Short Works of Richard Corelli, M.D.

A Collection of Short Works
by Richard J. Corelli, M.D.


SYMBOLISM IN DREAMS

I Dreams I Nightmares I Eating Disorders I Multiple Personality Disorder I
I Borderline Personality Disorders I Alcoholism I

Dreams have been objects of boundless fascination and mystery for humankind since the beginning of time. These nocturnal vivid images seem to arise from some source other than our ordinary conscious mind. They contain a mixture of elements from our own personal identity which we recognize as familiar along with a quality of otherness in the dream images that carries a sense of the strange and eerie. The bizarre and nonsensical characters and plots in dreams point to deeper meanings and contain rational and insightful comments on our waking situations and emotional experiences. The ancients thought that dreams were messages from the gods. Today we know that they are messages from a deep source of wisdom and understanding within ourselves. Every dream is a message from some deeper unconscious part of myself to the more conscious everyday part of myself expressed in a language that needs to be learned and understood. The dream has been called the royal road to the unconscious. A modern way of saying that would be that the dream is the window to the soul.

There are many different ways of approaching dreams as their meaning is often on many different simultaneous levels. On the most superficial level we can look at the dream as a commentary on some ordinary everyday experience or situation that the dreamer is dealing with. On a deeper level we can explore the drama taking place in the dream with each image and symbol in the dream representing some psychological aspect of the dreamer. It can be looked at as a dialogue among the characters and feelings that inhabit our inner world. Dreams can be extraordinarily elusive like trying to catch a butterfly just always out of reach. Our conscious mind seems to be reluctant to allow us full recollection or understanding of our dreams. Because dreams talk to us in a strange and foreign language of symbols and images they disturb our conscious preconceptions of who we are and what we are about. Dreams are like looking down into a deep chasm into our souls. We sometimes are afraid we will fall into the abyss if we look too long or too deeply into ourselves.

It is often helpful to make a conscious reminder to oneself before retiring for bed by saying I will remember a dream tonight. It is important to lie still for a few moments when awakening from a dream and to stay with the feelings and images of the dream. Then record in a notebook by the bedside a few key words from the most vivid images or symbols that appear in the dream. Later that day when convenient one can fill out the plot and action of the dream in more detail. It is very difficult to try and hold a dream in memory if it is not first written down. Dreams tend to evaporate quickly with the light of day just like the morning dew. It may be useful too to write down any immediate associations or reactions to the dream. Start to reflect on the separate images in the dream and see what comes to mind. Take note of the feelings and associations that flood your mind as you pay attention to the images. Examine action that takes place in the dream which is often like a play or movie with a plot and sub-plots. It is important to remember too that the images in the dream are not to be taken literally. The dream will often exaggerate images and feelings in grotesque and bizarre ways to try and get our attention. Understanding dreams is more like reading poetry than prose. It is a world of imagination and fantasy that can show us aspects of ourselves that are like long buried treasures waiting to be discovered.

I would like to explore some of the possible meanings and associations to some common dream images and symbols that most people will have experienced at one time or another. One caveat is that each dream is the unique personal experience and possession of the dreamer and that the same image may have different meanings for different people based on their own individual experiences and the context of the lives and the context of the dream in which it occurs. Only the dreamer can ultimately know the correctness of any particular interpretation of an image or symbol that occurs in a dream as to the meaning for that particular dreamer. We can look at some of the universal images that commonly occur in dreams and reflect on the possibilities that the image suggests. This can be a way of amplifying the image to enrich and deepen its significance and to present deeper layers of meaning.

