lunes, 28 de mayo de 2018

Highlights of the History of Dream Theory

Elaborations of a Draft that served for a Grand Rounds Presentations, Regions Hospital, Saint Paul, May 19 2009.  Last updated May 2018.

Juan Carlos Belalcazar, MD MSc                                                                    

“We are stuff
as dreams are made on;
And our little life
Is rounded with a sleep”

William Shakespeare, The Tempest.

“All that we see or seem
Is but a dream within a dream.”

EA Poe.

“I search everywhere for some
new inspiration
But it’s more than cold reality
can give
If I need a cause for celebration
Or a comfort I can use to ease
my mind
I rely on my imagination
And I dream of an imaginary time”

Billy Joel, Everybody has a dream.

I have a dream
I will cross the stream

“Barbaro eres y atrevido;
cumplió su palabra el cielo;
y así, para él mismo apelo,
soberbio y desvanecido.
y aunque sepas ya quien eres,
y desengañado estés,
y aunque en un lugar te ves
donde a todos te prefieres,
mira bien lo que te advierto:
que seas humilde y blando
porque quizás estás soñando,
aunque ves que estás despierto.”
Basilio a Segismundo,
Jornada II,
Pedro Calderón de la Barca, La Vida Es Sueño, 1636

“Psychoanalysts have been particularly blind regarding religious subjects”


This highlights of the history of dream theory endeavors to explore important contributions to this subject matter that are relevant to the practice of psychotherapy today (mainly exploratory / expressive treatments). It is a selective exposition of contributions that seeks to explain how the mind works.  It begins with the towering figure of Sigmund Freud, whose theories are still debated today.  From his work I chose the ideas that I consider are still useful and interesting and leave aside those that are not. At some points I give contemporary comments to his ideas.  I also chose two of his followers, Jung and Fromm, whose contributions are also worth mentioning in this regard.  Relevant comments based on the Ulm textbook of psychoanalysis and Aaron T. Beck are also made.
An exposition of the history of the neurobiological correlates of dreams follows.  It throws a light on the psychological theories mentioned above, favoring or not this or that aspect of the psychological theories. The philosophical approach is that of a dual aspect monism that underscores the importance of explanation set forth by neurobiological data that can inform the understanding of the mind. But the reader has to acknowledge that some psychological data are still not illuminated by neurobiologic reductionistic endeavors and that mind-body isomorphism can be problematic, especially if this is done only from the bottom up: in the directions that starts in the workings of the body and ends in the mind.  To illustrate this point this review ends with information derived from psychotherapeutic research on dreams that tends to favor one neurobiological concept over another.  We are now supporting a special kind of dual aspect monism derived by recognizing that social interaction and communication is a reality produced by evolutionary biology and cultural processes that recognizes that emotions, sensations and words (and other symbols) are the building blocks of thought, and that the mind at this level has certain autonomy that require a functioning neurobiologic substrate, but that to a certain extent, goes above and beyond this substrate as an emergent entity that can influence lower levels of the organism. 

The neurobiological approach on dreams underscores the contributions of Michel Jouvet and his followers that complement rather than oppose more recent theories (Mark Solms).  My presentation shows that Solms and Hobson (a Jouvet follower) share in some respects common ground regarding the importance of emotions in dreams, the lack of complete fit between dreams and REM sleep and regarding the idea that the activation of the forebrain by the brain stem is a condition si ne qua non for the appearance of dreams.  They differ on the importance ascribed to emotions as the generators of the dream plot: for Hobson emotions are salient but secondary, for Solms affiliative/hedonic emotions are the primary motive force of the dream plot. At the end I argue that emotions may be involved in dreams as primary and reactive ones. Repressive processes active in the formation of dreams are an example of this. Following implications of MF Reiser’s work I show that interpretative-associating mental work may be needed to uncover one type of emotion when the other dominates in the dream and the nodal network of episodic memories of past experiences related to it, especially if they are difficult to acknowledge by the dreamer.  Sleep and especially dreams have a creative repairing process that may guide the individual with the help of attachment figures (the good aspect of family members, mentors, writers, therapists, musicians, artists) through the maze of modern life (See Gaston Bachelard The Right to Dream).  A secure base (Bowlby 1988) provided by the therapist is necessary for the lovely plays and creative processes of children and patients to unfold, recovering from previous damages to the self (sometimes imposed from the outside as is the case with Oedipus at the beginning of his life, or the many migratory tragedies or trauma we see daily in the news or other sources we have access to including religious ones, eg the Bible).
In this Highlights, issues related to memory and learning processes associated to REM sleep and NREM sleep are not discussed and can be found elsewhere (Winson 1990, Kocsis 2016, Boyce 2016, Crick and Mitchison 1983, Stickgold 2006, Walter 2007, Poe 2008, Lewis 2013, Chen and Wilson 2017, Mathew 2017). Other contributions relevant to the practice of other types of psychotherapy including CBT and dream work based therapies, are discussed by Hill and Spangler (2007).  Sleep disorders related to REM sleep like REM behavior disorder (Schenck 2005, Schenck, Bundlie, Ettinger and Mohawald 1986) and Narcolepsy are only mentioned in passing here.  Finally, sleep disorders related to dreaming and slow wave sleep are worked out by Auerbach (2007) and Paul Reading (2013) and other textbooks of sleep medicine and not mentioned here.
This paper on dreams ends with a discussion of recent findings about the neurobiological correlates of consciousness but also its behavioral and social/interactional (environmental) factors.

Freud on Dreams

In 1900 Freud published the Interpretation of Dreams.  In this book he argued that dreams have a meaning and that they are amenable to interpretation.  
He started by quoting some scientists of his time who thought dreams where the product of a disorganized sleeping brain without any capacity of psychic or high order mental process, that is, that they are devoid of intrinsic meaning and therefore are not amenable to interpretation.
For example Ives Delage (Freud 1900 pg 114)“In short dreams are the product of thought wandering without purpose or direction, attaching itself in turn to memories which have retained enough intensity to stand in its way and interrupt its course, and linking them together by a bond which is sometimes weak and vague and sometimes stronger and closer, according as the brains activity is abolished by sleep to a greater or lesser extent.”
Or worse Strümpell (Freud 1900 pg 110) who saw dreams as the product of a purely physiologic or somatic process comparable with the “ten fingers of a man who knows nothing of music wandering over the keys of a piano.”
He also quoted others who pointed out to the similarity between the dream experience and the experience of psychotic persons during waking life and stated that some of these authors viewed “dreaming as a useless and disturbing process and as the expression of the reduced activity of the mind” (Freud 1900 pg 124).

Freud set in his work to prove this scientists and authors wrong by describing an analysis of his own dreams. Analysis of dreams meant applying free association of the dreamer to the dream elements, in a manner similar to which he and Josef Breuer had applied free association to the pathological ideas of nervous patients.  Free association entails the verbal expression or detection of the stream of thoughts that occupy the mind in the present with an attitude of uncritical self-observation.

Freud demonstrated that dream imagery makes sense when it is related to these free associations of the individual who by necessity include experiences the individual has had in the recent and sometimes the remote past.  Freud believed the individual tends to resist the knowledge of some connections between dream images and the recent thoughts/memories connected to them, and specially between the thoughts of recent experiences with those of the remote past (infancy and childhood) and that interpretation by a sensitive listener (analyst) would permit the individual to make these connections arise to conscious awareness.  

The building blocks of sensory memories (in which the visual has preeminence), and memories of thoughts and feelings are the persons current or actual experience in which the reward seeking wishes of the individual are always present in interplay with the environment, which sometimes allow and sometimes poses obstacles to the fulfillment of those wishes. Frustrations are inherent to the human condition, frustrations brought about by reality that include the social and relational constraints (coming from care takers and authority figures during infancy and childhood).  During his lifetime the individual apprehends the present- current situation with a psyche rooted in neurocognitive abilities and executive functions directed to these actual experiences seen through a lens shaped by past experiences.  One of the shaping influences of the psychological lens of the individual is the internalization of these social and relational constraints prohibiting the fulfillment of those wishes.

Freud believed that one of these internalized constraints crystallizes in the act of repression, which in the case of dreams is brought about by the dream censorship (what he will later call the superego).  In his father centered psychology he tended to underscore the role of repression and the dream censorship (1900) stemming from the internalized male authority figure.  He believed that the instigator of dream imagery was an infantile wish, which acted upon recent memories, the daytime residues.  The dream-work would disguise the infantile wishes thoughts (the latent meaning) through displacement, condensation, the means of representation of logical connection between the dream thoughts, the considerations of representing concepts and abstract thoughts into pictorial concrete images and the constant translation between a dream element and its meaning (symbols in dreams).  The dream work is the process by which the latent dream content results in a manifest dream content (the actual images).  If the dream work would not transform the crude latent content into more socially acceptable images the dreamer would wake up from sleep.  Freud believed dreams are the guardians of sleep. 

Freud believed there was a conflict between the dream censorship and the infantile dream thoughts-wishes, which brings about the final product: the dream imagery. He believed dreams were closest to these infantile wishes than the products of the mind in waking life. Dreams are the royal road to the unconscious, he wrote. The resistance towards the experience of the infantile wishes, disguised or not, is diminished in sleep and actually allows the dream process to occur. “The state of sleep makes the formation of dreams possible because it reduces the power of the endopsychic censorship”(Freud 1900, pg 565).
Freud devised a psychic apparatus with a perceptual  end at one side and a motor end on the other.  He followed the reflex arc as a template (Freud pg 576).  He thought a series of memory traces followed the perception, which were associated among other things by simultaneity.  He thought the critical agency he mentioned when talking about the dream censorship was localized near the motor end and as the agency “which directs our waking life and determines our voluntary conscious actions”(pg 579) This agency is associated with the preconscious, that is the system which contains a memory of the past which can be turned into consciousness when we shift our attention to it.  Freud located the unconscious between the perceptual end and the preconscious.  Freud thought one can easily bring to consciousness the contents of the preconscious but in the case of the unconscious only with effort (interpretative work). These contents are ideas (Freud 1900 pg 582).  There is a regressive process in dreams from the ideas in these systems that ends up stimulating the perceptual end producing the dream imagery: “in a dream an idea is turned back to the sensory image from which it was originally derived” (pg 582).  The logical connections between ideas tend to be lost in this regressive process except that they can be expressed in perceptual images, that is, in a concrete form.  Freud adds that there are memories with greater sensory force than others, which act like a magnet in this regressive process (pg 586).  

Freud thought that wishes in the unconscious and the preconscious are clothed as ideas.  In fact he uses the terms interchangeably.   He thought that conscious wishes which have not been dealt with during the day, or have been suppressed to the preconscious find reinforcement from a powerful unconscious wish related to it in order to instigate a dream during the night (pg 591).  Freud thought this unconscious wish in adults is an infantile one.  This infantile wish plus ideas left latent during the daytime are unable to activate the motor end of the psychic apparatus during sleep (which characterizes this state, Freud 1900 pg 593, and we may now clarify the REM phase of sleep) and begin the regressive process described that ends in the dream imagery. 

Freud presents the experience of lactation of the infant as the experience par excellence.  He explains how a need (hunger) builds up in the infant and how he reacts with disorganized motor behavior: he screams and kicks helplessly.  When the external world satisfies this need a coupling of the prior inner needy sensation and its associated motor behavior with the pleasurable sensory experience of satisfaction takes place.  When the need arises in the future the mental apparatus tries to represent through memory the pleasurable experience of satisfaction, and we may add, tends to activate the motor pole in a less disorganized way: that is through movements that where more promptly and adequately followed by satisfaction in the past.  Freud explains that the impulse that tends to re-establish the situation of the original satisfaction is what he calls a wish (Freud 1900, pg 605), and we may add that this lies in the path from disorganized to organized thinking and action.  We may add further that thinking is a process the individual has access to, so that he or she can figure out how to handle the external world in order to obtain satisfaction. “Thought is after all nothing but a substitute of an hallucinatory wish; and it is self evident that dreams must be wish fulfillments, since nothing but a wish can set our mental apparatus at work”(Pg 606).   Whereas primary process thinking (the one occurring in the unconscious which defies the common laws of logic like the principle of contradiction), endeavors to establish “perceptual identity” by the regressive pathways described above, the secondary process thinking -or thinking proper-, (the one used in waking life to handle the external world and which obeys the principles of logic), endeavors to create “thought identity” with the past experience of satisfaction “through an intermediate stage of motor experience” (Freud 1900 pg 641).  A dream is a fabric of these two threads: the recent thoughts and goal oriented memories of the secondary processes utilized and set in disarray by the wildest impulses of the unconscious whose fingerprints are erased by the dream censorship.

We may add further that one of the primordial wishes of the individual follows with the development of the ego (the cognitive and executive functions capabilities of the individual) and has to do with the practice of the actions toward safety and maintenance of the self, provided initially by the parental figure to the helpless infant.   These kinds of wishes are what Freud later called interest and would sometimes conflict with the pleasure-seeking wishes described in the previous paragraph.  This lies in the cornerstone of his first instinctual theory  (Freud 1917).   While some psychoanalysts have underscored  the importance of the feeding process as an analogy useful to understand thinking (for example Bion 1962) others have stressed out the importance of the relational issues of safety and maintenance of the self in the individuals cognitive build up  (for example Bowlby 1982).  Interest has to do with the two main acts of all moving animals of which humankind is only one example (taken modified from Llinás 2001): 1) the impulse to provide food to one self and the ones related to oneself (  the impulse to prey upon or exploit the environment) and 2) the impulse to protect oneself and those related to one from predators and danger. 

