The Relationship between Dreaming & Terminal Illness: A

The Relationship between Dreaming & Terminal Illness: A New Look at
Mind & Body

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Introduction: Can Psycho-Oncology Save Psychology?


In a review of Jennifer Barraclough\'s Integrated Cancer Care:
Holistic, Complementary, and Creative Approaches (Oxford University
Press), Bart van der Lugt, chair of the Elisabeth Kübler Ross
Foundation, writes the following: "In the book many references are
offered to support the scientific evidence of the holistic approach.
Nevertheless, it is also stated that there are far too few
references, especially when compared to the scientific evidence
presented by mainstream medicine. This is due not only to a lack of
funds, but also to the unwillingness of the universities, the places
designed to do the research, to participate in or conduct studies."


As an emerging clinical speciality, psych-oncology addresses the
needs of a unique medical population, and is one of the few useful
directions into which Psychology is currently branching. The needs
posed by the population of cancer patients prompted psychologists to
concentrate into an integrated package the collection of skills that
set this class of professionals apart from rival social workers and
psychiatrists. I use the term "rival" here in reference to losses
sustained by psychologists within an increasingly competitive and
fiscally-conscious mental health delivery system, where psychologists
are often abandoned in favor of less expensive social workers for
therapy positions or deemed of secondary value in settings where
prescribing psychiatrists have staked ground.


As a field of both treatment and research, psycho-oncology is the
best hope for psychologists to earn the public trust with research
responsible to nature. There is nothing like nature to keep a science
honest. Occasionally, I find I have to remind people that science
itself, which is concerned with the pursuit of truth, is itself a
cultural and historical product (a social construction), and
therefore it is at its best when it is defined and governed by a
limited number of broad guidlines rather than micromanaged by a large
number of technical rules. A science grounded in nature is a science
characterized by a rigorous attention to the raw facts that make up
the phenomena under study (see ADHD Science for an understanding of
how psychological research suffers from confounding facts and data.
Keeping science a clean lens to nature requires a reminder as to what
it means for science to slip away from nature.


Grounding a science in nature does not mean restricting the scope of
a science\'s subject matter and methodology to material entities.
Brain-based dream research has taught us what it means to lose the
real object of our curiosity in that test tube we call a cranium.
Psychological researchers operating from a metaphysical materialism,
lab rats who have substituted the research tool (the brain) for the
phenomenon as the object of understanding, often dig too deep to
retain any hope of returning to life on the surface (of experience).


Then you have those professors who pave over (urbanize) their
territory in order to put it on the map and make it accessible to the
public at large and to the ranks of respected sciences. They put
layers of loose asphalt between their feet and the raw phenomena.
Like wayworn pavement, Psychology\'s social and statistical
constructs, representing time-limited and culture-bound pseudo-
phenomena, is torn up and replaced wholesale every couple decades,
much in the same way, at a century scale, the policies and procedures
forming the \'science of Psychology\' itself will ultimately be
replaced with little progress to show for its time under the sun.


In either case, we\'re dealing with a cosmetic form of science that
abandoned all the fundamentals. This is a science that has been
contaminated excessively by institutional concerns, and aims tied to
the representation, reputation, and management of its academic and
professional community and its economy of careers. But cancer will
keep at least one class of psychology academics and professionals
grounded. Much in the same way cancer cuts through, captures, and
crystallizes the essence of life for the cancer patient, the needs of
this unique medical population will cut through, capture, and
crystallize the science of Psychology. This is one class of
psychologist that will not lean on the cosmetic features of harder
sciences to cover up or compensate for the frivolousness of their
hypotheses and the ineffectiveness of their essential research
design. This is one class of psychologist that will balance rigor
with relevance and temper personal career interests with priorities
grounded in nature and in the public interest. After all, this is
cancer.


