in dreams. It is suggested that sensory typing is a straightforward manner of handling all of the reported hallucinations. This classification moves one away from focus on bizarreness, or other aspects that may be titillating. Further, it opens the prospect of using scanning technology to explore these different patterns of neuronal expression, as has been the case with lucid dreaming. Daydreams are often treated as a separate form of hallucination or hybrid state. Relaxation during the day or pre-sleep seems to engage the same mechanisms. As my Genesis Journey suggests, one can guide this process just as vividly as one can guide multi-sensory REM dreams. I am therefore suggesting a common typology of consciousness states that operates 24/7 across one’s sensorium; a typology that is built on our virtual reality generator, and Allan Hobson’s protoconsciousness theory. Two final comments: Using subjects with sensitivity to hybrid states demands its own special methodology. One cannot use large statistical numbers to gain the type of information presented here. Hypersensitive subjects should be recruited and trained for subjective

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research purposes. Hybrid research that combines subjective– objective methodology offers new avenues for research and theorizing about brain states and functioning. Secondly, teaching control over dreams and hallucinations has considerable therapeutic potential. Those who move in and out of these states could probably benefit from control as I have over my lifetime. Those who are unable to control their hallucinations, especially the elderly, individuals who are brain damaged or schizophrenics, can either learn to enjoy them or at least not be as severely traumatized. Reference: Just, G.A., Autobiography of a Ghost (2009).

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APPENDIX II

Glen Just’s new self-observation experiments

r. Just’s terrifying dreams, his hallucinated ghost, and his mystical states are seen by him and by me as neurodynamically linked and altered expressions of consciousness control systems of his brain, the further understanding of which could lead to a long-sought unity of brain and mind, a unity that Freud sought, but could not achieve, in 1895. The emerging model is, thus, important not only to psychology and psychiatry, but, as Dr. Just emphasizes, to a genuinely human philosophy as well. I now present accounts by Dr. Just of self-observation experiments that he conducted after our meeting in Boston. He wrote the following account on September 27, 2012.

D

Hypnopomic and Hypnagogic Image Construction I was up at 4:30 a.m. this morning editing an article I’m writing with Allan Hobson. I went back to bed a little after 8:00 a.m. Pre- and -post sleep imagery was stronger than usual. I’ve been playing with this phenomenon during and since my visit with Allan Hobson in Boston in late July. While being aware that I was in a dual state, but still

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dreaming I was viewing a large beautiful dahlia. When I focused on the dahlia, it immediately morphed into a dahlia patch of perhaps two dozen flowers. I dozed off and upon partially waking a second time, there was a horse-drawn farm wagon in my waking image. I moved the wagon on impulse and the physical context changed immediately. I can appreciate more fully with these exercises how suggestion works in one’s dreams. My virtual reality generator is also available for creative work as I transition in-and-out of my sleeping–waking cycles. I will try another experiment next time I take a post-night’s nap like this. I want to see if I can hold the dream image longer and bring it into a full-wake state. The above two examples indicate how one is able to hallucinate something like my Moses in a university classroom. In the classroom, during the 1970s, he was sitting in my proctor chair in the far corner of my classroom when I entered. I started lecturing and looked up at least twice to find him still sitting there. Moses was unmoving, looked straight into the middle of the classroom, made me terribly nervous, and finally disappeared. If I have such an hallucination again, I will try having him move about. These are new experiments for me. Vivid hallucinations of this type have been rare for me, and the Moses hallucination was particularly disconcerting. Others: The peyote ceremony where the young Indian man returns to the fire pit from the netherworld of death, and the ghouls at the time of my mother’s death. I not only have better explanations for them after discussions with Allan Hobson, but I realize this phenomenon can be experimented with by holding dual states. The dual imagery, when I recalled my mother smothering me during management training, progressed like a neuronal attractor moving in dual state space. My trainer was gradually superimposed on the crib attack scene until both images were equally vivid—like superimposing two plastic overheads on each other. Finally, the actual scene and room that I was sitting in faded away and I was totally visualizing the attack scene itself. I became aware that my trainer had been superimposed on this scene and my memory was beginning to associate her with the repulsion I felt at that moment for my mother. I called her and asked for a coffee appointment that evening. We met and the association was broken. It is easier to understand flashbacks with PTSD after these experiences. I feel strongly that my trainer would have become permanently associated with my mother, thereby making it difficult or impossible to

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work with her in the future if I had not met with her for coffee that evening. By the time we met I was already experiencing considerable difficulty being in her presence. Analogously, one can appreciate how easily PTSD associations are made and the necessity of military personnel to avoid others, or block out common associations made throughout the day with alcohol or drugs. Trauma that passes a certain threshold of intensity easily forms contextual associations. And, it seems, visual flashbacks or new visually generated elements can and do occur instantly, that is, if my experience is typical as reported above. The last word is experiment. Experiment with yourself and experiment with the other. The laboratory of the bedroom is open to all. Use it well.

