RECONNECTIONS:

AN EXPLORATION OF

THE FUNCTION OF DREAMING

THESIS FOR THE COMPLETION OF:

THE AMSTERDAM MASTERS OF MEDICAL ANTHROPOLOGY

POLITIEK EN SOCIAAL CULTURELE WETENSCHAPPEN

UNIVERSITEIT V AN AMSTERDAM

THESIS SUPERVISORS:

PROF. DR. J.N. SCHREUDER

PROP. DR. H.U.E. THODEN V AN VELZEN

DR. H. TEN BRUMMELHUIS

MARIANNE VYSMA

FEBRUARY, 2001

I I I

I !

ACKNOWLEDGEMENTS

First and foremost, I would like to thank the people who shared their stories with me,

for patiently answering my often intrusive questions to the best oftheir ability, many

times in great pain. My thanks also goes to the interpreters who sbared this charged

space with us.

I would also like to gratefully acknowledge the Susan Bach Foundation of Zurich,

Switzerland for their grant-in-aid which supported this project.

I am, of course, very thankful to the clinic De Vonk for allowing me to conduct my

research on their premises, especially since my project fell outside of the usual

'stage' procedures. I showed up more or less unarmounced in the middle of the

vacation period, was there at irregular times, and disappeared again much the same

way. Because of the extreme personal discomfort I experienced during the

interviewing process, I am afraid I must have often seemed to be an awkward

presence in their midst. Nonetheless, I was shown unvarying kindness and respect:

the staff continued to inquire with interest about the aim and progress of my research

and tolerated the intrusions of my interview times into their regular schedules with

the patients.

In particular, I would like to thank: Peter Ventevogel, who 'thought along with me'

in the embryonic stages of the project, and who introduced me around the clinic;

Marianne Spape and Els Overmars, of 'het Secretariaat', who coordinated the various

administrative details during my time in de Vonk; a special thanks to Emmy van

Bourgondien, who was invaluable in her effcient scheduling (and rescheduling) of

clients and interpreters; the sociotherapists, individually and as a group under the

direction of Frieda Kooij, who were actively supportive towards me, and from whom

-through observation of their firm and concerned ('betrokken'), though wholly

unsentimental, attitude towards the patients and their pain- I learned much, even if

they may not have realized that; Hans Rohlof and Ronald Rijnders, the staff

psychiatrists under whose day-to-day responsibility I conducted my interviews; and

Roe! Evertse, who absorbed the financial consequences of my research into de

Vonk' s budget.

I am indebted also to my advisors. The most important of these debts is to Bas

Schreuder, whose Amma lecture was the initial spark that fused the various strands

of my personal interests into an idea, and who then, with his inimitable combination

of calm and enthusiasm, with concrete questions that grounded me and a genuine

delighted concentrated interest in my conundrums and progress, guided the project to

completion.

Also a heartfelt thanks to Bonno Thoden van V elzen, who put his immense

anthropological knowledge at my disposal, but who was most helpful to me in his

bemused naming of the transference which encouraged me (at long last- though he

could not have known that) to use my own voice, to write what I needed to write.

And to Han ten Brummelhuis, for his careful reading of the first attempt and his

comments and suggestions that helped shape the final draft.

And my gratitude for the conversations with Unnikrishnan Payyappallimana, Laura

Ciaffi, Barbara Miller, Noa Loevy, and Robert Strubel whose warm attentiveness

sustained me during the long struggle to give birth to this thesis.

TABLE OF CONTENTS

I. INTRODUCTION Anthropology and psychoanalysis A personal note

!I. RESEARCH QUESTIONS AND THEIR CONTEXT

Ill. LITERATURE REVIEW Sleep and dreaming: the biological perspective Sleep and dreaming: the anthropological perspective Sleep and dreaming: the psychoanalytic perspective

IV. METHODOLOGY The venue Study population Overview of patients and interviews

V. SLEEP AND DREAMING FOR PEOPLE WITH PTSS A phenomenological description of the

sleep of people with PTSS A phenomenological description of the

dreams of people with PTSS

VI. RECURRING EXISTENTIAL THEMES IN PEOPLE WITH PTSS

VII. DREAMS AND DREAMING IN NORMAL CIRCUMSTANCES

VIII. DREAMS AND MEANING

IX. RECONNECTIONS

APPENDICES A. Abridged transcripts of interviews

Man, 31, Serbia Man, 33, Zaire Woman, 27, Angola Woman, 33, Ethiopia Woman, 39, Sierra Leone Man, 53, Chechnya Man, 3 7, Iraq/Koerdistan Woman, 33, Afghanistan

B. NITE Questionnaire

C. Sample of patient explanation

BIBLIOGRAPHY

I 2

6

8 8 10 12

14 14 15 17

19

19

24

29

32

35

44

48 48 50 51 53 54 56 62 65

65

66

67

I. INTRODUCTION

I undertook this study to begin to explore the notion that dreaming has a function. As

far as we can tell from the anthropological record, this idea is an intrinsic assumption

in many different cultures, including in our own during previous times. Currently,

psychoanalysis is the only generally accepted discipline in the West which has a

fully worked-out theory on the function of dreaming. Although there are ideological

distinctions among the various schools, each of them makes use of dreams as a an

avenue of indirect communication, especially in regard to aspects of the transference

relationship. However, psychoanalysis exists on very uneasy footing with the West's

emic epistemology which relies heavily on the scientific method with a decided

biological emphasis. Nonetheless, even in scientific sleep research, there is emerging

evidence that dreaming- or rather: a specific sleep phase during which a certain kind

of dreaming occurs- has a function in maintaining the human organism.

Dreaming itself is of course beyond investigation because it is a personal experience

taking place during sleep. The dream experience can only be made accessible for

research via dream reporting.

1.1 Anthropology and psychoanalysis

Psychoanalysis with its fundamental assumption of a dynamic interaction between

the conscious and unconscious, both within the individual as among people, is, as

many people have remarked, both a way of looking at the world as well as a method

of healing. Medical anthropology too has its two sides: one that aims at examining

and describing the multifaceted approaches and strategies to illness and healing; and

a second, more activist and applied wing that is aimed at using such understanding in

order to combat disease and promote health- mostly in 'other' countries and

cultures. I began this project firmly on the heuristic side of both disciplines, and I

hope that is where I more or less ended up. However, in the middle, confronted as I

was with the suffering of the people, and aware of being identified with the context

of the clinic, I became increasingly entangled in the applied orientation of medical

anthropology, and the psychotherapeutic part of psychoanalysis. At its lowest point I

encountered what had up to that point been an unconscious motivation: that of

I

wanting to 'prove' that the dreams of trauma patients had 'meaning' that could be

used therapeutically to help promote healing.

That notion was sheer hubris. Both for reasons of impossibility: in one short project

one can not hope to 'prove' anything but perhaps at best only to sharpen the

questions; and also because it was unnecessary: the patients at the clinic were being

helped very well. In the following section I want to take a brief detour to describe the

subjective arc of my experiences, because in the end, it served the purpose of

differentiating the themes that were important in the writing and analysis of this

project.

1.2 A personal note

All in all I did 14 interviews, each lasting more or less one-and-a-half hours.

Everyone of those nearly 20 hours of talking was very difficult for me. Difficult in

the sense of: agonizing and disorienting, so much so that at one point I seriously

considered abandoning the research.

Part of it was the confrontation with the horror. Each one of the patients had

experienced abominable things. Repeated rape. Beatings. Mutilations. Confinement

without food, water, or sometimes even light. Being a witness to the violent death of

loved ones, children, siblings, parents, comrades - and the inexorable feelings of

guilt and helplessness that results. These were terrible stories and hearing them was

difficult, more difficult than I had expected. After all, I had read a great deal of the

literature, not only the professional literature, but also a number of books in the

dismal- and growing - canon of memoirs from survivors: from the holocaust, from

the Stalinist camps, from China, Chili, Cambodia; from South Africa, Bosnia,

Ethiopia, Morocco; from the journalists taken prisoner in the Middle East. And the

particular story of each of the persons I talked to was already in their case-file. But

being in the presence of the pain of such experiences is much different than reading

about them. This was not an 'other'. In all fundamental respects this was a person

like myself and it overwhelms the imagination to realize that people can experience

such things and still look and act the same.

2

Nonetheless, while that was difficult, it was not the core of my discomfort. Most of

the people in the helping professions working with trauma must experience such a

period of inoculation, as it were. During that time one finds an attitude that can be

summed up under the rubric of' doing the best one can', however differently each

individual or professional grouping (psychiatrist, psychotherapist, nurse, social

worker) may define that. Or not. Those people usually find another line of work.

But even though I am an psychotherapist (a Jungian psychoanalyst in-training) in

these interviews I was not, in fact, present as a member of the 'helping professions'. I

was there as a researcher. And I was asking about dreams. Drean1s belong to the

most intimate of human expressions because they provide a vista into the inner world

of a person, a world that is normally hidden, often even from himself. All literature

on dreams, the anthropological, the psychological and the historical, contains an

imp licit assumption that the telling of dreams to another is an appeal for help in

decoding its meaning. Yet my research scheme called for me merely to record the

dreams, not to engage in a discussion about the contents.

Other anthropologists who have done ethnographic dream research have encountered

this problem and recent literature on the topic has contained a lively discussion on

the issues of transference and the 'temptation of the investigator to change roles and

become the healer' (Kracke, 1999). I had thought my awareness of such pitfalls and

the precaution of only talking to patients who were already in a therapeutic

relationship would be sufficient to keep me from this blurring of roles and sometimes

that is bow it was. Other times, however, that proved not to be the case. Inevitably, I

found myself, at various times, responding to the dream images and the emotions

they embodied and called up.

Nonetheless, this created a situation where I was 'damned ifl did, and damned ifl

didn't'. Trauma dreams, as this thesis will show, are a category of experience, akin to

reliving the trauma situation. By asking them to tell me such dreams, I was laying

bare the wound (trauma, it may be recalled, is the Greek word for wound). Ifl did

not respond and merely listened and recorded, I felt- it is an ugly but accurate image

-as if I were poking in the wound without offering anything in return. On the other

hand, ifl became engaged with the person in this situation, I felt as ifl were starting

on something, a therapeutic conversation as it were, which I already knew I would

3

not be able to finish adequately because two meetings are hardly sufficient for any

sort of therapy.

When I confided these misgivings to several of the clinic staff, including one of the

supervising psychiatrists, the response was supportive and also contained a

reassurance along the lines of, 'But you are giving the patients a chance to tell their

story, you are giving them empathic attention, and that alone could be of therapeutic

value'. That, it slowly emerged, had been my unconscious assumption as well, but it

contradicted my experience in these conversations. Again and again I felt as if I were

violating the basic rule of anyone coming in contact with the wounded or the ill or

the suffering: 'First of all: do no harm'.

Eventually I realized that I had unwittingly stumbled into an ongoing debate in the

field of trauma treatment which has been there since the beginning more than a

century ago. A full discussion is beyond the scope of this thesis, but, briefly stated, it

concerns the value of verbalizing and thereby discharging pent-up, distressing

emotions, a process known as abreaction. One side holds that abreaction can provide

much-needed relief, it is also sometimes called a catharsis, for a trauma victim,

whereas another side cautions that, under certain circumstances, to encourage or

induce abreaction is not only useless but can often be harmful, because it disturbs an

attempt at psychic organization aimed at maintaining homeostasis. (For a fuller

discussion see: van der Kolk, 1996, chapters 12 and 13). During the course of my

interviews I traced the arc of that discussion, starting out on one side and ending on

the other. I will expand on the reasons in the final discussion section and I mention it

here only because it sheds some light on the extreme discomfort I felt during the

interviews.

All this is evidence of the recurring subjective/objective conundrum so central to the

epistemology of, among other fields, anthropology and psychoanalysis. Because I

prohibited myself from stepping in the therapeutic role, it is as ifl denied myself all

marmer of subjectivity. By which I mean that instead of creating a shared subjective

space, I made the mistake of holding myself to the scientific ideal of maintaining an

objective attitude. Initially, that is. Eventually I realized that such an ideal is

impossible for me to attain because I do not believe in it Aptly the change was

ushered in, in part, because of my own dreams. Since the topic of this thesis is

4

dreams, I want to briefly mention that, in the course of interviewing and writing, I

dreamt about most of the patients I interviewed- several times about situations in

which they were helping me. It was as if I had to assimilate part of their story before

I could write about them, almost as an initiation rite.

I started this research in the full conviction that the content of dreams would contain

meaning that could be helpful to an individual, especially as it related to eventually

integrating the traumatic experiences. Although I found some compelling evidence in

support of this thesis, nonetheless the totality of my findings -which included the

statements and stories of my informants, but also my own subjective experiences in

asking the questions and hearing the answers- caused me to significantly temper this

in retrospect na"ive stance and furthermore even to place serious questions alongside

the whole concept of' integration'.

The following report aims to be a descriptive case-study that shows how persons

from various cultures who are all suffering from the after -effects of trauma,

experience and make use of their dreams.

5

Il. RESEARCH QUESTIONS AND THEIR CONTEXT

One of the main reason for choosing trauma victims for this study is based on an

axiom of biomedical science: pathology is the high road to understanding

physiology. It is easier to see how processes work by studying what happens when

things go wrong. This is true for both somatic as well as psychic processes, and

dreaming is at one and the same time a physiologic as well as a psychic process.

Dreams and nightmares- especially those repetitive ones featuring an element,

either experiential or affective- are one of the primary symptoms of patients

suffering from post-traumatic stress syndrome. Patients report experiencing such

dreams and nightmares as tremendously intrusive and as a barrier to resuming

normal life; it is often the pivotal symptom that moves a patient to seek help. In the

interviews for this study I tried to gather information on: the frequency and content

of remembered dreams of the patients; their culturally received notions about the

meaning and function of dreams; and what personal meaning they themselves assign

to such dreams, what interpretations they attach to its contents, and what, if any,

connection they make between the dreams, their suffering and their trauma

biography.

I did not, however, come to this study as a blank slate. Based on my professional and

personal experiences with dreaming and dreamers the study was informed at the

outset by two suppositions and a hypothesis (in that order):

• dreams have psychological meaning to the individual as a social being

• creating meaning is an essential ingredient in the recovery process of any

psychic illness or trauma, including post-traumatic stress syndrome; or:

creation of meaning is one of the defining characteristics in the difference

between acute and chronic post-traumatic stress syndrome

• dreams - including nightmares -have a function in creating meaning for the

trauma victim or survivor.

In order to begin to test the last item, the hypothesis, my three research questions

were:

6

• In what way and to what extent is the idiosyncratic (personal) meaning a

patieny assigns to nightmares or other dreams influenced by the notions of

dreaming in his or her culture of origin?

• Is it possible to recognize culturally specific elements in the content of the

dreams or nightmares?

• To what extent do persons perceive and experience dreams as

commnnication or a form of contact or message from outside the personal

self?

From the beginning I had a vague uncomfortable perception- like distant warning

drums -that at least the first two research questions were fundamentally flawed

given the design limitations of the study. I wonder if one can study culture in the

individual, and, furthermore, I doubt if one can even discern cultural elements in an

individual under siege (which is how a person suffering from the effects of trauma

comes across), especially not in just two exposures, the interviews. The course of the

interview process confirmed the intuition. The nexus of the conversations returned

again and again to what I identified above as the suppositions and hypothesis: the

relationship between dreaming and the trauma experiences. The suppositions should

have been (or perhaps unconsciously were) my research questions, and in what I

heard, not surprisingly, I found some evidence- sufficiently compelling to be

studied further- to support the hypothesis.

Accordingly, I would like to dispense with the first two research questions here at the

beginning. I did not find, in this study, any relationship between the meaning and

experience of dreams and the notions of dreaming in the culture of origin. And I

could not recognize any culturally-specific elements in the content of the dreams or

their associations around them. The answer to the fmal research question is much

more complex and is related, as the findings will show, to dreaming as a category of

experience, and I will return to it in more detail in the final discussion section.

7

ill. LITERATURE REVIEW

In the following, I will briefly: sketch some scientific findings about dreaming

derived from sleep research; provide an overview of some of the readings in dreams

and anthropology; and include a discussion of dreams from the psychoanalytic

perspective

3.1 Sleep and dreaming: the biological perspective

Sleep is a basic biological activity, and, therefore, a necessity for maintaining normal

life. Its disruption or absence can be both a sign and a cause of pathology. Sleep is an

altered state of being; we cease to hear, see or be aware of ourselves or our

surroundings. Like all unconscious activities, sleep can be seen in others, but

experienced only in retrospect. It is possible to say: I have been asleep, but not

possible to say: I am sleeping.

