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Posttraumatic Nightmares, a new volume by Melvin Lansky, is a compendium of previously published clinical papers on the vicissitudes of trauma and its psychological sequelae. The emphasis is on recurrent nightmares, the “hallmark” symptom of posttraumatic stress disorder (Ross, Ball, Sullivan, & Carnoff, 1989).
Lansky's primary contention is that repetitive chronic posttraumatic nightmares, rather than being literal replays of the traumatic incident, actually have dynamic and “unconscious latent” sources that reflect, in addition to the trauma, important clinical data regarding the dreamer's pretraumatic experiences. Lansky suggests that these terrifying dreams actually screen and defend the dreamer against earlier, more hurtful traumata, usually involving sexual or physical abuse or both. Thus, far from being merely repetition compulsions or unintegrated sensory memory experiences, posttraumatic nightmares serve a vital function by transforming unacknowledged shame stemming from these deeply rooted narcissistic injuries into “more acceptable” fear and terror. In so doing, nightmares provide a modicum of much-needed coherence to a badly fragmented and unintegrated self-structure. This is an original and potentially useful contribution, both to psychoanalytic dream theory and, more importantly, to the clinical treatment literature of trauma. This viewpoint, however, when taken within the broader scope of the sleep and dream literature, presents a number of conceptual difficulties, which are discussed later in this review.
On a positive note, Lansky's insistence that even seemingly repetitive nightmares serve an essential psychological function is consistent with the tenets of scientific dream and REM sleep literature emphasizing the adaptive function of dreams (Breger, 1967; Fiss, 1986; Fosshage, 1983; Levin, 1990; Moffitt, Kramer, & Hoffman, 1993). Lansky is quite correct in his contention that, beginning with Freud (1920), most clinicians and dream researchers hav