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GENERAL BIBLIOGRAPHY

Birnholz, J. C. (1981). The development of human fetal eye movement patterns. Science, 213: 679–681. Dahlstrom, A., & Fuxe, K. (1964). Evidence for the existence of monoamine-containing neurons in the central nervous system. I. Demonstration in the cell bodies of brain stem neurons. Acta Physiologica Scandinavica, 62: 1–55. Dresler, M., Wehrle, R., Spoormaker, V. I., Koch, S. P., Holsboer, F., Steiger, A., Obrig, H., Sämann, P. G., & Czisch, M. (2012). Neural correlates of dream lucidity obtained from contrasting lucid versus non-lucid REM sleep: a combined EEG/fMRI case study. Sleep, 35(7): 1017–1020. Hartmann, E., Rosen, R., & Rand, W. (1998). Personality and dreaming: boundary structure and dream content. Dreaming, 8(1): 31–39. Havens, L. (1988). Making Contact: Uses of Language in Psychotherapy. Cambridge, MA: Harvard University Press. Hobson, J. A. (2009). REM sleep and dreaming: towards a theory of protoconsciousness. Nature Neuroscience Reviews, 10: 803–814. Hong, C. C., Harris, J. C., Pearlson, G. D., Kim, J. S., Calhoun, V. D., Fallon, J. H., Golay, X., Gillen, J. S., Simmonds, D. J., van Zijl, P. C., Zee, D. S., & Pekar, J. J. (2009). fMRI evidence for multisensory recruitment

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associated with rapid eye movements during sleep. Human Brain Mapping, 30(5): 1705–1722. Jouvet, M. (1962). Research on the neural structures and responsible mechanisms in different phases of physiological sleep. Archives of Italian Biology, 100: 125–206. Jouvet, M. (1973). Essai sur le rêve. Archives of Italian Biology, 111: 564–576. Jouvet, M., & Michel, F. (1959). Electromyographic correlations of sleep in the chronic decorticate & mesencephalic cat. C. R. Seances Soc. Biol. Fil., 153(3): 422–425. Kety, S., Rosenthal, D., Wender, P. H., & Schulsinger, F. (1971). Mental illness in the biological and adoptive families of adopted schizophrenics. American Journal of Psychiatry, 128: 302–306. Mahowald, M. W., & Schenck, C. H. (1992). Dissociated states of wakefulness and sleep. Neurology, 42(suppl 6): 44–52. Riemann, D., Voderholzer, U., Berger, M. (2002). Sleep and sleep–wake manipulations in bipolar depression. Neuropsychobiology, 45(Suppl 1): 7–12. Sherrington, C. S. (1906). Integrative Action of the Nervous System. London: Constable. Solms, M. (1997). The Neuropsychology of Dreams: A Clinico-anatomical Study. Hillsdale, NJ: Lawrence Erlbaum. Thomas, D. (1969). Adventures in the Skin Trade. New York: New Directions Books. Tisher, P. W., Holzer, J. C., Greenberg, M., Benjamin, S., Devinsky, O., & Bear, D. M. (1993). Psychiatric presentations of epilepsy. Harvard Review of Psychiatry, 1(4): 219–228. Voss, U., Tuin, I., Schermelleh-Engel, K., & Hobson J. A. (2011). Waking and dreaming: related but structurally independent. Dream reports of congenitally paraplegic and deaf–mute persons. Conscious Cognition, 20(3): 673–687. Yalom, I. D., & Leszcz, M. (Eds.) (2005). Theory and Practice of Group Psychotherapy (5th edn). New York: Basic Books.

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Cannon, W. B. (1942). “Voodoo” death. American Anthropologist, 44(new series): 169–181. Cartwright, R., Agargun, M. Y., Kirkby, J., & Friedman, J. K. (2006). Relation of dreams to waking concerns. Psychiatry Research, 141(3): 261–270. Elazar, Z., & Hobson, J. A. (1985). Neuronal excitability control in health and disease: a neurophysiological comparison of REM sleep and epilepsy. Progress in Neurobiology, 25: 141–188. Epstein, A. W. (1977). Dream formation during an epileptic seizure: implications for the study of the “unconscious”. Journal of the American Academy of Psychoanalysis, 5(1): 43–49. Freud, S. (1895). Project for a Scientific Psychology. S.E., 1. London: Hogarth. Freud, S. (1900a). The Interpretation of Dreams. S.E., 4–5. London: Hogarth. Freud, S. (1912–1913). Totem and Taboo. S.E., 13: 1–161. London: Hogarth. Freud, S. (1921c). Group Psychology and the Analysis of the Ego. S.E., 18: 65–143. London: Hogarth. Hobson, J. A. (1988). The Dreaming Brain. New York: Basic Books. Hobson, J. A. (1989). Sleep. Scientific American Library. Hobson, J. A. (1994). The Chemistry of Conscious States: Toward a Unified Model of the Brain and the Mind. New York: Little, Brown.