Though the amount of sleep changes as part of maturational developments, and there

are also cultural and seasonal variations (for example the custom of taking an

afternoon nap or siesta, or the increase of sleep in winter), the average adult spends

about a third of his or her life asleep, that is: eight of the 24-hour day/night cycle.

Sleep researchers have identified two fundamentally different types of sleep, known

as REM (from: Rapid Eye Movement) sleep and non-REM sleep. REM-sleep is

further characterized by electrical brain activity that is similar to the activity during

the waking state, as well as muscular atonia (a sort of sleep paralysis). Non-REM

sleep is also divided into successively deeper stages numbered one through four, the

last being the deepest sleep. We tend to sleep in 90-minute cycles starting with non­

REM sleep and then moving to REM-sleep. In the first two cycles of the night, non­

REM sleep stages 3 and 4 (known as 'deep sleep') are also present, though they

decrease or are absent in the latter sleep cycles. REM-sleep gets longer, that is: it

comprises a larger part of the 90-minute cycle as the night progresses.

8

Although it was initially assumed that people dreamt only during REM-sleep (and

one still finds this persistent mistake in some writings), experiments in sleep

laboratories show that, when woken up during REM-sleep, people report dreams 80

percent of the time, and when woken up during non-REM-sleep they report dreams

74 percent of the time. The types of dreams are dissimilar, however.

"Accounts of dreams from REM sleep are in general livelier, more complex, bizarre, and more highly emotionally colored than dreams from non-REM sleep, in which rational and realistic elements similar to waking thoughts prevail. Researchers who were not informed about the stages of sleep from which dream reports were obtained were able to distinguish dreams from REM and non-REM sleep solely on the basis of their content." (Borbely 1989:56)

There is also a third 'type of dream' reported by victims of trauma called nocturnal

re-experiencing in which the trauma repeats itself exactly as it happened. Such

'dreams' are characterized by 'hyper arousal', an increase in heart-beat, breathing

and breaking out in cold sweat, as well as disorientation upon sudden awakening,

often with a scream. While they can be recalled and recounted immediately upon

waking, there is often no memory of the event the following morning. Nocturnal re­

experiencing can be compared to sleepwalking or bedwetting and, like them, tends to

occur as the person moves out of deep sleep. (Schreuder 1999:73)

Victims of trauma report all types of dreams about their trauma: in what seem to be

REM-dreams, elements about the traumatic situation are woven into a new and

different narrative; in what seem to be non-REM dreams, a more straightforward

scenario of the trauma situation presents itself, often repetitively, with only minor

variations. In the case of both types of dreams they often report somatic reactions

such as sweating, a racing heartbeat, a shortness of breath.

REM-sleep and the dreaming that occurs during it have been the focus of most of the

interest of sleep researchers since its discovery in the 1930s because until then, sleep

had been conceived of as a resting state. Based on phylogenetic research thus far,

REM-sleep has not been found in cold-blooded animals such as reptiles (except

perhaps the crocodile) and fish, though in the warm-blooded animals birds and

mammals (with the exception of dolphins who sleep with one-half of their brain at a

time) it is possible to show 'paradoxical sleep'- so called because of the electrical

brain activity's similarity to the waking state. (Jouvet 1994:42) Ontogenetically, it

9

has been shown that REM-sleep occurs in the womb and comprises a greater amount

of total sleep in an infant than in an adult.

Why do we dream according to sleep researchers? A well-known French researcher,

Michel Jouvet proposes that REM-sleep updates our innate genetic material in light

of recent experiences and learning. He argues that unrefined instinctive patterns of

behavior are inborn and that REM-sleep dreams, by integrating new material, modifY

and increase the sophistication and complexity of such patterns. He calls this an

'endogenous phylogenetic learning process' (Jouvet 1994:92).

2.2. Sleep and dreaming: the anthropological perspective

Dreaming and the telling of dreams to another seem to be a universal human

activities. Over the ages, where there are historical records, and across all cultures, to

the extent we can determine from anthropological inquiries, there has been an

interest in narrating and interpreting dreams. For while the dream itself is a uniquely,

irreducibly individual experience, the experience is often so vivid that there is an

urge to share it, and in the telling, discover a meaning.

The 'I' that is suspended during sleep, is present in the dream. Nonetheless, there is a

clear sense of difference between the awake 'I' and the dream 'I'. This difference has

been given various cultural expressions. Many cultures posit a parallel world full of

spirits, those of living plants and creatures, as well those of ancestors and those yet­

to-be-born and one has contact with that world during sleep. Other cultures believe

there is a dreaming soul that leaves the body and wanders the world at night. In our

own culture, as, for example, the biblical story of Joseph testifies, we have in the past

believed that dreams were the vehicles for messages from God.

The literature on anthropology and dreams is comparatively small (though growing)

but very rich. However, a few general observations are possible.

i.) Dreams are a form of communication Whatever the source of dreams or the

ontological explanations of what happens to humans during dreams, one recurring

description of how the dream is experienced in waking life, is the sense of it being a

10

message. It can be a warning or an admonition or a revelation or an announcement,

either a comment on past behavior or a prognostication on future action. It is often

experienced, in short, as an obligation or invitation to pause and examine one's life­

actions, attitude or social relations -whether through introspection or consultation,

or both.

For example, among the Kagwahiv in Brazil 'dreams, like myths, are sources of

significant information about the nature of the world and the spiritual beings in it,

and, like myths, they are to be shared, puzzled out, and understood' (Kracke

1987:31)

ii.) The message is encoded requiring interpretation. We know another's dream only

when it is told to us, but even our own dreams are remembered better (or perhaps at

all) when they have been put into narrative language, when they have been moved

from multi-sensory images in which we experience them and are woven into a story.

The images themselves, and the affect they unearth through associations from

memory and cultural/mythological amplification, are richer than the text and

therefore need to be explicated. This is similar to what Freud meant with his

distinction between the manifest and the latent content of the dream, and Jung' s

suggested difference between the concrete and symbolic images of the dream. In

those cultures that posit a supernatural parallel world, the assumption is that there are

different meanings in that world than our own.

iii.) There are different kinds of dreams. Dreams can be classified into 'big' or 'little'

dreams, or 'typical' or 'extraordinary' dreams, those having 'personal', 'relational'

or even 'collective' (tribal) significance. In a general sense, dreams can pose daily or

existential dilemmas, conflicts, choices. For example, among the Sambia in eastern

Papua New Guinea, who, until the 1969s engaged in constant inter-tribal warfare,

initiates still receive explicit instructions to watch their own dreams for omens of

impending attack. (Herdt 1987:56)

iv.) Different dreams are told/shared in different contexts. Some dreams are private

and may never be told, others only to a shaman, still others from mother to daughter

or father to son. Among the Kalapo in Brazil 'for young men, and to a lesser extent,

11

~ I I

young women in puberty seclusion, dreaming is considered a crucial and integral

part of the process of acquiring knowledge of one's biological and characterological

self' (Basso 1987:97).

v.) There is an interactive relationship between dreams and myths. Dreams often

contain images and elements of cultural myths and can, in turn, be interpreted using

the mytb as an explanatory model whose key unlocks the meaning for the dreamer.

Several anthropologists (Obeyesekere 1981, Steward 1997, Thoden van Velzen,

1997) have suggested on this level personal dreams that are told or acted out cross­

fertilize, 'update' and keep alive cultural myths.

2.3 Sleep and dreaming: the psychoanalytic perspective

As almost everyone interested in dreams and dreaming notes, Freud's monumental

early work The Interpretation of Dreams was the first modern comprehensive and

systematic attempt to survey and explain psychologically the phenomenon of

dreaming. His subsequent conclusions were both individualistic and reductive. He

described the psychic apparatus consisting of two antithetical forces, one which

constructs the wish and the other which exercises censorship, thereby bringing about

a distorted, hallucinatory fulfilhnent of the wish- which is the dream.

He used his own dreams to describe the workings of the dream: how day residue and

infantile material are intertwined in the dream work; how the manifest content of the

dream contains concealed within it the latent meaning; how the dream work is carried

out in primary process (emotion-driven) thought, using the mechanisms of

condensation and displacement. By means of secondary revision, the ego knits the

dream thoughts into a coherent sequence, thereby protecting sleep. In times of stress

or as the result of trauma, the capacity for secondary revision is faulty and the

resulting dream may not always protect sleep. The dream, in Freud's well-known

formulation, is thus the guardian of sleep (Freud [ 1900] 1996:3 87).

Jung disagreed with Freud that the dream is essentially a wish-fulfillment and held

that the dream is a 'spontaneous self-portrayal, in symbolic form, of the actual

situation in the unconscious' (Jung [1948]1969:263). Its basic function was

12

'compensatory'. In part he agreed with Freud that in preserving sleep, the dream can

be seen to have a biological compensation, but he went further and maintained that

the dream's chief purpose was in relation to conscious (waking) life: dreams are

compensatory to the conscious situation of the moment.

Correspondingly, the dream should be interpreted not according to what its cause

might have been (as in Freud's day residue and infantile wishes) rather to what its

aim might be. He agreed with an earlier author that, in terms of the psychic energy

involved in dreaming, there is a 'prospective-final significance of dreams as a

purposive unconscious function which paves the way for the solution of real conflicts

and problems and seeks to portray it with the help of gropingly chosen symbols'

(Jnng [1948]1969:255)

Freud and Jung thus fundamentally disagreed on the inherent attitude of dreaming­

whether or not it was backward-looking or fmward looking. Freud firmly believed

that the dream was rooted in the past. 'By representing a wish as fulfilled the dream

certainly leads us into the future; hut this future, which the dreamer accepts as his

present, has been shaped in the likeness of the past by the indestructible wish' (Freud

[1900]1996:428). Jung on the other hand held that the dream, in its

'prospective function is an anticipation in the unconscious of future conscious achievements, something like a preliminary exercise or a sketch or a plan roughed out in advance. Its symbolic content sometimes outlines the solution of a conflict. ... It would be wrong to call [dreams] prophetic, because at bottom they are no more prophetic than a medical diagnosis or a weather forecast. They are merely an anticipatory combination of probabilities which may coincide with the actual behavior of things' (Jung [1948]1969:255)

The paradox about dreams then is that , though they occur during a period of

unconsciousness, they are in essence a 'content of consciousness' (Jung [1948]

1969:237) because we know about our dreams and wonder about them and tell them

only when we wake up. Foucault, in an early essay on dreaming makes a similar

point when he questions whether or not 'we are justified in speaking of dream

'images'? No doubt we become conscious of a dream only by way of images, and

starting from them ... [however] the image is a view-point on dream imagination, a

way for waking consciousness to retrieve its dream features'. (F oucault, [ 1954]

1993:73).

13

IV. METHODOLOGY

4.1 The venue

De Vonk is the only clinic in the Netherlands specializing in the treatment of

refugees and asylum-seekers who suffer from the effects of war or other organized

and collective violence. It is a satellite of Centrum 45, a nation-wide treatment-center

for war-victims, which was founded more than a quarter century ago to treat those

people who were showing delayed symptoms from their traumatic experiences in

World War II. In addition, Centrum 45 strives to be a top quality research and

educational institution in the field of psychotrauma. It actively encourages and

subsidizes a wide range of research projects aimed at practical as well as theoretical

understanding of the individual experience and socio-cultural effects of

psychotrauma.

Treatment of De Vonk patients- which has psychiatric, psychotherapeutic, and

psycho-social components- is aimed at working through or learning to live not only

with past traumatic experiences, but also the contemporaneous problems of living in

exile, uncertainty about the future, and language or cultural differences in illness

experiences. De Vonk has a 24-bed residential clinic where patients, and if necessary

their dependent children, can spend up to several months in treatment. There is also a

day clinic program and a out-patient (polikliniek) section, offering psycho- and/or

social therapeutic guidance as well as pharmacological interventions. De Vonk has

on average 150 patients in treatment per year.

All patients in de Vonk have been diagnosed as suffering from some form of Post­

Traumatic Stress, a collection of symptoms that is alternately known by the initials

PTSS or PTSD (for .syndrome or Disorder). The Diagnostic and Statistical Manual of

Mental Disorders (commonly referred to as the DSM-IV) of the American

Psychiatric Association, which is increasingly becoming the standard manual for

biomedically trained psychiatrists in all cultures, includes PTSD in the general

category of Anxiety Disorders, and defines it as follows:

'the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury; or other threat to one's physical integrity; or witnessing an event that involves death, injury or a threat to the physical integrity

14.

of another person; or learning about the unexpected or violent death, serious hann, or thereat of death or injury experienced by a family member or other close associate. The person's response to the event must involve intense fear, helplessness, or horror.'(DSM-IV 1994:424).

The diagnostic criteria include, among others, 'recurrent and intrusive distressing

recollections of the events, including images, thoughts, perceptions; recurrent

distressing dreams of the events; [and] acting or feeling as if the traumatic event

were recurring (includes a sense of reliving the experience, illusions, hallucinations,

and dissociative flashback episodes, including those that occur on awakening'

(DSM-IV, 1994:428)

Although it is possible to be diagnosed with PTSS without the presence of dreams, I

selected for this project only those people who specifically mentioned suffering from

dreams and nighttime experiences.

4.2 Study population

In consultation with the director of the clinic in his function as a member of the

internal research committee (de kern commissie voor wetenschappelijk onderzoek) it

was decided that the population of patients would be defined as those who:

• had been accepted for, but who had not yet started, treatment at de Vonk

• were suffering from dreams or nightmares

• had no medical contra-indications for participation (such as active or latent

psychosis)

The consideration of 'ethnicity or cultural background' as a selection criteria was

mooted a number of times in discussions with other researchers and psychiatrists at

the clinic. The original proposal, in fact, stated that I would interview an equal

number of people from two different countries - for example: four patients each

from, say, Sierra Leone and Afghanistan- and then, following a tried and true

analytic tradition, compare and contrasts their answers and descriptions.

I decided against focusing on one or more cultures and, instead, to interview the first

eight people who matched the above criteria- irrespective of their country or culture

of origin. The reasons for doing so were three-fold. The first was practical and

concrete: time constraints. I had only three months in which to complete this project

15.

and to focus on one or more cultures would have meant sacrificing the criterion of

interviewing only those people at the beginning of treatment. In any given month, an

average of X number of people are accepted in to treatment at the clinic, but it might

take three or four months, or even longer to collect four each from, to follow the

above example, Afghanistan and Sierra Leone.

Secondly, in these discussions I discovered again that both by training and by

temperament I am inclined to explore and describe differences of whatever kind

largely in pursuit of universals, whether in the inner world by way of depth

psychology or in the outer world by way of anthropology. And finally, the study was

exploratory in nature, and is part of a lively and ongoing research tradition in the

clinic on the nature and function of dreams. My idea was to start with a general

survey and then, depending on what I found, subsequent studies could then further

define any similarities or differences, by looking at a larger population from one or

the other culture.

Within a metaphysical framework then, I took as my beginning point- that is: the

defmition of the unit of study- not a microcosm of culture, such as, for example, a

village in Ghana, or even an aspect of culture, such as, witchcraft among the Azande,

but instead a diagnostic category ofbiomedically science, that is: psychiatry. This is

somewhat ironic because I spent much of the previous year fuhninating against the

tendency ofreification in Western science in general and biomedicine in particular.

Nonetheless, whether I like it or not, it is my emic perspective. And so for this study

I took a relatively recently accepted classification (PTSD was only incorporated into

the DSM in 1980) as if it were a real thing and used it as an anthropological prism to

see what, if any, cultural differences or similarities could be discerned in how people

suffered from one of its symptoms: the presence of trauma-related dreams.

The study population is defined then as: people who are suffering from PTSS as the

result of trauma experienced in the context of organized violence; who were accepted

for treatment into de Vonk; and who had intrusive trauma-related dreams.

One additional guideline was initially incorporated but was subsequently scrapped

before the interviews began: that of interviewing patients who were on the waiting

list but had not yet started treatment. The argument for interviewing at that stage

16.

were two-fold: it would be helpful for the patients themselves, because the clinic

administration and staff had received indications that the often considerable waiting

time- sometimes up to two months - was a hardship for the patients; and also

because I would interview the patients before they had been exposed to any clinic­

based ideas about trauma dreams.

