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Michigan Psychoanalytic Institute & Society

Opening the Dreambook

By James Kern, M.D.

Astronomers tell us that the objects in the universe are steadily on the move outward and away from the place where it all began at the moment of the big bang. A speck of concentrated matter could no longer contain its energy and so it flew apart, spraying the void with speeding fragments. I happened onto such a speck one day--a powerhouse of a book--whose close-knit psychological insights blew me away and into new trajectories that have enlivened me from my 20s to my 70s. My life and my understanding of humankind changed forever on that day at what was warp speed--at least for me. So here's a story of a book that changed my life.

In my early years in a small town in Napa, California I decided I wanted to be a doctor and make house calls. Our family doctor, Dr. Murray, brought us confidence and compassion mixed with applied science and miraculously got us better. I wanted to be like him.

In 1959 I was 25, a newly minted doctor now interning at Detroit Receiving Hospital, looking forward to a career in internal medicine. But something was wrong. In the medical clinics where I worked I was finding that patients were more interesting than their diabetes or hypertension. The individuals' lives and their personal struggles fascinated me. Their diseases bored me. Also, many were ailing for no detectable physical reason, and I felt helpless to offer anything useful. I realized that my image of a life in medicine had me working with patients rather than on their diseases, but that vision was at best auxiliary to the internist's main task of combating their diseases. I was in a quandary.

While on a break one day, midway through my intern year, I was sitting in the tiny medical library at the hospital and pulled a book off the shelves at random. It was one of a set of volumes called, The Psychoanalytic Study of the Child. I chose a chapter by Phyllis Greenacre, M.D. entitled, "The Family Romance of the Artist" because it promised to be the most escapist of the chapters (family! romance! artist!). I expected to steal a few minutes in light desultory amusement before getting back to serious business on the wards. But what I read woke me up.

Here was a physician who was writing about the inner struggles of writers and how early psychological strains had shaped their creative output while damaging their lives. And she said something else. That every patient is the ultimate author of his or her unique life and that much of that authorship was determined outside awareness--it was mostly unconscious. Dr. Greenacre was regarding authors as patients and patients as authors!

You must realize how naive and unsophisticated I was then for these well-trod 20th century ideas to have been so revolutionary for me. My medical training had taught me to regard Freud and his ideas with skepticism at best and, at worst, as dangerously cultish. I knew how to be properly contemptuous of all Freudian concepts as though they were Transylvanian evils to be warded off--certainly not applicable to real human beings--all of this even though I had never read any Freud. However, Dr. Greenacre seemed to think that psychoanalysis shed some light on the mission of physicians. I felt I needed to get to the source.

The only book of Freud's I had heard of was The Interpretation of Dreams, so the next day I found it on the shelves. The title seemed deliciously arcane. I opened to somewhere in the middle, as is my wont, and began a part called, "the analysis of a specimen dream." It was 25 pages long and I was hooked then and there and still am now some 47 years later. The writing itself was both incisive and graceful. (30 years later Freud was to win the Goethe Prize for literature.) And the voice of the author as he explained his inner adventures and discoveries was down to earth, personally engaging, humorous and wonderfully evocative. His conclusions were both dazzling and disorienting; absolutely counterintuitive but sensible at the same time, given the new tools for understanding he had shaped. He encouraged independent consideration of his findings by his book companion--the reader--in a respectful way. This was not the voice of the dogmatic and dying octogenarian whose sad face graces T-shirts all over the world. That embattled, cancer-ridden Freud was to come later. At this moment he was in the prime of life--40ish-and at the height of his intellectual powers. The previous 15 years of his professional life had led to a series of redirections before he came upon this stunning thesis which would set the course for his future. A man after my own heart since I had been feeling direction-challenged at that moment.

So what did I read in this old book? He talked about this "specimen dream," his own dream in fact. It dealt with a strained doctor/patient relationship. The patient in the dream would not cooperate with Freud's examination of her throat--she balked. Several of his learned colleagues weighed in on her condition, all stupidly in one way or the other. Freud studied this dream of his with the scientific focus of a microscopist. He suggested that the reader give each dream the same respect and open-minded wonder that a biologist might give a new organism. Instead of looking to the dream story for an allegorical meaning--the mistake that mankind had made for millennia--he enlisted his patients as contributors to the inquiry, urging them to verbalize whatever ideas came to mind in connection to each fragment of the particular dream. Being the patient of the moment, he followed his own advice. (I might note that his including the patient in the joint exploration was an unusually democratic plan of action to take in that highly authoritarian era.) What did he discover? To his chagrin he found that his own dream was not a satisfying affirmation of his capacities, as it seemed to be, but, rather, camouflage. It was dreamt to spare him the recognition of painful feelings of shame and inadequacy for a mediocre outcome in the treatment of this dream patient, named Irma, in her real life.

The dream insists that the patient's non-cooperation and the other physician's half-baked opinions were the culprits in the Irma case. But Freud's sober analysis of the dream suggests otherwise. He concludes, at the end of this introspective voyage, that this dream was a front for disguised--that is unconscious--wishes, fears, and feelings which the dreamer didn't want to know about.

My reactions? I dimly realized the importance of what he had discovered. At first I read it as the heroic story of a young doctor who single-handedly unlocks the ancient mystery of dreams. It was a decoding triumph, a psychological Rosetta stone finally demystified. Also, I could vaguely sense how it might relate to people in general. Each individual's unconscious struggles might be revealed by this new decoding process. Further, the reader is shown that distressing past experiences lay behind the dream. This idea gives Faulkner's famous comment a psychoanalytic home: "the past is never dead--it's not even past."

Gradually, I began to see clinical implications. This compact psychological story of cause and effect threw light on a world of hidden experience which powered not just dreams but much human disability which was outside of the reach of medicine as practiced then. There was hope for recovery of function in conditions previously known to be untreatable. I thought of my unfortunate patients in the medical clinic who'd been told that there was nothing wrong with them. Later I was to become intimately familiar with a technique which offered curative possibilities--for me and for others--when understood and applied properly. The field of psychoanalytic therapies had indeed radiated out from this moment in time--a dream analyzed in 1895.

I began to recognize a possible career in medicine which could bring back the doctor/patient relationship to front and center. In a few months my plans to become an internist had been set aside. Now I wanted to be a psychiatrist, a psychoanalytic one. Freud, the Younger, through the explosive book he wrote with such personal courage, scientific rigor and, especially, literary magic, had joined Dr. Murray as another ideal for my life.