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Dowling describes several phenomena of sleep as they arise from three different mental states and two forms of mental organization. In dream or REM sleep, the child is attuned to "inner mental events" and is intensely physiologically responsive to these events. Night terrors, enuresis, and somnambulism do not usually take place in REM periods, but rather in disordered arousal from stage 3 or stage 4 sleep. This has led to the conclusion that these are not psychological events so much as physiological ones. Dowling questions this assumption. He discusses symbolism and meaning in dreams in terms of "universal" symbols, the patient's "field of meaning," and the individual dream and its associative meaning. Isakower phenomena (hypnagogic) are described. These are amorphous; they are predominantly vestibular and tactile sensations that accompany indistinct visual and auditory sensations, with blurred distinctions between mouth, skin, and hand. There are two levels of organization in these phenomena: the primary process, with mobile visual imagery, and earlier forms of organization, with diffuse, static, or absent imagery. Symptom formation, artistic imagination, scientific intuition, dreams, and play all derive from the former, acting-out behavior and other sensorimotor expression from the latter. Piaget's understanding of the child's development of mental operations puts these phenomena in perspective. For example, Dowling likens the mental process between eighteen and thirty-six months to the symbolic primary process, and that of the pre-eighteen-month-old sensorimotor child to the pre-representational and pre-symbolic Isakower phenomena and night terrors.