Excerpts from Must Read Books & Articles on Mental Health
Books, Part V
The Recovery Book- Al J. Mooney, et al.
Chapter 29- A Guide to Preventing & Surviving Relapse. pp. 541-555
Most accidents are programmed to happen. A distracted parent a toddler to play near an
open stairway. A harried cook neglects to wipe up a spill on the kitchen floor. A sports
fan polishes off a six-pack at a game and then heads home behind the wheel of his car. The
tragedies that follow are almost inevitable. it's the same with relapse. It usually begins
long before the recovering addict yields to the prodding of a companion or of a
treacherous inner voice with "oh, what the hell! Why not?" So it's important to
become familiar with attitudes and behaviors that can undermine recovery, to be alert to
situations that can trigger relapse, and to recognize warning signs that your recovery is
about to take a turn for the worse.
It's no secret that the risk of relapse is greatest in the first few
months of being clean or sober. That risk diminishes with time, but it never completely
fades away. Many life events--for example, ill health--can send the risks soaring once
more. Those with the incurable disease known as alcoholism/addiction are always walking
the edge of a cliff. just one false move, one misstep, and they can tumble deep into the
abyss of drinking and drugging. After the fall it's not impossible to haul oneself up
again. But you can spare yourself a lot of bruises if you build a good strong fence
between you and the cliff. Whether you just picked up a thirty-day chip or took a bow at a
meeting for thirty years, continued vigilance is the price of sobriety.
What is Relapse?
Relapse is a medical term describing the return of signs and symptoms of a
disease after an apparent recovery. You can have a relapse with the flu--and you can have
one with the disease of alcoholism/addiction. In neither case is the prognosis grave. It's
likely you will recover from both, but while the flu will probably be self-limiting and go
by on its own, you'll have to take very positive steps to recover from relapse into
A person in recovery is considered to be in relapse when he or she
starts drinking or using again. The behavior can be out of control or there may be an
attempt to control it. A slip, on the other hand, as we use the term here, is taking that
first drink (or drug) or two and getting help before going further. Anywhere from 10 to 60
percent of those in recovery will have at least one relapse. (The percentage depends on
hose statistics you use. No two programs have the same success rates.) Most relapses occur
early in recovery, and the prognosis for those who relapse early is better than for those
who relapse later. Of those who relapse afterr a solid foundation in treatment, most will
eventually have a successful recovery. These people come to understand relapse not as a
failure but as a lesson in how to succeed, not as a sign at they should resign themselves
to a life of substance abuse, but as a sign at they need to work harder at escaping that
Myths Related to Relapse
Because relapse is shrouded in shame and embarrassment, many myths have grown up around
it--myths that may endanger recovery if they aren't recognized as such. You may have heard
these recited as gospel:
"Relapse is inevitable.'' Sometimes people in recovery hear so much
about relapse that they begin to believe it's part of getting better. "I might as
well have my slip now and get it over with" is not an uncommon attitude. But in fact,
most successfully sober individuals have never relapsed, and the chances of staying sober
in the long run are better if you don't relapse.
"Relapse inevitably means failure." For some people, relapse is an
important part of recovery. They aren't truly committed to sobriety the first time around;
they haven't experienced enough pain to persuade them that they can't safely drink or use
drugs. But they learn something each go-around, and by the time they're truly motivated to
remain clean and sober permanently, they've acquired the tools to get the job done. Of
course, those who don't learn from their relapses are doomed to more of the same.
"Relapse can't be prevented." Not only is it possible to prevent a
relapse, it is possible for the great majority of people in recovery to do so
successfully. Avoiding relapse is much less a matter of willpower than of being
knowledgeable about what causes a relapse, how to minimize the risk in unsafe situations,
what the signs of impending relapse are, and what to do if a slip is about to occur.
"Relapse after a period of sobriety and it will take months or years to hit
bottom again." Alcoholism/ addiction is a progressive disease. It continues
to get worse in a kind of shadow progression during recovery. Those who relapse usually
find that when they wake up "the morning after," they are in worse trouble than
when they swore off. In fact it generally takes only a few hours to a few days to reach
bottom in a relapse.
Lapses That Can Trigger a Relapse
If you've been in recovery for a while and have really been paying attention, you can
probably come up with a long personal list of behaviors and attitudes that could put you
at risk for relapse. Your list may include the following:
Dishonesty. Shakespeare said it first, but it's a reminder that can't be
repeated too often: "To thine own self be true." Self-deception denies your
disease, dodges your responsibilities, neglects the fundamentals of your recovery program,
rationalizes unwise actions, and fails to evaluate you (or your good and bad traits)
You live outside your own value system--cheating on your spouse,
defrauding your employer, breaking the hearts of your parents. A sociopath, whose mental
illness makes him hostile toward society and its moral code, might not have a problem with
this, but most of us are uncomfortable living a lie. And this discomfort can jeopardize
recovery. Even if you aren't ready to admit that what you are doing wrong, if you know
someone is being hurt by it, you are still endangering your recovery by creating uneasy
feelings of guilt. Such feelings are hard to live with, and it's natural to want to
smother them with drugs or drown them in gin. It's just as necessary to be truthful with
others--at home, at work, at play. Failing to confide the truth, nothing but the truth, to
those trying to help you--physicians, counselors, sponsors, others in AA--is another way
dishonesty can sabotage recovery. Sometimes we lie as a way of protecting ourselves,
hoping to avoid the consequences of the truth. But in the long run, the consequences of
lying are always worse. We lose the respect of others. Perhaps worse, we lose self
respect. Those with successful recoveries will testify that absolute honesty is the single
most important factor in preventing relapse.