My own discomfort at the prospect of interviewing people about their trauma who

did not have the container of a therapeutic relationship was strengthened in

conversations with the clinic staff. As a result, I only interviewed patients who were

already in treatment. After selection, patients were invited for two interviews to talk

about their experience of 'painful and frightening dreams'. While the letter specified

that the interviews were part of a research project and stressed that refusal to

participate would in no way affect or compromise their further treatment at de Vonk,

the letter was sent out on clinic stationary and eo-signed by myself and a clinic

psychiatrist.

At the beginning of each interview I again explained that the collected information

would be used for a research project, though I emphasized that personal information

would be safeguarded, all autobiographical details would be eliminated, and

anonymity would be preserved. In addition I asked for permission to audiotape the

interview. Three people indicated their discomfort at audio taping and with them I

kept handwritten notes. At the end of the first interview I asked again if they were

willing and able to participate in a second interview, giving them the opportunity to

opt out if the subject matter had been to taxing. Several patients elected to do so.

4.3 Overview of patients and interviews

All in all I had 14 interviews with I 0 patients. Those ten patients consisted of: seven

of the patients that were initially selected using the criteria explained above; one

proof interview with a patient who had been a clinical patient for eight months; and

two patients who were recommended for inclusion by the clinic staff. Of the initial

eight patients selected, only four patients were interviewed twice as I intended. Of

the remaining four patients:

• one patient did not show up at all

17.

• one patient showed up for only one interview, more than 1.5 hours late

• one was interviewed once but then dropped out because the symptoms had

become wholly somatic and he no longer suffered from dreams

• one patient declined to participate in a second interview because the discussion

was too upsetting

As a result there were six patients I interviewed only once: the remaining three from

the initial selection (above), the test patient; and the two patients recommended by

the clinic staff (with one the intent from the beginning was to interview her only

once and the second patient declined participation in the second interview because

the first interview proved to be too painful).

Of the 14 interviews, nine were done with the assistance of an interpreter, four were

done in English, and one was done in Dutch.

Other general characteristics include:

Gender

• men • women

Birth region

6 4

• Africa 5 • Form. Yugoslavia 2 • Form. Sov. Union I • Middle East 2

Religious background • Islamic • Christian

• none

Form of Treatment

• •

in-patient out-patient

5 4 I

8 2

Length oftime in the Netherlands

• • •

up to one year one - three years more than three years

4 4 2

18.

V. SLEEP AND DREAMING FOR PEOPLE WITH PTSS

A disturbed pattern of sleeping and dreaming is a central feature of those suffering

from the after-shocks of trauma (Schreuder 1999, van der Kolk, et.al. 1996, Barret,

et.al. 1996). Recall from the above brief discussion on sleep-research that, as far as

we can tell, a normal biological sleep for humans comprises on the average eight

hours and contains a more or less stable pattern of REM-sleep and non-REM sleep,

each of which is associated with a certain kind of dreaming, the first of which is

more 'fantasical', the second more 'realistic'. A 'night-time re-experiencing' of an

event seems to be more of a 'memory intrusion' (Hartman, in Barrel 1996:105) and

characterized by a full range of heightened physiological arousal that is lacking in

ordinary dreaming.

This section will describe how the people I interviewed experienced their sleep, the

waking up, and their dreams.

5 .I A phenomenological description of the sleep of people with PTSS

In order to gather data on the pattern of sleeping and dreaming of my study

population I used the existing research instrument called the NITE (for: Nocturnal

Intrusions after Traumatic Experiences; see Appendix B). The NITE is a structured

questionnaire designed to compile information on:

• the presence of agents that might influence sleep (i.e. medication, the use of

nicotine, alcohol or caffeine

• sleeping behavior (i.e. the time between going to bed and falling asleep, also

sometimes called 'sleep latency'

• the number of times sleep was interrupted at night

• the total period of sleep; and when such sleep took place, early or in the middle of

the night, or towards morning)

• the presence and quality of dreams (if they were frightening, repetitive, had really

happened, bodily symptoms)

19.

There are three versions of the NITE, with the only essential difference being the

time frame of the questions: last night, during the past week, or during the past

month. I used the ]-week version. The questionnaire seems quite straightforward and

I had anticipated that it would be the easiest part of the interview. However, here

again, experience proved differently.

People begin by saying that they don't sleep at all, or hardly at all. Later they say

they do sleep, but they never sleep without any dreams or rarely. Then when I begin

to ask the specific questions, it turns out that it is almost impossible to answer them

individually. The course of the discussion usually went like this: first comes over­

generalization, sentences beginning with 'always' or 'never'; then comes over­

particularization: explanations with much detail from night to night; and only then

after that, is it possible for sort of summarizing abstraction take place: constructions

that contain the words 'usually' or 'generally' but with many particular modifiers.

In practice, it was almost impossible to get specific answers to each of the individual

question, even though they were designed to elicit simple factual information. In the

first few interviews I took the NITE towards the end of the interview, but in each

instance we ran out of time. Later I tried beginning with the questionnaire, but then it

took so much time that was afraid there would be insufficient time left to discuss the

issues and questions that were more central to my research aim. In the end, what

worked best (though I do not know how methodologically sound the practice was)

was to note down the answers that came spontaneously, in the course of the

interview, as part of the conversation, and, when time allowed, to ask the remaining

questions separately at the end of the interview.

Whether I began with the NITE or asked it at the end ofthe interview, the sequence

was often something like this:

Interviewer: I would now like to ask you a few questions about your pattern of

sleeping and dreaming.

Respondent: Oh, I sleep very little, almost nothing at all, every night. And I dream

always the same, it is always about the same thing, about what has happened to me.

20.

Interviewer: Yes, I understand, but still I would like to ask some specific questions.

For instance, in the past week, on the average, how late did you go to bed? [the first

question of the NITE].

Respondent: You mean last night?

Interviewer: Well, in the past week, on the average.

Then there would be a considerable silence, and then, more often than not, people

would list each day in minute detail, such as: I never sleep, really. In the past week?

Last Thursday [this interview was on Wednesday] I can't really remember. On

Friday I was back at the AZC [for: ;!Ziel-~oekers fentrum, the residential refugee

centers; patients spend the week in the clinic and their weekends at 'home', if there is

one, or in the refugee center if they have not yet been assigned permanent housing]

so I didn't sleep at all, there is so much noise there, all those people, and then on

Saturday I was very tired all day, I tried to sleep, but ... maybe, I went to bed about

11 o'clock in the evening but I couldn't sleep, so I got up again and sat in the chair,

and then, between two and three o'clock I must have fallen asleep for a little while,

and then I woke up . .. please do not ask me further, it was terrible . .. (Woman, 33,

Afghanistan).

Or: I don't know what time I went to bed It is the same, each night. I stay awake as

long as I can, then I am tired, around maybe 3 o'clock in the morning, or later, and

then I dream, the same dream every night. Then I wake up and feel terrible. Then,

from about 4:30 on, I don't sleep anymore (Man, 31, Serbia).

Or: Last night I went to bed around 11. I knew I wouldn't be able to sleep but I didn't

want to disturb the others. I lay there for an hour maybe, then I got up, and turned on

the light. Then around midnight I tried to lay down again. Then I must have slept

between 2 and 3 o'clock, for a little while. Then I woke up with a dream. Then I slept

maybe for a half hour between 5 and 5:30 in the morning, and I dreamt again, and I

didn't sleep anymore (Man, 48, Sudan).

At first I thought this difficulty of answering questions about their own sleeping

patterns might be the result of a reduced capacity to generalize. In certain

psychopathological conditions there is a narrowing of consciousness, whether

temporary (as in shock, for instance) or more systemic (such as in schizophrenia).

21.

For people in such circumstances, it is as if the world becomes very concrete and

immediate. It is almost impossible then to talk about the category of, say, books, or

tables, or sleep; it becomes this book, or that table, or, as in the above examples, I

sleep this hour and not that hour. They are not able to place experiences or notions in

categories and then in a process of comparison differentiate common characteristics

or properties that make things similar or different. However, when I switched tactics

again and tried to ask the questions for the previous night instead of for the week

preceding the interview, I encountered the same reluctance to answer questions that

related to sleep separately from questions that related to dreaming. Furthermore, in

the course of the conversations I realized that, in fact, this function of consciousness

was unimpaired and that the ability to summarize and generalize was fully present.

Most persons were able to abstract the patterns in their own sleeping behavior and to

adequately describe them.

For example, one man said, I don't dream every night, but if I don't dream. then I

sleep very superficially, the smallest of noise and I am awake again. And when I

sleep deeper, then I dream. Sometimes that seems like a very long time, as if I've

been sleeping for a long time, but then in retrospect it turns out to have only been a

half hour or so. Actually, on the average I don't sleep more than three hours per

night. And if I dream less, !feel much less tense (Man, 53, Chechnya).

And another man said, I never really sleep. I always wake up out of a dream. I dream

every night. Sometimes not, but very seldomly. For example, in the past three weeks

there was maybe one time that I didn't dream. Or twice. But all the other nights:

dreams. Always. And then I wake up out of the dream, sometimes after two hours,

sometimes after even five minutes. Other times I don't sleep at all, and then, during

the day, I sleep a little, but even then I dream again. (Man, 31, Iraq/Koerdistan).

In the course of the conversations it gradually occurred to me that part of the

difficulty was a miscommunication along the lines of the disease/illness distinction

in medical anthropology: disease is what the doctor sees; illness is what the patient

feels. Asking questions about sleep in this context also has a similar duality. Sleep is

a biological necessity, and from a biomedical standpoint it is unlikely that people do

not sleep at all, as scientific sleep research has proved beyond any doubt. The intent

of questions aimed at further defining the 'disturbed pattern of sleeping' as a

22.

symptom of PTSS, then, are to determine more exactly with how much or how little

sleep this patient is surviving.

Most people I interviewed realize they do, in fact, sleep in this way, by which they

mean that they slip into a state which is not conscious, daily life. But sleep also has a

generally accepted experiential definition: 'a natural periodic suspension of

consciousness during which the powers of the body are restored'- and that is what

most people who suffer from the effects of trauma miss so desperately. It is the sleep

Shakespeare wrote about,

' .... the innocent sleep, Sleep that knits up the ravel!' d sleave of care, The death of each day's life, sore labour's bath, Balm of hurt minds ... ' (Macbeth I!, ii, 36-40)

The dreams they suffer from each night, their intrusive presence, makes sleep in the

experiential sense nearly impossible, and that is what they are at pains to convey:

yes, technically they 'sleep' but there is no 'suspension of consciousness'.

One man explained it thus, I have a feeling that something is not right in my head. It

has to do with the things that happened in my country and what I have experienced.

That is the origin of my problems now. Before I had no problems. Then I slept the

way others sleep. Everything was quiet in my head. Now it is as there is something

broken in my head (Man, 23, Zaire).

'Then I slept the way others sleep' is movingly evocative of what the patient is trying

to explain: objectively speaking, he does sleep, a little; but there is problem both in

the amount and especially in the quality of sleep, and it is for this that he is seeking

help. Another patient explained the kind of sleep he was searching for. Do you know

the only time I slept properly during the past year? It was when I had had an

operation on my shoulder and they gave me an anesthetic. That was the best sleep I

have had since all these things happened to me. (Man, 63, Bosnia).

Under normal circumstances 'The world of sleep and the world of wakefulness are so

different that each of us could be said to live in two worlds' (Borbely 1986: · 13) One

of the hallmark of victims of trauma, however, is the blurring of the boundary

between these two worlds, and also the painful and abrupt transition between them.

The memories of the horrors they have been through are so insistently present that

23.

most of them long for the relief of ordinary sleep. However, in sleep they find

themselves in the same or similar circumstances through the presence of repetitive

dreams and nightmares. They are then 'jerked awake' as it were, in a desperate effort

to flee the re-experiencing.

After such a dream I awake with a scream. I am breathing heavy. My heart is

pounding, I am drenched in sweat is a recurring description, stating in lay terms

almost word for word the biomedical description of the sleep disorder 'night terror':

'the arousal of sleep is abrupt and frightening, with autonomic system activity

producing diaphoresis, hyperapnea and tachycardia (Elman and Atrobusl99l :64).

Waking up is terrible. My body is cramped, I can't get enough air, I want to get

away, to run. It is good thing electricity was discovered. If I turn on the light it gets a

little easier. (Man, 53, Chechnya) For other people, however, the re-lived terror is so

intense that the transition between the world of the dream and the here and now is

more gradual. I always sleep with the light on, but then I wake up out of a dream like

that and it feels as if it is still dark and only later, very slowly, do I feel that the light

is actually on. And I can't sleep in a bed any more, because if I do, !fall out of it. I

sleep on the ground now, but I usually go to sleep here (gestures in front of him) and

wake up there, in the corner. (Man, 37, Iraq/Koerdistan).

5.2 A phenomenological description of the dreams of people with PTSS

In eight ofthe ten people I interviewed the initial exchange invariably went as

follows: I dream every night, and it is always the same. I dream about what

happened to me. 1 When I asked for an example, I would get a description, usually

with a strong sensory component, I hear the screaming of a child for its mother; or: I

can still smell the bodies; or: I always dream about dead people and horrible things,

for instance about torture and things like that. It is always horrible.

However, when the discussion proceeded, what I encountered again and again was a

frustrated and desperate attempts to describe the elusive quality of the dreams in the

words that were available between us. Eventually it became clear that the gap of

1 The other two said: I don't dream because I don't sleep

24.

understanding was centered around the idea of what is 'real' and 'not real' Although

some of the patients had only arrived in the Netherlands in the past year, in my

conversations with them I sensed a thorough understanding of onr categories of what

had actually happened and what was a dream. This understanding was for a large part

based on recognition: such categories existed in their own cultures as well. The

difficulty began in the assignment ofthe designates as 'real' and 'not real', as the

common question 'Did that really happen to you?'

This question came largely as part of a system of dream classification arising out of

the combination of trauma research and sleep research, on the basis of which one can

make decisions on whether dream experiences can or can not become part of the

therapeutic process. (Schreuder 1999:87).

In asking about the content of dreams then, as I was doing, I wanted to try to make

the distinction between a re-experiencing of the actual trauma and a re-experiencing

with a symbolic content, and in order to make that distinction I used the emic

distinction of real and not real.

Every language contains terms that have come to attain cosmic scope of reference, that crystallize in themselves the basic postulates of an unfonnulated philosophy in which is couched the thought of a people, a culture, a civilization, even an era. Such are our words 'reality', 'substance', 'matter', 'cause' .. .. [and] 'space', 'time', 'past', 'present', 'future'. (Whorf!956:57).

'Reality' to in onr understanding and usage of the word is almost synonymous with

'objective': 4

objective: (philos.) Belonging not to the consciousness or the1krceiving or thioking SUBJECT but to what is presented to this, external to the mind, real.

What I found, however, was that to all of them the dream was as real as the

conversation we were having in which they told me about the dream. So that,

although there was a blurring of the worlds of day and night- which they recognized

as a sign of pathology for which they were therefore seeking help, there was no

blurring of their being able to tell the difference between them. It was more that

'real' to my informants described the sensory and emotional experience -whether in

the inner or the outer world- and 'real' to me as a researcher in the scientific

tradition describes something that has verifiably happened, something that can be

confirmed, substantiated by a third party.

25.

,

So that, to reiterate: For us 'what really happened' is the actual trauma experience­

and the dreams about them are real as a memory but not as an experience. Dreams

are a mental product, akin to thinking, albeit unconsciously; for example in sleep

research, dreaming is known as 'sleep mentation'. However, for some of my

informants, that is: those suffering from PTSS, dreaming is a phenomenal

expenence:

Phenomenal: a. known through the senses rather than through thought or intuition. b. a temporal or spatia-temporal sensual experience as distinguished from a noumenal..

One man explained: Dreams and memory . .. even though they both concern the

same images, still it is different because what I see in my dreams ... it feels as if it

happens again for real. I wake up with a pounding heart, bathed in sweat, because at

that moment it seems as if it is happening again to me. Yes. Dreams are more real

than thoughts. They are as if it is real. ... And then when you wake up, the terrible

feeling just stays with you. I am actually afraid of these dreams, afraid to go to sleep.

(Man, 53, Chechnya).

This does not seem to be only the case of trauma dreams, but rather characterizes the

dreams of those suffering from PTSS, because this same man explains: Last week,

for instance, I was walking along the beach and I saw a woman JPI:/'(playing with her

dog, I must have watched her for a half an hour or more, she threw a ball in the

water and I was so impressed that this dog dove under the waves to retrieve the ball .