At this point it would be good to make a digression that has to do with dreams we share. The quota of aggressiveness towards self or other(s) (the environment) necessary to establish the two goals of interest may be inappropriately increased if the interplay between the individuals inner representation of joy vrs. distress is tilted towards the negative (see below).  It follows that for human beings feeling well is a process that begins with ‘me’ and through the pulling force of necessity,  and the impulses of love includes ‘you’ and develops towards to an ever increasing ‘us’ which will finally include ‘them’.   Unfortunately we must be aware that the frail bridges life forcefully spans over long periods of time (eros) may be easily destroyed in a blink by thanatos.

It may follow from Freud’s thinking that pleasure-seeking wishes are the hallmark of the unconscious thinking activities of the mind.  Minimizing pain/distress and avoiding fear are one of the primary functions of the ego or preconscious in the service of interest.  The first uses the primary process and the second has at its disposal the secondary process of thinking.  During development the first tends to be primordial in chronological terms and impetus, provided safety and food are given, but tends to be repressed to the obscurities of the unconscious as the ego develops socially and strives for self-maintenance and safety.  At the beginning the good experience of sucking lays the groundwork of pleasure and satiety in future experiences (via a maturational processes that ends in joyfulness and gratitude: the positive aspects of mood and thinking) whereas the bad ones (including excessive long or short waiting-frustration) tend to lead to distress and insatiable and greedy feelings (the negative aspects of mood and thinking) (Cf. Melanie Klein 1937).  At the beginning the satisfaction of pleasure seeking wishes are supported by the safety and the food the parental figure provides which is a sine qua non.   In another work Freud (1914) stated that the libido supports itself on interest (anlehnen).   Unfortunately, as psychiatric practice teaches us daily, the infringements to the safety and maintenance of the self provided by the care giver(s) during infancy and childhood impinges negatively on the quality of what means to love and be loved, that serves as template for the individual to apprehend the future as it becomes present.

Interest has to do with the secondary function of dreams (the primary one being pleasurable wish fulfillment) that Freud described in a footnote to his Interpretation of dreams (1900 pg 618-619), that is the ‘function ludique’: “that is as practice” (playing)  “in the operation of main instincts and as preparation for serious activity later on”.  In these playfull operations of dreams are included “thinking ahead, forming intentions and framing attempted solutions which may be perhaps be realized later in waking life”.  In this secondary function of dreams Freud emphasizes the importance of the day-time residues and the activity of Preconscious thought.   We will come to this later when we tackle the problem of nightmares and their relationship to traumatic experiences and when we mention the current Hobson-Solms debate about the role of emotion in the making of dreams.

We need now a word on the origin of repression.  We mentioned above it had to do with the societal constraints the ego imposes on wishes deemed inappropriate by the environmental context the individual arrives at with development.   Freud speaks of “wishful impulses which can neither be destroyed or inhibited”, and whose “wish fulfillment would be a contradiction of the purposive ideas of secondary thinking”.  “The fulfillment of these wishes would no longer generate an affect of pleasure but of unpleasure; and it is precisely this transformation of affect which constitutes the essence of what we term ‘repression’” (Freud 1900, pg 643).  In Civilization and its Discontents (1930) Freud explains that the motive force for this process to occur (the origins of the superego) is the withdrawal of love originating in the parental figure or the threats thereof (who is also the provider of food and safety).  Subsequently when the ego develops to be in charge of the self, it turns out to be an “effortless and regular avoidance of the memory of anything that once had been distressing”, an “ostrich policy” “which is still to be seen in the normal mental life of adults” (Freud 1900, pg. 639).
Summing up Freud on dreams I will quote from Hermann Beland’s (1991) afterword to the Traumdeutung:  “This book expanded without question humanity’s self knowledge to the whole dimension of the unconscious, and opened a Via Regia, a Kings way to understand the transferences (Übertragungen) of unconscious thought processes on to conscious awareness, to integrate this understanding and to apprehend the therapeutic effect of this integration.”

Jung On Dreams:
The Swiss psychiatrist and initial follower of Freud developed his own ideas on dreams and psychological processes which became to be known as Analytical Psychology. Per Anthony Stevens (1994) (a contemporary Jungian Psychiatrist) Jung added a third source to the memory traces the individual has at its disposal to make the actual dream imagery: to the previous day(s) and childhood experiences mentioned by Freud he added the “collective unconscious”, belonging to the evolutionary history of our species. The functional units of the collective unconscious are the archetypes rendered by contemporary Jungians as instinctual patterns that shape experience, behavior and emotion and are expressed in representations of dreams and myths.

Jung maintained that dreams are natural spontaneous products of the unconscious psyche, which aim to throw a light to the ego “when consciousness has strayed too far from its foundations and run into an impasse” (CW X para 317).  “They do not deceive, they do not distort or disguise … They are invariably seeking to express something that the ego does not know and does not understand” (CW XVII para 189).  The dream is a spontaneous “self portrayal, in symbolic form of the actual situation of the unconscious” (CW VIII para 505).  “The ‘manifest’ dream picture is the dream itself and contains the whole meaning of the dream” (Jung 1934/1974 pg 97).  “Often enough they appear senseless, but it is obviously we who lack the sense and ingenuity to read the enigmatic message from the nocturnal realm of the psyche” (Jung 1934/1974 pg 99).

Jung proposed dreams have a compensatory function consistent with his notion of psychic homeostasis.  “When we set to interpret a dream it is always helpful to ask: what conscious attitude does it compensate” (Jung 1934/1974 pg 101).  Dreams “always stress the other side in order to maintain psychic equilibrium” (CW VII para170).  When the individual “assimilates” the meaning of the messages from his unconscious the need for compensation diminishes.  “Assimilation” “means mutual penetration of conscious and unconscious”, not the “falsely interpretation and depreciation of the unconscious” (Jung 1934/1974 pg 101).  

Dreams seem to serve the imperative of self-realization in life which Jung called individuation. “Dreams are our most effective aid in building up our personality” (Jung 1934/1974 pg 101). “In the dream the psyche speaks in images and gives expression to instincts, which derive from the most primitive levels of nature.  Therefore through the assimilation of unconscious contents, the momentary life of consciousness can once more be brought into harmony with the law of nature from which it all too easily departs, and the patient can be led back to the natural law of his own being.” (Jung 1934/1974 pg 108).
Jung thought dreams have a synthetic and subjective quality to be distinguished from the analytical and objective quality Freudian theory implies (Quoted in Thomä and Kächele 1986/1987 page 150).

Jung thought the dream’s meaning had to be amplified looking from the present to the future: dreams have an anticipatory nature in the teleology of the individuation process (1934/1974 pg 92).  Jung minimizes the importance of connecting the dream elements with individuals past.  The dream experience has to be amplified by elaborating on the personal present situation of the dreamer, his or her cultural context and by connecting it to its archetypal meaning, that is by applying themes and symbols of legends, mythological and mystical sources to its elucidation (Stevens 1994 pg 112-119).
It is important here to underscore the importance of the personal present situation of the dreamer, what Jung called the Status Quo, which includes the appraisal of the “phenomenology” of current relationships (Jung 1934/1974 pg 102-103). 
For Jung symbols in dreams don’t have a constant translation to a concrete sexual meaning.  They have a vague meaning which can be narrowed down for the particular individual according to his current life situation. There are a great many of them (symbols) “and all are individually marked by subtle shifts of meaning.  It is only through comparative studies in mythology, folklore, religion and philology that we can evaluate their nature scientifically” (Jung 1934/1974 pg 108).   Jung believed “that the unconscious mind is capable at times of assuming an intelligence and purposiveness which are superior to actual conscious insight.”  He thought this may be a “basic religious phenomenon and that the voice which speaks in our dreams is not our own but comes from a source transcending us.” (Jung 1938, pg 45).

Some psychoanalysts who have remained loyal to Freuds method have also written on how on some level the manifest dream depicts the current developmental state of the dreamer and the situation of the self (see Thomä and Kächele, 1986/1987, pages 148-160) and in this regard may resemble some of Jung’s ideas (See for Example CW IX ii para 9).  For some other former psychoanalysts overindulgence in this aspect of dream theory became the origin of a separate school of therapy (Aaron T Beck 2005, 2008). On the other hand, while it is interesting establishing parallels between themes of mystical, legends and myths sources with concrete dream imagery it is doubtful this can represent any kind of genetic transmission of ideas from the species evolutionary history. It is rather a reflection of the universal character some human predicaments have during the lifespan of the individual in its interaction with the environment.  
It is needless to say that much of the individuals dispositions of interaction with the environment are given by his constitution which may be predominantly bio-genetic, that is what he or she inherits from the genes of his/her ancestors that survived their environment of evolutionary adaptedness to reproduce (Bowlby 1982).  This gives a gross common background to everybody upon which the different variations of the individuals genetic makeup within a population are added or subtracted.  The reader may also recall in this regard Freud’s enlightening idea about the parallel series (Freud 1917, pg 362).
Furthermore one can say that Jungs “ingenuity and sense”  to read the enigmatic messages of dreams may amplify their meaning by enlightening them with particular contents of folklore, myths, religions or philology, but may also add values, directions and meaning which can be extraneous to the individual at hand, and especially if this occurs in the context of a therapeutic relationship, alien to the proper nurturance of the patient.  Love and human interactions are always rendered in a particular “language”.  In order to provide care the therapist has to learn and attempt to speak the “language” of the patient and not vice versa, although it is common that patients will identify with one or other aspect of the valued therapist (that is, specially after successful treatments).  Jung tended to have a mystic conception of life, which may be alien to those directed to the practical aspects of it. (One has to point out nonetheless the importance Jung gave to mythos and how it complements with logos.  He was unable, though, to pass from the realm of the soul to the abstract and to the concrete (and viceversa) as the neurologist-psychoanalyst was (Freud)).  Finally one can criticize Jung’s psychology stating that it tends to minimize inner conflict, especially between the reward seeking impulses to move forward and the inner (in relation to the outer) obstacles the person has to get there.

Here nonetheless, we have to give credit to religious people (those who selflessly try to do good and unite different traditions and peoples lineages, beyond frontiers). There is a big literature on dreams and religion, starting with the Bible, other Holy Books and oral traditions in different cultures.  The reader can also refer to (Whitmont EC, Brinton Perera EC 1989, Campbell J 1970,  and Frobose-Thiele 1957, Dalai Lama 2010, Dominguez Morano 2000). 
The reader can find books that disparage religious people (Boyer  2001) by explaining the natural and evolutionary factors in the origin of religious thought especially regarding creation stories and the magical explanation of the mysteries of the events of the world/universe prior to the scientific inquiries into these events.  There are is also literature on the origin of religious longing in the individual stemming from the psychology of infancy and childhood, whether based on the biologically mediated mother infant relationship (Wathey 2016) or based on the importance of the father figure (Freud 1927).  But the reader can also find books that treat the generosity and tolerance of good religious people in high regard, despite acknowledging its evolutionary and cultural history (Rappaport 1999, Ries 1993, Armstrong 2009).  Religious people must acknowledge the critique of some atheists or agnostics when they point out to the violence nurtured in crooked hate religious groups, including some Christian groups or nations throughout history and some other groups currently. Good religious people have to acknowledge as Karen Armstrong and other authors have, that hateful acts, whether at the individual or group/nation level, are contrary to core religious teachings. Additionally, as Pope Francis said recently there are some atheists who are more generous with the other and the poor than most Catholics and Christians. This writer focuses more on some of the teachings of religiosity that may inform social values and mores and not so much on its literal creation stories, which may not withstand scientific evidence (Prothero 2017).
In this regard black sheep like Freud (the Godless Jew), Budelaire, Poe, Dostoyevski, Alvaro Mutis, Garcia Marquez, Richard Dawkins (the devils chaplain) Nietzche, Carlos Fuentes and countless others keep reminding the establishment of their flaws. Others like Borges (1985) who never won the Nobel Prize but deserved it knew the underpinnings and damages of envy. Freud mentioned that in every patient there is a poet and he himself won the Goethe Prize (named after the great german poet) for his good writing skills in german language.  Freud valued the importance of transience and at the same time recognized the limits of individual life, as some religious people do, and the importance of enjoying the little things of life that make life endearing.  Freud and Jung lived through tumultuous times and were suffering men who could help their patients only so much without the modern medications we enjoy today (despite sometimes, their severe side effects).  It may be that some of the sufferings and acting outs of black sheep are the product of the repression, abuse or neglect placed or once placed upon them by the “white” sheep. (As stated in the Bible, Jesus was particularly interested in the poor, the other (foreigner or stranger), the sinners, the sick, the mentally ill, and marginalized, and all of this can teach us something). Freud was a peacemaker abhorred by the arrogant Nazis (See the letters between Albert Einstein and Sigmund Freud).  Copernicus, Newton, Einstein, Darwin-Wallace, Planck, Freud and Jung have left a tradition that, like science and any religion, still remains today.

