In the article "Debunking a Dream Theory" in the October 6 issue, it is unclear what was debunked: that REM sleep is not equivalent to dream sleep or that Freud was once again wrong in seeing a parallel between dreams and psychosis. Debunking Freud on the flimsiest evidence appears to be the favorite pastime of modern psychiatry.

As for debunking Freud because he considered dream as temporary psychosis, there appears to be a problem of semantics here. Our DSM checklist–driven mind may see psychosis only as a diagnostic entity, but psychosis also simply means the inability to distinguish real from unreal. And that is what happens in dreams—most bizarre and incredible visual images are perceived as real. Nowhere, as far as I can recall, did Freud state that psychotic illnesses are an intrusion of dream state into walking life. He viewed hallucinations and dreams both as driven by wish fulfillment, but that is as far as he went.

This defense of Freud is important because premature and inadequately researched debunking of psychoanalysis has done tremendous harm to psychiatric education. About a quarter century ago Freud’s theory of wish fulfillment was debunked by the activation-synthesis hypothesis of dreaming. This alleged debunking took on a celebrity status, and psychiatrists en masse abandoned interpreting dreams—no doubt to escape learning the arduous psychoanalytic method. The activation-synthesis hypothesis argues that dreams occur in REM sleep, and since REM sleep is generated by the pons, which is subcortical, dreams are not wish fulfillment. No one tried to discredit this hypothesis when it became increasingly clear that dreams occur in non-REM sleep as well (which is not generated by the pons). This loving protection of activation synthesis no doubt occurred because by equating dreams with REM sleep, which is measurable by surface electrodes and therefore capable of providing statistics and easy publications, one was protecting a multibillion-dollar publish-or-perish industry.

What needs debunking is the almost mystical reverence with which professionals and lay people alike view REM as a unique state that is neither wakefulness nor sleep and that has an exclusive domain over dreaming. Dream when analyzed and stripped of its mysticism is nothing but ordinary wishful thinking in which we engage all the time when our attention is not totally occupied by the external world. When we are awake, we daydream, and we continue to dream through all the different stages of sleep. When dreams become intense, as sleep deepens, part of our mind awakens to contain the intense nature of our wishes. It is this partial awakening that is captured as REM by the EEG, for REM-sleep and awake EEGs are almost identical. And the awake part of our mind (psychotically) believes that our wishes are coming true so that rest of the mind/brain can continue to sleep. The celebrated activation-synthesis hypothesis of dreaming that pons generates REM sleep needs modification. What pons generates during REM stage is a state of partial awakening, not dreaming.

Surendra Kelwala, M.D.

Livonia, Mich.