The number of images or symbols in dreams is countless. Anything that can be dreamed of can carry a deeper psychological and emotional significance for us than what may be first apparent on the surface. An example might be a dream about a house. This is a very common dream motif as often the action in a dream will take place in a particular setting. A dream of a house may be about a particular place we know or have lived in or may be a fantasized unreal place that we might never have imagined in waking life. The meaning of a house often suggests either the psychological or physical place that we inhabit. The house and what is going on in it may suggest something of what is occurring in our body or our mind during our waking life. The house may remind us of our childhood home with its attendant feelings of belonging and alienation, security and insecurity, conflict and harmony. The house is a psychological extension of our identity and physical being in the world. The different areas of the house may represent different areas of our inner psyche. Sometimes the house or some of its rooms may be unfamiliar representing unexplored areas of potential within the personality. Exploring an unfamiliar house may represent a new journey of exploration into our own personalities or to work out some psychological problem that resides within our emotional living space. It is fairly common to dream of returning to a house that you knew in childhood. It may represent a return to a familiar situation but with new possibilities. The feelings and reaction to the house and its inhabitants or contents is crucial to understanding the significance of the house in the dream. It may represent a wish to return to a time of childhood innocence or of a need to move on and leave home by getting on with some unfinished part of one's life.

We know that dreams provide us with a unique view of ourselves that often comes from a deeper and wiser part of our psyche and that tends to counterbalance and moderate our conscious waking perceptions. Dreams sometimes also comment on the larger cultural and worldwide issues that may be constellated within the psyche of our entire community.


NIGHTMARES

I Dreams I Nightmares I Eating Disorders I Multiple Personality Disorder I
I Borderline Personality Disorders I Alcoholism I

Nightmares are a universal occurrence that we all experience at some time in our lives. Some people may experience nightmares often. Nightmares are disturbing dreams which may follow us for years worrying us with their persistence and their vividness. Nightmares in ancient times were thought to be caused by evil spirits that would haunt and suffocate people while they slept. The nightmare is often accompanied by feelings of oppression and helplessness. Nightmares make a more lasting impression upon us and the feelings from the dream will often linger on into our waking life the following day. The nightmare serves to get our attention to something that is psychologically important to us often something that has been seriously neglected in our waking life. Sometimes it is possible to deal with the nightmare by coming to terms with it and understanding what our fears are about. Recurrent nightmares indicate a particularly serious problem in our waking life that needs to be confronted. We may wake from these dreams with feelings of acute distress or worry or even panic. These fears may arise from our deepest frustrations, repressions and inner conflicts. They may also be a form of self-punishment for unacceptable parts of ourself that we need to to come to terms with. A frequent theme is of being chased or pursued by a monster or demon of some kind. This may indicate some aspect of our emotional life that we are trying to run away from. Monsters in mythology often guard the treasure sought by the hero. They often guard sacred or holy places. We are the hero in our dreams just as we are the hero in our daily waking lives. We must confront and understand the monster in the dream which represents some unwanted part of ourself that we need to confront and integrate in order to recover the treasure which is a deeper psychological understanding of ourself. Often if we can turn around and face what it is that we fear it will transform itself in the dream and will cease to be horrifying once its nature is identified. We sometimes dream of someone trying to break into our home. This is often an inner psychological figure who may represent some shameful or unwanted part of ourself who is breaking into our consciousness. It is about to break into our awareness and then we will have to confront this unwanted aspect of ourself. The purpose of this figure seems to be to reflect all the worst aspects of our character so that we may become more fully conscious of those traits and accept these unwanted but vitally necessary parts of ourself. These aspects are often quite evident to those whom we live with or know us well but are hidden from our own conscious opinion of ourself and thus will appear alien and scary to us in our dreams. The intruder in the dream may represent some awareness or insight that is about to break through into our consciousness. It appears scary because it is unknown what demands it will make on us but it actually should be welcomed into our psychological house because it brings with it a gift of self awareness. Every aspect of the dream represents some part of ourself.