Erich Fromm on Dreams:
Erich Fromm was a sociologist with psychoanalytic training member of the Frankfurt School, which provided constructive critique to society at large.
Fromm thought that Freud’s reliance on the idea of pleasurable wish fulfillment of dreams was excessive.  “Instead of assuming that the dream is the distorted presentation of a wish, one may formulate the hypothesis that the dream represents any feeling, wish, fear or thought that is sufficiently important to be present during our sleep, and that its appearance in dreams is a sign of it’s importance” (Fromm 1979/1980, page 72).  In a resemblance to Jung’s contributions he wrote: “I have found that many dreams do not contain a wish but offer an insight into one’s own situation or into the personality of others”.  And returning to Freud’s Legacy he added: “In order to appreciate this function one must consider the particularity of the state of sleep.  During sleep we are liberated from the task of sustaining our existence by work or by defending ourselves against possible dangers” (Fromm 1979/1980 page 72).  He wrote that in dreams we see the world subjectively and not from the objective point of view of waking life that seeks to manipulate it.   He maintained dreams are poetic and speak the universal language of symbolism common to all times and cultures.  The world appears in a subjective poetic manner.  Fire may stand for love or destructiveness but not the concrete physico chemical phenomenon by which we bake a cake (page 72).
Taking a probably harsh and unfair stance, Fromm (1979/1980 pages 73-79) disparages Freud’s free association method in one of Freuds self analyzed dreams, the dream of the Botanical Monograph. He points out that this dream were he was turning the page of a monograph he dreamt he had written of a plant which contained a dried specimen of it, shows how Freuds scientific analytic outlook on life had converted love and Joy into a dried object of scientific scrutiny.   This dream was showing Freuds own tendency to intellectualize of which, per Fromm, Freud was refusing to be aware of.  “Freud’s method of endless associations is an expression of resistance against the understanding of the meaning of his dreams”.  Fromm may be right when he points out that sometimes free associations may be serving resistance and not insight, but is usually the other way around: they are spawned with desire.  Furthermore Freud accepts in one of his free associations that he is not very generous when showing affection with flowers (an association to this dream): “Being more generous than I am, my wife often brought me back these favourite flowers from the market” (Freud, 1900 pg 204).  Last but not least Fromm overlooks in his 1979 critique, the underlying wish which serves as a common thread in Freud’s free associations to the dream elements:  the ambitions of a physician scientist to be well known and famous through his work (although Fromm mentions it in his 1951 book, pg 93), which can be traced back to the infantile wish of being valued and loved by the parents (which Fromm does not mention, and which is healthy but may be secondarily hypertrophied in some cases).
In other critical remarks to Freuds self analytical work with another dream which had Freuds Professional ambitions in the center stage, Fromm (1979/1980 pg 80-89) emphasized Freuds neurosis and his difficulty of  assimilating childhood wishes with what in his view was Freud’s rational respectable bourgeois life.  He added that the idea of the censorship had more of a social character than Freud assumed, and that the degree to which the dream images disguise, or code latent dream thoughts, varies from dream to dream and depends on the “sanctions which society puts against those who think unthinkable thoughts in their sleep and it also depends on such individual factors as how submissive and frightened a person is, and hence to what degree he feels in need of coding a thought which can be dangerous” (page 89).
Erich Fromm distinguishes between conventional, accidental and universal symbols in dreams.  Conventional symbols refer to the meaning something has by social acceptance, be linguistic units (words) or icons like a flag of a certain country. Accidental symbols arise between a certain element of reality, say a city, and a specific experience with a specific outcome and mood related to that element of reality.  To get to know accidental symbols free association is necessary he writes.  Universal symbols “on the contrary is one in which there is an intrinsic relationship between the symbol and that which it represents”.  He refers to abstractions people make stemming from certain elements say, fire and water, regarding their sensory qualities (energy, movement, lightness, movement, grace, gaiety, beauty, destructiveness, aliveness, continuity) and their connection with emotions and thoughts which have intrinsic affinity to those qualities.  Universal symbols are “rooted in the experience of the affinity between an emotion or thought, on the one hand, and a sensory experience on the other” (Fromm, 1951, pg 17). “The universal symbol is rooted in the properties of our bodies, our senses, our minds, which are common to all men, and therefore not restricted to individuals or specific groups”.   The expression of universal symbols is done in a poetic manner in dreams.  Examples are fire in a fire place “which is a source of pleasure and comfort, it is expressive of a mood of aliveness, warmth, happiness and pleasure”.  Whereas fire in a building or a forest “may represent fear, powerlessness, or of one’s own destructive tendencies” (1951, pg 20).

Elaborating on the idea that dreams can express deep insights into oneself and into others, Fromm stresses the importance of taking into account the quality of the meaning the external world has for the dreamer in order to understand this.   He states that during waking life individuals are faced with the management of the external world “mastering our environment, changing it, defending ourselves against it.  This means that he has to think in terms of time and space” (1979/1980, pg 96).  This gives to waking consciousness its character.  “While we sleep we are not concerned with bending the outside world to our purposes.  We need not look at the outside world; we look at our inner world, are concerned exclusively with ourselves.”  “In sleep the realm of necessity has given way to the realm of freedom in which ‘I am’ is the only system to which thoughts and feelings refer.”  “Sleep is taken up with the function of self experience” and not with the function of action.  He explains that the unconscious processes are related to this special mode of life, that of non-activity.  These processes are relegated to the night and have a ghost like, intrusive character during waking life as we deal with the external world.  He explains that the categories of irrational thought processes differ in each case.  During waking life unconscious irrational processes if present, should have in a non psychotic person an ‘as if’ character, where the person can distinguish its manifestations from those of  the real external world he has to deal with.  On the other hand, while dreaming, thought categories and states of feeling are employed in reference only to “my self experience” and are devoid of this ‘as if’ character.  The sensory experience of dreams just is.

“If I feel that a person is a coward, I may dream that he changed from a man into a chicken.  This change is logical only in terms of what I feel about the person, illogical only in terms of my orientation to outside reality (in terms of what I could do, realistically, to or with the person).” (Fromm, 1951 pg 28).

Fromm recognizes three explanations of dreaming: 1. Following Freud as wish fulfillments, 2. as feelings strong enough to be expressed “even in our sleep” and 3. as the attempt the mind makes to give a story like (unfolding of events) quality to these feelings.  He likens this to the rationalizations the woken person makes of actions he finds himself doing after being suggested previously during hypnotic trance.  “We feel in our sleep as we do in our waking life, but just as little as in the waking state can we tolerate having feelings which are not explained.  Thus we invent a story which serves to explain why we feel fear or joy or hate, and so on.”  
He adds that when the influence of the cultural interactions during the day have been beneficial in order “to develop the very best in us”, the person tends to regress to a primitive, animal and unreasonable state of mind during the night.  But when the influence of the social encounters has been harmful, exerting negative influences, we can be “more intelligent, wiser and capable of better judgment when we are asleep than we are awake”.  “Our dreams do not only express irrational desires but also deep insights and the important task of dream interpretation is to decide when the one and when the other is the case” (Fromm, 1979/1980, page 101).  As can be seen Fromm recognizes the individual can have ethical insights and realizations, even while dreaming.  Perhaps his Jewish religious education is playing a role here: in this sense, he underscores the importance of the Talmudic statement: “A dream which has not been interpreted is like a letter which has not been opened” (page 70).  Fromm nonetheless states this ethical insights conveyed by the dream experience is not, like Jung thinks (see above), stemming from an external “source of revelation transcending us”, but from the individual’s psyche itself:  “what we think in our sleep is our thinking”(1951 pg 97).

On nightmares and post-traumatic nightmares: Freud’s and Contemporary views.
Freud proposed distressing dreams where also an example of his wish fulfillment theory. He maintained in this case that the dreamers ego could not fail to experience as distressing the satisfaction of a repressed unconscious wish, which will lend its support to distressing residues of the previous days and by this means render them capable of entering a dream.  These include well justified worries, painful reflections and distressing realizations.  He maintained that this distressing feelings are of a defensive quality (to the ego), whereas the wish has a creative quality stemming from the unconscious-id (Modified from Freud 1900 pg 179). “The satisfaction at the fulfillment of the repressed wish may turn out to be so great that it counterbalances the distressing feelings of attaching to the day’s residues; in that case, the feeling tone of the dream is indifferent, in spite of its being on the one hand the fulfillment of a wish and on the other the fulfillment of a fear. Or it may happen that the sleeping ego takes still a larger share in the constructing of the dream, that it reacts to the satisfying of the repressed wish and itself puts an end to the dream with an outburst of anxiety” (Freud 1900 pg 596).  Freud added that in the interplay between the (Super-)ego and the repressed, it may come about that the predominant wish of the dream is one of punishment: the wish that the dreamer may be punished for a repressed and forbidden wishful impulse.   There would be here two wishes: the unconscious one (derived from the id) and the preconscious punitive one (derived from the super-ego). (1900 pg 597).
Freud explained (1932) that in the case of traumatic neurosis (as he called PTSD) nightmares can be explained as an attempt (emphasis in the original pg 29) at the fulfillment of a wish. “In certain circumstances a dream is only able to put its intention into effect very incompletely, or must abandon it entirely…While the sleeper is obliged to dream, because the relaxation of repression at night allows the upward pressure of the traumatic fixation to become active, there is a failure in the functioning of his dream work, which would like to transform the memory traces of the traumatic event into the fulfillment of a wish. In these circumstances it will happen that one cannot sleep, that one gives up sleep from dread of the failure of the function of dreaming.”

Elaborating on Freud (1920) we can say that the agencies of the dream work confronted with traumatic experiences are like the motivations of a theatrical company reproducing a tragic play: they attempt to represent unfortunate experiences and secondary negative feelings in ways that that may be agreeable (pleasurable) enough to be taken into consideration, (or agreeable enough to be handled in an effort to master them).  The ego attempts to benefit from the unfortunate traumatic experience re-processing it in order to turn overwhelming affects (anxiety) into signal affects that can be utilized when facing the approximation of a similar situation in the future. In the service of interest, the ego endeavors to restore the breached integrity so that it can be better able to support future pleasurable activities (please recall the ‘function ludique’ of dreams mentioned above). We can say that the person in his dreams wishes that his painful past experiences would had been otherwise or that they can have another outcome only to be reminded again and again that this was or is not the case.  A repetition compulsion that may be apparent not only in dreams but in the repetition of the transference may be the expression of a basic tendency that endeavors to restore an earlier state of things (Freud on the death drive 1920 pg57). But the repetition compulsion of the transference and of bad dreams may also be in the service of Eros and is there just waiting for an outside intervention that disprove the unconscious negative expectations of the individual in order to unlock and change them. Sometimes a therapeutic intervention (as exemplified by Rosalind Cartwright’s suggestion made to a woman suffering from post traumatic dreams after a rape/assault, of warding off the perpetrator in the dream- which is a supportive intervention promoting aggressive assertion in the service of the ego) can mobilize the events in the dream to a more positive outcome, and diminish their painful burden in daily life and subsequent dream experiences.   
Recent contributions to the understanding of nightmares and post traumatic nightmares stemming from the work of a specialist in the matter, Ernest Hartmann (1998), dissimilar to Freuds views in some respects, goes none the less along similar lines in others.  It stresses the importance of emotional processes in the formation of dreams.  Dreams “make a pictured metaphor of our emotional concerns”, “weaving in new material”, “which helps us to adapt to future trauma, stress, and the problems of life” (pg 2).
“If we think of the mind as net in the concrete sense of a fishnet or a pice of woven cloth, we think of trauma as a kind of tear in the net and the process of making connections as reweaving.  If we think of the situation after trauma as a storm-tossed sea with mountainous waves rearing up, then dreaming may be something that smoothes out the water, disperses the storm’s energy, and gradually calms the seas. Or if we think of a kind of electrical grid with excessive excitation in one area and lack of excitation in others, dreaming may be ‘calming’ by spreading out the excitation.” (1998 pg 122).

Matthew Walker (2017) has recently advanced a theory of REM sleep and dreaming in which he thinks that both processes serve the purpose of purging traumatic or unfortunate experiences of their negative (threatening or depressing) emotional value. In REM sleep, as we will see there is modulation of the noradrenalin neurotransmitter (which is involve in fight/flight reactions) which enables REM sleep manage traumatic experiences in sleep to convert them in less disturbing ones.  He also mentions evidence that REM sleep permits the cueing of the interpretation by the individual of emotional faces in the continuum kind-threatening which allows the individual to better navigate the social world the next day.  In his view persons who have less REM sleep tend see the social world in a more threatening way.  Also, persons that cannot decrease the noradrenergic tone of their dreams are prone to posttraumatic nightmares after a traumatic experience.  In his view, and following Raskind, the use of prazosin reduces the noradrenergic tone of individuals with PTSD allowing a resolution of posttraumatic nightmares. 

Finally something has to be said about the psychological corollaries of the facts and phenomenology of REM behavior disorder (Schenck 2005, Mahowald, Schenck 2009).  It may seem from these observations, that the dreamer is primarily acting out activities related to his interest(s) and not his libido.  But even in this cases where thanatos predominates (threatening or persecutory in character) pleasure in its rawest form cannot be erased: it supports itself on interest and remains with sadistic or masochistic qualities.
Along similar lines Revonsuo’s (2000/2003) theory of dreaming, as simulation and rehearsing of fight/flight reactions towards worldly threats (see the function ludique mentioned above),  accounts for some aspects of the threatening/persecutory character of dreams,  just mentioned, but it dismisses the hedonic/affiliative color that, although may be unconscious, none the less tinges all dream imagery of humans and possibly mammals.