HALT. Hunger, Anger, Loneliness, or Tiredness can make you vulnerable to
relapse, so be sure to guard against each of these. Eat three square meals a day with
regular snacks in between to keep up your blood sugar level and ward off hunger. Talk
about your anger and examine it honestly. Take charge of it before it begins to take
charge of you (it is believed to act as a mood changing drug, making people do things they
wouldn't do otherwise). Remain active in a recovery community such as AA, and attend
meetings often enough to keep loneliness at bay. Regular social activities with recovering
friends are also helpful. When loneliness troubles you, immediately call a sponsor or AA
buddy. Avoid overdoing at both work and play to avoid fatigue; don't take on more than you
can handle. Exercise regularly, since moderate amounts of exercise increase energy levels.
Unrequited Thirst. Finding yourself thirsty (especially hot and thirsty)
with nothing to drink but a frosty beer can be extremely risky. So avoid such situations
by being sure that, whether you are sailing a boat, cheering your favorite team at a ball
game, or playing a sweaty set of singles on a tennis court, you're well-supplied with
frosty sodas, juice, or ice water. If necessary, bring your own thermos.
Negative Feelings. Resentment, ingratitude, self-pity (telling yourself
you're the victim of bad luck rather than someone who's made poor choices), pessimism
(your thermos is always half-empty rather than half-full), impatience (you crave instant
gratification--one day at a time isn't good enough), frustration ("Why can't
everything go just the way I want it to?"), are all attitudes that can undermine
recovery. If you don't acknowledge these feelings and deal with them quickly and
constructively (see Chapter 15), they will inevitably lead you over the edge of Relapse
Unrealistic Expectations. Expecting too much too soon (a trait typical of
alcoholics/addicts) can lead to disappointment and resentment, which in turn can lead to
the nearest bar or dealer. In early recovery, it should be enough that at the end of each
day you can say, "I've stayed clean and sober today." See page 315 for dealing
with expectations realistically.
Unattended-to Phase One Issues. If haven't worked Steps One, Two, Three, if
you never got a sponsor (or don't really confide in the one you have), if you haven't
dealt with other basic issues of early recovery (Chapters 6 through 15), then your
recovery has a weak foundation. This will make it difficult for you to be strong when
faced (as you will be daily) with temptation.
Unresolved Phase Two Issues. If problems in your relationships, your work,
or other aspects of your life still have not been adequately faced and solved, they will
make negative feelings simmer and eventually come to a boil. If this is the case, return
and finish your Phase Two work now, before its unresolved issues finish you. Most winners
in recovery agree that they can't afford the luxury of "emotional litter" in
their lives. Dealing with emotions rather than ignoring them keeps that litter from piling
up. See Chapters 17 through 21.
Renewing old friendships. Once recovery seems well established, it may seem
silly or over-cautious not to see an old friend you used to drink or use with. "She
called and sounded so friendly--why shouldn't I see her? Am I supposed to live the rest of
my life like an orchid in a hothouse?" But unless and until that person is in
recovery to, you're in permanent danger of picking up where your relationship left off.
Getting Back on the Old Merry-Go-Round. As your recovery progresses,
feelings of invulnerability are likely to recur: "I'm doing great. Seeing some of my
old playmates, visiting some of my old playgrounds, won't bother me a bit." But
that's like skydiving without a parachute: the odds are definitely not your favor. If you
find yourself invited to a party or other event that is important to attend but that you
suspect could be risky, take an AA ally along if at all possible. Study the partying tips
on page 180 and use them to plan your every move ahead of time: What will I do if offered
a drink? A joint? A snort? When you're on the spot, stick to your plan like the tortoise
to his shell.
Remembering the Old Days. Otherwise known as "romancing the drink (or
the drug]." Putting a shine on the bad old days ("Hey, remember that time when
we all got loaded and ... ? ") can make them suddenly seem like good old days. Don't
dwell on the past or you'll dwell in it. If someone else tries to romanticize your
drinking or drugging days, put on the brakes with your own memories: "Yeah, and you
vomited all over yourself and your date." If you're the one who starts romanticizing,
bring yourself up short.
Indulging in doubtful habits. Nicotine (in tobacco) and sugar (in most
processed foods and almost all desserts) have been associated with relapse in some
recoverees. Although studies haven't shown this scientifically, a number of observers
nevertheless believe it's a fact. Other compulsive behaviors--gambling, sex, eating--may
also weaken defenses against relapse. So follow the life-extending, sobriety-sustaining
health bits recommended in Phase Three.
Shifting the Blame. If you can always find someone or something else to
blame for your problems, past or present, you aren't putting the responsibility for your
life where it belongs: your own lap. By relinquishing your responsibility to deal with
your life, you return to the irresponsible behavior of addiction. The next step is to turn
to addiction itself.
Situations That Invite Relapse
Sometimes those in recovery don't do anything specific to set themselves up for a
relapse, but life itself sets them up. Certain situations, while not inevitably leading to
relapse, do weaken one's defenses. The only protection: eternal vigilance. If find
yourself in one of the following situations, stay constantly aware of the risk of relapse.
As necessary, take steps on page 547 to be sure that moment passes you safely by.
Bad Times. Not surprisingly, many people relapse when something goes awry in
their lives. Almost any major problem can trigger a slip, including the death of a spouse,
child, or other loved one; the loss of a job; natural catastrophe (a home destroyed by
fire flood, for example); or an illness--anything from a cold to cancer.
Good Times. While you might be alert to a possible slip when things go
wrong, you're much less likely to be wary when everything's coming up daffodils--you
inherit a substantial amount of money, you patch up your marriage, you get a great new job
or a promotion. In fact, most people tend to let their guard down completely when
everything is going right. They toast themselves mentally: "I'm doing great. Staying
sober is easy. I don't have the problems others have. I'm in control." Gradually,
counseling sessions are canceled, "better" ways are found to spend evenings than
going to AA meetings, and before you know it, you've slipped on a banana daiquiri.