The intruder in the dream represents some part of ourself that we have kept outside our awareness for too long and now needs to be let in. It may represent a feeling or attitude that we need to be more conscious of. Another nightmare is the disaster dream. These are often extremely vivid and we may awaken terrified and apprehensive. These dreams should not be ignored nor taken literally. The disaster may indicate some emotional upheaval that is taking place or about to take place in our life. The disaster may involve an earthquake, our world is being shaken up; or an avalanche, feeling overwhelmed and buried by some situation we find ourself in or perhaps the thawing out of some frozen emotions; or a flood, being caught up in the currents of everyday life and not feeling on solid ground; or a fire, being consumed by passion or rage or some other strong feeling that may feel out of control. The disaster may be a positive image indicating a significant change tearing down old patterns of behavior and a turning point of opportunity or it may be a warning of something valuable in our life thatπs falling apart or being swept away. Sometimes it may represent both aspects since change and crisis often carry both positive and negative feelings with them. The nightmare is a dream that needs to be taken seriously. They are urgent psychological messages that something in our emotional psyche needs to be paid attention to and can no longer be ignored or we do so at our own peril.


EATING DISORDERS

I Dreams I Nightmares I Eating Disorders I Multiple Personality Disorder I
I Borderline Personality Disorders I Alcoholism I

Anorexia nervosa and bulimia nervosa affect many persons with 90-95% of cases occurring in women. Preoccupation with weight and body size is a primary symptom in both anorexia nervosa and bulimia nervosa. The extent of these eating disorders ranges from 1-10% of adolescents and young women although some women develop eating disorders later in life e.g. after the birth of their first child and some women turn to weight and body perfection as a way to establish some type of identity or to cope with marital and sexual issues or to deal with separation from their own grown-up children.

Patients with anorexia nervosa drastically diet and restrict food intake to as few as several hundred calories per day, limit food selection, and often demonstrate compulsive symptoms regarding food and other matters. Patients with anorexia nervosa experience an intense fear of gaining weight or becoming fat even though they may be seriously underweight. The person claims to feel fat even when emaciated or may feel that one area of the body is too fat. As body weight declines menstruation ceases. Anorexia nervosa seems to be a particular occupational hazard among models, ballerinas and gymnasts where our cultural obsession for thinness and perfection reaches its highest levels. Patients with bulimia nervosa are often of normal weight or slightly overweight but suffer from frequent eating binges which are recurrent episodes of rapid consumption of a large amount of food in a short period of time. They feel a lack of control over eating behavior during the eating binges and may engage in self-induced vomiting after meals, use of laxatives or diuretics, strict dieting or fasting, or vigorous exercise in order to prevent weight gain and are often self-destructive in other ways as well. Patients with either type of eating disorder may exercise for hours daily and may demonstrate unusual food preferences, social isolation, diminished sexual interest and depression. There is a persistent overconcern with body weight and shape. Many patients demonstrate both anorexic and bulimic behaviors together and up to half of anorexia nervosa patients may eventually develop bulimic symptoms.

Physical complications of anorexia nervosa include malnutrition and cardiovascular compromise, low blood pressure and slow heart rate, loss of menstrual periods, dehydration, electrolyte disturbances, fluid retention, osteoporosis, infertility, gastrointestinal motility disturbances, and hypothermia. Physical complications of bulimia nervosa include electrolyte disturbances, mineral and fluid imbalances, gastric and esophageal irritation and bleeding, large bowel abnormalities secondary to laxative abuse, fluid retention, and erosion of dental enamel and gingivitis secondary to vomiting. The early childhood histories of patients with eating disorders are often complicated by medical and surgical illnesses, separations, family deaths and behavioral disturbances. Sexual abuse has been reported in 20-50% of patients with bulimia nervosa. Patients with anorexia nervosa show increased rates of depression and obsessive-compulsive disorder. Patients with bulimia nervosa show increased rates for anxiety, chemical dependency, manic-depression, personality disorders, dissociative symptoms, sexual conflicts and disturbances, and a variety of impulsive behaviors that may include overspending, shoplifting, promiscuity and self-mutilation. The families of patients with bulimia nervosa often show increased rates of substance abuse particularly alcoholism along with depression and obesity.