History of the Neurophysiological correlates of the dream experience:
Claude Gottesman begins his thorough neurobiological history of dreaming (2007 pg 2-51) with Lucretius report in “De Rerum natura” about 98 to 55 BC about some activation of horses and dogs during sleep: sweating, panting, straining, sniffing, tossing of legs resembling some waking behavior. Lucretius included humans dream imagery in this report. Gottesman also quotes Fontana who in 1765 wrote of some “trembling” of cats and dogs  “as it were in convulsion” shortly after sleep.  Hervey Saint-Denys in 1887 wrote that a period after falling asleep is almost devoid of dreams, and when dreaming occurs “the sexual organs that passion usually stir up are modified; respiration becomes panting, interrupted by sighs, the heart palpitates.” (Quoted in Gottesman 2007 pg 3).  Raehlman and Witkowski first described eye movements in sleep in 1877. In 1880 narcolepsy / cataplexy was described by a naval physician, Gelineau, as a disturbance in which the person falls asleep suddenly following an emotional arousal losing muscular tone (cataplexy), a phenomenon which is frequently associated with loss of contact with the outside world and the onset of dreams (quoted by Jouvet 1993/1999 pg 32).
For Michel Jouvet (1993/1999 pg 3)  the physiologic understanding of dream experience began with Alfred Maury in the late nineteenth century.  A professor of the College de France who was quoted by Freud in his magnum opus (1900), Maury replaced the popular idea that dream imagery was the product of the immaterial spirit being in constant motion while the body underwent “periodical death”, with the notion that the dream was an episodic event intermediate between sleep and wakefulness.  Maury woke up sleeping subjects at regular intervals and noted that they rarely recalled dreams.  Dreams were not occurring permanently during sleep. It was thought dreams that appeared when dream was lightest, either when falling or waking from sleep, or when the sleeper was subject to external or internal stimuli like pain.

In 1875 Caton discovered spontaneous and induced electrical activity of the brain of monkeys and rabbits using a Galvanometer (Gottesman 2007 pg 4).  In 1929 the Swiss psychiatrist Hans Berger published his findings about his new instrument the electroencephalogram, a device that recorded electrical activity of the cortex measured in the scalp or directly in the cortex (electrocorticogram). Aside from describing the alpha rhythm, he laid the foundations that established (by Bremer in 1936 quoted by Gottesman pg 6) that during wakefulness the EEG showed a low voltage fast (greater than 12 Hz) desynchronized electrical activity and during sleep it was dominated by high voltage, slow (less than 3 Hz) synchronized electrical activity (Mentioned in Saper, 2000, pg 897). 

In 1930 Jacobson made the first report of a correlation between dreaming and eye movements during sleep. In 1937 Klaue described periods of deep sleep in the cat accompanied by low amplitude fast electrical activity in the cerebral cortex different from the predominantly slow activity of sleep (quoted by Jouvet, 1993/1999 pg 32, and Gottesman 2007 pg 4). In 1944 Ohlmeyer described a periodic cycle of penile erections in men during sleep.  This tended to occur every 90 minutes and with an average duration of 25 minutes (quoted by Jouvet 1993/1999 pg32). 

After the development of the microelectrode during the Second World War years, in 1949 Giusseppe Moruzzi and Horace Magoun (Jouvet’s mentor) discovered the reticular formation as the part of the brain responsible for ‘arousal’ or alert / waking state. They showed that transecting the ascending sensory pathways in the brain stem did not interfere with wakefulness or sleep.  But lesions of the reticular formation in the brain stem leaving the sensory ascending pathways intact produced behavioral stupor and cortical electrical activity resembling sleep. Moreover, some years later this same group showed that the transactions of the reticular formation through the pons greatly reduced sleep.  They thought that the activity of the rostral portion of the reticular formation at the pons and above contributed to wakefulness, and that this activity is normally inhibited by neurons in the reticular formation below the pons (Rechtschaffen and Siegel 2000 pg 936). 
In 1953 Aserinsky and Kleitman published their seminal paper on the associated phenomena related to rapid eye movement sleep and non REM sleep.  When awakened 20 subjects 27 times during REM reported dream recall, while 19 of 23 awakening outside of REM there was no dream recall. The respiratory rate was higher during REM and there was a suggestion that heart rate increased too. The association between REM and rapid low voltage activity of the EEG was clarified in 1955 and especially, 1957 when the same group, William Dement and Nathaniel Kleitman clarified the issue further: “They woke up subjects during REM sleep on 191 occasions.  In 152, or 80%, they recalled dreams very clearly. In contrast, they woke up during slow was sleep 160 times and only got 11 reports of dreams (7%)”. They wrote about REM sleep as an  “activated sleep” (Gottesman 2007 pg 5). The rapid activity of the EEG accompanying rapid eye movement in sleeping subjects resembled the EEG of someone falling asleep, and following Maury, these authors talked about the return of light sleep (Quoted in Jouvet 1993/1999 pg 5). Thus the findings so far showed that sleep was an active phenomenon and that one could distinguish two stages of sleep. (Jouvet pg 33). In 1959 Jouvet performed polygraphic studies of the sleep wake cycle by electrodes implanted chronically in various major brain structures and in different muscle groups of the cat.  He clarified the two different sleep patterns: “One was slow wave sleep, accompanied by slow, high amplitude cortical electrical waves, and normal muscle tone.  The other was a deep sleep, characterized paradoxically by brain acitivity similar to that of waking, by rapid eye movements, and by almost total loss of muscle tone.  This is the sleep state that I named paradoxical sleep” (Jouvet 1993/1999 pg 34).  Jouvet thinks REM sleep is a third state of the brain different from slow wave sleep and waking.   This sleep state tended to occur every 7 minutes in the mouse, every 90 minutes in the human, every 180 minutes in the elephant, that is proportional to the logarithm of the weight of the animal (Jouvet 1993/1999 pg 37).   Evarts in the 1960s (Quoted by Gottesman 2007) clarified that REM sleep was the “deepest” sleep state due to its association to its highest threshold to awakening through peripheral stimulation or brainstem reticular stimulation.  He showed how the neurons of the primary visual cortex were more activated during this sleep stage than in slow wave sleep, something confirmed in a latest study by Scilari (2017).   Other authors in the 1960s confirmed that the pyramidal tract was more activated in REM than in slow wave sleep and still others in the 1960s and 1970s reported about high central excitability/responsiveness during REM sleep as measured in the cortex or in the thalamo-cortical circuits (Mentioned in Gottesman 2007 pg 6).
Michel Jouvet (1993/1999) explains the mechanisms of wakefulness- slow sleep – and REM sleep as follows.  The activation of the cerebral cortex by reticular activating system neurons in the midbrain, which use acetylcholine as neurotransmitter, accounts for arousal or the waking state.  (Dopaminergic systems are also active in waking, (Hobson 2007, pg 78)). The reticular activating systems receive excitatory input from locus ceruleus neurons which use norepinephrine as neurotransmitter.  Once the following conditions are fulfilled the organism’s brain active processes are triggered including those of the serotoninergic raphe nuclei of the medulla to fall asleep: the proper inactivity time (circadian in our species), lack of auditory, visual, tactile or olfactory inputs signaling danger or predators, lack of pain, hunger, thirst, temperature or sexually activated needs.   If there is a predator the locus ceruleus will be activated and sleep will not occur.    Saper and colleagues (quoted in Hobson, 2007) have showed that waking is mediated by the activity of the locus ceruleus, the raphe nucleus and the histaminergic Tubero Mamillary Nucleus (TMN) of the hypothalamus while sleep is mediated by the activity of the ventro lateral preoptic nuclei (VLPO) in a flip-flop switch fashion. Gabaergic firing increases when the VLPO nucleus dominates. The preoptic nuclei of the hypothalamus include the circadian pacemaker, the suprachiasmatic nucleus (SPC).  Orexin secreted by the lateral hypothalamus (LHA) stabilizes this switch.

The patients affected with sleepiness who had encephalitis lethargica in the early 1900s where discovered to have lesions in the posterior hypothalamus, those afflicted with insomnia where found to have lesions in the anterior hypothalamus (Markow and Goldman, 2014 -Compare to the encephalitis lethargica treated by Oliver Sacks with L-Dopa in the 1960s).  The VLPO nucleus in the anterior hypothalamus contain GABA ergic cells and is implicated in the production of NREM sleep, and those cells adjacent to the VLPO are thought to promote REM sleep by inhibiting noradrenergic and serotonergin neurons of the brainstem (Markov and Goldman 2014).  The posterior hypothalamus/TMN receives histaminergic input and has hypocretin (see below) receptors; both histamine and hypocretin produce activation of TMN cells, which leads to sustained wakefulness.   “At the same time, hypocretin activates the noradrenergic and serotonergic cells in the brainstem, which send inhibitory signals to the anterior hypothalamus, taking the GABAergic brakes off wakefullness, thus reinforcing the wake state.” (Markov and Goldman, 2014).

Orexin (or hypocretins) receptors exist throughout the brain and spinal chord, and the peptides are produced by hypothalamic neurons that surround the fornix and exist in the dorsolateral hypothalamus.  These regions are involved in the control of nutritional balance, blood pressure and temperature regulation as well as endocrine secretion and arousal.  Hypocretins play a role in all these functions. Their origin in the lateral hypothalamus receives direct input from the SCN (suprachiasmatic nucleus, the cyrcadian rhythm clock) and their levels are highest during the waking period (stimulating the ARAS, see below), and increase furthermore with sleep deprivation. Hypocretin input to the brainstem REM-on cells controls the switch into REM by reducing the firing rate of the REM-on cells during the waking period  (Markov and Goldman 2014 pg 13).

Penny Lewis (2013 pg 41) writes: “communication between the preoptic sleep-promoting system and  the ARAS (ascending reticular activating WAKE UP system which is cholinergic) is not a one way street.  Neurons in the ARAS system project to the preoptic area and given, the chance, they can shut those neurons off. So these two systems are actually reciprocally interconnected; each one inhibits the other.  (   ) Whichever side is switched on most strongly will dominate and firmly keep the other side off.  That is why we spend so little time in a semi asleep phase.  We are either sleeping or we’re not- that’s what this arrangement tries to ensure.”  (In Engineering a flip flop switch). “The balance of this switch is very slowly altered as you get tired and sleep pressure increases across the day” (signaled by increase adenosine which inhibits the arousal promoting neurons of the basal forebrain; adenosine a breakdown product of ATP, increased further during sleep deprivation. Its receptors are blocked by caffeine), “and also as circadian input gradually shifts to indicate that it is time to sleep” through decreased hypocretin tone (see above).
When orexin is absent or abnormal (as in narcolepsy), the person can fall alseep readily, and go directly into REM (through lack of inhibition of the REM on cells).  Increasing serotonin levels (for example after taking SSRI) will inhibit REM sleep, which may be increased in depressed and anxious states, thereby augmenting the amount slow wave sleep. Unfortunately SSRIs disrupt sleep continuity and induce periodic limb movements (Lewis 2013 pg 45).  

But lets go back to Jouvet. If the cortex is ablated the activity of the pons/ medulla responsible for heart rate and breathing changes of REM sleep persist and eye movements and muscular atonia still appear periodically.   The pons is also the origin of phasic signs of REM sleep which include also the lateral geniculate nucleus of the thalamus and the occipital cortex (the so called PGO spikes which we will mention later).   Tonic activity of REM sleep includes the cerebral cortex activation and the muscular atonia.   The command center for postural atonia was discovered by Sakai and his colleagues from the university of Lyon (quoted in Jouvet 1993/1999 pg 46).  It is the locus ceruleus alpha a small group of neurons near the locus ceruleus.  It is stimulated by acetylcholine and inhibited during waking and slow wave sleep by the norepinephrine released by the locus ceruleus.  “Thus during waking and sleeping the activity of the locus ceruleus is high while that of the locus ceruleus alpha is zero”.  During paradoxical sleep the activity of the locus ceruleus is low, that of the locus ceruleus alpha is high.  Jouvet (1993/1999 pg 47) states this command center sends excitatory signals to the “inhibitory reticular formation” (its magnocellular nucleus) mentioned above, whose activity increases? during paradoxical sleep.
The characteristic rapid and low amplitude waves of the EEG characteristic of REM sleep and the waking state is explained by Rechtschaffen and Siegel (2000 pg 941-942) adding more detail to the mechanism.  Probably following Steriade and McCarley who they reference, they state that the sleep spindles and slow waves of the EEG of non REM sleep are blocked by the activity of the mesopontine cholinergic neurons who are active during REM and the waking state.  “Acetylcholine and other transmitter released by these cells depolarize the GABA-ergic inhibitory neurons in the reticularis nucleus.  This depolarization causes the inhibition of noradrenergic and serotonergic neurons and the activation (or desinhibition) of cholinergic neurons in the pons.” This “depolarization prevents the hyperpolarization that activates the low-threshold calcium channels, which in turn initiate the rhythmic firing of the reticular neurons.  In the absence of rhythmic firing of the reticular neurons, the thalamocortical relay cells fire only asynchronously, and this asynchronous activity results in the low-voltage EEG characteristic of waking and REM sleep”.  This in turn is associated with the excitation of GABA ergic neurons in the thalamus that “block the burst firing mode that produces high voltage waves in the EEG”.  
What needs to be remembered from this complicated explanation is that in REM sleep the cholinergic tone of the mesopontine area including the reticular formation increases, the activity of noradrenergic, (histaminergic) and serotonergic neurons decreases and the activity of GABAergic neurons there and in the thalamus increases. “The serotonergic, noradrenergic and histaminergic wakefulness promoting neurons have a discharge pattern nearly opposite to that of the cholinergic sleep promoting neurons.  The discharge rate of serotonergic, noradrenergic and histaminergic neurons is fastest during wakefullness, decreases during NREM sleep, and virtually stops firing during REM sleep (Markov and Goldman 2014, pg 12)”

