Dreams in Schizophrenic Patients

An artist suffering from Schizophrenia created this painting. It helps one to understand what is going on inside the mind of a schizophrenic

Imagine being stuck in a large, dark theatre, watching a scene from a movie that you find completely terrifying. The scene plays from start to finish. Just when you heave a sigh of relief, the scene starts to replay. This goes on and on for over eight hours, with no way for you to stop it. After a certain point, you aren’t just watching anymore, but are taking part in your nightmare.

This is how patients with Schizophrenia dream. According to the American Psychiatric Association, “schizophrenia is a chronic brain disorder, [that] when active, symptoms can include delusions, hallucinations, trouble with thinking and concentration, and lack of motivation” (APA). These symptoms are not only seen in the daily life of a schizophrenic, but also in their dreams. The worst part of this illness is that a schizophrenic cannot differentiate between dreams and reality.

Which is our true reality: our waking moments or our dreams? With a brain disorder such as schizophrenia, the answer is unclear. Patients genuinely cannot distinguish their dreams from reality. The way they think during the day is similar to how mentally “healthy” individuals dream at night. Many of their thoughts are disoriented, confused and unstructured because, in dreams, there is no need for chronological order. Schizophrenia is a brain disorder that is very hard to diagnose in the early stages, as the symptoms are more internal than external; the mind is affected more than the body. As the illness becomes more chronic, the symptoms are seen in the patient's behavior. Since there is no known cause for this illness, people often refuse to believe that it exists. I read an article which stated “Most people who live with mental illness have, at some point, been blamed for their condition. They’ve been called names. Their symptoms have been referred to as “a phase” or something they can control ‘if they only tried’” (National Alliance on Mental Illness, NAMI). However, schizophrenia is not something that can be controlled. The patient has to be taken to a psychiatric ward to get the help they need. If untreated, the illness could be harmful to the patient and others around them.

In a study about the dreams of Schizophrenics, researchers study the contents of their dreams using questionnaires: “Dream reports from patients with schizophrenia have also been described as being more negative, destructive and containing more themes of death and painful sexuality, fewer themes of friendly actions initiated by other dream characters, and a higher frequency of morbid and brutal mutilation imagery (Schizophrenia Research, Elsevier). In other words, most of their dreams are nightmares with very negative content. After thinking about the content of the dreams of Schizophrenic patients, the next question I thought of was: Are the patients victims, or are they the ones inflicting the pain on others?

If the patients are the ones committing the murder, or the painful activities that are supposedly the content of their dreams, then it would explain why most patients are aggressive, since the aggression they see in their dreams come out when they are awake as well. However, according to research, “patients with schizophrenia experience dreams in which they are victims of aggression” (Schizophrenia Research, Elsevier), meaning that the schizophrenic patients dreamt that they were the ones being harmed, rather than the ones harming others.

When asleep, patients could have been dreaming that someone was after them. Which is why when they wake up these hostile images are playing in their subconscious, and they reacted aggressively. The patient's aggression could have been more out of fear than an actual desire to cause harm. This “is consistent with the delusional experience of persecution” (Anxiety and Hostility in the Manifest Dreams of Schizophrenic). “Delusions of Persecution” are notions or gut feelings that schizophrenic patients get about someone hunting them down to kill them. They are labeled as ‘delusions’ because these notions are just that: Delusions. Nothing based on facts. The patient generally has no proof regarding them. For example, there was an incident where a woman was giving food to a schizophrenic patient, who proceeded to run out screaming “She’s going to kill me! She’s going to kill me!” (Anonymous patient). A lot of people in the building heard her screams and ran up to see what was wrong. When they came to her apartment, all they saw was a terrified look on the woman's face and a plate of food in her hand.

There was no reason or trigger for a fit like that, but the patient still had a paranoid reaction, because she assumed the woman was trying to kill her. During the delusions of persecution, the patient does not necessarily know who is out to get them: they just assume that there is someone coming for them. This could happen when they see a stranger on the road, or, when they see someone they live with. I think the fact that the patient did not know who was chasing her made her more suspicious of those around her. The idea of dreams making their way into what we consider to be reality is true not just for schizophrenic patients, but also for people who are considered to be mentally healthy.

It is common for people to have dreams regarding a movie they had watched recently, a play they have seen, a book they have just read, or dream of the people they have just met. To understand this better, I interviewed my roommate about her dreams. She told me that she has a lot of dreams about music videos, popular stars, and people she had crushes on. The dream about the films would make sense, as she wants to major in Integrated Digital Media and produce videos. One dream of hers that stood out to me was related to what she had been watching on Youtube. It was in the afternoon, she was lounging on her bed, mindlessly browsing through Youtube when a very interesting video came up on the playlist. It was the music video for the song “Moo” by Doja Cat. Shortly after this, she fell asleep and had the weirdest dream.