Many of the physical and psychological symptoms of eating disorders may result from starvation and malnutrition. Starvation disturbs sleep, impairs concentration, and causes indecisiveness, preoccupation with food, mood lability, anxiety, irritability and depression. Patients with eating disorders often experience a pervasive ineffectiveness in their lives which results in an attempt to gain self-control in the area of weight and body size. These patients often feel ill-equipped for the developmental tasks of growing up and this results in a weak sense of sexual identity and a pervasive sense of ineffectiveness and helplessness. Preoccupation with appearance and weight may become a focus for attempts at mastery and self-control during a stormy adolescence when struggles for autonomy, identity, self-respect and self-control take place. There may be a fear or rejection of adulthood.

Parents may have high expectations for the their children to succeed and may place unrealistic expectations on them. Women with greater degrees of conflict regarding maturation, separation, sexuality, self-esteem, or compulsivity may be more prone to develop eating disorders. Initially patients may be praised for thinness by family and peers but eventually they experience a growing sense of the eating disorder becoming their core identity. Other patients will persistently deny the abnormality or the severity of their eating disorder. Self-worth and attractiveness have become too closely associated with dieting and weight control for women in Western culture. More than 50% of women in United States report that they are dieting. The current epidemic of eating disorders may be related to our societal overevaluation of thinness and beauty.


MULTIPLE PERSONALITY DISORDER

I Dreams I Nightmares I Eating Disorders I Multiple Personality Disorder I
I Borderline Personality Disorders I Alcoholism I

Just about everyone nowadays is familiar with the concept of multiple personality disorder from having seen movies like The Three Faces of Eve or Sybil. A multiple personality disorder is essentially the coexistence within an individual person of two or more distinct and different personality states. A personality can be defined as a relatively constant and consistent pattern of experiencing, relating to, and thinking about one's environment and one's self. In multiple personality disorder there is fragmentation into several personalities each of which may have its own unique memories, behavior patterns, and social relationships. The number of personalities may vary from two to over one hundred with occasional cases of extreme complexity. At least two of the personalities, at some time and recurrently, take full control of the personπs behavior, The transition from one personality to another is usually sudden over a few seconds or minutes but rarely may be gradual over hours to days. The transition is often triggered by stress or some meaningful environmental cue. Transitions may occur when there are conflicts within the person among the different personalities. Personalities may be aware of some of the other personalities and even experience the other personalities as friends, companions, or adversaries. Some of the personalities may be aware of the existence of the other personalities but not have any direct interaction with them while some may be unaware of the existence of the others. At any given moment, only one personality interacts with the external world and the other personalities may actively listen in on or influence what is going on. The personality that presents itself for treatment often has little or no knowledge of the existence of the other personalities. Most often there is an awareness of lost periods of time or distortions in the experience of time. Some admit to these experiences if asked, but few volunteer such information because they fear being called liars or being considered crazy. Others are unaware of their amnestic experiences or make up memories to cover the amnestic periods. The individual personalities may be quite different in attitude, behavior and self-image and may even represent extreme opposites. For example, a quiet retiring spinster may alternate with a flamboyant promiscuous bar fly. At different periods in the person's life any of the different personalities may vary in the proportion of time that they control the person's behavior. One or more of the personalities may function with a reasonable degree of adaptation while alternating with another personality that is clearly dysfunctional. Different personalities may have different eyeglass prescriptions, different responses to the same medication, and different levels of intelligence. One or more of the personalities may report being of the opposite sex, of a different race or age, or from a different family than the other personalities. One or more the personalities may be aware of hearing or having heard the voices of one or more of the other personalities, or may report having talked with or engaged in activities with one or more of the other personalities. Most often personalities have proper names, usually different from the first name, and sometimes different from both the first and last names, of the individual. Often the names have symbolic meaning. Onset of multiple personality disorder is almost invariably in childhood but most cases do not come to clinical attention until much later usually in adult life. The disorder tends to be chronic, although over time the frequency of switching between the personalities often decreases. The degree of impairment varies from mild to severe, depending primarily on the nature of and relationships among the personalities and only secondarily on their number. Complications include suicide attempts, self-mutilation and other violent behavior, and substance abuse. The disorder is almost always preceded by sexual and/or physical abuse or other forms of severe emotional trauma in childhood. The disorder is not nearly as rare as it had commonly been thought to be. It is diagnosed from three to nine times more often in women than in men.