It has to be mentioned that there are thalamo - cortical oscillation frequencies of REM sleep and waking which are similar: they are about 40Hz, the so called gamma range.  This was  first described in human’s REM-sleep by Llinás and Ribary using magnetoencephalography (1993).  The coherence of these waves may underlie conscious experience during wakefulness and dreaming.  The difference is that in dreaming this thalamo-cortico-thalamic activity is not modulated by sensory input.  Or to put it differently Rodolfo Llinás talks about waking consciousness as a dream like state modulated by the senses (Lecture, Universidad de los Andes, Bogotá 1992).
“In short, thalamic activity can be continuously regulated by sensory or cortical synaptic input, the latter being more powerful.  Thus when these neurons are sufficiently depolarized positive to (-50mV), they generate subthreshold oscillations at frequencies near 40 Hz (gamma band).  This activity supports thalamo cortical resonance and is the functional antithesis of the rhythmycity that supports the perceptual indolence of slow wave sleep” (R. Llinás and M Steriade 2006 pg 5).  Buzsaki has also made contributions regarding the “gamma buzz” (Quoted by Walter 2007 pg 29), and Hobson (2009 pg 811) has clarified that the coherence of 40Hz oscillations in quantitative EEG studies diminishes from waking to lucid dreaming and to REM sleep.  Recently Ferguson and colleagues have described a rythmicity in one type of internuerons of CA1 cells of the hippocampus important for memory consolidation during REM sleep (2013).  Also a review by Carlo Cipolli and colleagues (2016) add further nuances to the gamma buzz relavant in the recording of this frecuency and the theta rhythm (described first by Winson 1990) that show that “consolidation of dream content and the formation of episodic memories are associated with increased mediotemporal connectivity in both REM and NREM Sleep.”  Transcranial alternating current stimulation “in the lower gamma band during REM Sleep influences the ongoing frontal brain activity and induces self-reflective awareness in dreams”. 
Matthew (2017) has recently summarized the role of the thalamus by stating that in REM sleep the brain stops the blockage of the communication between the thalamus and the cortex which predominates in NREM sleep, that happens in a similar way during the brain state of waking life.
But now lets leave behind the research into thalamo cortical activity and these new findings and return to the research done in the mesopontine area described by Michel Jouvet.  We are now to mention the second efferent pathway of the locus ceruleus alpha relevant to REM sleep: it sends descending inhibitory signals along the reticulospinal tract to the spinal cord.  “There, at the motor neurons that innervate the muscles directly, they block excitation coming from the motor area of the cerebral cortex (itself excited by PGO activity) and produce postural atonia.  Sometimes a few motor signals cross this inhibitory barrier, causing small movements of the fingers, or the ears and whiskers (in cats), but essentially only the eye and respiratory muscles escape this intense inhibitory activity.” (Jouvet 1993/1999 pg 47).
Regarding the PGO spikes it has to be said that “it can be excited by drugs or lesions whose common denominator is suprression of the liberation of serotonin from the raphe nuclei”.  This can happen during waking.  The PGO system has some generators located in the pontine reticular formation (the parabrachial and dorsal tegmental nuclei).  They appear to be automatic cholinergic pacemakers, “for periodic PGO activity can still be recorded from the pons in an animal whose pons has been isolated from the rest of the brain.”  From the generators there are pathways that ascend either to the lateral geniculate nucleus (LGN) or the visual cortex and also excitatory signals to the oculomotor nuclei responsible for eye movements during paradoxical sleep  (Jouvet 1993/1999 pg 49).  The PGO activity not only alters the LGN and the visual cortex.  With microelectrodes it can be seen that it also alters (excites or inhibits) other neurons in the reticular formation, the thalamus and internuerons of the cerebral cortex as demonstrated by Mircea Steriade (Quoted by Jouvet).  This includes neurons responsible for voluntary and postural motor activity, which is blocked during REM sleep, as mentioned above, by synaptic terminals of the locus ceruleus alpha at the spinal cord level.
Finally, Jouvet (1993/1999 pg 50) mentions the so called “permissive” systems, which by his rendering should be named “inhibitory” or blocking systems of REM sleep.  To the serotoninergic and noradrenergic neurons already mentioned above, he adds the histamine-containing neurons of the hypothalamus (please refer to the flip-flop switch mentioned above) .  These systems which are active during waking and dormant during REM sleep, include the paragigantocellular area of the medulla, which controls heart rate, blood pressure and respiration.  Neurons located in this area are sympathetic and excite the locus ceruleus. The decreased sympathetic tone is associated with peripheral vasodilation and lowering of body temperature.

The Hobson – Solms controversy and the role of emotions in dreams.
Following Jouvet, Hobson and McCarley (1977) state there are three operating states of the CNS:  waking (W), synchronized (S) or slow wave sleep, and desynchronized sleep (D). They mention that in desynchronized sleep the rapid eye movements are generated at the brain stem level and that the cortex is then provided with feed-forward information about the eye movement.   They stress that D sleep is the physiological substrate of “halucinoid dreaming” and that this occurs as a “preprogrammed brain event and not a response to exogenous (day residue) or endogenous (visceral) stimuli” (pg 1338). They stress that “if we assume that the physiological substrate of consciousness is in the forebrain, these facts completely eliminate any possible contribution of ideas (or their neural substrate) to the primary driving force of the dream processes (pg 1339).”  Hobson and McCarley give an executive central role to the gigantocellular nucleus of the reticular formation as the executive generator of D sleep.  They mention “paramedian reticular giant (G) cells” of the pontine tegmentum reticular formation which excite and are excited by acetylcholine as the generator (see Rechtschaffen and Siegel above).   Hobson and McCarley state this neurons interact reciprocally with the two aminergic neurons nuclei, the “locus ceruleus and the Raphe nucleus”.  Norepinephrine and Serotonin “are hypothesized to be inhibitory to the G cells.  “D sleep will therefore be enhanced by increasing G cell excitability, and this can occur by either adding cholinergic drive or substracting aminergic inhibition. Conversely,  D sleep will be suppressed by subtracting cholinergic drive or by adding aminergic inhibition”.  (Hobson (2007) recently has clarified that the primary specific REM-on cells are glutamatergic and are related in a reciprocal positive feedback loop with the cholinergic unspecific REM-on cells of the pontine reticular formation he described 30 years earlier. In his new model the relationship of this REM on cells with the aminergic REM-off cells remains the same).  Elsewhere (2009 pg 810) he points out that Gabaergic neurons also play a role.

Hobson and MacCarley explain dreaming as a psychological concomitant of D sleep, which accounts for activation of the forebrain, occlusion of sensory input, blockade of motor output at the spinal cord level and the generation of information within the system.  “It is a clock trigger mechanism, (   ) the periodicity of which is hypothesized to be a function of reciprocal ineraction of reciprocally connected, chemically coded cell groups in the pontine brain stem” (pg 1346).  Activation of the different parts of the rostral brain by this dream state brain stem generator produces disparate, internally generated elements, which then are insufficiently integrated (synthesized) by the forebrain in a constructive way, “and not in a distorting way as Freud presumed.”  Dream bizarreness is a function of erratic / random activation of the forebrain by these physiological brainstem mechanisms, and not the end result of a  psychological censorship.  The only thread of meaning and sense dreams convey is only marginal and secondary to the activation of the higher brain structures by the brain stem generator.

Hobson’s approach emphasizes the bizarreness of the dream experience that resembles the delirium of organic brain disease (Hobson 1997) or the psychosis of Schizophrenia (Scarone, Manzone, Gambini, Kantzas, Limosani, D’Agostino, Hobson 2008). In these writings Hobson goes hand in hand with Freuds  medical contemporaries (Delage and Strümpell mentioned above) up to the point of stating that dreams are after all just “cognitive trash” (Hobson 2002 pg 23).  Freud was a representative of a tradition older than civilization that seeks to find sense underlying the nonsense of dreams, while Hobson in these writings seemed to convey this is a flawed endeavor. But in his latest review Hobson describes REM stage dreaming as a form of primary consciousness (protoconsciousness) which may have some resemblance to Freud in his treatment of Kant (Cf. Panahi 1980/1993 pg 13 and Hobson, 2009 pg 805). Additionally Freud noted in his analysis of Jensens “Gradiva” that psychosis is the product of the same conflictual forces which produce dreams and are amenable to interpretation (1906).

The recent review by McCormick and Westbrook (2013), on the neurobiology of sleep and dreaming does not shed any new light on the physiological correlates of dreaming, which are mentioned here.

Mark Solms (2000/2003 pg 52) acknowledges Jouvet’s findings that when the cortex is separated from the brainstem it no longer, displays the cycle of REM activation (which is preserved in the isolated brainstem), but he questions the necessary relationship established in the 1950s and 60s that REM physiology is the equivalent of the dream experience.  He states this state of our knowledge, as developed by Hobson and coworkers,  needs a revision.

He starts by stating that not all dreaming is correlated with REM sleep.   He mentions how REM sleep and dreaming are incompletely correlated (Solms 2011).  He mentions how even Hobson accepts that between 5 and 30% of awakenings during REM sleep don’t elicit dream reports, and at least 5-10% of Non REM awakenings do elicit dream reports that are indistinguishable from REM reports. He states that the principle that dreaming can occur in the absence of REM which was initially reviewed by Vogel (1978 pg 1534), and that REM can occur in the absence of dreaming turned out to be accepted even by Hobson.  A recent review by Cipolli and colleagues from the Unversity of Bologna (2016) report that dream like mental experiences from people in lab settings are reported after over 80% of awekenings from REM sleep and about 50% of awakenings from NREM sleep.

In this regard again Solms (pg 52) values the results of studies by David Foulkes  in the 1960’s which pointed out that complex mentation can be elicited at least in 50% of awakenings from Non REM sleep. As Klösch and Kraft (2005 pg 42) point out David Foulkes had changed the question from “where you dreaming just now?” to “What was going through your head just now?”.  Again, although this and subsequent studies did show that the average NREM dream is more “thoughtlike” than the average REM dream, Solms underscores what for him is crucial:  that some NonREM dreams can’t be differentiated qualitatively from REM dreams.
Recent findings (Siclari et al 2017) have pointed out that dreams may even be more frequent in NREM sleep than previously acknowledged.   Siclari and colleauges found that relative decreases of low frequency acitivity in high density EEG (256 channels) recordings (EEG activation) in posterior cortical (perieto-occipital) regions,  was associated with dream experience and when low frequency high density EEG activity increased in the same area, subjects reported no dream or any experience whatsoever.  These findings held irrespective of the dominant EEG frequencies in NREM or REM sleep. The blurring of the REM/NREM dichotomy by these authors may leave Hobsons AIM model (see immediately below) without relevance but may still allow for Solms neurologic underpinnings for dream motivation.   Be it as it may, regular EEG recordings predominate in all world sleep labs, and as Matthew (2017) points out it still has something to say.

Solms points out that Hobson adapted his model to this findings by abandoning the idea that all dreams are generated by the brain stem mechanisms that produce the REM state. But the “closely related claim that all dreams are generated by pontine brainstem mechanisms has been retained” (Hobson quoted in Solms 2000/2003 pg 53).

In his AIM model Hobson (Hobson, Pace Schott, Stickgold 2000/2003, Hobson 2007, 2009) states that both REM and nonREM dreams are attributed to reciprocal interactions between aminergic and cholinergic brainstem neurons at least in one of the three dimensions that compose the model.  Activation of the forebrain is in the x axis (increasing from left to right), input/output is in the anterior-posterior axis  (I) (having lowest motor output anteriorly, the highest motor output posteriorly, the highest internal input anteriorly and the lowest external input posteriorly), and the ratio of aminergic to cholinergic activity of the brainstem in the bottom up axis (M- modulation) (being lowest at the bottom and highest at the top). “Dreaming is mostly like to occur at sleep onset (when residual activation is high and when I and M are falling) and in late night NREM (as activation level rises); dreaming is maximal in REM (when activation level is highest) and I and M are at their lowest values”  (Hobson 2007 pg 82).

Hobson and colleagues (2000/2003 pg 44) explain that activity of the reticular formation (which is located in the brainstem) accounts for the activation dimension of the model, and that thalamo cortical activity as mentioned above and “both input-output gating and nonsensory activation of sensorimotor cortices” may be related to the input dimension of the model.  Quoting Pompeiano, Hobson (2007pg73) states that the presynaptic inhibition of the IA afferent fibers from sense organs in the skin and muscle to the spinal cord plays a role here.

To counter the data that the brainstem is the generator of dreams, Solms (2000/2003 pg53, 2011) shows how dreaming is eliminated with forebrain lesions that preserve the brainstem.  Clinico anatomical studies of 26 human cases of brainstem lesions that eliminated REM sleep documented loss in dreaming capability in only one of these cases in which lesions of forebrain structures could not be excluded. In the other 25 cases “they could not establish this correlation” (with dreams)  “or they did not consider it”. He mentions that lesions big enough to damage the REM and non REM components of the oscillator tend to be incompatible with the preservation of any conscious experience.  Solms explains this is a reason why brainstem lesion studies will probably never directly refute the idea that the brainstem is the generator of dreams.  Solms writes this can be refuted indirectly via the corollary hypothesis that dreaming is not controlled by forebrain mechanisms, that is by demonstrating that dreaming is eliminated after specific lesions of the forebrain that spare the brainstem and most other parts of the forebrain.  He quotes different published studies with a total number of cases of 1000 cases with mainly two types of lesions: 1) In the posterior convexity of the hemispheres near the parieto-temporo-occipital (PTO) junction, and 2) In the white matter surrounding the frontal horns of the lateral ventricles (ventro mesial quadrant of the frontal lobes- VMFL).  He mentions the PTO junction has been demonstrated to be important to mental imagery, so this is not surprising.  In a  NOVA TV special Solms (2009) reports about a case of a woman that could not dream and had disturbed sleep and had a lesion in the PTO junction that spared the dopaminergic systems and the brainstem neurotransmitters.