Milestones. Being sober for thirty days, six months, one year, or five years
is certainly something to celebrate. But it should also be a reminder: Keep working your
program. A clean and sober anniversary can be a time of confidence and elation
("Everything's going so well!"), of anxiety and depression ("Things are
going too well; it can't last." or "They aren't going well enough"), or of
complacency ("This sobriety is a breeze; now what?"). Unless it's also a time of
caution and reflection, a recovery milestone can put recovery at risk. Don't be the runner
who, having crossed the finish line and achieved his goal of running a marathon, bronzes
his running shoes and takes to his rocking chair.
Few people pick up their chip and then celebrate with a binge, but many
think, "Okay, I've proved I can do it. Now I can relax a little." They take to
that rocking chair, skip the next meeting or neglect to check in with a sponsor, and their
sobriety becomes vulnerable. The riskiest clean and sober anniversaries, experience shows,
seem to be three months, six months, and one year.
Vacations. Getting away from it all can be a tonic for anyone, recovering or
not. But because that often takes vacationers far away from their usual support systems,
it can also be a great opportunity for a gin-and-tonic relapse. So pick and choose
vacation destinations thoughtfully. Choose recovery-related retreats and conventions in
early recovery, and later on stick to resorts and destinations that stress sobriety. When
possible, share vacations with support group friends. Tips on sober getaways, see page 10.
Change. Starting a new relationship or breaking up an old one, switching
jobs, and moving all seem to increase risk of relapse. It's not surprising--all rank high
on any psychologist's list of super-stressors. They all, involve adventures into the
unknown, and the attendant high anxiety creates an uneasy thirst. So if you can avoid or
postpone them, make no major changes until you are solidly in Phase Two, and even then be
alert to the potential risk.
Boredom. Once the early work of recovery is completed and work and
relationships are on an even keel, the addict may long wistfully for excitement-often for
the wrong kind. If you crave the rush that excitement brings, get it the safe way.
Illness or Physical Ailments. Aches and pains--headaches, backaches,
surgery, dental problems, injuries, or other physical complaints--all have been linked to
the start of drinking and drugging. Not surprisingly, they've been linked to relapse too.
Sometimes that's because of the anxiety and depression the illness triggers. Sometimes
it's because of the medications prescribed to chase the pain.
Some people in recovery feel safe taking a prescribed medication
(sometimes, even a sleeping preparation), as though the doctor's imprimatur somehow
magically prevents a drug from acting like a drug. Not so. The patient believes he can
control such usage, but more often than not finds out too late that he was wrong. Result:
relapse. And the fact that the drug was prescribed and used with the best of intentions,
and that relapse was accidental, doesn't help its victim one bit. So if you
experience frequent headaches, intestinal disturbances, muscular spasms, or any other
symptoms, be alert for signposts warning that you're speeding toward what might be called
a medically prescribed relapse. If you become seriously ill and require medication for
either treatment or surgery, or if you're about to have a baby and think you might need
pain relief in labor, be sure that you and your physician follow the guidelines discussed
on page 247.
Unexpected Exposure. You're a nurse, and you find yourself with the key to
the narcotics cabinet. You're doing the spring cleaning, and you turn up a cache of vodka
you'd forgotten about. On the commuter train en route home every evening, you start
running into a guy you used to get high with. If you don't have a workable plan for such
eventualities, relapse is only a misstep away. So be sure you plan ahead.
Triggers: Something you see (powdered sugar spilled on the table, a
photogenic frosty mug of beer in a TV commercial, the outfit you used to wear to wild
parties); something you hear (rock music you associate with shooting up, soul music that
takes you back to your drinking days, the music you were listening to the first time you
smoked a joint); something you smell (bourbon or stale beer, the perfume worn by the girl
you used to do cocaine with, vanilla extract when you're baking a cake, an acrid whiff of
marijuana from the joint of a passer-by); something you taste (nonalcoholic beer or wine,
ice cream artificially flavored with rum, a bowl of pretzels or salted peanuts like the
ones canny bartenders use to double your thirst); something you touch (grains of sugar, a
leather jacket, a flat mirrored surface or highly polished oak countertop). Any these
flashback stimuli could trigger a craving for alcohol or drugs. Again, vigilance--being
prepared for psychological ambushes--lessens the danger.
Relapse doesn't just happen. There's an early warning system built into recovery. If
you're always on the alert for its red flags--behaviors that quietly (or noisily) signal
that a relapse may be imminent--you can head off a slip before it happens. If any of the
following are suddenly part of your life (or if they've been part of your life in recovery
all along), then take preventive action immediately. There's no time to lose.
Elaborate excuse-making. When you find yourself going to great creative
lengths to rationalize or explain away your behavior--why you missed a couple of meetings,
why you've been late to dinner every night for a week, or why a report at work is long
overdue--you are probably tottering on the brink.
Panic in the streets. Or anywhere else. Anxiety or panic attacks, thoughts
of suicide, compulsive behaviors (gambling, promiscuous sex), and eating peculiarities,
are sure signs that your life is getting out of hand. They require immediate attention. If
seeing to your Phase One priorities doesn't get you better fast, seek help from a
Irresponsibility. You start avoiding your commitments, failing to do what
must be done. You do things that you know are not in your own best interests, or that are
in the worst interests of those you care about.
Breaking the rules. The rules laid out for aftercare no longer seem to apply
you. You've "forgotten" to refill the prescription for Antabuse. You make a
beeline for your old haunts and hangouts instead of detouring around them. You don't see
the need to promptly make amends when you make a mistake. You stop taking inventory.
Lying low. You used to check in with your sponsor a couple of times a week.
Suddenly you realize it's been more than two weeks.
Sick thinking. How can you tell your thinking is running a fever? You start
missing the action at the bar and wonder if it really was the alcohol that caused your
problems. While sipping a soda, you ponder the possibility of an innocent little
"scientific experiment" social drinking. You feel sorry for yourself . You start
to dial your sponsor when temptation invades your mind; you abruptly hang up. You act on
impulse rather than with forethought.