“I was walking on a lane that was surrounded by farms on both sides. Those fields were bare. There were plants blowing in the wind when out of nowhere, I hear “MOO, MOO,” so I kept walking, and came upon a farm, in which I saw a black and white figure that looked like a cow. The only reason I say it looked like a cow is because the creature was not standing on four legs, like a normal cow. Instead, it was standing on two. I thought I was dreaming so I kept walking closer toward it. When I realized it was not only saying MOO but other words in English as well, I kept walking toward this quasi-bovine. As I got closer, I realized it was saying “B*tch I’m a cow, b*tch I’m a cow, I’m not a cat, I don’t say Meow”. As I continued walking toward the “animal”, it turned out to be a human dressed as a cow, who was dancing to the lyrics mentioned above. Once I realized the truth, the scenery changed, even though the song continued.

I was no longer walking with the fields on the sides. Instead, the fields became pixelated, and a just-as-pixelated burger showed up. Then, the scenery changed again. It became the Microsoft screensaver we all love, with the blue sky and green hills. Before my eyes, the scenery changed again. This time, it changed so that everything was a black and white cow pattern. No hills, nothing. Everything turned into a cow pattern. The setting changed [AGAIN] into anime breasticles in a skimpy bikini top, bouncing up and down. The Cow-human started twerking. And I realized that she was an actual person walking toward me, and she had fries up her nose. And then I woke up” (My roommate, Anonymous).

After watching the video, I realized that her dream was just a replay of the video itself. The reason I thought this dream was intriguing is that it is exactly the opposite of the dreams of schizophrenic patients. My roommate's (Person A) dream may seem out of the ordinary, but most healthy people dream about surreal and bizarre things. Person A's dream of the ‘cow-woman’, ‘pixelated fields’ and ‘nudity’ is probably higher up on the bizarre scale as compared to the dreams of most people, but in comparison to the dreams of schizophrenic patients, her dream is completely different.

“In terms of their bizarreness, patients' dream reports do not have greater incoherence or implausibility but rather lower levels of bizarre elements than dream reports from controls” (Schizophrenia Research, Elsevier). ‘The controls” are the “mentally healthy” group of people who were studied in this research experiment. Interestingly, researchers found that the dreams of Schizophrenia patients tend to be far less bizarre than those of normal human beings. This correlates with the fact that the reality of a schizophrenic is portrayed in his or her sleep. One would assume that, because their reality is so distorted, their dreams would be the same way. In my opinion, I think that their dreams are less bizarre because their brains do not have the capacity to be creative since most schizophrenic patients use fewer mental processes compared to normal individuals. If they are constantly worried about someone attacking them, then I highly doubt that their brain has time to imagine a singer dressed as a cow.

When talking about her dreams, my roommate also mentioned the dream that she had of punching someone in the face. “I was best friends with all the members of my favorite band ‘Pretty Much’. They were having a party and had invited a friend of theirs whom I did not like. I got so annoyed with him after a point that I walked up to him and said, “I don’t like you” and I punched him right in the face” (Person A). In another dream, Person A shared a kiss with her favorite band member from ‘Pretty Much’, whom she had had a crush on since she first discovered the group. These are the kind of dreams that most people can relate to. We always see people we have interacted with in our dreams. Sometimes we see people we don’t remember seeing, but there are usually familiar people in our dreams.

Schizophrenic patients’ “feelings [are] underrepresented in the dreams of patients with schizophrenia, which is in accordance with the affective flattening in the course of the illness” (Anxiety & Hostility in the Manifest Dreams of Schizophrenic). “Affective Flattening” is the decline of emotions within schizophrenic patients, during which the tendency for a patient to not “feel” increases as the disorder becomes more chronic. This occurs because there is a loss of grey matter in the brains of schizophrenics. “Neuroscientists from the National Institutes of Mental Health (NIMH) and other schizophrenia researchers report seeing up to 25 percent loss of gray matter (grey tissue containing nerves, dendrites and bare axons that are found in the brain and spinal cord) in certain areas of the schizophrenic brain. Gray matter refers to certain areas of the brain involved in hearing, speech, memory, emotions, and sensory perception” (Schizophrenia Brain: Impact of Schizophrenia on the Brain). Since the patient can no longer process emotions, their dreams are devoid of emotion. Person A talks about anger and sexual incidents in a couple of her dreams, which are normal for most people. There are dreams that also make her really happy or really sad. But for a schizophrenic, all dreams are the same. The only emotion a schizophrenic probably feels in his or her dreams is the fear of being attacked. (“Grey Matter.” Dictionary.com)

Even though patients with the disorder tend to be aggressive toward themselves or others in their daily lives, they are not aggressive in dreams. The patients are not victims in their own dreams, but “[are] quarreling or fighting significantly less in their dreams, compared with the controls (9.3% versus 19.4%), and [are] also less often insulting other dream persons verbally or physically” (Anxiety and Hostility in the Manifest Dreams of Schizophrenic). In Person A's dream, she punched someone and straight up said: “I do not like you”. As someone who knows Person A's personality, I can speculate and say that she would probably not do the same in her daily life. While schizophrenic patients, on the other hand, may not be abusive or aggressive in their dreams, but behave that way in their daily lives.