In what constitutes one prong in a multi-pronged study of the
relationship between dreaming and waking experience, I turned to
cancer patients to explore the relationships between symptomatology,
blood chemistry, and dream anomalies among patients with different
coping styles. In rocking the foundation of a person\'s life, the
stress of cancer provides the clearest window. Jung once remarked in
the classic (and arguably defunct) language of psychoanalysis that
every individual has a signature \'neurosis,\' and I might add after
extensive interviews with 28 cancer patients that the cancer
diagnosis caricaturizes the person, acting as an amplifier (or
gravitational lens) for the neurosis. As a research tool, the sample
of cancer patients acted as a gravitational lens to dream life. Their
cancer cuts through, captures, and crystallizes the essence of the
relationship between their dreaming and waking lives. Like infrared
technology used to observe surface features of a distant cloud-
covered planet, the dreams of cancer patients helped me discern in
the hinterlands of the psyche certain imperatives that appear to
address the patient\'s style of coping. Like cancer itself, which is
an objective expression of nature, dreaming, which is not refracted
by waking will and desiderata, minimizes the static -- random,
arbitrary, and frivolous elements -- that cloud our understanding of
various systems that include the individual or that is the
individual. And as experiences, dreams, regardless of whether they
are remembered or interpreted, exert an influence over the dreamer
similar to that of waking events, by altering sources of
consciousness. Using experience as a potent and efficient language,
dreams operate on the faculties, the mental sense organs, through
which we organize and interpret reality.


While my primary interest is that of the dream, my project
demonstrates the value of dream research for an understanding of the
mind-body relationship and the broad restructuring of lifestyle in
the wake of a cancer diagnosis, when patients confront issues of
identity, mortality, and change (i.e. body image, sexuality, family
roles, finances, disability, appetite). Patients diagnosed with
cancer amend wills, re-evaluate relationships with friends and
family, redefine their goals and put their fulfillment on an
accelerated schedule, and reconsider their faith and the self\'s
survival of death.


The content/characteristics of the dream experiences of cancer
patients in my dissertation research varied with the nature of their
coping styles as well as with blood chemistry and physical symptoms.
The research demonstrates what is possible when we include an
exploratory stage in psychological research, in which science is used
as a tool of exploration rather than crudely as a tool of skepticism
or as a mechanism to reinforce institutional culture. The pdf
documents corresponding to each major section (i.e., Introduction,
Method, Results, Discussion, and Appendices) represent an abridged
consumer version, but all the major findings are summarized below:



RESULTS:



When I reviewed my semi-structured interviews data, the data
suggested three groups of participants based on the coping styles:


Sensitizers. These individuals initiated radical life reforms in
response to the diagnosis aimed at altering their basic character.
Each of them mentioned a long-standing, if not lifelong, personal
problem that heavily tainted their self-concept and sense of personal
history. They viewed their cancer as an extension of a troubled
history.


Examples: (a) A 45-year-old female bank manager, who purchased a
Harley-Davidson and joined a riding group. (B) A male with bipolar
disorder gives away all his possessions, attempts to reconcile with a
son he had not seen in years, and marries a woman with schizophrenia
he met in the supermarket the prior week.


Dreams of Sensitizers:


AFFECT: NEGATIVE
IMAGERY: REALISTIC


The only nightmares reported during the study were reported by
Sensitizers and each Sensitizer reported at least one nightmare. Each
also reported having to cope with the lingering residue of the
nightmare. The nightmares revisited or referenced a pivotal event in
their troubled history.


Repressives. These individuals denied that their cancer altered their
lives in any way. They reported growing irritation with family
members who stressed over their condition.


Dreams of Repressives:


AFFECT: NEGLIGIBLE/FLAT
IMAGERY: DISTORTED/BIZARRE


These were unemotional dreams in which past or present waking
environments were markedly distorted or mis-represented. These
rational patients often reported being embarrassed by these dreams,
as if it reflected on them personally.


Crisis-Induced Reactors. These individuals exhibited a measured
response to disease symptoms or to revised prognoses from their
oncologist.