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Hobson, J. A. (1998). Consciousness. Scientific American Library. Hobson, J. A. (1999). Dreaming as Delirium. Cambridge, MA: MIT Press. Hobson, J. A. (2001). The Dream Drugstore. Cambridge, MA: MIT Press. Hobson, J. A. (2002). Dreaming: An Introduction to Sleep Science. Oxford: Clarendon Press. Hobson, J. A. (2005). 13 Dreams Freud Never Had. New York: Pi Press. Hobson, J. A. (2011). Dream Life: An Experimental Memoir. Cambridge, MA: MIT Press. Hobson, J. A. (2013). Ego ergo sum: toward a psychodynamic neurology. Contemporary Psychoanalysis, 49(2): 142–164. Hobson, J. A. (2014). Psychodynamic Neurology: Dreams, Consciousness, and Virtual Reality. New York: CRC Press. Hobson, J. A., & Friston, K. J. (2012). Waking and dreaming consciousness: neurobiological and functional considerations. Progress in Neurobiology, 98: 82–98. Hobson, J. A., & Friston, K. J. (2014). Consciousness, dreams, and inference: the Cartesian theatre. Journal of Consciousness Studies, 21(1–2): 6–32. Hobson, J. A., & Leonard, J. (2001). Out of its Mind: Psychiatry in Crisis. Cambridge: Perseus. Hobson J. A., & McCarley, R. W. (1977). The brain as a dream state generator: an activation- synthesis hypothesis of the dream process. American Journal of Psychiatry, 134(12): 1335–1348. Hobson, J. A., & Wohl, H. (2005). Angels to Neurones: Art and the New Science of Dreaming. Parma: Mattioli 1885. Hobson, J. A., Friston, K. J., & Hong, C. C. H. (2014). Virtual reality in waking and dreaming consciousness. Under review. James, W. (1902). The Varieties of Religious Experience: A Study in Human Nature. New York: Longmans, Green. Joyce, J. (1922). Ulysses. Paris: Sylvia Beach. Jung, C. G. (1961). Memories, Dreams, Reflections. New York: Random House. Just, G. (2009). The Autobiography of a Ghost. Mankato, MN: Eagle Entertainment USA. Just, G. (2011). Mind of the Mystic. Mankato, MN: Eagle Entertainment USA. Just, G. (2012). Dreams, Creativity, and Mental Health. Mankato, MN: Eagle Entertainment USA. Kahan, T., & LaBerge, S. (1996). Cognition and metacognition in dreaming and waking. Dreaming, 6(2): 235–249.

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Llewellyn, S. (2013). Such stuff as dreams are made on? Elaborative encoding, the ancient art of memory, and the hippocampus. Journal of Behavioral and Brain Science, 36(6): 589–607. Mack, J. E. (1994). Abduction: Human Encounters with Aliens. New York: Charles Scribner’s Sons. Metzinger, T. (2003). Being No One: The Self-Model Theory of Subjectivity. Cambridge, MA: MIT Press. Metzinger, T. (2009). The Ego Tunnel. New York: Basic Books. Proust, M. (1981). Remembrance of Things Past (Vol. 7), C. K. Scott Moncrieff, T. Kilmartin, & A. Mayor (Trans.). New York: Random House. Rechtschaffen, A., Bergmann, B., Everson, C., Kushida, C., & Gilliland, M. (1989). Sleep deprivation in the rat. X. Integration and discussion of the findings. Sleep, 12(1): 68–87. Revonsuo, A. (2000). The reinterpretation of dreams: an evolutionary hypothesis of the function of dreaming. Journal of Behavioral and Brain Science, 23(6): 877–901. Revonsuo, A., & Valli, K. (2008). How to test the threat-simulation theory. Conscious Cognition, 17(4): 1292–1296. Rosenhan, D. L. (1973). On being sane in insane places. Science, 179(4070): 250–258. Snow, C. P. (1960). The Two Cultures. Cambridge: Cambridge University Press. Tranquillo, N. (Ed.) (2014). Dream Consciousness: Allan Hobson’s New Approach to the Brain and Its Mind. Cham, Switzerland: Springer. Voss, U., Frenzel, C., Koppehele-Gossel, J., & Hobson, J. A. (2012). Lucid dreaming: an age-dependent brain dissociation. Journal of Sleep Research, 21(6): 634–642. Voss, U., Holzmann, R., Tuin, I., & Hobson, J. A. (2009). Lucid dreaming: a state of consciousness with features of both waking and non-lucid dreaming. Sleep, 32(9): 1191–2000.

