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Neuropsychoanalysis: An Interdisciplinary Journal
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The Neuropsychology of Dreams: A Clinico-
Anatomical StudyRamon Greenberg M.D.
a
a11 Waverly Street, Brookline, MA 02146, e-mail:
Published online: 09 Jan 2014.
To cite this article:Ramon Greenberg M.D. (1999) The Neuropsychology of Dreams: A Clinico-Anatomical Study,Neuropsychoanalysis: An Interdisciplinary Journal for Psychoanalysis and the Neurosciences, 1:1, 128-130, DOI:
10.1080/15294145.1999.10773253
To link to this article: http://dx.doi.org/10.1080/15294145.1999.10773253
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that Schacter is unaware of this, it gets scanted in
the main part of
Searching
r
Memory
and is not
adequately brought to bear in TheMemory Wars.
The case for therapeutically recovered memories
pales compared to the case against them. His cautions
notwithstanding, Schacter's arguments of doubt are
more than convincing to me, and can be made even
stronger by including the role of social forces in influ
encing memory. His efforts to identify shades of
gray (p. 277) seemmore rhetorical than real, and the
middle ground (p. 277) he hopes to mark out, more
virtual than real.
Searching
r
Memory
is a magnificent book. Schacter
draws from a richly textured and vast pallet of often
conflicting information to paint a wonderfully detailed
panorama
of
memory, the mind, and the brain
as
seen
in the advances of the last several decades. His love
for his subject, as well as his extraordinary erudition,
are unmistakable. Judged from the standard
of
how
many references I checked off to locate and read, it
is a treasure trove. I only wish he had stated his perva
sive doubts about the recovered memory issue less
ambiguously, and hope I have not overestimated his
skepticism in the process.
References
Andreason,
N
(1995), Posttraumatic stress disorder: Psy
chology, biology, and the Manichaean warfare between
false dichotomies.
Amer.
Psychiatry
152:963 965
Southwick, S., Morgan, A., Nicolaou, A., & Charney,
D
(1997), Consistency
of
memory for combat-related trau
matic events in veterans of Operation Desert Storm.
Amer. Psychiatry
154:173 177
Brooks Brenneis Ph.D.
2700 Marshall Court
Madison Wisconsin 53705
e mail: [email protected].
The Neuropsychology Dreams: A Clinico Ana-
tomical Study by arkSolms. Hillsdale,
NJ:
Law
rence Erlbaum, 1997, 292 pp., 55.95
This book is a goldmine, full of many deep veins al
though it also has a few shallow ones. The author
provides an extremely rich view and review of the
Book Reviews
role of the cerebral cortex in dreams. He does this in
three parts: (1) a comprehensive review
of
neurologic
literature from the nineteenth century to the present;
(2) his own study of 361
cases with cerebral lesions
and a group of symptomatic controls without CNS
pathology; and (3) a series of hypotheses he develops
which weave through the clinical material and help
keep a focus on the meaning of the findings. The major
impact
of
this book is how clearly the author demon
strates the crucial role played by a number
of
telence
phalic structures in the generation of dreams. This
convincingly contradicts the long accepted notion that
REM sleep and therefore dreaming is mainly the result
of
pontine activity. The pontine theory has contributed
to the belief that dreams are inherently meaningless.
For psychoanalysts such an idea should not make
sense. Indeed, this reviewer's sense, as an analyst, that
dreams could not be purely based on pontine activity
led to a study (Greenberg, 1966) showing the im
portant role of the visual association cortex in the pari
etal area in the generation of the eye movements in
REM sleep. At the same time animal studies also
showed the cortical contributions (Jeannerod, Mouret,
and Jouvet, 1965). Nonetheless, the belief in the cen
tral role of the pons persisted. Solms' book should put
an end to such thoughts as he shows, both in his review
of
the literature and from his own cases, the essential
role
of
the cerebral cortex in the generation
of
and
quality of dreams.
Solms begins his presentation by describing the
Charcot-Wilbrand syndrome based on case reports by
Charcot and Wilbrand. These turn out to be two differ
ent disorders although they have been lumped together
as one. In the Charcot form the patient loses visual
dreaming although dreams continue in other modal
ities. Such patients also suffer from visual irreminis
cence, a condition in which they lose all visual
imagery in waking life. The Wilbrand variant seems
to have complete cessation of dreaming. Interestingly,
the lesions in these two forms of disorder are in differ
ent locations and have differing waking symptoms.