Strapping on spare parachutes. You discover that you've kept the numbers of
pushers or liquor stores in your phone file, but you reason that they're important
reminders of the error of your old ways. You decide to leave them there as historic
markers. You turn down a ride to a meeting with an AA friend because you know you can't
stop for a drink with him "just in case" you need one. When an old drugging
buddy calls to ask "What's happening?", you reply vaguely rather than with a
clear, firm "I'm finished with drinking and drugging. I've joined AA."
Treading water. You've hit a plateau. You follow your program faithfully,
but things are not getting better day to day, month to month. If this lack of progress
continues for six months to a year, it's time to think about seeking professional help,
even if you had treatment (in- or outpatient) earlier. Some people are so sick initially,
their ability to think so dampened by drugs, that treatment is less effective than it
could have been. For these people recovery often stagnates, and some form of booster
treatment without waiting for relapse is often the way to go.
Going to hell with yourself. You find yourself forgetting to take a bath,
roll on the deodorant, brush your teeth before you slip into bed, get your hair cut, wash
your clothes, see the doctor when you are ill. The next thing you're likely to forget is
your sobriety. Keep an eye open for deteriorating personal hygiene. A deteriorating
recovery program often lies behind it.
Switching poisons. Alcohol is your nemesis, so what could be wrong with
smoking a joint or two? You're a cocaine addict who never had trouble with alcohol, so why
not just switch to harmless social drinking? Or tranquilizers were your downfall, so why
should a short snort be a problem? The answers will swiftly become evident page.
Denial. If any of the above describes your behavior, yet you insist you
aren't at risk for relapse, you've just followed Alice down a rabbit hole into Wonderand.
Your denial could be taking the form of refusing to believe that, now that you're sober,
you have an alcoholism/addiction problem at all. Or you may be denying other
problems--health problems, financial problems, relationship problems, work problems.
Continued denial of reality could lead to giving up on recovery and trying to escape your
problems in an old familiar way: through the brief Nirvana of substance use. The only way
to "escape" problems is to face them head-on and just plain wrestle them into
Heading Off a Relapse
If you notice any of the mentioned red flags (or any like them) waving in front of your
face, try any or all of the following suggestions to avoid falling off the wagon and under
its wheels. Remember, the compulsion to drink or drug will pass, if you do something else.
--Call your sponsor (or counselor or addiction specialist) immediately. Here's where that
list of emergency numbers in your purse or wallet comes in. If you fail to contact the
first person you call, work your way down the list until you do reach someone.
-- Go to a meeting. If your usual meeting isn't on, go to one that is across town or, if
necessary, in another town. Make no excuses. Spare no expense. Do whatever it takes to get
-- Increase the number of meetings you've been going to. You may have to do a meeting a
day--or more--for several days or weeks to get back on track.
-- Put mileage between yourself and temptation. If you're a health professional, ask a
trusted colleague to take charge of your key to the narcotics cabinet. Walk out of a party
or other event the moment you begin to sense "that old feeling" coming on. Say
sayonara to the "friend" urging you to have "just one."
-- Try relaxation techniques, meditation, prayer, reading (the Big Book or other
inspirational materials), pick-me-ups (munchies, exercise), or other methods of smothering
a compulsion to use or drink.
-- Sign up immediately for a recovery weekend or retreat. Total immersion in a convivial,
sharing, understanding atmosphere for forty-eight hours can be a very sobering experience.
-- Remember what pre-sobriety life was really like. Now is the time to pull out that cache
of rub-your-nose-in-it materials you prepared in early recovery (the history, letters,
photos, videos, etc.) so that you don't forget to remember all the gory details. Ask
yourself what it is you want to get out of the drink or drug that's tempting you, and
whether there might be a better way to reach that goal. Also, think about the term effects
of that drink or drug you and on those you love most. Our surveys of successful recoveries
indicate that perhaps the most powerful force restraining people who feel a compulsion is
pure old-fashioned fear--of sliding back into hell, of pain degradation, of dying.
-- Always be prepared. Know what would do in a whole list of perilous "if"
situations: if you suddenly discover a bottle of liquor you buried long under a pile of
sweaters in the cedar closet. If you're offered a joint a new friend who doesn't know your
history. If an emergency room doctor prescribes a mood-altering drug for the blinding pain
of an ankle sprained on the ski slopes. If you run into an old drinking or drugging buddy.
Know not just roughly what you would do, but precisely, including the
very words you would use. Anticipate the kind of response you might get in turn, and
decide how you would handle it. Role-play with AA friends to prepare for the real thing.
Rehearsing sticky situations beforehand opens up a prepared escape route. And knowing what
to expect from yourself helps you live up to your expectations.
-- If you feel a slip is close and fear you'll fail the challenge, consider giving
yourself a "booster" at a weekend retreat, a refresher program, or an in- or
outpatient treatment facility. Some treatment centers do not accept sober people, and most
insurance carriers will not cover treatment for someone who hasn't relapsed. You may be
able to arrange an admission for mental health reasons or for an impending relapse, and be
covered that way.
Signing-in before you actually have a slip, you skip the detox portion
of the treatment and move directly to dealing with your mental state--which is where the
problem is, anyway.
-- If you spot a pattern of regular slips, or a cycle of periodic sobriety followed by
slips, try to head them off. If, for example, you seem to relapse every six months or so,
check in for a booster after four or five months. This tinkering with your body's clock
could block that relapse.
-- Strengthen your recovery. Thoughtfully and honestly evaluate your recovery program to
expose the weaknesses that keep you tottering on the brink of relapse. Then return to
Phase One (Chapters 6 through 15) to find the best ways to overcome them. Also study
Chapter 5 of the Big Book (How It [AA] Works), and suggest discussion topics at meetings
that you think will be helpful. Dropping back to square one (in this case, Phase One) now,
before a slip, will be a lot easier, and more productive in the long run. It's like a
talented rookie shortstop in a batting slump being sent down to the minors for a few weeks
to work on hitting the curve ball. If he looks upon it as a learning opportunity, not a
disgrace, he'll be back. And so will you.