Dreams of Crisis-Induced Reactors:


AFFECT: POSITIVE/EUPHORIC
IMAGERY: REALISTIC



Blood Chemistry:


Blood chemistry differentiated two types of dream anomalies: process
anomalies (violations of laws than cannot be replicated in waking
reality; breaks in the fabric of normal experience) and content
anomalies (the misrepresentation or distortion of elements unique to
the waking routine of the dreamer, e.g., fireplace is in wrong
location; cousin who attends UCLA is a USC student in the dream; wife
has blond versus black hair).


Analyses linked reports of process anomalies to a set of chemicals
(e.g., glucose, creatinine, red and white blood cells) that share a
critical role in the production of energy. It is believed process
anomalies may result from surges in energy required to restore
depleted oxygen to damaged heart or lung muscle tissue. Reports of
difficulty breathing on The Quality of Life Inventory and the body\'s
ability to manufacture glucose anaerobically (i.e., without oxygen)
also fueled speculation.


While process anomalies appear to accompany increases in red and
white blood cells, content anomalies, by contrast, may accompany
damaged red and white blood cells. The correlation of mean and total
content anomalies with lactic dehydrogenase (LDH) buttress the
observation that content anomalies appeared in the dreams of patients
with blood malignancies and active lymphomas.


Objective (Noumenal) vs. Subjective (Phenomenal)


I observed a greater incidence of distorted dream characters in
patients whose X-rays or toxicology reports indicated a poor
prognosis for cancer. I observed a greater incidence of fictional
dream characters in patients who reported appreciable symptoms of
cancer (as indicated by a Quality of Life Inventory).



DISCUSSION:



Some patients received grim news from their physician concerning the
prognosis of their cancer but did not report appreciable symptoms. By
contrast, other patients reported symptoms and functional impairments
but did not receive discouraging news from their physician concerning
tumor growth or metastases. In both cases, patients capitalized on
the ambiguity to exercise discretion and personality in designing
coping strategies (e.g., repressives and sensitizers). The bizarre
dreams of repressives may have compensated for their overly
conservative coping strategy, reflecting cognitive processing aimed
at predisposing the patients to broaden their attitudes to assimilate
more facts about their cancer. The conservative nightmares of
sensitizers (i.e., harkening back to painful memories) may have
compensated for their overly progressive coping strategies, thwarting
their attempted alienation from themselves and their pre-diagnostic
history.


But crisis-induced reactors reported both grim progress reports from
their physician and appreciable, limiting symptoms. They were not as
free to impose their own will and personality over their coping
style, and their attitude accurately reflected the facts of their
disease. They may have been rewarded with dreams that were both
positive and realistic -- dreams devoid of the distorted imagery that
bemused repressives and of the painful affect that haunted
sensitizers.


One explanation for the pattern of results is that dreams exercise a
regulatory function within an antinomian (i.e., oppositionally-
structured) psyche. Many theorists have proposed a balancing function
for dreaming, but this compensatory function has been difficult to
verify, and our failures to date, our neglect, distortion, and
oversimplification is the fault of both the complexities of dreaming
(and waking) life and the unproductive fussiness of modern
psychological \'science.\'


insisting out of the gate on controlled experimental research as an
arbiter of questions about dreaming is counterproductive. Without
exploratory research, we lack the scope and depth of factual
information about dreaming necessary to frame the issues and produce
the questions worth asking. Without this information, it is
impossible to isolate for use in controlled experimental research
the \'important variables\' with which a person is likely to be
concerned during sleep.


Removing the static. However, by selecting cancer patients as
research participants, I defined a relatively homogeneous group whose
lives have been simplified by a singular threat. The compensatory
function of dreaming would be most conspicuous under conditions in
which the psyche is polarized by a form of stress that forces one to
come to terms with one\'s identity, mortality, and with changes in
multiple life domains. A disease like cancer is notorious for
disrupting daily activities and ravaging one\'s financial,
interpersonal, and physical status.


by subjecting research participants with diverse lives and
personalities to standard stimuli (e.g. Tetris) for use as a common
metric in the measurement of dream references to the common pre-sleep
activity, as many sleep lab researchers attempt to do, we turn a
blind eye to the life of the participant and base an answer to a
mystery on something with no intrinsic value or lasting importance to
the participant.