Charcot's variant and subsequent cases like it seem to
have bilateral lesions in the medial occipital temporal
areas, while Wilbrand's variety is most clearly the re
sult of
bilateral lesions in the medial basal frontal ar
eas. As Solms provides his extremely comprehensive
review one learns that lesions in a number of other
cortical and subcortical areas can affect the subjective
experience of dreaming. He describes increases in in
tensity, decreases in intensity, and loss of some sen
sory modalities in dreams. He clearly demonstrates
how the effects on dreams are not the result of primary
7/25/2019 15 the Neuropsychology of Dreams: A Clinico-Anatomical Study
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Book Reviews
sensory region impairment but are the result of dam
age to areas where perceptions are integrated and pro
cessed. The import is that dreams develop from the
inner and private life
o the mind, drawing on stored
rather than currently impinging sensations. To put it
succinctly, what the mind cannot experience, cannot
be dreamed about. For those more interested in this
aspect o dreams see Greenberg (1966) and Greenberg
and Liederman (1966). Solms describes in great detail
the many different areas o the brain where damage
affects dreaming and where the defect in waking men
tal life is clearly reflected in the disordered dreaming.
This is a major observation which those interested in
dreams must keep in mind, and the author provides
ample evidence for this statement. In fact he provides
more than he realizes, for there is another side to this
connection between waking and dreaming mentation:
the emotional life
o
the patient. While the author ac
knowledges that some o the changes in dreams may
be funct ional, I feel he doesn't fully present the
possibility that nightmares, o increased or decreased
intensity, or even in some cases cessation o awareness
o dreams may stem from patients' reactions to the
effects
o
their cortical lesions on their lives. As he
described the sudden and traumatic occurrences, I
found it hard to ignore this factor in the changes in
patients' experience o their dreams. Adding this fac
tor does make somewhat fuzzy the purity o the effect
o the brain lesions. However, we must learn to deal
with this additional complexity.
Solms presents two other trains o thought which
should be o interest to psychoanalysts. One that really
impressed me followed his discussion o the move
ment in dreams from abstract thought to concrete im
ages. It brought to my mind Freud's (1900) discussion
in chapter 7 o the regression in the perceptual system
involved in the generation o dream images. Sure
enough, Solms quoted this very passage on the next
page. On the other hand, Solms would like to have us
believe, on the basis o his findings, that dreams really
are the guardians o sleep. It is with regard to this that
I find the main shallow vein in this book. The discus
sion o REM sleep research is limited to four pages
plus interpolated referrals to REM studies in parts o
the book. In many ways it is not fair to ask more o
the author o such an encyclopedic book. However, I
am afraid that while Solms clearly suggests further
important REM sleep studies that still need to be done,
he has failed to integrate many existing REM sleep
studies. These make a strong case for the need for
REM sleep and support the idea that sleep may be the
29
guardian o dreams. Furthermore, I think the absence
o the consideration
o
a large body o REM sleep
research has led to the author's too ready dismissal
o any higher level functions for the dream process
(Greenberg and Pearlman, 1993). Thus, in what is a
superb contribution to our appreciation
o
the role
o
a complex cortical system to dreaming, we find the
author falling into the camp
o
what Freud called the
,'physiologists who minimized the meaning and the
function o dreams.
To summarize, this is a superb book. Despite the
enormous amount o detail involved in describing
many different case reports, the book holds together
because o the way Solms connects the findings with
his hypotheses about the roles o different areas o the
brain. The major areas that he pinpoints
as
playing
crucial roles are the medial temporal occipital, the me
dial basal frontal, and the lower parietal convexity.
The book will be a major source for anyone interested
in knowing about the role o the cortex in dreams.
The book also points toward further research on the
connections between REM sleep and dreaming and
fits nicely with more recent work demonstrating brain
activity by using PET scans (Hong, Gillin, Dow, Wu,
and Buchsbaum, 1995). The findings show clearly the
elaborate networks in the brain that are involved in
dreaming. For me this book reinforces Freud's recog
nition that the study o dreams clearly reveals mind
and brain connections.
References
Freud,
S
(1900), The Interpretation o Dreams.
Standard
Edition
4 5. London: Hogarth Press, 1953.
Greenberg, R. (1966), Cerebral cortex lesions: The dream
process and sleep spindles.
Cortex 2:357 366.
Liederman, H (1966), Perceptions, the dream pro
cess and memory: An up-to-date version
o
Notes
o
a
Mystic Writing Pad.
Comprehen. Psychiatry 7:517 523.
Pearlman, C. (1993), An integrated approach to
dream theory: Contributions from sleep research and
clinical practice. In:
h Functions Dreaming
ed. A.
Moffit, M. Kramer,
R
Hoffman. Albany: New York
State University Press.
Hong, C. C., Gillin,
J
C., Dow,
B
M., Wu, J.,
Buchs
baum, M.