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INDEX

abuse, 22, 95, 101, 116–117 child, 95, 97, 113, 151, 155 emotional, 2 nicotine, 15 parental, 22, 104–105, 107–108, 112, 152 positive, 153 severe, 95 trauma, 105 activation-synthesis, xvii, 41, 66–68 affect(ive), 55, 59, 78–79, 102 disorder(ed), 5, 69, 80 negative, 35, 60, 112 predominant, 107 spectrum, 85 Agargun, M. Y., 60–61 aggressive, 29, 73–74, 78, 85 compulsively, 73 impulse, 71 intervention, 99 symptoms, 88

aminergic activity, 47, 49–50 neuronal, 50 boost, 59 brainstem cell groups, 45, 56 cells, 47, 52, 54 chemicals, 51 complex, 54 demodulation, 50 dominance, 50 efficacy, 54, 85–86 enhancement, 57, 81 forces, 51, 85 hyper-, 84 inactive brain, 50 inhibition, 43, 85 inputs, 49 modulation, 107 neuromodulators, xiv, 45 neuronal discharge, 54 neurons, 42, 45–48, 54–56 pro-, 15

189

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190

INDEX

reuptake blockade, 56 self, 48 strength, 53 system, 42, 44, 46–48, 50–51, 81, 83, 85 neuromodulatory, 56 neuronal, 44, 48 waking, 42 tone enhancement, 54 weakness, 47 anger, xx–xxi, 4, 9, 11, 19–20, 22, 32, 74, 77, 90, 110, 166 explosive, 161 management, 59–60, 71–73 narcoleptic, 59 repressed, 71 anorexia nervosa, 69, 85–87, 89 anxiety, xx–xxi, 28, 30, 34–36, 42, 57, 59, 62, 70, 73, 76, 78, 87–88, 92, 96, 98, 107–109, 114–115, 142, 170, 177 clinical, 72 dream(ing), 35, 49, 52, 76, 85, 108 fear, 72 -free, 42, 100 hyper-, 35 importance of, 74 intolerable, 80 management of, 109 panic, 76, 161 physiological, 88 primary consciousness, 34 -ridden, 116 severe, 98 traumatic, 98 unbearable, 86 assault(ive), 9–10 ego, 9 astral travel, 99–100, 117, 119, 133 Baudelaire, C., 127 behavior(al), 1, 15, 62, 70–71, 75, 77–78, 91, 96, 113–114, 134, 138, 141, 147, 168, 170, 176 see also: disorder(ed) adaptive, 139

anomalous, 9 anorexic, 86 approach, 13, 100 catatonic nocturnal, 9 change, 146 cognitive-, xv, 91, 99 compulsive, 73 conditioning, 70 conventional, 57 desirable, 75 human, xvii idiosyncrasies, 105 infuriating, 27 intervention, 141 modification, 170 neuroscience, 12 obsessional, 87 parental, 4 pattern, 24 reinforcement, 114 patterns, 168 rescue, 14 sexual, 25 thermally conservative, 89 treatment, 70 unwanted sleep, 26 violent, 30 volitional, 144 Bergmann, B., 116 brain (passim) activation, xviii, 49–50, 60, 62, 65–66, 68, 76, 107, 143, 163 activity, xiv, 7, 93, 96, 114 anatomy, 58 anoxia, 103 biogenic amine enhancement, 85 calisthenics, 71 cells, 45–46 chemistry, 50 damaged, 97, 176, 178 deficiencies, 93 dream(ing), 50, 172 dynamism, 110 frontal, xxi cortical, 51