If You Do Slip
First of all, remember that one slip (taking that first drink or fix) does not an
irreversible relapse make. A close call or an actual slip doesn't mean you're a failure,
just that your recovery program needs immediate first aid. For some people, one or more
slips, or even a full-blown relapse, may become a meaningful part of their recovery
process. The following steps can turn a slip into a learning experience--one that, instead
of damaging your recovery, will strengthen it.
-- Recognize that you made a mistake, but that you don't have to compound it. One drink
doesn't deserve another. Don't surrender to the "Now that I've had one, what
difference will a few more make?" despair. The difference could be
considerable--between being sober this time next year and being dead.
-- Leave the scene of the crime without a moment's hesitation. If you're at home, dump the
drug or alcohol down the toilet before you go, or it will be waiting for you on your
return. Your destination should be an AA meeting, your sponsor's home, the home of another
friend, your counselor's or doctor's office, or some other safe haven.
-- Get immediate help--from your counselor, your doctor, your treatment program, your
sponsor, or whoever you feel would be most useful in directing you back to the road to
recovery. Pick up the nearest telephone and start calling your list; keep trying until you
reach someone. Don't be embarrassed to ask for help. You are not the first person in
recovery to slip, and you won't be the last.
-- No relapse "just happens." Once the immediate crisis is over, do an inventory
to try to determine why you slipped. Look over the risky attitudes, behaviors, and
situations described in the preceding pages, and see which may have been responsible for
your fall. Were there physical cues--sights, smells, sounds, tastes--that triggered your
actions? Figure out how to evade or alter them in the future, and take measures to be
certain that you do.
-- Reinforce your recovery program as though you were starting from scratch in Phase One:
go to more meetings, rework the Twelve Steps, read the Big Book and other literature, do
more meditations, and so on.
-- Consider a treatment booster shot in- or outpatient.
-- Assure yourself that you can succeed. You can.
If You Relapse
At any time in. recovery you return to your drinking or drug using behavior, even only
sporadically, you are in relapse. Taking the appropriate action is critical to your
Get short-term help. Don't think about it--do it. As soon as you can pull
yourself together to make a phone call, call your counselor, sponsor, doctor, treatment
program, or another strong, reliable AA person. If you wait until you hit bottom again
(even if it's just a few days), it's no melodramatic exaggeration to say that you may not
live to make another stab at recovery. Leave a message if you can't reach someone, then
call the next name on your list. Don't stop calling until you've reached a sympathetic and
sober person who is able to come immediately. Alternately, call a cab to take you to an AA
meeting. When you get in the taxi, ask driver to take you directly to your destination
"even if I change my mind the on way."
Detoxify. If you experienced withdrawal the first time you quit, you are
likely to again, even after just a small dose of alcohol or another drug. Since withdrawal
symptoms are generally more severe the second time (or subsequent times) around, you may
require medical detox. A few days of hospitalization by your family doctor may be all you
need. If you--and someone you trust, who has considerable experience in these
matters--decide that you don't need hospitalization, fully and carefully follow the
procedures on page 80 for safe home detox, even if you didn't the first time. Attempt this
only if you have an AA member or another steadfast, knowledgeable, and thoroughly reliable
friend keeping the vigil with you. If your AA clubhouse has cots, you may be able to
Get long-term help. If you didn't go the formal treatment route the first
time around, now is a good time to try it. If you did but lacked motivation the first
time, professional treatment may be particularly valuable now. If you really open up your
mind, all the words you listened to but didn't make a part of your life then should now
finally make sense.
If you have a history of periodic sobriety and relapse, professional
treatment may be not only valuable but absolutely necessary for your survival. Impaired
judgment from drinking could set you up for self-destructive behavior, even suicide.
Typically, relapse is a time when many people alternately seethe with anger and wallow in
self-pity: "I'm never going to climb out of this hell. Nobody gives a damn about me.
My family would be better off without me. I might as well end it all."
There are a variety of professional treatment options (see Chapter 3).
Which you choose will depend on your health, your addiction, your wallet (or your
employer's), and personal factors. Down the line, you may be able to further protect your
recovery by agreeing to drug testing at work or school, by having your sponsor or
counselor agree to report you to your boss or dean at the first sign of a slip
Spotlight your shortcomings. You didn't relapse accidentally, unless a
friend with a distorted sense of humor sneaked some booze or hash into your beef goulash.
(What were you doing socializing with anyone who could think that was funny, anyway?) The
newly sober recognize that they have a lot to learn about recovery. But relapsers
sometimes feel that they are experts on recovery, that the relapse was "just a
fluke." If told "What you need is ninety meetings in ninety days," their
smart-aleck response is likely to be "I know what I need, and that ain't it!"
But someone who lacks the humility necessary to crawl back on the recovery wagon is likely
to see it roll without him.
If you want to get sober again-this time for good--the first thing
you're going to have to admit is that what you know about recovery couldn't fill a shot
glass. Then start your program over from scratch, soul-searching for the chinks in your
recovery armor that made it possible for drugs or alcohol to seep through. You can go to
your old group, or if you find it more comfortable, make a fresh start at a new group, one
where you aren't recognized as an old-timer.
Re-focus on recovery. Eventually, what you learn from your relapse will
allow you to carry a powerful message to others. Right now you have to forget about being
a sponsor or helping other people, and instead look after number one. Even if you've been
sober for years, a relapse means you have to stop everything and concentrate on the work
of recovery--on Phase One work. You'll probably complete it in less time than you did the
first time around, but you need to "get it" better than you did then.
Making meetings mandatory. Don't ever let going to Twelve-Step meetings
become a random activity; structure your life so that meetings are a routine part of it.