. . and at night I dreamt about this, step for step, as if it had been filmed, I dreamt it

just as I had seen it that afternoon, but very concretely as if I experienced it again,

not in another form, but just exactly that. And I woke up with a longing: I wish I had

such a dog. I was a little jealous. Do you know Ernest Hemingway? The Old Man

and the Sea? There he says, 'The more I get to know about humanity, the more I love

animals'. So that, although this was not by any definition a trauma dream, the dream

experience for this trauma patient was as vivid as his waking (what we might call his

'real') life

Again, it does not seem as if cultural differences are the sole explanations, because

another man explained that, In my country people talk about their dreams all the

time, but many people don't believe in them so much But many people do believe in

them. I myself, I believe in dreams. When I dream about my family, my wife and

children whom I haven 't seen in three years and two months, or about my younger

brother who is dead, or about my father who is missing, then I feel as if it is real, as

26.

if I really saw them. For example, I dreamt that my father and my brother came to

visit me here in the clinic with flowers for me. !felt as if they were really here. (Man,

33, Koerdistan).

Other people made a slightly different point: they equated dreams with the emotional

content of experience, a sort analog experience, as if feelings had taken form. One

woman who had had to flee her home country leaving behind the two oldest of her

three children explained Last week I dreamed that I had been tied up and brought to

a cemetery, I must have talked out loud because my daughter touched me and asked,

Mama, why are you talking, what is it? I told her nothing, to go back to sleep. No, I

was never taken to a cemetery. But before, there, I was tied up and blindfolded. It

was not, in the dream, a cemetery I knew. I was very afraid. When I woke up, I asked

myself, What happened, why did I dream about a cemetery? And then I thought about

my children who are still in Africa and wondered, What if they are dead? That day I

had received a frightening letter from the Red Cross. The dream was, as it were, a

sort of mirror of the feeling of fear I'd had that day.

Another woman echoed this description. What I dream is not exactly as it happened,

the things I have undergone . .. but rather something that can be compared to it. For

example, I always dream about death, difficult, horrible things, such as the tortures,

and things like that. So the dreams bring up comparable feelings, but it is not a

direct memory, not exactly the way it was. Nonetheless, she described a period of

disorientation immediately upon waking, that can have the character of a

hallucination, though it does not seem to be psychotic in any way. Last week, I woke

up out of the dream and I was shaking, bathed in sweat. I got out of my bed to check

on my children in order to try to get back to myself But then I saw them, three

Taliban, just outside the window, and I took a pillow and screamed into it, for more

than a half an hour, so I wouldn't wake up the children. (Woman, 33, Afghanistan).

When I asked her if she went to the staff room to seek help, she said, 'They were

real, I could see them. But I knew I was here '.

This blending of a sense of place was also described by another woman. Once I

dreamt of my cousin, lying on a hospital bed. But it seemed that the bed was just

outside my door here in the clinic. She was all torn up [gestures from her throat in a

straight line down the middle of her body] she was open and very bloody. She was

27.

crying, crying, in so much pain. Blood and pain. Also her mother was there. She was

trying to comfort me. It was terrible, terrible. But she was trying to comfort you, I

said. And she answered, Yes, that is true, and there were also tears in the dream so

that might have been a good sign, but all I can say was that it was terrible. I didn't

want to go to sleep for three days afterwards, it was terrible. I was crying and so

scared. (Woman, Sierra Leone).

To go to sleep for people who dream in this way then has the quality of a

transportation, which has a spatial-temporal aspect: that of being back in another

place and another time. The feeling of being 'there' continues a long time into the

waking state, even though, cognitively- that is: consciously and in their waking state

-they know they are 'here'. The state they are in, then, is one of deeply painful

dissonance between 'knowing' and 'feeling', which, psychologically-speaking are

two complementary forms of awareness, and which, under normal circumstances,

usually function in concert with one another.

28.

VI. RECURRING EXISTENTIAL THEMES IN PEOPLE WITH PTSS

There were some common themes echoed by my informants in trying to convey or

express how they felt since their trauma experiences. These feelings were not

directly expressed in dreams but were rather related to their dreams as a sort of

wormhole through which they were again transported into the reality of what they

had experienced - and therefore were experiencing again.

These are themes that have also have been uncovered in other anthropological

research as important cultural categories, and, as such, these themes may point to an

underlying archetypal human experience. However, to understand them more fully,

additional research needs to be done. One of them has to do with the notion of'clean

or pure' versus 'unclean or impure'.

One woman summed it up succinctly, The difference between a dream and a

nightmare is that a dream is clean. A nightmare is not, it is not clean. And so, you

feel not clean after you have had a nightmare. (Woman, 31, Ethiopia). In information

I got from the case file, I learned that this feeling took very concrete behavioral

expression: she refused to bathe or change into clean clothes. She had been a

prisoner, and had shared a small space with two other people, both of whom were

executed in her presence, and says she can still feel the blood spatters on her body.

The active sensory experience of being 'unclean' was echoed by three other people.

One man said, 'Do you know what is worse than the dream itself? The scents I carry

with me. [Takes out perfume strips from his pocket and hands them to me, the kind

one gets at cosmetic counters in department stores]. I spend a lot of money. almost

daily, buying very expensive perfUmes, that I want to spray around myself The scent

of the corpses ... And also, washing my hands, I have a compulsion about

handwashing, they always feel dirty, soiled. That is worse than the dream. That I

have night and day. Sometimes I wake up out of a dream and take a shower in the

middle of the night. (Man, 31, Serbia).

Another man recounted a dream he'd had the previous night, It wasn't a real dream,

it was a nightmare ... It was very disturbing, and afterwards I wanted to go take a

29.

shower but I didn't because I was afraid I would disturb the others (Man, 48,

Sudan). Still another man said, 'The blood of my friend, my buddy, on my body. That

I can not forget, I can still feel it. (Man, 37, Koerdistan).

This theme is related to a second theme for which I have borrowed the term

'liminality' and which has to do with a sense of not being like they were 'before' -

and that, the way they were before, was 'like other people'.

If someone hasn't experienced what I experienced, than they can't know my

problems. Even if I talk for a month in a row, still you won't be able to understand

me. Because if someone has had real problems, than he talks different. I saw

everything and it is still in my eye. Dreams have to do with problems. Normal

problems, they are soon gone, but big problems, they stay in my head and then I

dream about them. Sometimes, even if I don't think much, still I dream. Because it is

still in my head. (Man, 33, Koerdistan)

Another man said described it as a feeling of being on the outside of normal

humanity, of seeing others but not being able to reach them, to touch or be touched

by them. I have a feeling we can't find each other because you and others who

haven't experienced what I have experienced are, as it were, under glass, under a

bell-jar . .. I can't explain exactly what happened to me . .. even though you know a

lot, we have no points of contact. (Man, 31, Serbia) It was said with a wariness,

without ran cor or accusation.

And another man said, Since what happened, nothing matters anymore. It seems as if

I am present only as a body, but my soul has become black, totally black ... It seems

as if all good things have been conquered, captured, by bad things, and that [the bad

things] is the only thing that is left. (Man, 53, Chechnya).

In important ways, this sense of liminality has a concrete and very real aspect. As

asylum seekers in the Netherlands, most of them do not yet have a long-term

residency permit, and all of them are certainly without any of the various concentric

circles of cultural personas that have their own contexts that help define one as a

member of the collective: as a member of a family, or a tribe or ethnic group or

region or religion, or as having plied a particular profession or trade. The palpable

30.

missing of all these comforting guises was certainly present. But the way I

understood them to mean 'being on the outside' was in a much more fundamental

and existential way. It is summed up by the plaintive description of one of the

women (from the case file): I am no longer alive, so I might as well be dead.

In the case files, I found again and again the wish to be dead, though all of them

denied active suicidality. Most of them cited their children as a reason to remain in

this life. This feeling was for, for me, captured in the searing dream image of one

woman: I have been tied up and I am somewhere very high up in a tree or a building,

I don't have any idea what, but in any case what I see is [that the ground] is very

deep, something very, very far away. Then I fall, but my son, my nine year-old son

helps me [gestures with both arms as if to catch something], he prevents the fall.

At the time that I was beginning to become aware of these twin themes, I attended a

lecture on remembering and forgetting (though not in the context of psychotrauma)

which made a passing reference to the tale of Aeneas as told by Virgil. In the

simmering stew of images and impressions and thoughts that this interview process

became for me, I wondered for the first time if integration of certain traumatic

experiences was ever possible, and if not, what was the alternative? The bias of

psychotherapy sometimes seems so favored towards 'making the unconscious

conscious' that I wondered if it were possible to help people to forget?

At one point in the epic poem The Aenid, Virgil recounts that Aeneas visits his father

in Hades, and his father shows him the throngs of shades, the dead waiting to be

reborn, standing on the banks ofLethe, the river of forgetfulness at the edge of the

underworld.

Whole droves of minds are by the driving god compelled to drink the deep Lethean flood In large forgetful draughts to sleep the cares of their past labors and irksome years and, unrememb'ring of its former pain, the soul may suffer mortal flesh again (Aenid, Book VI)

Hades, for the souls between lives, is the archetypal liminal space. And that is what

many of the people at the clinic reminded me of: milling shades of their former

selves, who were neither dead nor alive, but who were nonetheless 'compelled to

live' by a 'driving god', hut who needed to taste forgetfulness before they could do

so.

31.

VII. DREAMS AND DREAMING IN NORMAL CIRCUMSTANCES

Nearly all the informants said that, in their home country when life was normal, it

was usual for people to talk about their dreams (7=y; 1 =n; 2=do not remember). The

extent to which they talked about their dreams, and the circumstances under which

dreams were discussed, and even the use that was made of the dream information

seemed to vary, but the common denominator was that dreams or 'that which I see

when I sleep' (woman, 33, Afghanistan) is a ordinary topic of conversation during

the day in a number of different cultures. In other words, in those cultures, an

archetypal individual experience- which is what dreaming is -becomes part of the

social discourse.

Dream sharing always seems to be in the context of a search for its meaning, with the

initial binary division being the determination if it brings good news or bears an

implicit warning. Most people said they could no longer remember any of the signs

of good or bad dreams because all the dreams they had now were bad ones. But two

people were able to list some of the indicators that in their home countries would be

common dream interpretations.

For example, to dream of new clothes that is a good dream. Or to build a house, that

is good, or to dream of a bird, or another animal, that is good, especially a cow.

Food is also good. But ancestors, no that is not good. Dead people in a dream is not

good. People in my country believe that if dead people appear in a dream, they will

come to get you. Also, when you are pregnant, dreams have meaning. If you dream of

an earring, you will have a girl. If you dream of a horse. you will get a boy. Dreams

about the body always have a meaning having to do with the family. But sometimes it

has to do with family close to you, sometimes with family farther away. For instance,

if you lose a leg, it could mean your brother will die. But if you lose part of a finger,

it might mean your cousin will die. (Woman, 33, Ethiopia).

Indicators of harm, in the form of accident or illness, to extended family members

was also one of the core meanings that were derived from dreams in another culture.

You must understand that people in Chechnya are very, very superstitious. and so,

yes, every morning people talk about their dreams, at the office, or with the maid, or

with friends or family and everyone has an opinion. For example, in my family, when

32.

someone has dreamt something that could point to someone becoming ill, then the

whole family calls one another to see who this could apply to, and, in the end, such

things always prove to be true in some fashion It happened just last week, when my

wife dreamt about her sister and when she called her where she is living now, in a

neighboring republic, it turned that her sister was sick (Man, 53, Chechnya. He is a

physician by profession, a neurologist, and all this was said ruefully, with a

headshaking, half-smile of amused bewilderment, that conveyed an indulgent

attitude something he does not understand but feels nonetheless compelled to admit

to be true].

The sense of a dynamic relationship between dreaming and waking life was also

echoed by another woman who explained that in her country people sometimes

changed their plans on the basis of dreams. Dreams are usually told to old people,

they know from experience if something is a good dream or not, or what it means.

When old people see meaning in a dream, they never tell the person directly what it

means. They just say, 'You must be carefol, on this day, or when you do that'. And,

yes, people in my country take their dreams seriously. For example, if they have an

appointment, and there is a dream that has a bad sign in it, or they have a bad

feeling after a dream, then they will cancel the appointment. [Woman, 33, Ethiopia].

One woman explained that in her country dreams are associated with witchcraft and

that there are prescriptive actions one can (or must) take in response to certain dream

signs. It is forbidden to talk about dreams at night, because then it will happen. You

can only talk about them in the morning. Crying in your dreams is a good sign. Also

climbing a mountain Also, when someone you were once close to comes to visit. But,

to fdream about blood is very bad Also, eating food in a dream, especially meat,

" that is a sign witches have been active. Snakes in your dreams also means witchcraft.

Also dreaming of flying. When that happens, then, when you wake up you should

drink some palm oil, and also you should put some palm oil and some small good

things to eat on a leaf and then place it just outside your door, or sometimes at the

first crossroads near your house. (Woman, 31, Sierra Leone]. When I asked her if

the things to eat were like an offertory, she disagreed, because she was raised as a

Christian and associated the word 'offertory' with the Christian liturgy. However,

she did concede that the actions consisted of some sort of propitiatory gesture to

powers that were beyond the individual. It seemed to be a sort of give-and-take

33.

I

! L I

movement, almost like an ongoing conversation or negotiation, between the personal

and the transpersonal, with dreams being an important channel of communication.

The interchange between events during the day and dreams at night was also

reported by another woman. In her story the dream concerned the emotional

relationship between a mother and her daughter, and it is as if the dream personage

offered a corrective for a misunderstanding between them. When I was little my

mother used to dream about my father. He had died I wasn't there when he died.

That caused me much suffering. When I was little, there was a period where it really

bothered me a lot. I cried much, out loud, and every day, and would hide then in the

chicken coop. My father had been dead for quite some time by then. I was very sad

One day, my mother came to the chicken coop and asked, 'Why must you still cry? It

has been such a long time!' She was a little angry. It was all so difficult for her.

Many children and no food

That night both my mother and I dreamt about my father. In my mother's dream my

father told her that she was abandoning her children, that she was not caring well

for them. In my dream, my father asked me why I hadn't been there when he died He

also told me that he'd died because of a parcel of land that by rights now belonged to

us, even though his family had taken it back. He said that we, as children, must obey

our mother because she was totally alone in caring for us and that it was very

difficult for her. When he was alive he used to talk to us like that, and when he was

dead we dreamt about him in the same way. (Woman, 31, Angola)

Two people explicitly associated the telling of dreams in the home country with

problem solving, using almost the same words. Other people used to talk about

dreams. I never did because then I didn't have any problems, so there was no need to

talk about my dreams to anyone. (Man, 33, Zaire).

34.

Vill. DREAMS AND MEANING

As I explained at the beginning of this report, by eschewing the therapeutic role, it

was almost as if! tried to deny myself any subjectivity at all, an attempt that was

doomed to failure because I believe that is fundamentally impossible. Listening is an

active process, especially if what is listened to has been solicited by questions,

questions which come from a 'subject' -in this case me. In this section then, I want

to describe not only what people told me, but also what I heard. What I heard was

influenced by my readings (in anthropology, psychoanalysis, and the literature on

trauma), as well as by the following observation by Jung,

There is a type of dream which could be called simply a reaction-dream. One would be inclined to class in this category all those dreams which seem to be nothing more than the reproduction of an experience charged with affect, did not the analysis of such dreams disclose the deeper reason why these experiences are reproduced so faithfully. It turns out that these experiences also have a symbolical side which escaped the dreamer and only because of this side is the experience reproduced in the dream. These dreams, however, do not belong to the reaction type, but only those in respect of which certain objective events have caused a trauma that is not merely psychic but at the same time a physical lesion of the nervous system. Such cases of severe shock were produced in abundance by the war, and here we may expect a large number of pure reaction-dreams in which the trauma is the determining factor. (lung [1948]1969:260)

Thus, whereas a number of contemporary psychiatric writers on dreams and trauma

differentiate several categories of trauma dreams (See, for example, Schreuder and

Kramer), Jung makes just two distinctions: dreams that are repeated as reaction to

trauma (and posits a physical lesion of the nervous system), which I read as the

previously described 'night-time re-experiencing'; and dreams that have a

'symbolical side'. In the following examples I explore such possible symbolic side of

the trauma dreams recounted to me.