A recent review of research by Cipolli et al (2016) by the university of Bologna, describe the importance of: "a posterior system, mostly unilateral (right), in or near the tempo-parietal-occipital junction.  Lesions to this system affect dreaming as well as waking visual imagery, while lesions more specific regions (involved in waking vision) (like V4 or V5) selectively affect dream representation of color or movement.  However, lesions to primary unimodal sensorimotor cortices do not affect dream imagery."  That is visual secondary (not so posterior) associating areas are the important ones in dreaming.  This researchers from Italy also recognize the importance of the anterior system of the VMFL (in Solms terms) or the vmPFC (ventromedial-prefrontalcortex) in their terms."

The VMFL is interesting in which it contains fibers that arise in the ventral tegmental area of Tsai, the source of the mesolimbic and mesocortical dopamine systems.  Solms quotes Panksepp, as stating that this was the target of the prefrontal leucotomy surgeries, which provide a substantial number of the 1000 cases mentioned.  “Its circuits instigate goal-seeking behaviors and appetitive interactions with the world, they are the “seeking” or “wanting” command systems of the brain.   Overactivity of this system can be induced by amphetamines, cocaine intoxication and L-Dopa.  This system is the target of most antipsychotic medications.  On the other hand the leucotomy was responsible for the lack of initiative and adynamia observed with these patients.   Lesions in this area have no effect on REM sleep but result in loss of dreaming clearly heralded with the generation of adynamia in patients with deep bilateral lesions.   Chemical activation of this system through L-Dopa produces not only psychotic symptoms, but vivid dreams and nightmares in the absence of any concomitant change in the characteristics of REM sleep (Solms pg 55 quoting Hartmann).  Finally epileptic seizures in the temporal lobe during the night normally occur during NREM and produce nightmares.

Additional to the clinico anatomical results, Solms mentions functional imaging studies done by Braun, Franck, Maquet and Nofzinger among others, which show that dreaming involves “the concerted activity of highly specific group of forebrain structures” associated with the limbic system (the emotional brain), visual integration areas, paralimbic and heteromodal areas (PTO cortex).  The functional imaging studies show it is not a chaotic activation of the forebrain cortex (as the activation synthesis hypothesis suggests) but a complex and specific involvement.  Solms mentions how the lesion of the dorsolateral prefrontal cortex  does not affect dreaming.  This has been confirmed by functional studies, which show no involvement of this area and explain the lack of self monitoring and poor executive functions exhibited in dreams.  He says (Solms 2006) this correlates with Freuds idea that the censorship function is relaxed during dreaming (see above).

Finally Solms explains the frequent correlation of dreams with REM sleep to a nonspecific effect of the active brain during paradoxical sleep.  He quotes Sitaram stating that cholinergic agents administered prior to sleep cause insomnia, administered during NREM produce REM sleep and administered during REM sleep produce awakening.  But things are not that simple. In this line of reasoning, countering Hobson’s modulation axis, I can add that anticholinergic drugs administered  to patients tend to cloud wakefulness (and not the opposite) to the point of altering the sensorium and generating delirium.  Solms (2011) states anticholinergics produce dream like mentation acting as blocker of Ach on the basal forebrain in REM.  

Markov and Goldman (2014) clarify that cholinergic neurons have a dual role: some promote sleep and some promote wakefulness.  There are two subsets of cholinergic neurons originating in the laterodorsal and pedunculopontine tegmental nuclei (LDT/PPT).  They are involved in the fast frequency and low voltage activation of the EEG characteristic of the cortex in both REM sleep and restful wakefullness (wake/REM on neurons) on the one hand, and on the other involved in the generation of REM sleep (REM on cells).  “The three physiologic components of REM sleep are controlled by different nuclei located in the pontine reticular formation (PRF). The REM on cholinergic neurons promote REM sleep by sending excitatory input to the PRF. This causes rapid firing of the PRF, which in turn produces the three cardinal components of REM sleep.  The PRF is shut off during NREM.   Cholinergic neuorons that project from the basal forebrain to the cerebral cortex and limbic areas are part of the vigilance waking system.  The side effects produced by anticholinergic medications likely result from a disruption of both the vigilance/wake producing cholinergic neurons and the wake/REM-on cholinergic neurons (pg 12)” 

 In any case, having in mind all the evidence Solms speaks of a dream-on dopaminergic mechanism dissociable from the cholinergic REM-on mechanism proposed by Hobson and colleagues.  In order for dreaming to occur activation during sleep has to be present.  That is “only if and when the initial activation stage engages the dopaminergic circuits of the ventromesial forebrain” do dreams occur.  He adds that the noradrenergic and serotonergic demodulation facilitate the primary dopaminergic effects responsible for dreaming.  “The available evidence suggests that the additional specific variable which causes dreaming is the activation of certain limbic forebrain structures” (2011 pg 540) Finally he states the functions of dreaming and REM sleep should not be considered equivalent (Solms 2000/2003 pg 57).   Following the lines of this reasoning I can only add that dream like mentation can be found in all three conscious states: day dreaming occurs while awake, thought like dreaming predominates during NREM, and halucinoid dreaming in REM.
Recently (Horner and Peever, 2017) have recognized the studies of Eban_Rothschild and colleagues with photometry which show that dopaminergic neurons of the ventral tegmental area are important in ethological important behaviors and “are most active in wakefulness and REM sleep and are least active in Non-REM sleep” which may support Solms view. 

Initially Hobson’s approach denied that emotion or reward seeking impulses of the individual may play a role in the formation of the dream experience.
In later writings results from PET scans studies (mentioned above) done in the 1990s of individuals during REM sleep made him change his mind: “While we were advocating a pons to forebrain direction for state determining processes such as neuromodulation and PGO waves, we were in no position to say which came first in dream plot construction: the chicken of the dream imagery or the egg of dream emotion.  We are now in a strong position to suggest that it is the egg that comes first. That is, we feel a certain way in dreams, and then we see imagery that is in keeping with that feeling.”  “Dream emotion was always consistent with dream plot features, no matter how out of kilter those plot features were with each other.”  “When we look at the pattern of brain activation revealed by PET in REM, we are struck by the proximity of the limbic structures to the pons and hence are led to wonder if it is not subcortical ponto limbic activation that determines dream emotion.  We also wonder whether the visuomotor images and plot features are fit to them as best the sleeping brain can, given its isolation from the outside world (its anchor in waking) and its lack of cortical control (its compass in waking).  This hypothesis resonates with what I call the emotional salience of dreams.  Freud would call it primary process and ascribe its presence to a relaxation of vigil over the id by the ego.  We agree on the nature of the process up to this point.  But instead of disguise or censorship, the direct revelation of feelings is impressive to us.  Disguise and censorship are weak if they are present at all”  “The unification of disparate and bizarre images is achieved by linking them via emotional salience rules”.  “From a Darwinian perspective, the emotions of anxiety (which engenders wariness), elation (which engenders affilitiaviness) and anger (which engenders defense or attack behavior) are highly adaptive.  Be careful; find a mate; and drive off competitors and predators.  These emotions are the building blocks of survival and procreation that Darwin has taught us are the twin goals of life.  An attractive theory, first put forth by Jouvet, is that REM sleep provides an opportunity to rehearse the survival emotions and behaviors.  (    ) To this, we can add the hypothesis that REM sleep emotions also provide an organization structure for memory…” (Hobson 2005 pg 34-35).  The reader may recall in this regard the function ludique of dreams, mentioned above following Freud.
In other writings Hobson (2007 pg 77) addresses this issues quoting research pointing out that dreams don’t require complex decoding to reveal their significance and that dream emotions are never bizarre and map well to cognitive elements “even if these elements are bizarre.” “The transparency tenet of the activation – synthesis says that yes, there is emotional salience in dreams, but no, the emotion is not concealed.  It is revealed and there for the taking”.  I would say not always, as psychoanalytic dream material (session content) commonly shows the “unreasonable” emotions of the person that at first where not directly evident. Hobson devalues the importance of free -association which is a point of view more in keeping with aspects of Jungs and Fromms point of view (see above).  But he goes further by stating that the information provided by dreams “may be equally accessible in waking life” an assertion that some therapists interested in dreams may not follow (see below), but are in keeping with David Foulkes Magnum Opus (1975 pg353).   David Foulkes nonetheless states that associative paths and particular symbolic outcomes “will remain relatively unsusceptible to predictive analysis”.  “The “noise” of the external world, which is manipulated in such studies, can only reveal “the coded structure of dream interactions”, which is an “achievement of social ecology, more than of personology”.  “When we consider sleep, where the interiorization rather than the external form of social reality matters, we see how little we know of persons.  Since Freud, that has been the frustration but also the challenge, of dream psychology” (1975 pg 359).  This sounds familiar to the readers of Sartre (1939).

The reader must also remember the interesting studies of Wolfgang Leuschner and colleagues at the Sigmund Freud Institut in Frankfurt (1988,  and presentation in Ulm in 1994).  They demonstrate how preconscious stimuli during waking life presented as geometrical forms are incorporated in the visual recollections of the dream the day after, but the self-other symbolic meaning of dreams are otherwise and remain.

Mathew (2017) underscores the importance of the dream state in REM sleep from an evolutionary perspective, stating is a calibration of brains, that allow an emotional processing, that enables, large, emotionally astute, stable, highly bonded and intensely social communities of humans.  Following Stickgold his views are along Hobsons in that he mentions that the dream state expresses the emotional preoccupations of the individual during waking life and enables him or her to be better adapted socially the next day.  He states that emotional meaning of dreams is evident in the dream plot and is not the product of a repressed wish disguised by dream censorship.

In other recent publication Hobson asked Turnbull and Solms (2007) whether they endorsed that the defensive desguise-censorhip agency mentioned by Freud is active in the formation of dreams.  Solms left the question open, acknowledged that even Freud accepted other factors different from desguise and censorship might be playing a role but added: “Of course, it is not clear to what extent, and how, an absence of executive functions, combined with powerful emotions, might produce what Freud called, ‘desguise and censorship’ but we are confident that the contents of consciousness would be greatly changed by this combination of psychological factors.”

From my own experience with dreams I have noticed that the Super ego qualities that sometimes may be identified as dominating a dream plot can be characterized as a “reactive emotion” that stands in conflict with more “primary emotions/wishes” that have to be elucidated with the tracing of associations.   The reader has to have into account  Freud’s statement that is the transformation of affect which is the cornerstone of repression, (that is the censorship is emotive in character see above).  If there will ever be a neural correlate of the motivating force of the censorship agency it should be localized in the limbic system in its relationship with primitive self- other episodic memories stored in the cortex with implicit/non declarative components to it.  These reactive emotions are not trivial. The psychological mechanism of repression has to do with survival as can be evinced with Freuds ostrich analogy (see above).

Turnbull and Solms (2007 pg 1119) note that the interpretable material of a dream may vary from case to case and that when interpretation is needed it is like the intepretation of degraded/distorted forms of thinking of the semantic paraphasias and amnestic confabulations of some neurologically injured patients.  “Degraded language and memory systems are not random.” “Rather, they are derived from the specific upstream (latent/non declarative) motivations and cognitions that generated them, as can often be inferred (‘interpreted’, if you will) from the context.”

Finally a statement which is contrary to Hobson’s assertions has to be mentioned about the importance of associations to dream elements and about the interpretative job of the dreamer himself or of the therapist. Hartmann (1998, 2000/2003) underscored the role of emotions in dreaming, although he might not have been the first (see Fromm assertions above, and Sartre 1939, mentioned above). He stated that dreams contextualize (produce a picture context for) a dominant emotion.  Recently Hartmann (2010) has identified a “central imagery” CI of the dream which may be picturing, very clearly, though metaphorically, the emotions of the dreamer. The “intensity” of the central imagery varies among dreams, being greater when the dreamer rates the dream as “highly significant” or after traumatic experiences.  Hartmann states dreams allow the making of broad connections guided by emotion “weaving new material” into existing memory systems.  “Dreaming has a role in the integration of new material into memory, where the importance of underlying emotion is crucial  (2010 pg. 210) indicating or labeling what is to be remembered”.
Morton F Reiser (1990, 2001) argued about the importance of nodal networks of episodic memories organized by emotions that underlie the making of dreams. Following Reiser (2001 pg 356) we can see how Freuds dream of the Botanical Monograph (mentioned above) was organized around the reactive affects of shame and guilt connected with specific past circumstances of  the outside world, connections that stand in relation to a wishfull tendency (ambition in this case, the primary emotive force), and that the meaning of this painful affects and wishfull tendency could be uncovered only after following the associative material offered by Freud (through interpretative-associating mental work). Reiser states that dreams depict a current emotional conflict which is linked to previous conflicts organized by similar emotional states as “spinning associative threads (..) connecting links between images that encoded earlier and earlier painful memories” which the individual dislikes and requires effort to acknowledge.  This is the reason why a third person, a sympathetic listener (a therapist) who was not the subject of those experiences, may be necessary: to ease the load of this interpretative mental work.  Explorative/ expressive therapies may be useful to truth seeking individuals who may be burdened by negative emotions but who have the ego strength to built a therapeutic alliance with a therapist while facing the demands of this work. This ultimately may unlock positive emotions in the dreamer, as the  vicissitudes of the ongoing transferential – therapeutic interactions unfold and become evident and generalized in current outside relationships.  
It has been well known from the work of Carol A Tamminga (Lecture, Hoston Medical Center, 2012) and countless other psychiatrists and neuroscientists that damages to the Hippocampus may underlie severe mental illness. Damages to the Hippocampus are usually secondary to biologic early trauma (genetic, prior to birth, or perinatal), or to mourning and melancholy (loss in a susceptible individual), and traumatic experiences associated with severe hunger, war (PTSD), corruption and poverty, conflicts between individuals, lineages, intolerant religious people or nations.  Persons with altered hippocampuses or this or that brain related issue (e.g. with poor executive functions) are usually easily repressed by others and tend not to be favored as “ideal” mates, and if they don't go down the path of crime they usually resort to other forms of creative attempts to seek attention to themselves (the humanities, arts or sciences-what Freud called sublimation). Unfortunately only a few are successful and most stumble and fall in their attempt to build a better world trapped as they are in the conventional dominant culture (drugs and pleasure seeking behaviour of permissiveness).  The nucleus accumbens fires more and more and kindles the amygdala, which ends up unconsciously inviting more trauma to or from the outside world (to or from others). These are the Beta elements of Bion, which John Thor Cornelius in a recent paper (2017) underscore as being associated with mental illness of patients with hippocampal damage who are unable to undergo reparation and integration “within a symbolic field”. Thor Cornelius also follows D.W. Winnicott (1971) who was well known by the British as a pediatrician who had radio broadcasts and supported many caretaker-child diads through his advocacy of healthy rearing through transitional space and playing, despite the horrors of the concurrent and preceding world war II.  