Strengthening the signal. In my research, however, once I used a
common threat (cancer) to define my research sample, I respected the
integrity and individuality of each participant by allowing him or
her to define the objects and activities of lasting importance and
intrinsic value to his or her own life. This technique increased the
width and length of my microscopic lens, so to speak, so I was more
likely to notice the changes in the person\'s life that were covarying
with characteristics of the dream experience.


The study also has implications for the relationship between mind and
body. As objective products of nature, dreams are the psychological
equivalent of somatic processes in that they are refractory to the
will. Thus any study that addresses the relationships between dream
characteristics and biological processes, especially one in a
population that provides a range of biological values (cancer
patients), is likely to be sensitive and powerful. In light of this,
I would advise psychological researchers that they need to get their
hands dirty in the data of the dream experience and in its
relationship with the waking life of the individual participant. Over-
controlled and rigorous research is often the most simplified
research, short-shrifting fact collection in the blind hope that the
materiality of the instruments or the mathematical precision of the
statistical formula will somehow distill the truth.



Why the Study Worked


This study worked the researcher\'s attitude toward science was as
healthy as that of the crisis-induced reactors to their cancer. I
realistically guaged the field\'s ignorance with respect to dreaming,
where I estimated a \'crisis of knowledge.\' Rather than submit to
institutional pressures to form a (circumscribed) hypothesis that
implies knowledge but that narrows our research unproductively from
what, by real account, is a position of ignorance, I restricted my
preconceptions to an open-ended pretheoretical framework that defined
a generous scope and depth for the collection of all facts I needed
to address a network of questions and make the most of hypothetical
findings. Most psychological research is tantamount to idle thrashing
due to poor planning and to lapses in the conceptualization of
important contributors to the research: the phenomena under study,
oneself as a researcher, the available research tools, and the best
fit among them. There is a feeling of NFL game planning here, as I
gathered all the information I needed to realistically assess my own
strengths and those of the phenomena that present to me as obstacles
so that I could benefit from my pre-game scheming and my halftime
adjustments to hypothetical or fluid data formations. You have to
approach a mystery like a block of marble from which you seek to chip
away, guided by glimpses of the form hidden within. You have to start
big. The null hypothesis testing system combined with our
requirements for publication force us to start small, to assemble our
form from rubble. Now if you\'re cutting up frogs or designing a
better spatula on a grant from Consumer Reports, this approach may
not prove destructive to your line of research, and unfortunately
these materialistic, technical, and utilitarian research studies are
increasingly defining modern Psychology due to the fact they lend
themselves to the policies & procedures that allow us to most
adroitly manage our affairs as a community and as an institution. But
if you\'re interested in dreaming, or many other psychologistic
phenomena, you have to make far too many sacrifices to yourself and
to your subject matter if you want to manage your affairs in ways
that preserve your career and that offer the community the kind of
contributions it can digest.


At various stages of the scientific inquiry we need contributions
from human reasoning. Unfortunately, this is not an area that gets
any quality assurance attention. The ability and inclination to
contemplate, muse, reflect, and apply logic, to draw constructively
from our experiences and imagination to build theories, or to just
say \'what if?\' are very important. These instincts are critical to
the business of knowledge production in Psychology.