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INDEX

function, xviii, 49, 51, 67, 104, 117, 141–144 heart-, 51 inactive, 50 maturing, xix mechanism, xv, 42, 61, 64, 89 -mediated, 20 mediation, 49 –mind, 7, 22, 42–44, 46, 51, 57, 62, 65, 69, 71, 74–75, 78–79, 82, 93, 98–99, 104–105, 115–116, 128, 135, 142, 144–145, 149, 155, 162 pacemakers, 51 physiological state of the, 101 REM dream process, 59 research, 7, 36 science, xiv, 22–23, 63, 68, 128, 137–138, 140–141, 163 sensitivity, 133 space, 55 state, xiv, 54, 76, 122, 131–132, 141, 143, 162, 178 stem, 42, 44–45, 48, 54–55, 56, 58, 65, 85, 135, 142 control, 145 diencephalic, 45 generator, 67 neuronal system, 47, 66 neurons, 5, 45 sensorimotor circuitry, 67 signals, 67 sleep-wake system, 81 state control neurons, 15 vestibular system, 106 substrate, 75 systems, 65 temperature, 115, 144 -washed, 4 Cannon, W. B., 50 Cartwright, R., 60–61 case vignettes Black Knight, 27–28, 31, 37 Chiara Perugino, 34, 72, 76, 86–88, 93, 104

191

Derrick Sutter, 4–7, 15, 33, 53, 57, 62–63, 155 Edward George, 32–33 Eliana Gergius, 35–36 Engine Man, 150–151 Francine Poppy, 11–12, 52–53, 57 Gerald Green, 31 Gordon Golden, 24–26, 89 Irvin Yalom, 36–37 Jane Hudson, 30–31 John Cabot, 17–22, 90 Lieta Siciliano, 83–88, 104, 153 Luciano Ferri, 89–90, 146, 154–155 Martin Hoskins, 71–73, 76, 88, 104 Max Truman, 32 Melvin Blinder, 23–25 Mr. Bibliography, 56, 71, 77, 83 Rosella Campobello, 12–15, 20–22, 30, 57, 70–72, 76, 82–83, 86–88, 90–93, 104 Sarah Sage, 7–9, 11, 53, 155 Soren Tooks, 28–29 Sybil Newhouse, 20–23, 52 Sylvia Gates, 34–36 William Hitchens, 9–10 Xavier Theodorus, 33 Yveline Cloche, 15–17 Zack Seidler, 29–30 Charcot, J.-M., 26 cholinergic, 46, 48, 53, 81, 84 activity, 47, 49 anti-, 86, 162 cells, 47 dominance, 50 dream(ing), 48 dream system, 42 forces, 51 hyperactive, 47 hyper-modulation, 50 neurons, 42, 47–48 overdrive, 47 stimulation, 92 strength, 53 Coles, B., 10

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192

INDEX

conscious(ness), xviii, xix, 1, 42, 45–46, 50, 55, 66, 69–70, 75, 103–104, 120, 128, 141, 144, 149–151, 161, 163, 168, 175–176 see also: anxiety, disorder(ed), Freudian(s), self, unconscious(ness) awareness, 64, 108 causality of, 75, 93 decisions, 135 development of, xix disordered states of, xiii dream(ing), 47, 62, 64 experiences, 153 expressions of, 100 guidance, 171 human, 101 mind, 128 motive, 93, 158 neurobiology of, xx normal, 177 pre-, xix primary, 61, 112, 160 proto-, xv, xvii–xx, 67, 74–75, 127, 142, 160, 163, 177 experiences, 76 hypothesis, xx, 143 processes, 143 theory, xv, xviii–xix, 37, 41, 70, 82, 85, 109, 123, 125, 142, 144, 163–164, 177 science of, 127–128 state, xviii, 46, 62–64, 78, 101, 111, 133, 141–142, 145, 153, 163, 177 alteration, 116–117, 165 control system, xiv–xv, 45, 103, 179 dissociated, 25 generation, 66 plasticity, 73 psychology, xv stabilization, 5 substrate of, 75 theory, 163 understanding of, 101

waking, xvii–xx, 41, 47, 85, 111–112, 122, 126, 134–135, 141, 143 Dahlstrom, A., 44 depression, 6, 11, 47–48, 53, 79–86, 88, 90, 116, 122, 145, 170 clinical, 79–80 manic, 80, 123 Descartes, R., 104 development(al), xviii–xix, 41, 43, 71–72, 75, 96, 138, 140, 163, 169 see also: conscious(ness) early, 109 insults, 33 neurodynamic ego, 110 postnatal, 124 prenatal ego, 110 psychological perspective, 113 uterine, 109 intra-, xx disorder(ed), xv, 44, 47, 58, 71, 86, 162 see also: affect(ive) borderline personality, 34, 130 clinical, 47 disease-, xv eating, 12, 25, 47, 85 mood, 122 obsessive-compulsive (OCD), 15, 47–48, 69–72, 75–78, 90 paradigm, xv post traumatic stress (PTSD), 105, 108, 180–181 psychiatric, 43, 57, 69 REM sleep behavior (RBD), 48, 58–59 seizure, 133 sleep, 20, 24, 26, 48, 59 state of consciousness, xiii symptomatic, 43 Dostoevski, F., 61, 134 dream(ing) (passim) see also: anxiety, brain, cholinergic, conscious(ness), self amnesia, xx analysis of, 66