In an enlightening paragraph Cipolli and Colleagues from the University of Bologna (2016) report: “Laboratory studies have consistently shown that dream contents result from the elaboration of several memory sources and not from a simple reactivation of previous events.  An individual’s current concerns and everyday life events (so called episodic memories) are seldom reproduced mechanically as dream contents, but rather, are largely transformed in combination with fragments of recent and remote events and items of semantic information.  Moreover, items of recent episodic information can be activated and processed not only over the following night (day residue effect) but also up to 5-7 nights later (dream lag effect).  Indeed, subsequent dreams reported after multiple awakenings of the same night show both repeated incorporations of pre sleep stimuli or suggestions and high frequencies of semantically equivalent or similar (so-called “interrelated” contents, regardless of the number of awekenings, sleep stage, or delay between awekenings.  Both types of findings indicate that the activation of memories is not random, but oriented by some concerns and/or relationships with previously accessed information.”  Following Stickgold and  colleagues Cipolli et. al state “the triage model, which posits that salient information is “tagged” for consolidation by emotional arousal, future relevance, and/or deliberate intention, stems from the evidence that the negative emotional tone of items of autobiographical memory fades faster over time than positive one.  Accordingly, sleep should provide a sort of overnight therapy for conflictual waking events and their negative emotional charge”.  This researchers fail to mention the obvious: that the lab situation can serve as a holding environment (despite the electronics and cables) with benign attachment figures/researchers that end up serving as therapists. (Freud called this the joint team between healing and research). Other lab research subjects can experience this same situation as “being a guinea pig” or still others as an opportunity for love or romance (Freud would smile).  It depends on their transference dispositions. Not by chance did William C Dement (1999) (the famous sleep researcher) find his wife in these circumstances.

Cipolli and colleagues (2016) finish their elaboration of the research of the cognitive processes involved in dream generation and recall by stating “a) dreaming is not simply a function of the consolidation process of recent information, either replayed or associated with older memories during dreaming and b) that only a part of the neural activity underlying dreaming, which is distributed across several cortical and subcortical structures, is influenced by the brain structures subserving different memory systems”.  They further add as a take home point  “Intracranial sleep recordings and high density electroencephalography have provided new insights into dreaming during various sleep stages and “off line” mental experiences in waking.”

Finally something has to be said about the fact that there is a correlation between the transference displayed in narratives of dreams and the transference displayed in narratives of previous interactive life experiences as measured by semi quantitative methods like the Core Conflictual Relationship Theme Method (Luborsky and Crits-Christoph 1998).  This is important because it shows that the emotional dispositions that underlie the transference processes are active during the night while dreaming, not as secondary random phenomena (as Hobson would imply) but as elements that make sense and are coherent with the waking preoccupations/ conflicts of the individual (see Cipolli et al immediately above).  These results also show that dreams may not be the only or the royal road to the understanding of the unconscious, which may be in keeping to Hobson’s recent assertions (see above). To this we can only say that plots of dream experience is to plots of waking life experience, what a sung out lyric is to prose: it may deliver similar information, but it does so in a more succinct, authentic, striking and creative way.

Coda: A note on Consciousness
I define consciousness here as “the subjective feeling of experience” (Gazzaniga, 2018, pg 135) or the “subjective feeling of existence” (pg143). In the previous sections I discussed experience predominantly in the dream state, but what follows will be focused predominantly on the waking experience. 

Human beings brains receive information from the outside world and the inside world. The sensory organs of odor, audition, vision, touch (delicate touch, pain, temperature, pressure, vibration), position of the body in space as related to gravity and movement (vestibular system) are mostly related to the outside world.  The gustatory sensory system signals the qualities of food (nourishment) we incorporate from the outside world to make it part of our own bodies. It is located at the gate between the inner and outer worlds. 
In the same way as we distinguish between exteroceptive sensitivity and proprioceptive sensitivity (receptors in muscles and tendons, autonomic sensory supply of the intestines), we can subdivide the motor system into an environment oriented ecotropic somatomotor system (striated, voluntary muscles) and an idiotropic visceromotor system (smooth intestinal muscles)  (Modified from Kahle and Frotscher 2003). 

Our ancestors and ourselves have to invest in the development of executive functions (mostly prefrontal cortex) muscular and aggressive coordination of the body to defend and acquire the nourishment we need.  We usually move out of our home base to bring some nourishment back again (EO Wilson 2015). At first human beings moved around associated to each other as a tribe (nomadism) to hunt and gather, and only subsequently started forming sedentary settlements (the origins of the Neolithic). Human beings usually associate with each other to defend themselves from others (as a family, group or nation) at the expense of others (families, groups or nations) and the environment.  This is the natural way to be that is common to most human beings and most social animals.
As Antonio Damasio points out (2010 pages 172-174) during wakefulness the brain has to select relevant information from the outside world out of the myriad “images” that come from the exteroceptive system.  He talks of an unconscious that is made up of two ingredients: “an active ingredient, constituted by all the images that are being formed on every topic and every flavor, images that cannot possible compete successfully for the favors of the self and therefore remain largely unknown; and a dormant ingredient, constituted by the repository of coded records from which explicit images can be formed”.
The selective process is the consequence of several conditions. “First, the brain constantly produces an overabundant quantity of images.  What one sees, hears, touches, along with what one constantly recalls- prompted by the new perceptual images as well as by no identifiable reason- is responsible for large numbers of explicit images, accompanied by an equally large retinue or other images related to the state of one’s body as all this image- making unfolds.
Second, the brain tends to organize this profusion of material much as a film editor would, by giving it some kind of coherent narrative structure in which certain actions are said to cause certain effects.  This calls for selectingthe right images and orderingthem in a procession of time units and space frames. (    )….
Third, only a small number of images can be displayed clearly at any given time because the image-making space is so scarce: only so many images can be active and thus potentially attended at any given moment.  What this really means is that the metaphoric “screens” in which your brain displays the selected and time-ordered images is quite limited. (   )….
The three constraints (abundance of images, tendency to organize them in coherent narratives, and scarcity of explicit display space) have prevailed for a long time in evolution and have required effective management strategies to prevent them from damaging the organism in which they occur.  Given that the selecting of images was naturally selected in evolution because images permit a more precise evaluation of the environment and a better response to it, the strategic management of images likely evolved bottom up, early on, well before consciousness did.   The strategy was to select automatically those images that were most valuable for ongoing life management- precisely the same criterion presiding over the natural selection of the image-making devices.  Especially valuable images, given their importance for survival, were “highlighted” by emotional factors.  The brain probably achieves this highlighting by generating an emotional state that accompanies the image in a parallel track.  The degree of emotion serves as a “marker” for the relative importance of the image.  This is the mechanism described in the ‘somatic marker hypothesis’.”  He goes on to say the emotions can become conscious as a feeling and serve adaptive purposes, or can be unconscious, or what he calls “covert, emotion-related signal of which the organism is not aware, in which case we refer to it as a bias”.  The reader can infer from this that mental illness is not adaptive and is detrimental to the individual, when covert biased based emotions dominate the picture.  We will come to this again below when we consider values in social interactions.
In their concluding remarks to a recent paper, Damasio and Carvahlo (2013) follow Pankseep by stating: “The advent of feelings (the sensory signals of the interoceptive senses in relation to exteroceptive information and the expression of feelings to the outside world-emotions) was simultaneously the advent of the mind. Early organisms capable of feeling were, for the first time in evolution and unlike all other life forms, aware of some aspect of their own existence” (…) which paved the way for the establishment of higher levels of cognition and consciousness.”  In this interesting paper these authors list the different brain regions that subserve feeling states along the evolutionary continuum that ended in the human brain.    “These regions can be found at all levels of the neuroaxis.”  The dominant structures in this regard are: “the nucleus tractus solitarius, area postrema, parabrachial nucleus, ventral tegmental area, other monoamine nuclei, substantia nigra and red nucleus, periaqueductal grey, the deep layers of the superior colliculus and the hypothalamus (all in the brainstem) in relation to other areas like the nucleus accumbens (hedonic qualia) amygdaloid nuclei (involved in flight or flight reactions of anxiety), and the most recently evolved structures that include the insular cortex (which modulate information which is generated in the brainstem via thalamic relay) and the parietal somatosensory cortices SI and SII (which also modulate neural signal from below and the damage of which, in the rhesus monkeys and humans causes emotional lability).”

Continuing with his book, “Self comes to Mind” Damasio goes on to write (2010, pg 175-176) : “All of the above strategies, I submit, began to evolve long before there was consciousness, just as soon as enough images were being made, perhaps as soon as real minds first bloomed.  The vast unconscious probably has been part of the business of organizing life for a long, long time, and the curious thing is that it is still with us, as the great subterraneum under our limited conscious existence.

Why did consciousness prevail, once it was offered to organisms as an option?  One possible answer, which we will consider ( ) is that generating, orienting, and organizing images of the body and of the outside world in terms of the organisms needs, increased the likelihood of efficient life management and consequently improved the chances of survival.  Eventually consciousness added the possibility of knowing about the organism’s existence and about its struggles to stay alive.  Of course, knowing depended not just on the creation and display of explicit images but in their storage in implicit records.  Knowing connected the struggles of existence with a unified, identifiable organism. After such states of knowing began to be committed to memory, they could be connected to other recorded facts, and knowledge about individual existence could begin to be accumulated. In turn, the images contained in knowledge could be recalled and manipulated in a reasoning process that paved the way for reflection and deliberation.  The image-processing machinery could be guided by reflection and used for effective anticipation of situations, previewing of possible outcomes, navigation of the possible future, and invention of management solutions.
(     )
The difference between life regulation before consciousness and after consciousness simply has to do with automation versus deliberation.  Before consciousness, life regulation was entirely automated; after consciousness begins, life regulation retains its automation but gradually comes under the influence of self-oriented deliberations.
The brain processes that are responsible for consciousness and deliberation are important only important at the end of the day by judging their outcome.

Thus the foundations for the processes of consciousness are the unconscious processes in charge of life regulation- the blind dispositons that regulate metabolic functions and housed in brain stem nuclei and hypothalamus; the dispositions that deliver reward and punishment and promote drives, motivations, and emotions; and the mapping apparatus that manufactures images, in perception and recall, and that can select and edit such images in the movie known as mind. Consciousness is a late-comer in life management, but it moves the whole game up a notch.  Smartly, it keeps the old tricks in place and lets them do the journeymen jobs.”

In this same book (2010) Damasio notably gives some credit to Freud, but hardly mentions developmental psychology, especially the developing infant and how primordial interactions, starting with the embryo-womb, continuing with a a fetus-womb, with a dreaming brain, that turns out to be a baby that is born to an environment with which she or he mostly helplessly interacts (at first) sometimes with some effort or trauma, which may create or not automatic emotive memory traces, mostly unconscious which may be or not biased emotions (his term), which may tag or not the exteroceptive system and convert themselves in transference dispositions (psychoanalytic term) which are mostly unconscious, and may sometimes overdrive the conscious management system sometimes in detriment of the individual or others.

The cognitive based approach that he ascribes to reflection, and learning from experience, developmentally has its roots in infancy when parents and caregivers lovely (in a good enough environment) play with their infants, toddlers and children, preparing them for future challenges (see the function ludique of dreams that Freud mentions above).   
If down the line, the person turns out to be mentally ill, therapists and psychiatric providers should dominate the situation where negative emotions run the show, nourishing patients creative forces in alliance with their repressed emotions (in Super ego dominant illnesses), or placing structuring and limit setting rules (in the Super Ego or ego deficient illnesses) while at the same time validating the other side of the personality, seeking integration.

It is no secret that almost all, if not all therapists and psychiatric providers learn to cope and managed to complete a difficult professional training, despite the problems they faced while growing up (Freud was no exception), and have suffered at one time in the similar or lesser degree what their patients are suffering.   A good part of us are good willed persons trying to be recognized enough to have patients and live from the profession.  Sometimes, ambition may be hypertrophied, for example in Freud, when we learn in the Interpretation of dreams (1900) that his father reprimanded him as a child for urinating from the house balcony or parental bedroom and stating to the young Sigmund he will turn out to be no good as an adult.  Damasio’s recurring  ‘soft nightmare’ (2010 page 177) that for some reason or other he would be unable to arrive on time to give a lecture (as famous as he is) may have similar developmental roots as well.  Both researchers of the mind have proven the obstacles wrong.