The first two case-studies are of people who said they have dreams that more or less

repeat the trauma as it happened, which would make them 'nightmares with a rigid

scenario' (Schreuder, 1999). Neither of them narrated a specific dream. They talked

about their experiences and then said that they dreamed exactly that, each night.

However, repeated questioning on my part revealed that, some times, there were

small differences in the dream. scenario in relation to the actual traumatic experience.

The first concerns the 53-year old man from Chechnya. He and his wife and their

two sons, four and nine, have been in the Netherlands for just under two years and

35.

live in a refugee center. A middle son, four years old at the time, was kidnapped and

murdered during the war conditions before the family fled. The oldest son was also

kidnapped but returned alive. When the man went in search of his sons, he was

subjected to humiliation, confinement and repeated beatings by the rebels.

I have endlessly repeating dreams, there is little variation, it is always the same

thing. It almost always concerns my little son who died. I still hear the screaming, a

child screaming for its mother, and that is what wakes me. And then I am fully

engulfed by a feeling of guilt.

Yes, changes in the dreams . .. the core is always the same, that which I know, which

I experienced, but sometimes there is a person there, in the dream, who wasn 't there

or someone is missing who, in what actually happened, was there.

For example, around the time of the kidnapping of my second child, who was later

killed. There were people who were by the fence and people wha were by the door.

The people who were by the door I saw at the time, but the people by the fence I did

not see, then. And in my dreams it is those people who return, whom I see, because

then I imagine that they climbed on the fence and that I could, maybe, have done

something. Now, as it is, I couldn't do anything, but if I see them, I imagine I could

have done something, and then there comes an enormous feeling of helplessness, I

am engulfed by a feeling of powerlessness, and then I wake up because it is literally

choking me.

Later in the interview when we return to this point he says something similar, but

with a different twist. Sometimes, there are people in the dream who were not there

in reality, and then it is often someone I know. Though at other times they are

strangers. For example, when I dream about what happened to my house, my

children, then, in the dream, I sometimes see an uncle, the oldest brother of my

mother, a man who is around 80 and who was never there in reality, but if I dream

about someone I know, if there is someone I know in the events in my dream, then,

sometimes, it is him.

Perhaps, because, on my mothers side, there is almost no one left, and I consider him

a sort of help. I ask him, 'A sort of help ... in the dream or in real life?' and he

36.

answers, In the dream. It doesn't happen very often, but it has happened a couple of

times, and then I am mystified, I wonder about it, I ask myself; why did I see him?

I must say that if I see something in my dream, something has always happened to

trigger it. For example, I meet someone, like you, for instance, who reminds me of

someone from my past, and then later, at night I see that person back in my dreams.

From this sketch several things can be abstracted. First, that although there is an

incessant repeating sameness to the dreams that he experiences, there are,

occasionally, small modifications. These modifications sometimes have an affective

meaning- i.e. they accentuate his feeling of helplessness- and sometimes a personal

meaning, for example in the presence of a witness who is experienced as a helpful

object. And fmally, that these modifications are not random but rather associative in

that they are connected to reminiscences from the previous day.

In light of this, if! were in a therapeutic relationship with him and he had told me

these dreams voluntarily, I might have thought about the contents in the following

way. In both dreams he told me, he saw people who had not been there at the time of

the traumatic experience. In the case of the addition of the maternal uncle, he

experienced the added presence as helpful and I might have wondered if this could

be a first signal of a reassertion of helpful objects, with the cautionary reminder to

myself that one swallow does not make a summer. Additionally, along with the

patient himself, I would try to explore why the maternal uncle appeared in this

dream. Were there reasons in the personal history why he was 'chosen' as it were, by

the dream, to appear as a witness or does the maternal uncle hold symbolic

significance in the Chechnyan kinship system?

Much more complex is the dream containing the presence of additional persons who,

when he woke, left him with an increased feeling of intense helplessness and

powerlessness 'because if they had really been there I might have been able to do

something. In the first instance, this might be seen as a 're-traumatizing' element,

and would call up an increased reserve of therapeutic empathy, which might even be

appropriate but hardly sufficient as an end in itself. Because if I followed the Jungian

belief that the return of symbolic elements in the dream served a compensatory

function, I might relate it to the presence, in his waking hours, of a pervasive feeling

of personal guilt.

37.

Guilt is an oft-reported phenomenon in PTSS sufferers and I also found expressions

of guilt in five of the people I interviewed. The issue of survivor guilt has been

written about extensively and even a summary is beyond the scope of this paper. I

mention it here only because, as a response to trauma, it apparently seems to be

either a pre-cultural or a multi-cultural phenomenon, and I wondered if guilt served

as an initial defense of the ego. Guilt creates, among other things, the illusion of

mastery, of control, over a situation, as the comment above shows. Guilt might then

be seen as a primary attempt at creating meaning where there is none, neither cultural

- because in the people I interviewed the trauma was suffered at the hands of the

collective, culture turned on itself, as it were- nor personal. However, an initial

defense of the ego could turn into a neurotic defense (in the Jungian conception: too

one-sided) if it is used beyond the time when serves its function. A sense of

helplessness, however intensely painful that is, might be seen as a component of

accepting reality which is a constituent part of a mourning process. For some people,

I hasten to add. Others may be so deeply traumatized that a sense - or at least a

residue- of guilt is always necessary, not unlike, for instance, chronic pain is present

after certain somatic injuries.

In light of these reflections it might be significant that, in other dreams, the patient

sometimes encounters his maternal uncle, whose presence he experiences as

'helpful'. Note that the fimdamental organization of the dream does not change the

abject, existential reality of the situation: the son is dead. Nonetheless, there is an

emotional shift when there is another, helpful, witness: the dream ego does not

immediately seize on the presence of the witness as a desperate possibility of

preventing what has already happened. In a fundamental way, in those dreams at any

rate, he is no longer alone with the horror. It could be the first small step on a long

road that might move him from re-living of trauma towards authentic mourning.

All of these things might occur to me but I would not share any of this with the

client, certainly not initially, and perhaps not ever. The reason is not that I want to

put myself in a superior position vis-it-vis the client, to hold on to 'knowing'

something that he does not know, but rather because I now 'know' something that he

himself already 'knows'- albeit unconsciously. I only 'know' it because he has told

it to me, or rather: shared it with me, by allowing me to step into his reality. The aim

38.

of this 'knowing'- consciously for me (as the psychotherapist) and unconsciously

for him - is to find an existential meaning, a meaning that has a very definite

temporal aspect: why did this dream (or dream image) come now.

The word 'knowing' is in quotation marks here because it not a cognitive certainty

but rather a provisional understanding, a working hypothesis that is always held

partially in abeyance. It is rather like, in a conversation, you 'know' what the other

person is saying and on that basis you respond. When you have, in fact,

comprehended the other person's meaning, then the conversation proceeds; if not, it

backtracks in order to add nuance, color, correction, amplification.

Dream interpretation proper, of the kind one has come to expect from Freud's

eponymous masterpiece, or any of the countless psychoanalytic case histories

(including these abbreviated ones), then, is rarely, if ever, part of my therapeutic

dialogue, much to the disappointment of some clients, who eagerly await what they

regard as a rather occult knowledge. Dreams then can be read, as it were, by the

psychotherapist, but are 'used' only in the sense that they are 'used' in the country of

one of my informants put it, When old people in my country see meaning in a dream,

they never tell the person directly what it means. They just say things like 'You must

be careful, on this day, or when you do that. (Woman, 33, Ethiopia).

The second sketch concerns a 31-year old man from Serbia. I was a journalist, but in

the army was assigned to the medical service. I was sent, together with a young

surgeon to fetch two wounded soldiers. There were bombs and shooting all around.

In the house were also two Albanian families, and there was also a little girl of about

five years ... I wanted to take the child . . First we thought that the two soldiers had

died, but one of them was still alive, and we took the soldier and left the girl . . IjJ~

myself have a daughter who is six years old . .. If we could have, I would have taken

him and her . . . but then they would have killed us. The surgeon was only 21 years

old, and then he would have been killed. I didn 't care about my own life. But we left

her behind and took the wounded soldier.

This is what I dream about, every night. It is always the same, every night. The little

girl couldn't talk, I don't know what she was thinking but her eyes were wide open

and so was her mouth [Then, in anguish:] They 're dead! I know they 're all dead!

39.

I ask him a number of times if the dream is like a memory of what has happened or if

there are ever any changes and eventually he allows (but very reluctantly, as if

relinquishing something to me) that, sometimes, the dream contains details that are

different from the experience.

The calor of the clothes, that is the only difference, and also the amount of light, that

is the only thing I can recall. And also, the wtry I leave, that is different, sometimes I

leave through the window, sometimes through the door. And, in the dream, when I

take the soldier, I have no feelings in my hands, it feels as if I don't have hands.

And the colors of the clothes. Sometimes, there, everything is dark grey, sometimes

there is red or orange. The little girl is alw~rys dressed in white. In rea/life, she was

wearing a green dress, a perfectly ordinary col or of green. But in the dream she is in

white. But her eyes, and all the rest, it is all the same. Even how the house is

standing, everything is as it was. I see myself, stepping into the house, but I don 't see

the surgeon or the soldiers or anyone else. I just see the little girl. And I see myself,

leaving. His associations around the color white were: Pure, clean. Snow.

Again here we see that in waking consciousness the feeling of personal guilt is

palpably present (recall that this man also had scent hallucinations and the need to

wash his hands), and again the way the symbolic elements are woven into the

repetitive dream seem to both substantiate and to contradict the feelings of guilt. The

image seems to corroborate his guilt because the little girl is now dressed in pure,

clean white, and he is, as it were, leaving innocence behind. But at the same time, the

symbolization also seems to contradict the personal aspect of the guilt, because, in

the dream, he has no hands. Hands can symbolize a certain conscious knowing or

understanding, a meaning that survives in words such as: comprehension or to

apprehend. And it could be that the dream conveys to him that he did not, could not

under the circumstances, know the full extent of what he was doing.

[Unwittingly, I just noticed, I have fallen into the tendency towards reification which

seems almost inevitable in our language, by assigning character and an intentionality

to 'the dream' (as in 'the dream conveys'). It would be more precise, or rather, would

40.

bespeak of a greater epistemological clarity (though might be more cumbersome) ifi

were to use the formulation 'the dreaming self seems to convey'.]

In the final example of functional meaning of dreams to the dreamer concerns the

proof interview I did with the woman from Sierra Leone. She had been a patient in

the clinic for just over eight months, along with her daughter and her nephew. At the

time of the interview she was one week away from leaving the clinic and to try to

begin again her life as 'being-in-the-world'. She and the children had been able to

flee to the Netherlands in the late summer of 1999 because her sister had been here

for several years. In the beginning of that year, the Red Cross camp in Sierra Leone

where the three of them had been living was taken over by rebels, and for the six

months she was raped almost daily, usually within sight of the children. Part of her

suffering when she was accepted for treatment in the clinic was that she had lost her

(Christian) faith as a result of her experiences, and wished to die, though was not

actively suicidal because of the responsibility she felt for the children.

When I asked her if there was a system of dream categorization in her culture, for

example, I said, between 'big' or 'little' dreams, she answered that 'some little

dreams can be very, very important'.

On such little dream she had had, she said, was 'from the Bible, from the first book of

David, Samue/46'. She would not say more and only urged me to read it. When I

looked it up, I realized that there were two books of Samuel and neither of them had

a chapter 46. However, in I Samuel, chapter 4, the story is told of a war that the

Philistines 'mustered against Israel', in which Israel was defeated and their camp was

taken over by the Philistines. The 'elders oflsrael' decide to bring the 'ark of the

covenant of the Lord' into the camp so that 'he may come and save us from the

power of the enemies'. Verse 4 to 7 (which includes Samuel4:6) reads:

When the ark of the covenant of the Lord came into the camp, all Israel gave a mighty shout, so that the earth resounded. When the Philistines heard the noise of the shouting, they said, 'What does this great shouting in the camp of the Hebrews mean?' When they learned that the ark of the Lord had come to the camp, the Philistines were afraid; for they said, 'Gods have come into the camp'. They also said, 'Woe to us! For nothing like this has happened before.

Given her trauma experiences, it is possible to imagine why it was so important to

her. Like her, the people oflsrael in this Bible story, were in a camp that had been

41.

7

overcome by the enemy and though they could not fight any longer, they did the only

thing they could do, and that was to bring the ark of the covenant, the material form

of the promise of God, into the camp, and the action frightened their enemies. In a

recursive chain of meaning, then, the 'presence of the Lord' represented hope to the

captive Israelites, and the dream containing this story might have brought a message

of hope and rekindling of faith for the patient. It must be stressed, however, that

these are my own ideas, I did not discuss my interpretations with her, nor were they

verified by her.

At the end of the interview, when she had shared with me her trepidation around

leaving the clinic, she told me the following dream. Last week I dreamt about my

nephew. He was wearing very tattered dress, his clothes were all torn up. I was so

surprised and kept on asking, Why? Why have you dressed him like this, in these torn

clothes? It was in my brother-in-law's house, in Africa. My sister was also there. My

nephew had been bathed and then was dressed in the tattered clothes. I was so

surprised. Why? I kept asking, Why these tattered clothes? Oh, he 'sjust going out to

play, they said, and I understood, but I was still surprised. When I woke up, I called

my sister and told her the dream and my sister asked someone from Sierra Leone

who knows about dreams. This woman said that it was a very good dream and that

we should donate (give) some of my nephew's clothes to someone who needs them.

As a psychotherapist, I completely concurred with 'the woman from Sierra Leone

who knows abont dreams': the prognosis in this dream was positive. The time was

the present, and the setting was normal life at home; to me it showed that she had

been able to make an emotional reconnection to a healthy pre-morbid part of her

psyche. Children in dreams often symbolize developmental possibilities and this

little boy was being sent outside to play, which is an appropriate activity for little

boys. To me it signaled that she was, indeed, ready to try life in the world. In light of

the theme of 'unclean-ness' which I had not yet, at that time, learned about, I now

find it significant that the little boy had been bathed.

The tattered clothes by which the patient herself was so intrigued and mystified I

read as a unsentimental reminder of the reality of her current existential situation: in

the Netherlands she is poor, a stranger and a refugee and she will no doubt

experience that the collective will not see her as a full person in her own right. In that

42.

light, I must say I was delighted and impressed by the practical genius of the

suggestion by the 'woman from Sierra Leone who knows about dreams' that she

should donate some of the nephew's clothes to someone who needs them. Such an

action would serve as tacit evidence that there are people who are even worse off

then she is herself and would preserve some of her pride and nourish her courage to

undertake the difficult task of creating a new life in a strange land.

As I write my own reactions to the dreams which might come close to

interpretations, I am aware that other reactions and other interpretations are possible.

First and foremost those of the dreamers themselves: in a dialogue they might

unearth their own associations and knit a meaning out of them. But also any readers

of this paper, including perhaps the psychiatrists, psychotherapists and

sociotherapists who were or are (as I was not) in a therapeutic relationship with these

patients. And to them I offer this story about dreams and the search for meaning. I

have been told there are many versions from other cultures, but the one I remember

comes from the Islamic Middle East.

A man wakes up out of a dream one morning which leaves a deep impression and

causes him to visit a dream interpreter who tells him what it means. Though the man

feels there is some truth to what he has been told, he is not completely satisfied and

goes to another interpreter. The same thing happens. He does this one hundred times,

at the end of which, in an agony of confusion, he goes to an Imam, and says, 'Master,

I have had a dream and have visited a hundred different interpreters and gotten a

hundred different meanings. Tell me, which one of them is true?' 'My son,' the

Imam says kindly, 'They are all true.'

43.

IX. RECONNECTIONS

I would like to begin this section with a more in-depth consideration of my third and

final research question:

• To what extent do persons perceive and experience dreams as

communication- for example: a comment on past or present behavior; an

admonition; a punishment; an encouragement; a recommended course of

action- or a form of contact or message from outside the personal self?

The raw material of which this question was a distillate was a psychological reading

of the anthropological record on dreams - as well as of the historical changes in our

own culture. The thought was that people who were part of a culture where there was

a collective agreement on a non-material dimension, whether that dimension was

more spiritual in structure, like the organized religions oflslam and Christianity, or

more magical, such as witchcraft (or, more likely, a combination between the two),

that such people wonld have a different experience of dreams than we in our own

culture where there is no longer such a collective agreement. In the West, while

many individuals are religious and may have a personal belief that dreams are a

message from God or from the 'beyond', such is no longer a collective assumption, \2,

and, as such, talk about dreams may;lanecdotal but not a normal component of the

social discourse. . '

And, indeed, I found plenty of evidence for the assumption. There was active

wondering, the day or even hours following a dream of whatever kind, about why,

why this dream, why this person appearing in the dream, why this moti£'theme/

subject, and why now?