The best example of this would be the behavior of my grandmother. She may have been a victim of aggression in her dreams, but when she was awake, she was the aggressor. Since schizophrenic patients use different mental processes than normal humans, the question also depends on whether or not they remember their dreams. Even healthy individuals, who use a larger number of mental processes than patients affected by the illness, do not usually remember their dreams.

I asked my friend, Person B, if he remembered his dreams, and was not surprised when he said he could not remember most of them. “I don’t remember most of my dreams. I remember one dream which revolved around a bathroom. I went to an elementary school called PS 50. I remember I walked from class to the blue bathroom in school. I went up to the urinal and started to urinate. Then I picked up my pants and went to the sink. I washed my face and saw myself in the mirror, dried my hands, and started heading out of the bathroom. ‘Twas was all. I don’t remember anymore” (Person B).

What is common in both Person A and Person B’s dreams is that they see people in their dreams. Person A saw famous singers, and Person B saw himself. A lot of people have dreams in which they meet their friends, family, famous people, or even random strangers. In the dreams of schizophrenia patients, this phenomenon is very uncommon. “Dream reports from patients with schizophrenia have also been described as [having] fewer themes of friendly actions initiated by other dream characters. Patients' dream reports are also characterized by a paucity of peer interactions, a greater proportion of characters being strangers” (Schizophrenia Research, Elsevier). Schizophrenic patients barely see people in their dreams. And if they do see them, then the people they see are out to harm them. In neither of the previously mentioned dreams are the people being extremely warm and welcome. Even then the interaction with people is sort of pleasant in the dreams. Person B’s dream is more neutral than pleasant, but at the very least he doesn’t have anyone attacking him. In my opinion, this makes their dreams seem even scarier. In a nightmare, I would rather be chased by someone I know, or have seen somewhere, rather than being chased by a complete stranger.

Even though the dreams of schizophrenic patients seem so different than the dreams of normal people, they do have some similarities. While they differ in content, the recalling of both dreams is similar. According to “questionnaire data when compared to controls, patients with schizophrenia report experiencing a greater number of nightmares but no significant differences were found on other measures including overall dream recall” (Schizophrenia Research, Elsevier). As compared to Person A’s dream Person B’s dream is much shorter and less complex. This could probably stem from the fact that he does not remember most of it. But his poor dream recall is not unique just to him. Most people don’t remember their dreams, schizophrenic or not. In my opinion, this may occur because the part of the brain that works in dreams may not be affected by the disorder.

In a study, researchers studied the brains of patients while they recalled their dreams using MRI scans. “Though [there was no] difference in gray matter between participants, they did find that high recallers had increased white matter density in the medial prefrontal cortex compared to low recallers” (Brain Anatomy Relates to Frequency of Recalling Dreams). In schizophrenia patients, the volume of white matter (pale tissue consisting of nerve fibers, found in the brain and spinal cord) in the brain has found to be lesser than those of normal individuals. However, in schizophrenics, there is “white matter volume and temporal lobe volume reduction i.e.[in the] superior temporal gyrus, amygdala-hippocampal complex, and parahippocampal gyrus” (Kubicki, Marek, et al. “Evidence for White Matter Abnormalities in Schizophrenia). The areas of the deficit of white matter in the brain of schizophrenics are different from the area of the deficit of white matter in the brain for those who can not recall their dreams. This is why the dream recall of a schizophrenic is the same as that of normal people who find it hard to recall their dreams. (“White Matter.” Dictionary.com)

In my mind, the idea of having a similar dream recall brings out the fact that mental illness or not, we are all the same people on the inside. Even though mental illnesses can change a person and make them scary, at their core they are similar to us. In the case of my grandmother, she became a violent and paranoid person because of her disorder. However, years later when I met her, after she had gotten the right treatment she needed, she reverted back to who she was before the disorder. She was sweet, gentle and loved playing with my brother and me. This really made me realize the importance of medication for people with schizophrenia and other disorders. If my mother had listened to my grandmother’s siblings, my grandmother would have probably never felt like herself again. I feel that more people need to take a stand and that trying to ignore a disorder such as schizophrenia can only make things worse for the patient and those close to them.

Bibliography

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