Going to the same meeting at the same time and in the same place each day (or later in
recovery, once or twice each week) will strengthen the habit--though the Twelve-Step
meeting on Monday night, for example, may not be with the same group as the one on Friday
Link your meeting attendance to your regular routine. Go to a meeting
on your way home from work, while you're out for your exercise, or en route to an evening
class. That way you know where you're going in advance and don't have to make a fresh
decision each time. You can say to friends, "See you next week," or arrange to
meet someone for a meal before the next meeting or to drive there together. If you find
yourself trying to choose between going to a Rotary meeting (or a movie, or a basketball
game) and going to your regular AA meeting, there could be trouble ahead. If you reach the
point where you find yourself choosing the movie or a game over the meetings, or
chronically missing meetings for other reasons, take action. There's very likely a relapse
in near future.
Unmask the villains. Carefully examine your current involvement in AA (do
you have and regularly confer with a sponsor? Have you gotten careless and cavalier about
attending meetings? Do you read the Big Book and other AA literature often?) and your life
(are your relationships healthy, is your job interesting and on track, is there too much
stress, too little fun in your life, too few friends?).
Don't be embarrassed. Your friends at AA know that nobody's perfect and you're
probably thinking "There but for the grace of God go I." You may feel
uncomfortable having to start all over again, and may even have to take some ribbing at
AA; but mostly you will get a lot of loving support.
Think Positive. Anyone can become successfully clan and sober--anyone who is
motivated and willing to put in the necessary hard work. This time, that anyone can be
An Elementary Textbook of Psychoanalysis- Charles Brenner
Chapter VII- Dreams, pp. 149-170
The study of dreams occupies a particular place in psychoanalysis. The
Interpretation of Dreams (Freud, 1900) was as revolutionary and as monumental a
contribution to psychology as the Origin of Species was to biology a half
century earlier. As late as 1931 Freud himself wrote, in a foreword to the third edition
of Brill's translation of The Interpretation of Dreams, "It contains,
even according to my present-day judgment, the most valuable of all the discoveries it has
been my good fortune to make. Insight such as this falls to one's lot but once in a
lifetime." Moreover, his success in understanding dreams was of immense help to him
during the early years of this century, at a time when his professional work was of
necessity carried on in complete isolation from his medical colleagues. In that difficult
time he was struggling to understand and to learn how to treat successfully the neuroses
from which his patients suffered. As we know from his letters (Freud, 1954) he was often
discouraged and sometimes even in despair. Yet however discouraged he might be, he was
able to take courage from the discoveries which he had made about dreams. There he knew
that he was on firm ground and this knowledge gave him the confidence that he needed in
order to go forward (Freud, 1933).
Freud was certainly right in valuing his work on dreams so highly. In
no other phenomenon of normal psychic life are so many of the unconscious processes of the
mind revealed so clearly and made so accessible to study. Dreams are indeed a royal road
to the unconscious reaches of the mind. Yet even this does not exhaust the reasons for
their importance and value to the psychoanalyst. The fact is that the study of dreams does
not simply lead to an understanding of unconscious mental processes and contents in
general. It leads particularly to those mental contents which have been repressed, or
otherwise excluded from consciousness and discharge by the defensive activities of the
ego. Since it is precisely the part of the id which has been barred from consciousness
that is involved in the pathogenic processes which give rise to neuroses and perhaps to
psychoses as well, one can readily understand that this characteristic of dreams is still
another, very important reason for the special place that the study of dreams occupies in
The psychoanalytic theory of dreams may be formulated as follows. The
subjective experience which appears in consciousness during sleep and which, after waking,
is referred to by the sleeper as a dream is only the end result of unconscious mental
activity during sleep which, by its nature or its intensity, threatens to interfere with
sleep itself. Instead of waking, the sleeper dreams. We call the conscious experience
during sleep, which the sleeper may or may not recall after waking, the manifest dream.
Its various elements are referred to as the manifest dream content. The unconscious
thoughts and wishes which threaten to waken the sleeper we call the latent dream
content. The unconscious mental operations by which the latent dream content is
transformed into the manifest dream we call the dream work.
It is of the utmost importance to keep these distinctions clearly in
mind. A failure to do so constitutes the greatest source of the frequent confusion and
misunderstandings that arise concerning the psychoanalytic theory of dreams. Strictly
speaking, the word "dream'' (in psychoanalytic terminology) should only be used to
designate the total phenomenon of which the latent dream content, the dream work, and the
manifest dream are the several, component parts. In practice, in the psychoanalytic
literature, "dream" is very often used to designate "manifest dream."
Usually when this is done it leads to no confusion if the reader is well acquainted with
the psychoanalytic theory of dreams already. For example, the statement, "the patient
had the following dream," when followed by the verbal text of the manifest dream,
leaves no in the mind of the informed reader that the word is intended to mean
"manifest dream." However, it is essential for the reader who is not yet fully
at home in field of dream theory to ask himself what the author meant by the unqualified
word "dream" whenever he encounters it in the psychoanalytic literature. There
is another term which in practice appears in the literature and in discussion and which it
is convenient to define here. This is the "the meaning of a dream," or, "a
dream means." Properly speaking, the meaning of a dream can signify only the dream
content. In our present discussion we shall try keep our terminology precise in order to
avoid the possibility of misunderstanding.
Having defined the three component parts of a dream, let us proceed to
a discussion of that part which we believe initiates the process of dreaming, namely of
the latent dream content. This content is divisible into three major categories. The first
category is an obvious one. It comprises nocturnal sensory impressions. Such impressions
are continually impinging on the sleeper's sense organs and at times some of them take
part in initiating a dream, in which case they form part of the latent content of that
dream. Examples of such sensations are familiar to all of us. The sound of an alarm clock,
thirst, hunger, urinary or fecal urgency, pain from an injury or disease process, or from
the cramped position of part of the body, uncomfortable heat or cold, all can be a part of
the latent dream content. In this connection it is important to bear two facts in mind.
The first is that most sensory stimuli do not disturb sleep, even to the extent of
participating in the formation of a dream. On the contrary, the vast majority of the
impulses from our sensory apparatus are without discernible effect upon our minds during
sleep. This is true even of sensations which in our waking state we should evaluate as
rather intense. There are persons who can sleep through a violent thunderstorm without
either waking or dreaming, despite the fact that their hearing is quite normally acute.