Nonetheless, it does not seem to me that this 'wondering' is part of a belief system

around messages and communication but rather a much more general and fully

autonomous (which is therefore, psychologically-speaking, unconscious) notion at

the root of all culture: that an emotional experience, any emotional experience, has

meaning. So that, as a result of the information I gathered, the answer to the above

question is 'yes' in the sense that there was an active consideration of its meaning,

44.

but 'no' in the sense that was not seen as a 'message that came from somewhere' but

rather as an experience that required decoding.

What I saw was a tacit demonstration of Geertz' oft-quoted dictum that man is 'a an

animal suspended in webs of significance he has himself has spun'. Just after the

dream, the questions beginning with 'why' would begin: Why did I dream about this,

in this way? Why him? Why that place? What will happen to me now or tomorrow?

Are my children dead? Will an accident happen? Are they coming to get me? With

this in mind, I saw that in dreaming and in the taking in of that experience, in the

sense of wondering about it, and, in many instances, asking others for a response to

that experience, one can see the very movement of spinning. This, in spite of the fact

that such spinning was part of a tremendous amount of suffering; that each person

appealed for help in bearing this suffering; and that the help of choice, in most cases,

seemed to be a request to 'take away the dreams'.

Biomedicine's answer to that is the development of drugs that are aimed to do just

that, concretely: to develop and in many cases dispense medicines that will stop

people from dreaming. No doubt for some people at some time that may be just

exactly what they need, in the sense that painkillers are often necessary (or at least

desirable) in order to purchase the rest that is needed to promote healing (or to allow

healing to take place). However, I wonder if the dreams can also 'be taken away'­

albeit more slowly, over the course of a much longer time -by sharing them with

'an' other or several others who will help in decoding or discovering a meaning.

I do not, emphatically, mean 'meaning' in the literal sense (as in: literal: taking

words in their primary sense and applying ordinary rules of grammar without

mysticism or allegory or metaphor). I carmot imagine there to be a literal meaning

for any trauma, whether it be the death of one child or loved one or all the sufferings

of war or the holocaust or any of the genocides that the 20th century saw and which

seem to continue unabated in this new millerrnium. And so, in that sense, it would

seem to be sheer hubris to believe one could help another in finding such meaning by

way of the dream - or any other way in the secular sense. However, I do believe one

could support the other's search for meaning, not by pretending that one could ever

get there, but by nourishing the process of searching itself.

45.

I also wondered about the function of dreaming and the telling of dreams in terms of ·---·------··"--·-'-... ' -"""~----.... ' --------~~---- ·--------...

this search for meaning. Why do people ~~)md why do peopleif~ll there drea~~)

Only the l"tt~rql[estion belongs to the domain of anthropology. Does the widespread

norm of telling dreams point to the practice as having a function in maintaining

either the individual or the society or both? Obeyesekere says that 'A striking feature

of contemporary cultural anthropology is the failure to bring the idea of human

agency, intentionality, or motivation to the study of culture'. (Obeyesekere

1990:353) Answering to Geertz 'webs of significance' he charges him with showing

the webs but not the spider at work. Other anthropologists since Geertz have shown

the spider spinning as it were, but have still neglected the spider's motivation. They

have, in other words, presented the spider without his niche or context.

Obeyesekere's answer to his own question is that 'The work of culture is the process

of transformation ... a process of symbolic transformation that refuses to put life

and death, Eros and Thanatos, into plus or minus signs ... '(Obeyesekere 1990:353)

The work of culture, iu other words, is to enable life to go on.

According to Heraclitus, 'We share a world when we are awake; each sleeper is in a

world of his own'. This is true in the extreme for people who are plagued by

recurrent trauma dreams, irrespective of whether those dreams repeat the trauma

exactly as it happened or clothe it in symbolism. What I saw was that the sufferers of

such dreams felt totally alone in their experience, to the point of certainty that

something is 'real' even if they 'know' it to be a logical impossibility, such as, for

example, the Afghan woman who saw the Taliban outside the window. At such

moments people deny themselves even the flight into psychosis.

In the earlier quoted essay on dreaming, Foucault traces the arc of the dream from

experience, to image, to word, and 'The word implies a world of expression which

precedes it, sustains it'. (Foucault [1953]1993:31) (He then goes on to propose an

'anthropology of expression' and I thought that such an anthropology would be a

pursuit to which I might dedicate my energies as an anthropologist, when I became

one.) I would go one extra step. The 'world of expression' implies an 'other' to

whom the expression is addressed.

As part of this research I wondered if people do not tell their dreams as a first step of

substantiating to themselves that they are still, fundamentally, part of those 'webs of

46.

significance'. That the movement of a dreamer after a dream is always to connect or

reconnect to others, because meaning is, in part, a shared reality. That the normal

dream sharing mechanism shows the private symbolic system interaction with

collective (cultural) symbolic system. And that in the normal dream sharing each

person is at some time the teller of dreams looking for a hand as it were to reconnect

and at other times the listener to dreams offering the hand to establish reconnection.

A reconnection to others is, in most instances, easier if there is a common culture.

Given the themes that echo throughout the stories of 'being on the outside' and of

'uncleanness', if I were to continue to work with a population of psychotraumatic

patients, I would he very interested in additional reading or research in mourning

rituals and purification rituals. Mourning rituals because it seems to me that in those

each culture organizes a sort of necessary process of forgetting, ofletting go of the

ties to loved ones who are no longer there. And purification rituals because they

provide steps or examples of rejoining the collective after an experience that sets one

apart. Such cultural algorithms, as it were, where the form -or at least the aim- is

always the same, but the content can be adapted to suit the particular circumstances,

is part of how I understand Obeyesekere's idea that the 'work of culture is

transformation'.

The concept of transformation, in the West, has often an ecstatic tinge to it, a change

that has something magical, mysterious and immediate to it: a flash of insight, a

'eureka' moment, Paul's conversion on the road to Damascus, the perfect anti­

depressant pill. Whereas the process of transformation is slow, laborious,

incremental, full of setbacks and circuitous trepidations. When I set out to explore

the 'function' of dreams I was in such a heroic mode. With much more humility I

would now posit that shamans can perhaps 'use' the dreams, because they at least

connect it to some sort of collective myth.

Perhaps the best we can do here is to by guided by the dreams -to be thankful that

the process exists- in order to 'track' the healing process, to 'gauge' what the patient

can bear and what s/he cannot, to even be grateful to the presence healing elements

when the/appear without wanting to exploit them immediately to 'help' the other

person.

47.

DenHaag December 2000

et L--)

i f I I

! ! I !

I

APPENDIX A

Man, 31, Serbia

I was drafted into the army. I am political journalist and they assigned me to the medical service. They send me, together with a young surgeon, to pick up two wounded soldiers in a Albanian house. Bombs were dropping . .. There were also two Albanian families. One of the Serbian soldiers was still alive, en we had to leave behind a little Albanian girl of five . . . I wanted to take the child. ... First we though that the two soldiers had died, but one of them was still alive, and the surgeon was frightened and we took him and left the child behind. ... I have a daughter who is six years old . .. The Serbian soldier was very big. ... She's probably grown by now as well. If I could have, I would have taken him and her . .. I said to the surgeon, 'If we would take her and not the other one, I'm sure they'll shoot and kill us. But we couldn't let the child go alone. The surgeon was 21 years old, they would have killed him ... I was completely unafraid for my own life, it didn't matter so much. But we left her and took the wounded soldier.

This is what I dream about, each and every night. It is always the same, every night. The little girl could not speak. I don't know what she had in mind, but her mouth was open and her eyes were open. I wanted to leave them all behind, all of them! They are dead, okay they are all dead! I know what would have happened to me: then they would have shot me and the surgeon, but I don't believe they would have shot the girl.

That is all I dream about.

The calor of the clothes, that is the only difference, sometimes in my dream. And also the amount of light, that is the only thing I can remember. And also the room, in the dream with the Albanian little girl, it sometimes {in the dream] seems as if I leave in a different way. And in the other dream, the dream where they are searching the house, there it seems as if, when I sit down in the armchair, I completely sink down, away. And in the dream where I take the soldiers, there, sometimes, it is as if I don't have any hands.

And also the calor of the clothes, in that first dream [with the Albanian girl]. Sometimes there are dark, grey colors, sometimes there is red or orange ... But the little girl is always dressed in white, in the dream. In real life she was wearing a green dress, a perfectly normal green calor. But her eyes and the remainder, it is always the same. Also, the way the house is standing there, everything is as it was. I see myself, climbing in the window, but I don 't see the surgeon, and I also don't see the soldiers. I see only the little girl. And I see myself leave.

I have the feeling that we can't find each other, in conversation, because it seems as if you are under a glass dome and you can not understand ... I can not explain to you, exactly, what happened to me ... even if you are a psychoanalyst and even if you know a lot, we can 't make contact, we have nothing in common.

Do you want to know what is even worse than the dream? The scent that I always carry with me [He takes scent-samples out of his pocket and hands them to me].

I spend a fortune, almost daily, to buy expensive perfumes. And daily I want to spray them around me . ... The stench of the bodies ... And also, I want to wash my hands, they always feel dirty, soiled. That is worse than the dream. That is what I have day

48.

and night. Sometimes I wake up and then I have to take a shower, in the middle of the night.

49.

I I

! I

I ! !

I '

I I '

i

I

I

Man, 33, Zaire

I have the feeling that something is wrong inside my head. It has to doe with the circumstances, with what happened to me in my country, with what I experienced. That is the source, the reason for my problems. Before, a long time ago, then I had no problems. I slept the way others do. Everything was calm inside my head. Now my head is broken. It is as if I am no longer the same person, the person I used to be. I am not myself My reactions are different than before. Sometimes I forget everything. And I am also irritated much too quickly. That is not how I used to be.

50.

Woman, 27, Angola

When I was a child my mother dreamt about my father. I heard her talk, at night, in her room. When she would wake up, she would say, 'Why do I have to dream about a dead person? Why?' It would often wake her up at night.

She would sometimes say to us kids, 'I dreamt about your father. He was not very happy with you. 'I do think that for her, there was a message in these dreams. It was all very difficult for her. Many children and no food.

My father had a piece of ground, where they planted things, things to eat, bananas and other things to eat. When he had died, his family came and they took possession of the ground. My mother asked, 'Is it customary, here, in your region, to do such things? I am his wife, these are his children. Now we have nothing left to eat. Is this how you do things, how you treat his family?' But they did it anyway.

I wasn't there when he died. That bothered me a lot. When I was small, there was a time that it bothered very much, that I wasn 't there when he died. I cried a lot, each day, and went and hid in the chicken coop. My father had been dead for a long while by then. I was very sad. Then my mother came and said, 'Why do you still have to cry? It has been such a long time!' She was a little angry. It was all very difficult for her.

That night both my mother and I dreamt about my father. In my mother's dream my father said that she abandoned her children, that she did not take care of them. My mother didn 't want me to hide in the chicken coop because then she dreamt about him every night.

My father asked me, in my dream, why I hadn't been there when he died. He told me he had died because of the piece of land where he grew many things, and that his family had stolen it from us, it belonged to us, and that my mother now had to take care of us, and that we had to mind her well, all of us, because life was very difficult for her. His family had gypped us and now we had nothing left.

When he was still alive he talked to us like this as well. And when he died, my mother would dream and the conversations just went on. Yes, it was as if we stayed in contact with him.

Now I only dream about the rapes, about the soldiers, how they handled the guns, what they did to me, and what they did to my children. That is what I think about all day. That is what occupies me in my dreams at night.

At night, when I go to sleep, I dream that my children are with me, that they go to sleep next tome, that we are all together. But here I am only with my daughter. And then I can't sleep, because they are not here.

During the day, when I eat, I think about my children, I think, 'I wonder what they have eaten. In the evening, when I go to bed I also think about them. At night I dream about them. Then I wake up and I lie in bed, thinking about my children. That is how it is, continuously.

Every once in a while I dream about the children themselves. I think about them during the day. The are always in my thoughts. But what occupies me the most in my

51.

dreams, that is my own problems, what happened to me. Not so much my children, but my own experiences.

Just the other day I dreamt that I had been bound up with ropes, my hands, and that I was brought to a cemetery and I must have spoken aloud in my dream, because my daughter touched me and said, Mama, why are you talking, what are you saying? I told her it was nothing. But later she asked me again, it was day then, and then I told her.

In real life I was never brought to a cemetery. But I was bound, tied up like that, and also blindfolded, that did happen. No, it was not a cemetery I recognized.

I was scared.

And when I woke up, I wondered, 'What does this mean? Why did I dream about a cemetery? 'And then I thought about my children in Africa, and asked myself, Oh, could they be dead? That can't be true. I had received a letter from the International Red Cross.

It [the dream] was actually a kind of mirror of the frightening feeling when I got that letter.

52.

l

I ' l ' J

I I

Woman, 33, Ethiopia

Dreams are told to old people, they know from experience if something is a good dream or not, or what it means. For example, new clothes, that is a good dream. To build a house or a bird, animals, in my country always mean something good, especially a cow. Food is also good

But ancestors, no that is not good Dead people in a dream is not good. People in my country believe that if dead people appear in a dream, they will come to get you.

Also, when you are pregnant, dreams have meaning. If you dream of an earring, you will get a girl. If you dream of a horse, you will get a boy.

If a tooth is lost, one of your relations will die. Also, if you dream of shaving your hair, someone will die.

Dreams about the body always have a meaning having to do with the family. But sometimes it has to do with the family close to you, sometimes with family farther away. For instance if you lose a leg, it could mean your brother will die. But if you lose part of a finger, it might mean that your cousin will die.

When old people see meaning in the dream, they never tell the person directly what it means. They just say, 'You must be carefUl, on this day, or when you do that'.

Yes, people in my country take their dreams seriously. For example, if they have an appointment, and there is a dream that has a bad sign in it, or they have a bad feeling after dream, then they will cancel the appointment.

Sometimes a dream might have a meaning that is opposite from what it shows.

The difference between a dream and a nightmare is that a dream is clean. A nightmare is not, it is not clean. Also, you feel not clean after you have had a nightmare.

Good dreams come in the middle of the night. Early evening dreams are nightmares. Because in my country people believe that you can not see deeply in the evening and in the morning.

53.

i I i

I

I

I I I

I r

Woman, 39, Sierra Leone

It is forbidden to talk about dreams at night. because then it will happen.

To dream of blood is very bad.

Also: eating food in a dream, especially meat, that is a sign that witches have been active.

When that happens, when you wake up you should drink some palm oil. And also, you should put some palm oil or also some small good things to eat on a leaf and then place it just outside your door. Also I or? place such an offering at the first crossroads near your house.

Snakes in your dreams also means witchcraft. Also dreaming of aeroplanes.

There is a saying, it is very important: 'Jj night were to turn into day, it would be a disaster'. Jf night turns into day, it is very bad, a disaster.

Crying in your dreams is a good sign. Also climbing a mountain. And also when someone you were once close to comes to visit.

Some little dreams are very, very important. [When asked for an example:] Like a bible passage. I once had a dream where a passage came to me from the first Book of David, Samuel4,6.

[When I asked more about this, she would only say, Read the passage. I wish I'd asked her how the message came to her: did someone say it, in the dream I mean, or did she wake up with the passage in mind?

In I Samuel, chapter 4, the story is told of a war that the Philistines 'mustered against Israel, in which Israel was defeated and their camp was taken over by the Philistines. The 'elders of Israel' decide to bring the 'ark of the covenant of the Lord' into the camp so that 'he may come and save us from the power of the enemies'. Verse 5 to 7 reads:

When the ark of the covenant of the Lord came into the camp, all Israel gave a mighty shout, so that the earth resounded. When the Philistines heard the noise of the shouting, they said, 'What does this great shouting in the camp of the Hebrews mean?' When they learned that the ark of the Lord had come to the camp, the Phi/is tines were afraid; for they said, 'Gods have come into the camp.' They also said, 'Woe to us! For nothing like this has happened before.]