BORDERLINE PERSONALITY DISORDERS

I Dreams I Nightmares I Eating Disorders I Multiple Personality Disorder I
I Borderline Personality Disorders I Alcoholism I

A person with a borderline personality disorder often experiences a repetitive pattern of disorganization and instability in self-image, mood, behavior and close personal relationships. This can cause significant distress or impairment in friendships and work. A person with this disorder can often be bright and intelligent, and appear warm, friendly and competent. They sometimes can maintain this appearance for a number of years until their defense structure crumbles, usually around a stressful situation like the breakup of a romantic relationship or the death of a parent.

Relationships with others are intense but stormy and unstable with marked shifts of feelings and difficulties in maintaining intimate, close connections. The person may manipulate others and often has difficulty with trusting others. There is also emotional instability with marked and frequent shifts to an empty lonely depression or to irritability and anxiety. There may be unpredictable and impulsive behavior which might include excessive spending, promiscuity, gambling, drug or alcohol abuse, shoplifting, overeating or physically self-damaging actions such as suicide gestures. The person may show inappropriate and intense anger or rage with temper tantrums, constant brooding and resentment, feelings of deprivation, and a loss of control or fear of loss of control over angry feelings. There are also identity disturbances with confusion and uncertainty about self-identity, sexuality, life goals and values, career choices, friendships. There is a deep-seated feeling that one is flawed, defective, damaged or bad in some way, with a tendency to go to extremes in thinking, feeling or behavior.

Under extreme stress or in severe cases there can be brief psychotic episodes with loss of contact with reality or bizarre behavior or symptoms. Even in less severe instances, there is often significant disruption of relationships and work performance. The depression which accompanies this disorder can cause much suffering and can lead to serious suicide attempts. It is a common disorder with estimates running as high as 10-14% of the general population. The frequency in women is two to three times greater than men. This may be related to genetic or hormonal influences. An association between this disorder and severe cases of premenstrual tension has been postulated. Women commonly suffer from depression more often than men. The increased frequency of borderline disorders among women may also be a consequence of the greater incidence of incestuous experiences during their childhood. This is believed to occur ten times more often in women than in men, with estimates running to up to one-fourth of all women. This chronic or periodic victimization and sometimes brutalization can later result in impaired relationships and mistrust of men and excessive preoccupation with sexuality, sexual promiscuity, inhibitions, deep-seated depression and a seriously damaged self-image. There may be an innate predisposition to this disorder in some people. Because of this there may ensue subsequent failures in development in the relationship between mother and infant particularly during the separation and identity-forming phases of childhood.

Treatment includes psychotherapy which allows the patient to talk about both present difficulties and past experiences in the presence of an empathetic, accepting and non-judgemental therapist. The therapy needs to be structured, consistent and regular, with the patient encouraged to talk about his or her feelings rather than to discharge them in his or her usual self-defeating ways. Sometimes medications such as antidepressants, lithium carbonate, or antipsychotic medication are useful for certain patients or during certain times in the treatment of individual patients. Treatment of any alcohol or drug abuse problems is often mandatory if the therapy is to be able to continue. Brief hospitalization may sometimes be necessary during acutely stressful episodes or if suicide or other self-destructive behavior threatens to erupt. Hospitalization may provide a a temporary removal from external stress. Outpatient treatment is usually difficult and long-term - sometimes over a number of years. The goals of treatment could include increased self-awareness with greater impulse control and increased stability of relationships. A positive result would be in one's increased tolerance of anxiety. Therapy should help to alleviate psychotic or mood-disturbance symptoms and generally integrate the whole personality. With this increased awareness and capacity for self-observation and introspection, it is hoped the patient will be able to change the rigid patterns tragically set earlier in life and prevent the pattern from repeating itself in the next generational cycle.


