Dream Consciousness and the Brain: Relevance to Psychopathology

Dreaming has progressively been marginalized in modern clinical approaches to the mental health and psychopathology. Scientific interest in dreams sur- vived, only partially in the field of sleep and consciousness research, where the study of subjective experiences when the brain is disengaged from environmental stimuli may contribute to investigate the neural correlates of consciousness. Nonetheless, progression of knowledge on the dreaming brain/mind was recently employed to model pathological mental phenomena such as psychosis. Indeed, a phenomenological overlap between dreams and psychosis has been described since antiquity. The loosening of associations and disorganization of speech, the pervasiveness of one's hallucinatory experience and lack of insight on the internal origin of incoherent and incongruous mental contents are among several shared phenomena between dreams and psychosis. Bizarreness quantified in dream and fantasy reports was found to be inversely proportional to the neural response of a right fronto-temporal network activated during the script-driven recall of these experiences in healthy volunteers, suggesting a role for these circuits in the dreamlike bizarreness of psychotic patients’ waking mentation. Other available neuroimaging studies also suggest that self-monitoring failure experienced during dreams and lack of insight in psychosis share the disengagement of the same frontal circuitry. However, incorporation of consciousness, psychosis and dream research in a “neuro-phenomenological” or “multi-level” framework remains speculative, and further work is needed to overcome many methodological limitations and to rigorously approach this fascinating field of enquiry.