An example of a very bad dream was triggered by a cart on wheels outside my room at night. I dreamt of my cousin, lying on a hospital bed. She was all torn up [she gestures from her throat in a straight line down the middle to her genitals] she was open and very bloody. She was crying, crying, in so much pain. Blood and pain. Also her mother was there. She was trying to comfort me. It was terrible, terrible. I didn't want to go to sleep for three days afterwards, it was terrible, I was crying and so scared.

[But she was trying to comfort you, I say.]

54.

Yes. And she was crying, so that might have meant it was a good omen. But there was also lots of blood, so that was bad. And it felt terrible. I was very, very frightened.

Last week I dreamt about my nephew. He was wearing very tattered dress, his clothes were all torn up. I was so surprised and kept on asking, Why? Why have you dressed him like this?

[Under questioning, the patient said that] 'It was in my brother-in-law's house, in Africa. My sister was also there. My nephew had been bathed and then was dressed in the tattered clothes. I was so surprised. Why? I kept asking, Why these tattered clothes? Oh, he's just going out to play, they said, and I understood, but I was still surprised.

I called my sister and my sister asked someone from Sierra Leone who knows about dreams. She said that it was a very good dream and that we should donate (give) some of my nephew's clothes to someone who needs them.

55.

Man, 53, Chechnya

Both for Chechnyans and for Russians there is a strong sense that the end of time is in sight. A feeling that an all-encompassing disaster will take place.

In dreams ... yes, in my family, when someone has had a dream that could point to something, for instance that someone could fall sick, then they call everyone in the family, what it could mean, who it could point to ... and then, something like that always comes to pass, as it were.

For instance, my wife dreamt recently that her sister was sick. and then she called to a neighboring republic where she lived and then she heard that it was true. And also. another Chechnyan woman who'd no contact at all with her family, but who continued to dream about her mother. intensely, who was still pretty young, really, perhaps 45 years old or so, en then. a week ago there came the message, via various sources, that her mother had died, in a bombing raid. One thinks then that such messages come from God. No one knows for sure, of course.

The people believe that everything that happens at the direction of Allah, there is a driving force . .. and, really. beyond that, one doesn't hear much. And dreams, then, are the images, the information, that we receive about Allah's will.

I myself have an ever-repeating dream, it contains very little variations, it is always the same. It almost always concerns my little son who died. I still hear the screaming and crying, and that is in fact what always jerks me awake. And then the overwhelming feeling of guilt washes over me.

It would not be possible to tell a dream the way for instance you might be able to recount a film. because there is so much that you forget. You only recognize the dream, and what stays with you are a few key moments, which you can remember very clearly. But many of the things in between, they just fall away.

What I dream about is especially is the child that cries for its mother, that begs for help. But it does not feel good to talk about it. Already again I feel the terrible guilt because I know that I am to blame, that I am the source of all these terrible circumstances. It hurts too much.

I have the feeling as if I am being cross-examined.

Time and again, in my dreams, it is as if I am completely back, as it were, in the situation, how it was when my other son, who is now in the Netherlands, how he was a victim of a kidnapping attempt in 1998. That is what true experience, he was kidnapped out of school. In Chechnya things like this often happen.

I dream about what really happened. I have experienced terrible things, and those things I see again. in reality, in my dreams.

I just cannot forget how I was humiliated by the other medical staff, and there is also a story about a nurse who was abducted by people with weapons ... she was never seen again.

56.

t ! I I I I !

These are images that you just can not set aside .. . I look for ways to distract myself, to keep myself busy . .. but If there is even just an hour, in a manner of speaking, when I have nothing to, then it all comes back at me.

All the good things that have passed, those things I do not dream about, those things I have totally forgotten. It somehow seems as If all the good things have been vanquished by the bad things. As if they have been driven out. Because of all that has happened, I have lost the capacity to think or to see anything in a positive light.

There, I was a doctor, a physician, and here I am a zero, naught.

I lie down but I do not rest.

In the dreams, it is always the same, it frightens you, because there it is again. And the terrible feeling, that stays with you. I am truly afraid of these dreams.

Sometimes things are more detailed, other times it scetches just the outlines, as it were. And what I do is try to take as many tablets as possible, so that I can release myself from the tyranny of these dreams.

I do not dream very night, but if I don't dream then I also sleep very superficially, every little sound, or murmur and I am awake again. And when I sink deeper into sleep, then I dream. Sometimes it seems as if I have been asleep for a very long time, but then in retrospect it only turns out to be a half hour or so.

Really, I do not sleep more than three hours per night.

The surroundings in the dreams, they are recognizable but fairly vague.

[The list of somatic symptoms of the NITE, he affirms he suffers from all of them.] It is a good thing that electricity was invented, because when the light is on you already feel a little better.

[When asked if events the previous day have an influence on the dreams at night he answers:] Last week; for instance, I was walking along the beach and for about a half an hour I watched a woman play with her dog, she threw a ball into the water, and I was so impressed that this dog dove through the waves to retrieve that ball . .. and that night I dreamt the whole scene again, step for step, exactly as I had seen it. As if it had been filmed, and then the scene just unfolded again. Ordinary and very concretely, just as I had experienced it, not in another shape or anything like that, but exactly as it had happened And I actually woke up with full of longing. I wish I had such a dog. To tell you the truth, I was a little jealous. Do you know Ernes! Hemingway? The Old Man and the Sea? There he writes, The more I get to know humanity, the more I start to love animals.

It was a shepherd, one of those big, black dogs. Him I saw very clearly, actually, I was so focused on him that the image of the woman dimmed a little, yes, she did throw the ball, just as it had happened, but actually my attention converged on the dog. The dog was very real.

[Later] Since the time that everything happened, nothing seems to matter anymore, everything leaves me cold. It is as if just my body is still present, but my soul has totally blackened.

57.

For the most part I dream about the people who surround me, people with whom I had contact there, not so much about what happened to me, but rather with the people who I associated with, there.

Where I dream ... the I see my children, again, the crying, shrieking, the noise, the wail of a sobbing child that is dying, that is crying for help. I also dream about the people with whom I worked, my colleagues. And I dream especially about the cellars, the underground spaces where we were those last days, and the shooting . ..

At one point we were in a building, between the two fighting sides, on the one side were the Chechnyan fighters and on the other side were the Russians, we were caught exactly in the middle, on a flight of stairs, the shooting happened all around us, the children were crying, Oh please let it stop, it isn't our fault . .. And the one side would shout back, Well, then, surrender, and the other side would retort, No, no, hold on ... I was not so much concerned about myself, but more about the children.

We had ended up on this flight of stairs because . .. in the first instance we were in the basement, and then I heard the soldier shout that a grenade should be thrown into the cellar because there were people there, I knew they were going to throw this grenade, so I wanted to bring my children to safety, and then we went upstairs, into the stairwell, because I thought, well, there we'll be safer, but it turned out that that was worse.

I also had taken my niece, the daughter of my eldest brother, and she'd just had a child, and I managed to just get us all to safety, in that stairwell, while the bullets were flying around our ears.

And so I dream about that basement. We were there for three weeks, the children couldn't go outside, no fresh air, that wasn't possible. There was also another woman with a small child, and I cared for, was responsible for all of them, for three weeks.

Dead soldiers were lying all around that stairwell. So we were caught between two fires, as it were. My son would drag the bodies inside, but then the one side would say, You 're helping the Russians or the other side . .. we were just in between the two sides. Caught. Those images, they'll be with me for the rest of my life.

We did have a radio, and we thought, surely someone will come to help us, but we were there for three weeks, without any help, without anyone coming to help us.

Later there was a march of people who came from the hospital, they were all wounded, they were being evacuated, accompanied by soldiers, and among them, walking as part of this group, were the medical personnel. By chance I ran into a woman I had know, she carried a white flag, as a sort of sign of surrender, she'd been in charge of the intensive care division, she knew me, and she said, What an outrage, we worked here for so many years, and now this is happening. By then I had my children with my, I was carrying one of them on my back And !just joined this march of people. But the woman said, Don't come with is, you will be killed, you must leave. But I wanted to go anyway, but the woman pushed me away, out of this crowd of walking people, but I wouldn't leave, and then a soldier came up next to me and he wouldn't let me leave anyway. And the woman said, But don't you see that he

58.

has children who are ill? Okay. said the soldier. let him leave them behind. And then the woman pushed me one more time, but hard, and then I removed myself from the crowd anyway, and then we fled. But that march of people ... that woman ... she died with them, on that road. Because later they were attacked and then shot.

And that is what I dream about, although there are varying interpretations. Those interpretations ... what can I say ... sometimes something is added, something that in reality did not happen, sometimes I see people I do not know, strangers. But the core, that is always what I know, the things I experienced.

Dreams and remembrance ... even though it concerns the same images, still it is different . .. because what I see in my dream, the way it feels is that it is happening all over again, in reality. Then I wake up with a racing heart, bathed in sweat, because at that moment, it seems as if it is really happening. Yes. The dreams are more real than the thoughts about it. The dreams as if it is reality.

Besides, I sleep very lightly, very superficially.

What I often dream is that I see my children just in front of me, crying for help . .. Then I see how the fighters humiliate people ... It largely concerns the humiliation of me, myself, how they punched me, at the time that my second child was held hostage, the child that was later murdered.

There were people standing by the door, and there were people who climbed on to the fence, the surrounding wall, and the people who were standing by the door, those I saw in reality, but the people at the periphery, those I did not see in reality, and in my dreams, those are the people that return again and again, because then I imagine how those people climbed on to the wall, how they did that, and then I imagine I could have done something. And then this feeling of helplessness, of powerlessness returns again, overwhelms me, that is what wakes me up, because it is a feeling of choking ...

Often I dream about the staff, in the hospital there, and about one of the nurses whom they killed, just like that, for no reason at all. That is what stays with me, her is who I continue to see.

Yes. Changes in the dreams ... The core, that always stays the same, that which I already know, which is the essence of it all, but sometimes there is another person, who, in reality, was not there, or there is someone missing, who in reality was present. Those are the variations, the but the core, the spirit, the gist of the story, that is always the same, that I see again and again.

Those variations, those do not happen often, really, but it does happen. Then, in the crowd of people I often see unknown faces.

But it has been a very long time since I have had normal, nice dreams. Now, they are all unpleasant dreams.

[When I went to fetch the patient for this interview he was drawing a dog and I now ask him if it was the dog he had dreamt about the previous week, the one he had talked about in the first interview.] No. I always draw dogs. Or horses. Dogs and horses. There, we also had a dog. He was shot by a soldier. The dog was following him, and they all had guns, and then he was killed. I often dream about that dog. The

59.

children sometimes ask about the dog. they ask, Is he still alive? But it is difficult to talk about it. I try not to talk about it.

The children keep on asking how things are now, in Grozny. Not so long ago, there was a supplement on one of the newspapers [about the situation in Chechnya}. A nation in shards, that was the headline, and there were also photographs and the children asked, Is that really what it looks like now? No, I always tell them, our house is still standing.

They are nine and five. Yes, very young, but they know everything. However, for me it is very difficult if they ask questions and my reactions can be a bit too aggressive and they understand that, too. And so they are afraid to ask questions, but they know very well what is going on. But I say that it all is okay now, that it is safe, that it is not war any longer. But the oldest, he knows better, he saw all those dead people. So many bodies, everywhere, every day. And I am not talking about what we saw, but what the children themselves saw. Those bodies were not cleared away. And we also saw that the dogs were eating those bodies.

Yes, the children also dream about it, and then they wake up screaming, the oldest even jumps up right, in his sleep, and then they do not go back to sleep, and I don 't sleep and my wife doesn't either.

[When I return to his mention of variations in his dreams he says:] ff there are people, in the dream, who were not there in reality, then often it is people I know. But it also happens that there are people I do not know

Who? Well, now I am talking about when I dream about what happened to my house, and to my children, and who I did see there, in the dream, is the oldest brother of my mother's, an uncle, in other words, a man who must be 80 or so, and, in reality, he was never there, but if I dream about someone I know, who is with me in my dream, then it is sometimes him. In reality, he lived close to me, on another street.

That is perhaps because on my mother's side almost no one is left, and yes, I do consider him as sort of a helpfUl presence. But actually, on my father's side there is also almost no one left.

[I ask: 'A sort of help ... When you are awake or in the dream?' He answers:] In the dream.

No, it doesn't happen often, he does not appear so often, it only happened a couple of times, and then I am bemused and foil of wonder that I have seen him and ask myself, Why did I see him?

I must say, it is such that, if I see something in my sleep, usually something has happened the day before. For instance, it has happened that that day I have met someone, and that someone reminds me of someone out of my past ... for example, you, I see you, now, and you remind me of someone and then I will see that person again, later tonight, in my dreams. Or I see a house that reminds me of a house there, and than it is an almost certainty that, the following night, I will see that house again in my dreams.

It is also like that with sounds, especially the sound of airplanes, because back there were often air raids, with bombing, and even though I know that I am safe here, still,

60.

nonetheless, each time I feel a little fear. And the children, well, they are continually afraid, as soon as they just hear an airplane or a helicopter . .. terrible.

There I was a physician, !was capable of helping others, and/just can't get used to the fact that I can not treat myself, heal myself

61.

I I

f

Man, 37, Iraq/Koerdistan

I dream every night. Sometimes I do not dream. but very seldomly. For instance, in the past three weeks there was one time that I didn't dream. Or twice. But the remainder of the nights, dreams. Always.

But before I start to tell you about that, I want to say that I have political problems. I am in coriflict with the government. My life is always in danger. In the war, much of my family died. Everything keeps on coming back to me, everything that happened, that is what I think about, during the day, all I do is think

And at night that is what I dream about. Sometimes I wake up because I am speaking out loud. It does not feel as if I am only dreaming, it feels as if I am in the middle of the problems again, as if I am really there. And then when I wake up, I can't fall back asleep again.

Sometimes I wake up and then I can not move, then I am totally stiff Then I try, slowly, carefully, carefully, to move again, and that happens then, very slowly. And also, I always sleep with the lights on. But then, when I wake up out of a dream like that, than it feels as if I am fully in the dark. But then, a little later, bit by bit, it feels as if the light is there again. Often, by that time I am no longer lying in my bed. For example, !fall asleep here (points) and then I wake up over there, in that corner. I cannot sleep in my bed, I always sleep on the ground, because when I am asleep I fall out of bed. That is why I sleep on the ground.

Before, when I was younger, I also dreamt, but that was because I was always being sought, by the authorities, I was often frightened. That is what I dreamt about. We were not strong, the authorities, the government, they were strong, they were everywhere. With the partisans I was always in flight, from one place to the next, we were always underway somewhere. From one village to the neighboring one . .. and then we'd have to move on again. Always the military troops were trying to find us. My life was always in danger for such a long time, always there were problems. My youngest brother was shot and killed.

In the hospital, I fell. Also here, by now I have been here three years and two months, here, too, I too I have fallen. Sometimes, on the street I just fall, and then the ambulance came and took me to the hospital again. I live alone in the Netherlands, no family, no friends. I am married. I have two daughters in my own country.

I have a small room in the city. I seldomly go outside, never downtown, I never go anywhere, because I am afraid to fall again. And then there will be no one there to help me. From here, from the clinic I go to my room [for the weekend] and then back to the clinic.

In my country, when people wake up the say to each other, Last night I dreamt of this or that. People answer then< Oh that was a good dream, or: No that was not a good dream. For example, in Koerdistan, if someone dreams about something, other say, You must wait for this or that. Or in another instance if someone dreams of something else, then, on the contrary, the message seems to be, No, now you must go.

62.

In my land, in Koerdistan, there are differences from the Netherlands. People believe that if someone dreams that ... [unintelligible] .. okay, fine, make a new family. But some dreams, that is clear, they will come out, that will happen.

People do talk about their dreams, but many people do not really believe in them. But many other people do believe in dreams. I, myself, I believe in dreams. When I dream about my family, my wife or my children, or my younger brother who is dead, or my father who is missing, then it feels as if it real. As if I have really seen them.

For instance, there is a problem in my family. I dream about it here. It is not the same, as if it is a film, but it is about the same things.

Dreams also have to do with problems you have. Normal problems, they are soon gone. But big problems, they stay inside your head, and that is then what I dream about. Sometimes, even when I do not think too much, still I dream a lot. Because it is inside my head.