Continuing with the nuero biological basis of consciousness, as physicians and biologists we are well aware that without brains (say by head trauma, anesthetics, brain injury, this or that medical disease, and this or that substance in our blood) our consciousness of our selves, the environment and their sequence in time related to others, other living beings, persons and objects, and the recall of this events may be altered or disappear.
Consciousness may be an emergent property of neural circuits firing synchronously at some times and asynchronously at others (Llinás 1988, 2001).  Some brain structures may be more important in this regard than others: the claustrum may be important, as C Koch and F Crick thought back in 2005, or the high association areas like the posteromedial cortices as Antonio Damasio pointed out in his book “Self comes to Mind” in 2010 (page 217) in relation to the hippocampus.  The neural networks subserving language in the left hemisphere (Gazzaniga’s verbal interpreter 1992, 2011) may be important in fabulating after the fact a narrative of our actions, while the habit performing brain (where the right hemisphere has preeminence in association with the reward system of the Ventral tegmental area and the nucleus accumbens, in conjunction with the thalamo-cortical circuits, basal ganglia, the limbic system- and the anterior cingulate sulcus, this last location, the seat of free will per F Cricks “The Astonishing hypothesis” (1994) may be responsible for the felt and covert emotions that A. Damasio talks about (see above) and guide our actions. Gazzaniga (2018) follows Pankseep and other researchers pointing out that the midbrain, and other subcortical structures subserving emotional states which guide behavior are shared across a greater number of species and interact in a layaered way with the newly phylogenetically speaking modular neocortex.  G Edelman thought (2004) that the stabilization of some thalamo-cortical circuits (reentry) is important as the substrate of conscious experience after being selected from other less competent ones. 

Regarding the neural correlates of consciousness, Koch, Massimi, Boly and Tononi (2016) recently have pointed out to the “posterior cortical hot zone that includes sensory areas, rather than to a fronto parietal network involved in task monitoring and reporting.”
Previously Tononi and Koch (2015) published a paper that showed how their model of “integrated information theory”, although somewhat complex, can serve as a testable theory that can explain many aspects of the neural correlates of consciousness.

Recently the importance of the claustrum has regained impetus. David Gurwitz in an internet comment to this research has noted, citing the work of Chau and colleagues, that this structure may be more important in regaining than maintaining consciousness.  I would add, that the old discovery that reticular activating system in the brain stem is the most important structure maintaining upper level circuits, still holds (Please see a review of the anatomical basics of consciousness in Hal Blumenfelds 2016 review). 

Anil Seth in his TED talk in Vancouver April 2017, states that consciousness is an active process whereby the brain has “controlled halucinations” of the world and the self to “predict ourselves” into existence, ie to navigate the world, survive and reproduce.

A very good review by Jane Epstein and David Silbersweig (2016) of the neurobiological correlates of motivation and its disorders, allows the authors to build a psychology (which may include consciousness) and a psychopathology.

So far so good, regarding the brain and its structures, and the seat of consciousness. But brains and people don’t live in a vacuum. In their excellent article “Cosnciousness: here, there and every where?” (2015) Tononi and Koch counter panpsychism and acknowledge that reportability (which include verbal social interactions) is usually the condition by which we consider that the other has a conscious experience. In this line of reasoning, they acknowledge the importance of behavioral correlates of consciousness. Sometimes reductionistic endeavours forget that the normal environment in which the brain is at home is in relation not only to things in the environment, but most importantly people, ie it is social. As Levi-Strauss pointed out in 1949, culture is the natural environment of the human being.

Gazzaniga (2018) is critical of the localization theories of consciousness. Although he acknowledges that there are modules with a specific function in the brain that have a structure that can be localized, these modules work in a layered fashion with other modules. In his view there is no single structure responsible for consciousness.  Consciousness is inherent throughout the brain. (pg231) and is difficult to stamp it out when one area of the brain is damaged. If you you lose one module you lose that modules contribution to experience, but consciousness persists. Each module can be responsible for a sense of experience that works in concert with other modules in a coordinated fashion along time scales, like bubles of air coming up in boiling water. He currently has been abandoning purely nativistic or materialistic point of view and tends to follow his mentor Roger Sperry who thought the brain had emergent properties and functions we call the mind when he writes: “If living systems work on the principle of complementarity- the idea that the physical side is mirrored with an arbitrary symbolic side, with symbols that are the product of natural selection-then purely deterministic models of what makes life will fall short.( )The symbolic representations within this system, with all their flexibility and arbitrariness, are very much tied with physical mechanisms of the brain. Ideas do have consequences, even in the physically constrained brain. No despair called for: mental states can influence physical action in the top down way!” (pg235).


In his TED talk in Vancouver, March, 2014, David Chalmers states that neurological correlates of consciousness don’t explain the subjective inner movie we all experience in our daily lives. Neurobiology explains behaviors, but he states “why is this or that behavior accompanied by subjective experience” is the hard problem of consciousness that cannot be explained by neurobiological reductionistic endeavors.  He states consciousness is a fundamental building block of nature ascribed to information processing systems.  His other assertion that consciousness can be ascribed to all physical things, e.g. a photon is more difficult to follow.
Dan Dennett thinks that subjective experience is just an illusion, that our brains tricks us to have in order to move and interact in the world, survive and adapt.
Gazzaniga (2018) on the other hand thinks that the principle of complementarity derived from Quantum Mechanics, specifically Niels Bohr, that quantum objects have complementary properties that cannot be measured, and thus known, at the same time can help us understand the mind/matter, subjective/objective gap.  He follows Pattee stating that this is an epistemic gap derived from the nature of living beings that is traceable to the origin of life when the first cell differentiated itself from its surroundings.

In the behavioral sciences, the way you search for information about the others mind determines or influences the information you gather. The act of observation is tied to the “facts”.  In human interactions symbols and meaning are usually consensual, that is social.

As a physician I tend to concur with John Searle (1997) in that only living beings with a nervous system have conscious experiences as we know them.  This kind of thinking goes back to the first half of the twentieth century or even before (Henri Ey 1963). The thermodynamic laws that living beings are subject to, that is, the metabolism of an inner milieu that sustains an organism at the expense of an abiotic and biotic surrounding world gives living beings their characteristic.  Neurobiology is a si ne qua non for conscious experience as we humans know it, but it is not sufficient, as I argue in this paper.

Even the anthropoid robots that are currently being developed in Japan and other civilized countries may be able to engage in a conversation and move about, but in the end would only be able to have behaviors, including reporting that they have experience or sensation.  Even if they are programed to search and maintain energy input to have them functioning and report to human beings they have a low battery, we can hardly empathize with this. This will be the closest machines can get to our conscious experience but it is nonetheless intriguing.  Additionally they wont be able to experience dilemmas in their behavioral output (it is all preprogramed) or conflicts.  They can only have errors and report or express they are having them.  Gazzaniga (2018) has the same point of view.

In the discussion between nature versus nurture regarding the construction of a persons cognitions and dispositions to action, the earlier Gazzaniga (1992) and Pinker (1997) leaned towards nature. Gazzaniga writes (1992): “While the environment may shape the way in which any organism develops, it shapes it only as far as preexisting capacities in the organism allow”. No wonder the title of his last book is called the “The consciousness instinct” (2018). I concur with this statemtent but tend to go with John Bowlbys one (1982), which states that behavior is like area (the result of height times width) that is, a product of nurture and nature. If it wasn’t for the womb, the embryo would not develop.  The nativists tend to have too much for granted.  They don’t see patients and their families with their struggles and sometimes severely conflictual inner worlds and relationships which may be perpetuated from one generation to the next.  Take for example a depressed mother after birth of her child.  It is well documented that this suffering mother can influence the newborns bonding and development. But the nativists have something right: in some behaviors and personality characteristics and phenotypes, genes have the handle and may be more impermeable to environmental interventions while in other behavioral patterns and phenotypes, the environment may be more important. Developmentally, there are critical periods in which environmental factors shape behavior and in the psychoanalysis of severely disturbed patients, the degree of regression that the psychotherapeutic situation allows and permit access to those critical periods has sometimes to be balanced with the severe acting out or “shooting to the own foot” of the patient that requires pharmacologic or other types of contention or “holding” measures.   
Alan Jasanoff (2018) recently released a book “The Biological Mind” that is critical of the neuroscience that studies the brain, the minds and the individuals in isolation.

Society and culture where brought about by evolutionary processes, but social and cultural processes shape our environment in which our brains interact with. There are artificial factors promoting which biological constitution can be successful not only in human organisms but in other species as well (Laland et al, 2014). We abandoned our environment of evolutionary adaptedness (the African savannah) and now we are dealing with social and environmental challenges not encountered before.   The internet and the social media is just an example. 

Additionally culture plays a role in how behavior deviation is conceptualized.  In North America most patients think, that the problem is not in how the individual and family displays their relationships, but in the patients brains and neurotransmitters.  The pharma industry goes with this and promotes it in the mass media, diminishing the importance of the psychotherapies.  In peer reviewed Journals valuable research is the one that mostly underscore reductionistic endeavors concordant with the mass media. North American dominant permissive culture tends to state: “I behave like this, I was born this way, my genes and brain and neurotransmitters determine this, I am not responsible for anything. I am not amenable to change”.  In 1994 a visiting mental health professional from the US in Germany was astounded on how the same type of patients were treated with therapy instead of medications. For a review of the social factors in mental health please see Compton and Shim (2015a and 2015b).

I will finalize this note on consciousness with a sobering statement. Those who ruthlessly seek status, property, and resources for them and their group, nation or family at the expense of others should counteract these impulses with what religious traditions have taught us over the centuries.  Social human values are important and are in continuous flux and conflict with higher social ones. We have the dominant or conventional cultural values and other higher values, which may be more difficult to put in practice, and which run contrary to the dominant ones. The dominant values usually can be explained by the evolutionary underpinnings of emotions and feelings in our brains that can be extrapolated from animals to human beings.  Higher values, which up to certain extent are also biologically rooted, enable the individual to constructively change their social environment and criticize society and sometimes require restraint. Our actions have consequences in the environment and others (a fact we should not be blind of).

The origins of guilt may be important for restraint.  The origin of the mental representation of guilt lies in the beginning of social situations: the mother infant relationship. The excellent article by Hugo Lagercrantz and Jean Pierre Changeux (2009), from the Karolinska institute and the Institute Pasteur, which show that before 6 months infants don’t exhibit a P300 evoked potential wave after a stimulus and that before 7 months their working memory is non functional.  But these last authors report how the fetus, newborn and infant prior to six months, show signs of experiencing stimulus and react to them, albeit with a primordial, mostly subcortical consciousness (at least that is how we infer the research findings). This body of work gives credence to the work of Melanie Klein (1937) and her followers, regarding the primordial origins of the sense of guilt in the human being after six months of age when these mechanisms are in place.  The mechanisms of memory allow the infant to make a unified experience of on the one hand the life protecting and nourishing giving mother and on the other, the moments of despair and frustration that are also part of the same care to which the infant reacts aggressively.   This unified experience is the building block of the sense of guilt and the future motivation for reparation.
The subsequent development of the moral sense of the individual is related to the individual experiences in the subsequent social interactions, usually the family of origin and the structure setting and limit placing father figure as psychoanalysis has taught us.
Social rules and laws allow order in functioning groups and social coexistence but require restraint and repression of excessive unreasonable (sexual or aggressive) parts of our selves.  Freud was aware that sometimes this sense of guilt could be at the same time exaggerated and faulty in a pathological sense, including some religious individuals.   Religious education can be enlightening in a social sense but if exaggerated can contribute to a pathological guilt related to sexuality. Although religious education may be important to bring about a moral sense and purposeful life in an individual, atheist and agnostic morality can be sufficient if it acknowledges the importance of higher social values.  You don’t need to be religious in order to be a good person or try to make amends and be a better person in the future. (Also, individuals and groups can divide cummunities and be destructive despite ascribing to a religious group or not). But the religions over the centuries, understood in a non-fundamentalist sense have taught us that we can go beyond our tribalism (including our belief system in-group) and our evolutionary determined basic drives to serve a higher purpose (Dalai Lama 2010).   An agnostic, or atheist spirituality my come close in this sense (Comte Sponville 2006).

 It can happen that our self-esteem may increase if we preserve the natural environment for future generations, or we help the other nation, the other(s), the foreigner, the immigrant, the poor, the medically or mentally ill and marginalized.  The description of Jesus and his teachings as described in the Bible is the best example of this, even if some consider this just fiction.  He goes beyond the golden rule. It is unreasonable in the sense that it is out of the ordinary, non-natural and non-tribal. 

We need our brains, sensory organs and bodies to be conscious and since the beginning of our lives we are confronted with social experiences that prompt or hinder empathy (which is mostly biologically based) and good actions. Non-fundamentalist religious teachings can move the individual to promote community wellbeing, solidarity, tolerance and a better world. Fundamentalist views regarding faith, including those of some atheists, and muslims may have the opposite effects. It is also true that you don’t need to be an atheist to be interested in science and its methods. George Lamaitre was an example of this.  Additionally you can be a scientist and at the same time be interested in religious issues. Newton was an example of this. 

Religious persons have to prove they can behave in a better way than non-religious persons. 

There will always be conflict (at the individual and social level) between these two forces: sometimes favoring other(s) at the expense of the self (as Christ did, as stated in the Bible) sometimes favoring the self or in-group at the expense of the other(s). 

With John Lennon I dream of an imaginary time when no individual or group sacrifices are needed, when violence between individuals, groups and nations can be kept in check and controlled from within, when solidarity is the norm and not the exception. With Beethoven (ninth symphony), I dream of a brotherhood of human beings that respects our natural environment and home planet.