S
(1995), Localised and lateralized cerebral
glucose metabolism associated with eye movements dur
ing REM sleep and wakefulness: A positron emission
tomagraphy (PET) study.
Sleep 18:570 580.
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130
Jeannerod, M., Mouret , J., & Jouvet, M. (1965), Etude de
Ia mortricite oculaire au cours de Ia phase paradoxale du
sommeil chez Ie chat.
Electroenceph. Clin. Neurophys-
io1
18:554 566.
Ramon Greenberg M.D.
11 Waverly Street
Brookline MA 02146
e mail:
r m o n ~ r e e n e r g
hms.harvard.edu
The Symbolic Species: The Co Evolution Lan-
guage and the Brain
by Terence Deacon. New York:
Norton, 1997, hardcover 29.95, paperback
15.95
A few years ago the UCLA neuroanatomist and psy
chologistHarry Jerison asked, What is so great about
being smart? with the implication that in our species'
history, it is hard to conclude that our intelligence and
our capacity for complex symbol use has done us more
good than harm. What is ironic and prophetic, as Ter
ence Deacon shows us in his extraordinary text, is that
symbol use itself may be the only means available for
shifting the balance toward a kind
of
positive outcome
for ourselves, if not for the planet. The more we under
stand about the nature and origin
of
our symbolic ca
pacities, he claims, the better we can regulate our
enormous cognitive potential. He wrote his mystery
novel, as he calls it, with this goal of increasing our
understanding about how symbol reference and lan
guage came about, and ultimately,
of
who we are.
For about a year several UCLA linguists, psycho
analysts, and psychologists and I met weekly, reading,
discussing, and debating The Symbolic Species:
The Co Evolution Language and the Brain. We all
concluded that this is a profound work, remarkable
for its scholarship and extreme detail, and deserving
dedicated study. Here, I will sketch out a broad and
oversimplified overview
of
Deacon's complex evolu
tionary scenario, and then discuss a few of his essen
tial arguments.
Somewhere in our fuzzy past there were groups
of australophithescines who had already been bipedal
for some time and who could communicate with con
text-bound gestures and sounds. These foraging homi
nids lived in the savannas of eastern and southern
Africa. We can only marvel that they survived at all
in what must have been a continuously perilous envi
ronment. Except for their nascent evolutionary edge
of symbolic reference, we might very well not be here,
or might not know it. The time was about 2 million
years ago; it had taken several more million years to
get to that point from the great bifurcation that split
Book Reviews
man-to-be from the great apes. Then, something very
strange happened. A shift in cognition, specifically in
abstracting capacities and learning by logical and se
mantic categorization, began to dominate the experi
ence
of
these individuals and groups, which hitherto
had been limited by mental representations
of
stimu
lus-response associations to the mostly local context
of
rewards and punishments. Environmental events al
ways had signal value about how to react for all ani
mals, but if a new waterhole was associated with the
possibility
of
reduced thirst, the only condition that
guided the approach behavior of prehominids was the
appraisal of immediate safety. But with a doubling of
brain size in what was to be a shift from australo
pithescines to true hominids like Homo habilis (tool
man), a new condition and option became possible.
With improved cognitive hardware the hominid could
apply a system
of
divergent ideas and images based
on principled rules. Homo habilis felt the urge to ap
proach water, but instead of drinking, might con
sciously wait for an animal to drink first, then follow
the animal to see
if
the water was deadly or safe to
drink. A logical theory had been conceptualized and
tested. Many of his or her vertebrate ancestors could
learn the stimulus-response associations that, together
with instinctual responses, made survival possible. But
this hominid and his kind also could learn
the
system
of relationships of which these correlations were a
part. If this individual's logical experimentation al
lowed for survival and offspring later on, he or she
could then carry the gradually developing genetic pre
disposition for flexible rule-guided behavior into the
next generation. Remarkably, in the initial nonre
sponse, the stimulus to approach water was intention
ally used against itself. He or she delayed gratification
conditional upon reasoning, thinking, planning, vicari
ous trial-and-error, long-term memory all
of these
nonautomatic capacities. This was possible because of
a simple but effective gestural and guttural system
of
rule-based and communicated labels for objects and
actions developed within groups
of
individuals. The
neurobiological substrate for this advance in everyday
experience of early hominids was actually not new;
many primates can do a bit
of
this
if
given enough
training and exposure in a controlled setting. But for
more advanced hominids, it became a primary prob
lem-solving tool and the natural thing to do. In its
fullest developments it would provide humans with
an
unprecedented sort of autonomy or freedom from
the constraints of concrete reference.
The neurobiological cause and consequence for
this symbolizing capacity, according to Deacon, is the
property of an expanded prefrontal cortex (PFC) in