Psychology professors know how to formulate hypotheses but they do
not know how to think hypothetically. They know how to apply pre-
conceived formula from a menu of Behavioral Science Statistics but
they do not know how to reason quantitatively (i.e. to conceptualize
relationships associated with a phenomenon in quantitative terms).
Moreover, there was once a time when hypotheses were derived from
sophisticated theories or understandings of human nature. In such
cases, the hypotheses represent miniature encapsulations or
representatives of the theories, testable predictions based on the
theories. Today it would seem that psychology professors mass produce
these highly circumscribed hypotheses from the outset, predictions
uninformed by any theory or adequate survey of possibilities. The
null hypothesis testing system provides them with a recipe, with few
of the meals being cooked from scratch. And psychology professors are
growing more agnostic with respect to any educated or individuated
philosophy of science. They know a 2 x 2 design and analysis-of-
variance (for example), and they simply reproduce research from this
template without any broad understanding or what they\'re doing or of
what else there is to do.


Modern psychology professors have thrown out the baby with the
bathwater. While they have a good case against the reified and
dogmatic aspects of old psychoanalytic meta-theories (like that of
Freud), they appear to use this argument as an excuse to suspend all
manner of casual contemplation and reflection, the kind of quality
thinking that lays the groundwork for data collection (i.e., "what do
I want to know?;" "what kind of data will be most likely to shed
light on my question?"; and "how do I go about acquiring it?").


What Do I Want to Know?


This is an important step in the scientific process because it
identifies the scope of the investigation. I for one have a BIG
question about a very NATURAL FRONTIER (i.e., dreaming). But most
academics define the scope of their inquiry so narrowly that nothing
of any interest is learned about the psyche. They do this for a few
reasons: (1) they are interested in some pragmatic or utilitarian
topic [e.g., aviation cockpit design]); (2) a highly circumscribed
question lends itself more readily to that artificial scientific
paradigm we call the \'null hypothesis testing system;\' and (3) it
also allows them to publish more frequently and in small units
(articles of 3-4 pages that are more easily accommodated by
journals), which is necessary to remain competitive in a saturated
job market predicated on \'publish or perish.\' (\'Publish or perish\' is
actually misleading. In today\'s competitive market, the formula is to
weight the number of publications by the reputation of their
respective journals).


Well, to get that interview for the tenure-track assistant
professorship (and ultimately tenure), most candidates have had to
publish in graduate school (usually as a sixth author of a four-page
publication), publish more than once a year, receive funds for their
research from some external agency, and present their findings at
regional conferences, but it is usually articles that are of the \'so
what?\' variety or \'junk.\' We are SPAMMING our body of knowledge with
trade papers analogous to junk e-mail. And our questions do not
reflect a childlike and intellectual curiosity about the psyche. They
are not the questions of explorers, intellectuals, muses, or
detectives, but of clerks and job hunters. In our SUVs, we are always
looking for the quickest, smoothest, and most scenic route around the
mountain, while we should be hiking over it.


What kind of data will be most likely to shed light on my question?


In my \'dreams of cancer patients research,\' I began with the
assumption that not much of anything is known about dreams. I
admitted ignorance, reveled in the mystery, and embraced the prospect
of discovery. Therefore, I designed a study that was so flexible and
adjustable as to (1) efficiently provide me a wealth of information
that I can consult if necessary. In so doing, I assumed that I would
not necessarily need all this information nor know at the outset why
I would need it. But it would be there. (2) Allow me to react to or
follow-up on questions that arise DURING the process of analysis. I
am assuming here as a detective and explorer that I may encounter
data that will inspire me to shift direction slightly. In short, I
want to design a study in which a WEALTH OF DATA can guide me in the
development of a THEORY which, in turn, can re-orient me in how I
approach and organize that same body of data. There were among my
professors critics who demanded formal hypotheses and, once I
porposed a few sham hypotheses, they demanded that the hypotheses
pattern my whole plan for analysis. The hypotheses not only
constrained my thinking, they blinded me to my data, but hey, it
allowed me to credit other people in the field for their remotely
related research. I don\'t know what it is about psychology professors
and their citation fetish. My open-ended theoretical framework may
not have met arbitrary requirements for parsimony and refutability,
but then no theory should have to meet requirements that apply only
to hypotheses. A theory only needs to be productive.


How do I go about acquiring it?