If someone has not experienced what I have experienced, if he has not been in my country, then they can not know my problems. Even if I talk for a month in a row, still you will not be capable of understanding me. Because if someone has real problems, then he talks differently. I have seen everything. It is all still in my eye. I have seen war, I have seen children burned alive, a woman who was burning. We were with so few people, but the army many thousands of people, airplanes, bombs. I had a friend who was tortured. He wanted to come to me, to get help. I told him, No stay where you are, it is not safe here. I will come to you instead. But he came anyway, and was hit by a bomb. He was cut in half[gestures diagonally across his body], one arm and his head were gone. I saw so much And also felt so much with my body. I was so often scared. The blood of my friend was on my own body. That I can not forget. In yet another war I was in a room, and a friend of mine in the next room. An airplane cam a bomb, everything was dark. I no longer heard my friend. Later I went to look. My friend was dead, everything was burnt.

Al these things I still see. Even if I am no in the Netherlands, sometimes it does not feel as if I am in the Netherlands, it feels as if I am still there, in my country. At night, I speak Koerdish.

Yes. That is what I see every night. Because it was not just one year that I had such experiences, or two years, no, eighteen years long. It was war for eighteen years. I bet I have seen 4000 villages, the government destroyed everything, people, cows, donkeys, all the animals, even the ground itself, everything, they destroyed everything. We would arrive in a village, and everything was dead. Everything dead.

In Koerdistan, there were no photos made of these things, there were no journalists, no European people were there. But I saw it. If someone would have bothered to come and see, they would not have been able to take it in, they would not have been able to stand to see it all. There are 182, 000 people missing, among whom my father. My father came for my wife. The government troops were on their way, the partisans were here [gestures], the government came from here. My wife was in a small village here [in the middle}. My father lived in the city. I said to him, There will be an attack. Go and fetch my wife. He was on his way to get them. And now he is missing. My wife then fled, with the others. Then it was almost seven months before I saw my wife again.

63.

I was also wounded, as a result of poisoned gas. I was in the hospital for two months, in Iran. In the war between Iran and Iraq I was captured by Iran in order to fight for them. I fell and then woke up in Iran. There I was in the hospital for two months. Problems with my eyes and with my lungs. After seven months my wife joined me in Iran. There we lived for three years.

Now I have been in the Netherlands for three years and two months, without family, without my wife, without children, without friends, always sick. Always alone in my room, thinking, dreaming. I know I have to talk. But I do not trust people. No one knows what my problems are.

Usually my dreams are about what has happened, really, exactly like it happened at the time. But sometimes not exactly, but almost. They are always bad dreams, never good dreams. Never. And I don't really sleep. I wake up out of a dream, sometimes after only two hours. Sometimes even I dream after five minutes asleep. Sometimes I do not sleep at all, and then, during the day I sleep a little, and then I dream again.

Sometimes I can not write down the dreams, because then the anger is too great. Sometimes I do write them down.

[Reads from his dteam file] Oh, yes, I remember this dream. I saw my father. My father said to me, Go and lie on the ground . ..

Oh, yes, I still know this dream. My father is missing. I am responsible for that. Because my father was on his way to my wife, I had asked him to do so. So my father is now gone, because of me, it is my fault. I always have with me a feeling that I did not do it right . .if I had not been a partisan, then my wife would not have been in danger, and then my father would not have had to go and fetch her. I am the reason my father is now missing.

... In this dream the whole family is lying on the ground [gets up and gestures], like this, they are lying like this in a row. My father is actively walking, next to where the family is lying. There is one place open, that place is for me. He says to me, You, you come here, to this place. I am afraid and say 'no'. But I go and lay myself down there anyway. My father has gasoline. He says, I am going to burn everything. I lie there, he comes with the gasoline, then everything is on fire. Everything is burning, and then I wake up. I wake up when my body .... yes. Not good.

I can not talk now. It is very difficult. Everything in my life is like this. Why does my father burn me? I am innocent. The government is guilty . ..

This did not 'really' happen [sarcastic]. But there are things that I have seen ...

One time I dreamt about this place. I am newly in the clinic. And my father and my younger brother are coming to visit me, with flowers for me. I feel as if it is real. My uncle, my cousin, who is torturer, he says, Perhaps the following night the others will come. I can not sleep. I cannot sleep. My cousin, the torturer . .. [I ask: Tortured?] Yes, dead now, because of the government. His body was never found.

Sometimes I feel in my dream that dangerous people are in my room. I think they will say, 'Why don't you come with us?

[Tears. Breaks off the interview.]

64.

I ! F I

Woman, 33, Afghanistan

Yes, with us dreams are often discussed, especially the content of the dream, its meaning, is it a good dream, does it bring good news, those sorts of things.

Here I do not do that, but at home usually one talks about dreams with older people, with my grandmother, for instance. Certainly when I was young. Later I did it less so. Others did, but as for myself, I did not really do so anymore.

I can no longer remember what the signs were of a good dream or of one that brought bad news, that was all so long ago. But yes, people did talk about them. Others, mostly, because they were more religious. Often it was soothing, Oh, that is not so bad, don't think about it too much, it will be all right.

Now I do dream but only bad dreams, about what happened.

They leave me with at horrific feeling.

But there is also a sort of feeling of premonition, that something will happen. For instance, not so long ago I had a dream of a beautiful young girl, long hair, wonderfUl, she was in Afghanistan, she was sitting at a table, but she had only one half of a body [gestures, cut in half across the stomach, with only the top half! eft], it was truly horrible. The next day my daughter had an accident, with her bike.

No, there is not much you can do with such a premonition, with such a feeling. It happens anyway, you have absolutely no grip on it. Would I have spoken about a dream like that if I were still in Afghanistan? I honestly do not know. There I didn't have such dreams. Or rather, yes, later I did, but before, no. I don't know. What can you do about it?

Last night? Oh, that was terrible. I was in a house foll of women, perhaps in Afghanistan, I do not know where. I went outside and by accident bumped into someone. She had a bloodied face, on one side, also her shoulder, because I had bumped into her, even though it was just for a moment. I couldn't understand it. I apologised. Then, there was nothing. Later, I saw the same woman, dead. So much blood on one side of her body, dead.

It did not exactly happen like that, no. But something like that. With my sister. It was my fault.

[Told with fits and starts, many tears. I tell her several times that we can stop though she indicates that she wants to finish. Then, however, she does want to break off the interview.]

[When I begin by asking how it was for her, after the first interview, she answers:] Did I talk to you last week? I did not feel very well last week.

The word 'dream' in Afghanistan means, literally, that which I see when I am sleeping.

Do people talk to each other about what they dream at night? Honestly, I am not sure. Perhaps, if the dreams are very frightening, perhaps then you tell them. But if

65.

were just normal dreams, then you wouldn 't be so quick to talk about them. I myself did not need to, I never thought about my dreams. Only recently, here.

At home it was usually young people, who would tell there dreams, to older people, for instance their parents or grandmother or grandfather. And they would say, Oh, that isn't so bad, they would try to distract the, so that they would not think about them any longer.

As for myself, I do dream, and those dreams leave me with an unpleasant feeling, as if something will happen. Like last week Then I had a dream like that, and I told it to my husband and he said, Oh, that must be because you are so preoccupied with it now.

It is only about terrible things that are going to happen. I never get a premonition about something positive.

No, I do not have the sense that I can do something with a premonition I get a dream and it leaves a feeling like that and then I can only watch it happen. I don't know what will happen, but I do know it will be something, something terrible will happen.

But that is not the case with each and every dream. Sometimes I dream and I know something will happen, and sometimes I have dreams that do leave a message. So there are two kinds of dream.

[My question: So some dreams are about what has happened, about the past, and some dreams are about the future, about what will happen?]

What I dream about is not exactly what happened, the things I experienced, I don't dream exactly how it happened . .. but more something that can be compared to it. For example, I always dream about dead people, difficult things, terrible things . .. for example about torture and things like that. Always awful.

Last week, I woke up out a dream and I was shaking, bathed in sweat. I got out of my bed to check on my children in order to try to get back to myself, But then I saw them, three Taliban, just outside the window, and I took a pillow and screamed into it, for more than half an hour, so I wouldn't wake up the children.

[When I ask if she went to the night staff to seek help, she said:) They were real, I could see them. But I knew I was here.

So the dreams bring up comparable feelings, like: this is how it was, but it is not a memory, as it were, it is not exactly the wcy it happened.

I do not get them every night. Last night I did not dream, but the night before, and in the weekend, yes then I did dream. Sometimes twice per night. A few nights ago, there were two dreams, one dream was in connection with my family, and one dream was associated with me. The were both about the same general topic, or about the same theme; both times they were about death.

[Tears, sighing, gestures of fending off. I carefully and expressly say we do not have to continue. But she elects to go on.)

66.

I r-

1

! 1

I I

I

The dream about myself . .. It was about a rope, I have been tied up, and I have been put somewhere very high, a tree or a building, I wouldn't know what it was, but in any case it was very deep what I see, something very, very far aw<zy. Then I fall. .. but my son, my 9-year old son, he helps me, he prevents the fall. [Gestures of catching something.] Yes, it is a very good feeling that he helps me, that he saves me, but still, when you see what is going to happen ...

This did not really happen, no, but yesterday, after this dream, I almost had a car accident, I was walking and was almost hit. In the first instance it did not occur to me that there was a connection between the dream and what actually happened, but later, later I thought perhaps there was one after all, because it was very close, it almost happened, I was almost hit, and the one who was driving, he was able to mange the situation, to control it, and to keep it from happening. So almost something terrible happened, and then in the end it didn't. So in that sense, in the feeling around it, not literally, but in the sequence, there were some similarities.

Do I believe that dreams can also have a meaning in the positive sense of the word, something that might be helpfUl? No, until now, I have not seen such dreams. Look, dreams that are about myself, okay, that is awfol, but not so important. But it is the dreams about my children, those are the ones that trouble me the most.

In my dreams is the place almost always unknown, I have no idea where they are situated. Family members feature and also other people I know, but I have no idea really where they pl<zy themselves out.

67.

I

I i 1-

~ I

I ~

APPENDIXB

j

F I

NOCTURNAL INTRUSIONS after TRAUMATIC EXPERIENCES (Biad 2)

Toellchtlng: S.v.p. invulen na iedere nacht en volgent de inGiructie van de behandelende arts.

(J = ja, ? = niet zeker, N = nee)

NAAM: ···············

DATUM

I MEDICA TIE 1 2 3 4 5 6 7

1 Naam medcatie en dosering (-door arts)

2 Tgdstip van inname fmcien van toepassing)

11 SlAP EN 1 2 3 4 5 6 7

1 Hoe 1aat ging u naar bed om te slapen?

2 Hoe laat viel u in slaap? (

3 Had u eigenijk veel vroeger wilen gaan slapen? JnJN

4 Kon u vlug weer inslapen aJs u 's nachts wakker werd? JnJN

5 Had u last van te vroeg wakker worden 's ochtends? Jn/N

6 Hoe 1aat &lond u op?

7 Was u nog moe toen u opstond? JnJN

8 Was u slaperig overdag? Jn/N

Ill ANGSTDROMEN I NACHTMERRIES 1 2 3 4 5 6 7

1 Heeft u deze nacht gedroomd? Jn/N

lncien NEE, dan kunt u &loppen met het beantwoorden .

.. '-< Heeft u een nare of angstige droom gehad? Jn/N r".

lncien NEE, dan kunt u stoppen met het beantwoorden.

3 Werd u wakker van deze droom? Jn/N

lndien JA, hoe laat werd u wakker?

4 Kunt u zich deze droom goed herinneren? Jn/N

5 - Werd in deze droom uw lelten bedreigd? Jn/N

6 - Werd u in deze droom achtervOigd? Jn/N

7 - Had u het in deze droom benauwd? Jn/N

6 - Had u in deze droom het gevoel vedamd te zijn? Jn/N

9 Heeft u eerder een zelfde droom gehad? Jn/N

10 Heeft u de gebeurtenissen in deze droom ook echt meegemaakt? Jn/N

11 Moest u door deze droom veel terugdenken aan bedreigende of nare ervaringen? JnJN

Opmerlcingen?

APPENDIXC

Prototype of letter sent to patients

Dear (name)

Frightening and painful dreams are one of the symptoms of the condition for which you are seeking help. We are trying to learn more about dreams and dreaming in the hope that this may, in the future, be used to improve diagnosis and/or therapy. For this research project you are asked to come two times for an interview lasting I Y, to 2 hours. Your travel costs will be reimbursed. The interview will be recorded on audio-tape. No identifying information will be on the tape and the tapes will be destroyed once they are transcribed. The data we collect will be used only for this study. Finally, in the report of the study, all personal details will be ornmitted so that participants in the study will be fully anonymous.

During each interview we will ask you about your own dreams. From now until tbe second interview we ask you to pay close attention to your dreams. If possible, please write them down each morning. We are interested in all the dreams you have, not only the frightening and painful ones. You may have long dreams or repeated dreams or just a fragment or an image. Some nights you may not dream at all. We are interested in all aspects.

Thank you for your willingness to participate in this study. We look forward to seeing you on (date).

Kind regards, (etc.)

signed

Marianne Vysma

Staff Psychiatrist

I ~ '

BIBLIOGRAPHY

American Psychiatric Association, 1994, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, (Washington, D.C.: American Psychiatric Association).

Barrett, Deidre, ed., 1996, Trauma and Dreams, (Cambridge: Harvard University Press)

Basso, Ell en, "The implications of a progressive theory of dreaming". In: Tedlock 1987:86-104.

Borbely, Alexaoder, 1986, Secrets of Sleep, (New York: Basic Books, HarperCollins Publishers).

Devereux, George, 1980, The Basic Problems of Ethnopsychiatry, (Chicago: University of Chicago Press).

Ellmao, Stephen J. aod John Antrobus, eds., 1991, The Mind in Sleep, 2nd Ed. (New York: John Wiley & Sons, Inc.).

Freud, Sigmund, 1900 [1996], The Interpretation of Dreams, (New York: Gramercy Books).

Foucault, Michel [1953]& Ludwig Binswaoger, 1993, Dream and Existence, Studies in Existential Psychology aod Psychiatry, Keith Hoeller, ed. (New Jersey: Humaoities Press International, Inc.)

Geertz, Clifford, 1973, The Interpretation of Cultures, (New York: Basic Books, Inc.)

Jouvet, Michel, 1994, Slapen en Dromen, (Amsterdam: Uitgeverij Contact).

Jung, C.G., 1948 [1969], "General Aspects of Dream Psychology". In: The Structure and Dynamics of the Psyche, Collected Works, Vol. 8, (London: Routledge).

___ __, 1921, [1969] "The Therapeutic Value of Abreaction". In: The Practice of Psychotherapy, Collected Works, Vol. 16, (London: Routledge)

Herdt, Gilbert, "Selthood aod discourse in Sambia dream sharing". In: Tedlock 1987:55-85.

Kracke, Waud, "Myths in dreams, thought in images". In: Tedlock 1987:31-54.

1999, "A laoguage of dreaming: dreams of ao Amazoniao insomniac", International Journal of Psychoanalysis, (80):257-271.

Obeyesekere, Gaoaoath, 1990, The Work of Culture, (Chicago: University of Chicago Press).

____ ,, 1963, The Concise Oxford Dictionary, (Oxford: Oxford University Press)

! r::: I ' I

Schreuder, B.J.N., 1996, Nachtmerries van de oorlog, (Delft: Uitgeverij Eburon).

__ ___, 1996, "Posttraumatic Re-experiencing in Older People: Working through or Covering up?", American Journal of Psychotherapy, 50(2):231-242

___ ., 1999, "Nachtmerries", Tijdschrift voor Psychoanalyse, 5(2):71-88

Shulman, David & Guy G. Stroumsa, eds., 1999, Dream Cultures: Explorations in the comparative History of Dreaming, (Oxford: Oxford University Press)

Steward, Charles, 1997, "Field in dreams: anxiety, experience, and the limits of social constructionism in Modern Greek dream narratives", American Ethnologist, 24( 40:877-894

Tedlock, Barbara, ed., 1987, Dreaming: Anthropological and Psychological Interpretations, (Cambridge: Cambridge University Press)

Thoden van Velzen, H.U.E., 1997, "Dramatization: How dreamwork shapes culture", Psychoanalytic Review 84(2): 173-188

Turner, Victor, 1992, Blazing the Trail: Way Marks in the Exploration of Symbols, (Tucson: University of Arizona Press)

Virgil, The Aeneid, In: David West, 1990, A New Prose Translation, (London: Penguin Classics).

Whorf, Benjamin, 1995, Language, Thought, and Reality, (Cambridge: Massachusetts Institute of Technology Press

I r

I I

I f= !