The second fact is that a disturbing sensory impression during sleep can have the effect
of waking the sleeper directly, without any dream, at least as far as we can tell. This is
particularly obvious in those situations in which we are sleeping "with one ear
cocked," or "with one eye, open," as happens for example with parents when
a child in the family is sick. In such a case the parent will often waken immediately at
the first disturbing sound from the child, however slight its intensity.
The second category of the latent dream content comprises thoughts and
ideas which are connected with the activities and the preoccupations of the dreamer's
current, waking life and which remain unconsciously active in his mind during sleep.
Because of their continued activity they tend toward waking the sleeper, in the same way
as impinging sensory stimuli during sleep tend to do. If the sleeper dreams instead of
waking, these thoughts and ideas act as part of the latent dream content. Examples are
innumerable. They include the whole variety of interests and memories which are ordinarily
accessible to the ego, with whatever feelings of hope or fear, pride or humiliation,
interest or repugnance which may accompany them. They may be thoughts about an
entertainment of the night before, concern about an unfinished task, the anticipation of a
happy event in the future, or whatever else one might care to imagine that is of current
interest in the sleeper's life.
The third category comprises one or several id impulses which, at least
in their original, infantile form, are barred by the ego's defenses from consciousness or
direct gratification in waking life. This is the part of the id which Freud called
"the repressed" in his monograph on the structural hypothesis of the psychic
apparatus (Freud, 1923), although he later favored the view, now generally accepted by
psychoanalysts, that repression is not the only defense which the ego employs against id
impulses which are inadmissible to consciousness. Nevertheless, the original term,
"the repressed," continues in usage to designate this part of the id. With this
understanding, therefore, we may say that the third category of the latent dream content
in any particular dream is an impulse, or impulses, from the repressed part of the id.
Since the most important and far-reaching of the ego's defenses against the id are those
which are instituted during the pre-oedipal and oedipal phases of the child's life, it
follows that id impulses from those early years are the chief content of the repressed.
Accordingly, that part of the latent dream content which derives from the repressed is
generally childish or infantile, that is to say, it consists of a wish appropriate to and
stemming from early childhood.
As we can see, this is in contrast to the first two categories of the
latent dream content which comprise, respectively, current sensations and current
concerns. Naturally in childhood the current and the childish may coincide. However, far
as dreams of later childhood and adult life are concerned, the latent content has two
sources, the one in the present and the other in the past. We naturally wish to know
what is the relative importance of the three parts of the latent content and whether all
three are to be found in the latent content of every dream. As to the first question,
Freud (1933) declared unequivocally that the essential part of the latent content
is that which comes from the repressed. He believed that it is this part which contributes
the major share of the psychic energy necessary for dreaming and that without its
participation there can be no dream. A nocturnal sensory stimulus, however intense it be,
must, as Freud expressed it, enlist the aid of one or more wishes from the repressed
before it can give rise to a dream and the same thing is true of the concerns of waking
however compelling may be their claim on the sleeper's attention and interest.
As to the second question, it follows from our answer to the first one
that one or more wishes or impulses from the repressed are an essential part of the latent
content of every dream. It also appears to be the case that at least some concerns from
current, waking life are a part of every latent dream content. Nocturnal sensations, on
the other hand, are not demonstrable in the latent content of every dream, although they
play a conspicuous role in some dreams.
We wish now to consider the relationship between the latent dream
content and the manifest dream, or, to be more specific, the elements or content of the
manifest dream. Depending on the dream, this relationship may be very simple or very
complex, but there is one element that is constant. The latent content is unconscious,
while the manifest content is conscious. The simplest possible relationship between the
two, therefore, would be that the latent content become conscious.
It is possible that this does happen occasionally in the case of
sensory stimuli during sleep. For example, a person may be told in the morning, after
waking, that fire engines passed the house during the night while he was asleep and he may
then recall that he heard a fire siren in his sleep. However, we should probably be
inclined to look on such an experience as a borderline or transitional experience between
ordinary, waking perception and a typical dream rather than to classify it as a true
dream. We might even suspect that the sleeper awoke momentarily when he heard the sirens,
although we must admit that this cannot be more than an assumption on our part.
In any case, for our present purposes we shall do better to confine
ourselves to a consideration of phenomena which are unquestionably dreams. Of these, it is
the dreams of early childhood which most often offer us examples of the simplest
relationship between latent and manifest content. For one thing, in such dreams we need
not distinguish between infantile and current concerns. They are one and the same. For
another thing, there is not as yet any clear distinction to be made between the repressed
and the rest of the id, since the very little child's ego has not yet developed to the
point of having erected permanent defenses against any of the impulses of the id.
Let us take as an example the dream of a two-year-old whose mother had
just returned from the hospital with a new baby. On the morning after his mother's return
he reported a dream with the following manifest content: "See baby go away."
What was the latent content of this dream? Ordinarily this is something that we can
determine only from the dreamer's associations, that is by the use of the psychoanalytic
method. Naturally, a two-year-old child cannot understand or consciously cooperate in such
an undertaking. However, in this case we can justifiably take the child's known behavior
and attitude toward the new baby, which were hostile and rejecting, as the equivalents of
associations to the manifest content of the dream. If we do so, we can conclude that the
latent content of the dream was a hostile impulse toward the new baby and a wish to
destroy or get rid of it.
Now what is the relationship between the latent and the manifest
content of the dream in our example? The answer seems to be that the manifest content
differs from the latent one in the following respects. First, as we have already said, the
former is conscious and the latter, unconscious. Second, the manifest content is a visual
image, while the latent content is something like a wish or impulse. Finally, the manifest
content is a fantasy which represents the latent wish or impulse as gratified, that is, it
is a fantasy which consists essentially of the gratification of the latent wish or
impulse. We may say then that in the case we have chosen as an example, the relation
between the latent and the manifest dream content is that the manifest dream is a
conscious fantasy that the latent wish has been or is being gratified, expressed in the
form of a visual image or experience. Consequently, the dream work in this example
consisted of the formation or selection of a wish-fulfilling fantasy and its
representation in visual form.