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INDEX

awareness, 63, 134 car crash, 59 concept of, 67 day, 129, 177 elements, 47, 69 emotion, 49–50, 61, 85, 107, 145 epic, 81 escape, 52 fighting, 59 flying, 4, 62–64, 103, 106–107, 118, 166 human, xv imagery, 59, 180 interpretation, 67, 125, 141, 150 irrational impulses of, 61 journal, 113 life, 111 -like features, 76 mentation, 58, 85 symptoms, 42 visions, 175 lucid, xx–xxi, 23, 54, 60–65, 99–100, 103–104, 106, 111–112, 115–116, 133–135, 145, 147, 171–172, 175, 177 non-, 64, 113 mind, 60, 62 motivation, 68 multi-sensory, 177 museum, 31 narrative, 176 neurobiology of, xvii–xviii neuroscience, 125 nightmare, 36, 50, 59, 96, 98–100, 104, 107–108, 113, 116, 134, 145, 166, 169–170, 172–174, 176 nocturnal, 150 normal, 35, 42, 85, 96, 107, 109, 145, 162 plot control, 99–100, 103–104 principles, 96 probability of, 47 recall, xx REM sleep, 49, 59, 62, 65, 68, 78, 85, 108, 143, 163, 176–177

193

research, 44, 106, 176 science, xiii–xiv, xviii, 50, 60, 99–101, 103, 126, 128, 134–135, 138, 163 stimuli, 67 study of, xix suppression, 162 symbolism, 67 terrifying, 100 theory, xvii, 37, 52, 67, 113, 117, 126, 145, 163 see also: Freud, S. -to-waking, 43 troubling, 111 unpleasant, 100 unremembered, 112 virtual, 51 vivid, 76 waking, 36, 62, 107, 129, 133–134 world, 62, 122 Dresler, M., 65 dual-aspect monism, 43–44, 93, 114, 128 dysfunction(al), 19, 44, 52, 75, 83 ego, 42 family, 123 psychiatric, 152 response, 52 ego, xvi, 6, 11–12, 14, 20, 33–35, 38, 42, 48, 53, 64, 88, 100–101, 103, 109–110, 112–113, 119–120, 143, 145, 152–153, 155–156, 162 see also: assault(ive), development(al), dysfunction(al) attribute, 140 boundaries, 34–35 damage, 6, 51, 155 death, 53 disunity, xv embroidery, 134 evolving, 109 function, 51, 61, 64, 134, 148 genesis, 109, 146 life, 22, 81 -support system, 62 murder, 9, 80–81

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194

INDEX

observing, 55 preconscious, xix quilt, 134 repair, 147 strengths, 138 suicide, 53, 80 theory, xix, 98 Elazar, Z., 133 epilepsy, 57–58, 61 Epstein, A. W., 133 Erikson, E., 140 Everson, C., 116 Ewalt, J., 1–3, 9–10, 17

non-, 126 philosophy, 139 post-, 150 protoconsciousness, xviii–xix psychoanalysis, 99, 139, 145 psychoanalysts, 2 psychoanalytic model, xix, 2 rules of therapy, 99 unconscious, xviii–xix, 16, 37 view of art, 31 Friedman, J. K., 60–61 Friston, K. J., 43, 60, 114 Fuxe, K., 44

fantasy, 4, 14, 64, 96, 125, 129, 131, 151 Federal Drug Administration (FDA), 79 Frenzel, C., 111 Freud, S., xiv, xvii, xx, 2–3, 18, 26–28, 30–31, 36–39, 49–50, 60, 66, 68–69, 71, 100, 105, 117–118, 123–125, 133–134, 138–139, 144, 146, 151–152, 160, 163, 169–170, 179 and cocaine, 56 and hypnosis, 113 and pessimism, 139 atheism, 160 -baiting, 33 –Bion discourse, 27 clinical claims, 17 couch, 31 disguise-censorship hypothesis, 66–67, 99 dynamic repression, 42, 69 followers of, 137 pompous delusions, 4 primary process, 160 rejection of, 37 theory, 50, 60, 113 dream, xvii, 117, 126, 145 Freudian(s), xiv, xxi, 66, 115, 160 distinction, 67 nature, 112, 118 neo-, 37, 140