To realize my goal of a flexible approach that allows me to make use
of maximum resources (DATA, THEORY), I need a lot of raw information.
(I liken my research to one of those shells on the beach that are
broad at its opening and progressively narrows to a closed point). I
usually begin with an interview (and a semi-structured one at that
permitted to vary in response [within certain constraints] to the
individual nature of the answers provided me by my research
participant). Of course, I had to overcome objections to semi-
structured interview protocols. Psychology professors prefer
standardized and psychometrically sound instruments to nimble
thinkers. Rigor. Rigor. Rigor. Personally, I have certain guidelines
regarding when not to put on a tuxedo. I don\'t wear one to bed. I
don\'t wear one to breakfast. And I don\'t wear one when I\'m replacing
a sun pump. I\'ll wear one if and when I collect my lifetime
achievement award. And no one\'s going to hand me an achievement award
for a lifetime of modeling tuxedos.


My data goes through many metamorphoses, but even as it changes form,
it is never lost and can be revisited. This raw interview information
is STEP 1. There is a lot of information here and it is as raw as it
comes and by that I mean it is the actual and individualized
responses to open-ended questions in a semi-structured interview.
STEP 2 usually involves coding the information. After a review of it
all, the data organizes itself (i.e., suggests a few category schemes
based on typical patterns of responses unanticipated before the study
was designed).


This is critical. Academics want me to formulate a hypothesis and
design a study to evaluate the hypothesis as \'right or wrong\' (i.e.,
reject/fail to reject). The problem here is that the raw question,
when transformed into a testable experimental hypothesis and then
into the corresponding statistical hypothesis, loses its meaning and
usually both its scope and depth. It becomes a dichotomous, one-
dimensional (yes/no type) question, at which point the academics are
interested only in adjudicating (answering) it, which assigns it a
significance without a thorough understanding of the facts from which
it is laundered (derived). If they reject the null hypothesis, they
have a positive result and they can celebrate by writing it up for
submission to a journal. Problem is, the original question on which
the hypothesis was based never got examined. They acquire only as
much data as necessary to answer the yes/no question statistically
(through a very cookie-cutter set of analyses that yield what is
known as an inferential test statistic). Frontiers are never settled,
phenomena never explored, theories never built, and meaning never
addressed. This science suffers from Attention Deficit Hyperactivity
Disorder.


So in STEP 2, my raw information is assigned codes or ratings, which
can now be used in some statistical analysis. My analyses are usually
of a descriptive or exploratory variety at first and, where I do use
inferential test statistics like t or F or r, I then usually treat
them as descriptive statistics and make them the raw data in
subsequent analyses. Now by this point, I have also (in addition to
interviews) administered a few questionnaires (which yield
quantitative data from the outset), reviewed the levels of chemicals
in their bloodstream as found in their medical charts, and collected
2 weeks worth of their dream material. I look for relationships among
all this rich data, some of these analyses are purely exploratory and
others guided by theories inspired by the patterns (typical clusters)
of responses that emerged in the data. To extend the study, there is
usually a post-dream-collection interview, which is not designed
before the research is undertaken but during data collection to
extend my knowledge. (For some reason, academics consider these post
hoc adaptations as some kind of sordid cheating and fraudulence but
it is just good detectivework. It seems to be okay when they do it as
part of a follow-up study. They just consider that separate from the
original study). In any case, this is how I conduct my research, and
while it gets treated as a pilot study, it produces something we see
so rarely in modern research: ideas worth testing, questions worth
asking.


But the most valuable decision I ever made was to respect the
integrity and individuality of my research participants, treating
each as a separate case in a series of n = 1 experiments...drawing
conclusions WITHIN individuals before abstracting ACROSS individuals.
I hope the impending (and rather ugly) mixing of metaphors will
illustrate the butchery that is modern psychological research...but
my approach contrasts sharply with the modern method of statistically
sausage-grinding decontextualized \'observations\' harvested from human
livestock like chaffe from wheat.