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and paper ( 82: 933-952) was discussed between 29 October 2001 and 14 January 2002. Full details of the discussion can be downloaded under the heading ‘Archives’ at the IJPA homepage (ijpa.org). A previous paper by one of the authors, ‘The unconscious and psychosis: some considerations on the psychoanalytic theory of psychosis’ ( 81: 1-20), was discussed in the spring of 2000 and the internet discussion was reviewed by ( 81: 625-35).
The authors consider that the Freudian theory of dreams is not directly applicable to psychotic and borderline patients with their constantly varying states of mental integration. These patients' dreams lack associations and have nothing to do with the metaphorical language of the dreamwork. Such dreams express the concreteness of the hallucinatory construction, but may also be a source of valuable information, which cannot be obtained from other material, on the manner of construction of the delusional system.1 The main thesis of this paper is that exploration of the dreams of psychotic patients may prove useful for understanding their psychosis and contribute to the analytic work of modifying the delusional state. The paper includes some clinical examples and a discussion of a longer case report.
According to clinical experience the relationship between the healthy and psychotic parts of the personality resembles a precarious compromise, which can easily break down.2 Persons with psychosis often describe themselves as imprisoned in an all-present system of delusions that can be activated at any time. To preserve their psychic equilibrium, patients often exert themselves not to experience or to keep their emotions ‘flat’.3 Such patients can see themselves as prisoners who can feel relatively safe provided that they