Gilliland, M., 116 Grunbaum, A., 117, 160 hallucinations, 36, 59, 98, 121–122, 172, 174, 177–178, 180 controlled, 175 hypnopompic, 59 perceptual, 161 psychotic, 42 reported, 177 self-generated, 172 sensory, 177 stark, 172 taste, 177 uncontrolled, 132 unwilled, 177 visual, 171 vivid, 180 waking, 172, 175, 177 Hartmann, E., 34 Harvard Medical School, xiii, 4, 30, 41, 138 Hayes, R. E., 48 Henneman, E., 41 Hobson, J. A., 32, 43, 47, 60–61, 111, 114, 128–130, 133–134, 157, 160, 176–177, 179–180 Holzmann, R., 134 homosexuality abusive, 72 fear of, 72 Hong, C. C. H., 60

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INDEX

hypnosis, xvi, xxi, 1, 12, 26, 30, 50, 113, 128, 133, 164, 170 formal, 17 road, 175 self-, 59, 96, 99–100, 104, 109, 112, 114–115, 134, 170 inhibition, 42, 58 see also: aminergic active, 46, 51 dis-, 85 inadequate, 42 motor, 59 muscle, 107 phobic, 12 selective, 75 insomnia, 20–21, 35, 47, 52, 79, 116, 142 neurotic, 145 intervention, xxi, 59, 82, 113, 115, 141, 166 see also: aggressive, behavior(al) active, 17, 166 biological, xvii chemical, 43, 53 clinical, 163 direct, 21, 91 immediate, 23 negative, 4 pharmacological, 141 physical, 42 psychological, xvii supportive, 138 James, W., 49, 101, 112, 117–118, 127, 139 Johns Hopkins University Medical School, 26, 60 Jouvet, M., 41, 45–47 Joyce, J., 127 Judge Baker Guidance Center, 10 Jung, C. G., 30, 123–125 Just, G., xiv, xviii, 36, 53–54, 59, 61, 70–71, 73, 76, 79, 81, 95–135, 146–147, 150–156, 159, 165–181 Kahan, T., 64 Kant, I., 74, 123, 127

195

Keller, H., 66 Kennedy, J. F., 29 Kirkby, J., 60–61 Koppehele-Gossel, J., 111 Kushida, C., 116 LaBerge, S., 64 Leonard, J., xii Llewellyn, S., 60 Lorenz, E. N., 66 Mack, J. E., 104 Mahowald, M., 59 Massachusetts Mental Health Center (MMHC), xiii, 5, 17, 27, 80, 113 McCarley, R. W., 47 mental illness, 12, 14, 19, 27, 42, 47, 57–58, 62, 75, 124, 126, 130, 138 Metzinger, T., 101–102, 146 Minnesota Multiple Personality Index (MMPI), 131 narcolepsy, 48, 58–59 National Institute of Mental Health (NIMH), 41 neurology, xiv, 43–44, 58, 99, 104, 133 psychodynamic, 44, 58, 65, 70, 91, 99, 123, 125–126, 133–134 neurons, 42, 48, 54–55, 67, 129, 134 see also: aminergic, cholinergic biogenic amine-containing, 45 brain stem, 5, 44 chemically distinctive, 44 control, 15 dopamine, 46 histamine, 45 noradrenergic, 55 norepinephrine containing, 46 serotonin containing, 46 object external, 74 solid, 167 subjective, 128

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196

INDEX

objective, 150 disturbances, 105 methodology, 178 resort, 98 subjects, 128 third-person phenomena, 106 viewpoints, 97 objectivity, 140, 177 Orne, M., 1 out-of-body, 107, 130, 165 escapism, 106 experiences, 99, 101–104, 119, 129, 133, 165, 167 subjects, 102 transformation, 100 Proust, M., 24, 127 psychosis, xiv, 5, 7, 9, 58, 74, 121, 130, 142, 145, 161 organic, 123 Rechtschaffen, A., 116 repression, 33, 163, 174 see also: anger dynamic, xviii, 1, 16, 42, 69 incomplete, 71 sexuality, 118 Revonsuo, A., 52 Rimbaud, A., 127 Rosenhan, D. L., 121 Russell, B., 127 Schenck, C., 59 schizophrenia, xvi, 2–3, 5, 7, 32, 58, 74, 80, 105, 121–124, 131, 178 chronic, 28 paranoid, 32 self, xv, 7, 35, 48, 76, 101–103, 119, 143, 147, 158, 175 see also: aminergic, hallucinations, hypnosis, theory -absorbed, 160 -analysis, 146, 157, 159 -appraisal, xiv -as-agent, 147 -assessment, 147