ALCOHOLISM

I Dreams I Nightmares I Eating Disorders I Multiple Personality Disorder I
I Borderline Personality Disorders I Alcoholism I

Alcoholism is a chronic, progressive and potentially fatal illness whose essential features include impaired control of drinking along with continued use of alcohol despite harmful consequences. Alcoholism is common and occurs in about one out of every ten persons in the general population. People of Northern European ancestry e.g. Irish, English and French, and Native Americans are at higher risk to develop alcoholism. Family history is a strong predictor of alcoholism because of an inherited predisposition. Alcoholism tends to cluster in families and it occurs at increased rates even when the children are raised by adoptive parents without alcohol problems suggesting a genetic influence to the illness. People who work in jobs that include access to alcohol on the job, co-worker pressure to drink, minimal supervision, high job stress, or a lack of routine may have an increased risk of alcoholism. There is often a history of alcohol related problems such as drunk driving arrests or relationship or job difficulties. A person with alcoholism may often be in denial about the presence or seriousness of their illness and might display joking or anger when the subject is brought up or might change the topic to avoid discussing an alcohol problem.

Most adults are light drinkers. About 35% abstain, 55% drink fewer than three alcoholic drinks a week, and only 10% consume one ounce or more of alcohol a day. The prevalence of drinking is highest in the 21-34 year age range. Most alcohol is consumed by a small percentage of people: 10% of drinkers consume 50% of the total amount of alcohol consumed. There are three main patterns of alcoholism. The first consists of regular daily intake of a consistent amount of alcohol; the second, of regular heavy drinking limited to weekends; the third, of long periods of sobriety interspersed with binges of daily heavy drinking lasting for days or weeks or months. It is a mistake to associate any one of these particular patterns exclusively with alcoholism. There may be recurrent use of alcohol in situations where it is physically hazardous e.g. driving while intoxicated. The person with alcoholism may decide to take only one drink but after taking the first drink continues to drink until severely intoxicated. The alcoholic may recognize that the drinking behavior is excessive and may have attempted to reduce or control it but has been unable to do so. There may be a persistent desire or one or more unsuccessful attempts to cut down or control drinking. Sometimes the alcoholic may wish to reduce or control drinking but has never actually made an effort to do so. A great deal of time is often spent in activities surrounding alcohol either drinking it or recovering from its effects. The alcoholic may suffer intoxication or withdrawal symptoms particularly when expected to fulfill major role obligations at work, school or home. There may be absenteeism because of being hung over or going to work or school intoxicated or driving while under the influence of alcohol. Social, occupational or recreational activities are given up or reduced because of alcohol use. The alcoholic may withdraw from family activities and hobbies in order to spend more time with drinking buddies or to drink in private. The person with alcoholism continues to drink despite social, psychological and physical problems caused by alcohol. Significant tolerance may develop which is a markedly diminished effect with continued use of the same amount of alcohol. The alcoholic may drink increased amounts of alcohol in order to achieve intoxication or the desired effect. Characteristic withdrawal symptoms develop when the alcoholic stops or reduces the intake of alcohol and the alcoholic begins drinking again in order to relieve or avoid those symptoms. This may involve drinking throughout the day beginning soon after awakening.

Alcoholism is often associated with use of other psychoactive drugs including marijuana or cocaine. Alcoholism is often associated with depression and anxiety. The mortality rate of alcoholics is two to three times that of the general population. Alcohol abuse is the third most frequent cause of birth defects in the United States. Most people are unaware that the first symptoms of alcohol abuse are usually social problems with relationships, work or the law. Many persons do not know that more than 25% of people who abuse alcohol will become alcohol dependent and that entering treatment before irreversible social and physical consequences of alcohol abuse occur improves their likelihood of recovery.


I Dreams I Nightmares I Eating Disorders I Multiple Personality Disorder I
I Borderline Personality Disorders I Alcoholism I



Author: Richard J. Corelli, M.D.
Author's Homepage: Psychiatry & Psychotherapy