Severe nightmares and vulnerability to psychosis

Research has shown that having severe nightmares is an indicator of vulnerability to potentially developing psychosis and psychotic episodes (1).  In my case, I have always had vivid dreams and nightmares, but the really terrifying ones such as being Tasered, being surrounded by bloodshot dying people, being shot at by zombies in computer games  (which I haven’t played once since I became psychotic – nor do I watch triggering films or TV), having rows with broadcast news editors at the BBC about vetting, and covering riots (not this past week’s terrible events but the Burnley riots of 2001: about which I made a documentary - which was nominated for an award), staying in hotel rooms where the doors won’t lock and intruders do horrible things to me (a reference to hospital I think- not that anyone in hospital has ever harmed me in any way) etc.

Just how common are psychotic nightmares?

I don’t want this post to be triggering so I’m not going to describe in great detail the terrifying, bizarre and relentless nightmares from which I have suffered since I first became psycotic … but I do want to share the benefits of my research in trying to understand the link between dreams and psychosis.  A friend of mine, who also has schizophrenia, has just put on an art exhibition of his psychotic drawings and I asked him what his inspiration was.  He told me he sees psychotic images all day long and all night long and he simply draws the frightening things that are in his mind.  His drawings are amazing – but surreal in the extreme.

It made me realise that I’m not alone and I decided to find out how widespread this is: certainly my NHS keyworker was so scared by my nightmares in detail that she needed supervision and eventually banned me from sharing them with her.  She actually started to have the nightmares herself.   I keep a journal every time I wake up with a nightmare – and looking back over these, it is no wonder that I dread going to sleep.  But as I've said, to share would be triggering.

In 2004 at a conference in Chicago (2) psychoanalyist Danielle Burgeron described an innovative approach to hallucination reductions (I don’t have hallucinations thankfully, other than smelling coffee grounds when relapsing!) by replacing the delusion with the dream. And Brian Koehler of New York University has explained that as patients recover from schizophrenia (that means a functional recovery – for 4/5 of patients there is no cure) then as hallucinations fade, they become replaced by psychotic nightmares (2).   There is a detailed guide to psychosis and dreams online (3).

Psychotic nightmares in children

The American Journal of Psychiatry (4) reported on the very worrying trend of psychotic nightmares in children and young people and how psychotic nightmares can trigger psychosis – they take a rather extreme example of a 9 year old with a very difficult upbringing and unique problems, who, like me, had never used drugs, becoming psychotic.  9 years old – this really distressed me.  I couldn’t handle psychosis in my twenties to the degree I made attempts on my life – how is a 9 year old meant to cope with something so devastating?

Latest research into dream lucidity

I want to finish this post with good news, because there was a report in 2009 into the use of dream therapy to help people with psychosis (5).  The focus of the attention is on so called “lucid dreaming” – that’s when you are aware that you’re dreaming.  This is something I can’t say has ever happened to me – but work is being done on increasing lucidity in psychotic nightmares so that sufferers can say “this is just a dream and I’m going to wake up now” and wake up.   I can wake up anything from once to a few times a night, but I never know it’s a dream until such a point as lucidity occurs naturally and my brain chooses to awaken me.  Often my heart is beating profoundly, I am sweating, shaking, disorientated and distressed. It’s a very unpleasant experience.  And I welcome all new research into helping to alleviate the distress that this causes to me and so many other people around the world like me.    

References in this blog:

1 ncbi.nlm.nih.gov/pubmed/9823031

2 isps-us.org/koehler/dreams.htm

3 psychosis-bipolar.com/understanding-psychoses-01.html

4 ajp.psychiatryonline.org/cgi/content/full/163/5/781

5 esf.org/activities/exploratory-workshops/news/ext-news-singleview.html?tx_ttnews[tt_news]=585