-awareness, 143–144 -centered, 154 -confirmation, 167 -congratulatory, 9, 157 -conscious(ness), 157 -construction, 102 -control, 22, 99, 113 -creation, 145–147 -declared, 17 -defense, xx -destructive, 134, 157 -discovery, 28, 61 discrete, 34 -divisive, 141 -doubt, 91 dream(ing), 35 -esteem, 8, 12, 18, 27, 30, 32, 38, 153 -evident, 59 -examination, 158 executive-, 96, 170 -generated, 172–173, 175 -help, 97, 99, 112 -image, 21, 144, 149 -improvement, 138 -induced, 84, 85 -inflicted, 31 -knowledge, 27 -manipulations, 116 -multiplicity, xv -observations, xviii, 109, 128, 158, 179 -other, 144 projection of, 171 -protection, xvi, 168–169 proto-, 143, 163 psychology of the, 148 real, 176 -realization, 141, 147 -reconstruction, 147 -recreation, 146 -reflective, 61, 147, 158 -reinvention, 159 -reliant, xv–xvi, xviii, 2, 4, 7–8, 12, 14, 18, 27, 38–39, 48, 81, 89, 96–97, 134, 153–155, 158

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INDEX

-respect, 137, 149 -responsibility, 123 -righteous, 11 -sacrifice, 148 -satisfied, 127 sense of, xix, 109, 130 -serving, 71, 160 -starved, 14, 93 -stimulation, 60, 84 -transcendence, 157 -treatment, xviii, 61, 96–97 -understanding, 141 -unity, xv virtual, 176 waking, 35 sex, 31, 35–36, 118, 156 appeal, 14 brain-mediated, 20 desire for, 91 education talk, 72 extramarital, 35 habits, 25 life, 91, 118 normal, 118 premarital, 20 scandals, 105 sexual, 36, 91, 160 see also: behavior(al), trauma(tic) activity, 90–91 boundaries, 118 delight, 79 desire, 160 deviant, 174 domain, 90 emotions, 36 encounters, 14 exploits, 31 expression, 118 fidelity, 117 hetero-, 25 homo-, 72 obsessions, 73 violation, 118 impulses, 36 intimacy, 73 molestation, 169, 174

197

peccadillos, 105 pirouettes, 17 play, 118 pleasure, 129 slavery, 152 tryst, 110 urges, 118 sexuality, 109, 117, 124 see also: homosexuality, repression Sherrington, C., 44–45 Snow, C. P., 127 Spiegel, D., 3 stress, 52–53, 115, 166 environmental, 109 -ful, 52 conditions, 52 induction, 53 muddy notion of, 52 response, 52 subjective, 149, 177 aspect, 75 awareness, 67 concomitants, 52, 58 data, 62, 149 details, 98 experience, 49, 51, 60, 62, 68, 78, 82, 93, 97, 104, 127, 131, 149–150 object, 128 –objective, 177 phenomena, 133 point of view, 149 sense, 130 viewpoint, 97 subjectivity, 101, 104, 120, 128, 131, 149–150, 157 first-person, 93 symbol(-ic), 12, 92 see also: dream(ing) approach, 125 character, 12 decoding, 92 disguise, 112 interpretations, 13, 26 relationship, 91

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198

INDEX

theory, xiv, xvii, xx, 2–5, 34, 36, 39, 43, 47–48, 66, 74, 80, 82–83, 85, 134, 139, 142–143, 150, 152, 163 see also: conscious(ness), dream(ing) activation-synthesis, 66 cannibalism, 27 chaos, 66 cognitive science, 97 double-bind, xvi, 2, 73 free energy, 115 of behavioral change, 146 of elaborate encoding, 60 of human imagination, 62 of pathogenesis, 146 of psychopathology, 117 of sexuality, 117 of the ego, xix, 98 of trauma, 117 psychoanalytic, 37, 99, 138 psychodynamic, 6, 139 psychological, 19 reciprocal action, 41 self, 103 Tranquillo, N., 128, 157 transference, 9, 12–13, 22, 24, 35, 90–91, 96, 138, 140, 176–177 counter-, 12–13 trauma(tic), xix, 42, 98, 104–106, 109, 113, 152–154, 169, 174, 178, 181 see also: abuse, disorder(ed), theory beating, 21

childhood, 35, 96, 98, 105, 147, 152–153 early life, 100 family history, 25 intellectual, 2 sexual, 169 Tuin, I., 134 unconscious(ness), 28, 36, 50, 69, 71, 91, 125, 151, 160 see also: conscious(ness), Freudian(s) collective, 123–124 communication, 132 demons, 1 desire, 91 dynamically repressed, xviii, 1, 16, 42 forces, 27 group, 28 impulses, 1, 90 infantile wishes, 66 wish(es), 67 paradigm, 33 University of Lyon School of Medicine, 45 Valli, K., 52 Voss, U., 61, 64, 111, 134 Wohl, H., xii Wolpe, J., 13