This is the relationship that obtains between the latent and the
manifest dream content in all of the dreams of early childhood, as far as we know.
Moreover, it is the basic pattern for this relationship which is followed in the dreams of
later childhood and of adult life as well, even though in these more complex dreams the
pattern is elaborated and complicated by factors which we shall discuss shortly.
First, however, we note that the process of dreaming is in essence a process of gratifying
an id impulse in fantasy. We can better understand now how it happens that a dream makes
it possible for a sleeper to keep on sleeping instead of being wakened by a disturbing,
unconscious mental activity. It is because the disturbing wish or impulse from the id,
which regularly forms a part of the latent content of the dream, is gratified in fantasy
and in that way loses at least some of its urgency and hence some of its power to waken
Conversely, we understand that the fact that the manifest dream is
regularly a wish fulfillment is due to the nature of the latent content, which after all
is the initiator of the dream as well as its principal source of psychic energy. The id
element which plays this role in the latent content can only press constantly for
gratification, since this is the very nature of the instinctual drives of which it is a
derivative. What happens in a dream is that a partial gratification is achieved by means
of fantasy, since full gratification through appropriate action is rendered impossible by
the state of sleep. Since motility is blocked, fantasy is used as a substitute. If we
express the same idea in terms of psychic energy, we shall say that the cathexis which is
attached to the id element in the latent content activates the psychic apparatus to carry
out the dream work and achieves partial discharge via the wish-fulfilling fantasy image
which constitutes the manifest dream.
At this point we must take account of the obvious fact that the
manifest content of most of the dreams of later childhood and of adult life is not at all
recognizable as a wish fulfillment on first, or even on second glance. Some dreams,
indeed, have as their manifest content images which are sad or even frightening, and this
fact has been cited repeatedly in the past fifty years as an argument to disprove Freud's
assertion that every manifest dream is a fantasied wish fulfillment. How can we understand
this apparent discrepancy between our theory and the obvious facts?
The answer to our question is a very simple one. As we have said, in
the case of the dreams of early childhood the latent dream content gives rise, via the
dream work, to a manifest dream which is a fantasy of the satisfaction of the impulse or
wish which constitutes the latent content. This fantasy is experienced by the dreamer in
the form of sensory impressions. The same obvious relationship between the latent and the
manifest dream content is sometimes found in a dream of later life. These dreams closely
resemble the simple ones of early childhood. However, it is more often the case that the
manifest content of a dream of later life is the disguised and distorted version of
a wish-fulfilling fantasy, experienced predominantly as a visual image, or a series of
visual images. The disguise and distortion are often so extensive that the wish-fulfilling
aspect of the manifest dream is quite unrecognizable. Indeed, as we all know, the manifest
dream is sometimes a mere hodgepodge of apparently unrelated fragments and seems to make
no sense whatever, much less to represent the fulfillment of a wish. At other times the
disguise and distortion are present in such high degree that the manifest dream is
actually experienced as frightening and unwelcome, rather than retaining the pleasurable
character that we should expect a wish-fulfilling fantasy to have. It is the dream
work which creates the disguise and distortion which are such prominent features of the
manifest dreams of later childhood and of adult life. We are interested to know what
processes are involved in the dream work and how each of them contributes to disguising
the latent content so that it is no longer recognizable in the manifest dream.
Freud was able to show that there are two principal factors to be
considered in connection with the dream work and one subsidiary one. The first principal
factor, which is, indeed, the very essence of the dream work, is that it is a translation
into the language of the primary process of those parts of the latent content which are
not already expressed in that language, followed by a condensation of all of the elements
of the latent content into a wish-fulfilling fantasy. The second principal factor consists
of the defensive operations of the ego, which exercise a profound influence on the process
of translation and fantasy formation, an influence which Freud likened to that of a news
censor with wide powers to suppress objectionable items. The third, subsidiary factor is
what Freud called secondary revision.
Let us consider each of these factors in turn. In the first place, as
we have said, the dream work consists of the translation into primary process thinking of
that part of the latent dream content which is originally expressed according to the
secondary process. This would only include what we have called the concerns and interests
of current life. Moreover, as Freud pointed out, this translation occurs in a certain way.
As he put it, there is a regard for the possibility of expressing the result of the
translation in the form of a plastic, visual image. This regard for plastic
representability, of course, corresponds to the fact that the manifest dream content
consists principally of such images. A similar regard for plastic representability is
exercised consciously in some activities of norm4 waking life, as for example in charades
and in composing cartoons and rebuses.
Another consideration that doubtless affects this process of
translation in the dream work is the nature of the latent dream elements which are already
in primary process language, that is, essentially, the memories, images, and fantasies
associated with the wish or impulse from the repressed. In other words, the dream work
will tend to translate the current concerns of waking life into terms or images that stand
in as close a relationship as possible to the material which is connected or associated
with the repressed. At the same time, of the several or even, perhaps, of the many
fantasies of gratification which are associated with the repressed impulse, the dream work
chooses that one which can most easily be brought into connection with the translated
current concerns of waking life. All of this is a necessarily clumsy way of saying that
the dream work effects as close an approximation as possible among the various latent
dream elements in the course of translating into primary process language those parts of
the latent content that need translating, while at the same time creating or selecting a
fantasy which represents the gratification of the impulse from the repressed that is also
a part of the latent content. As we said in the previous paragraph, all of this is done
with regard to visual representability. In addition, the process of approximation which we
have just described makes it possible for a single image to represent several latent dream
elements simultaneously. This results in a high degree of what Freud called
"condensation," which is to say that, at least in the vast majority of cases,
the manifest dream is a highly condensed version of the thoughts, sensations and wishes
which make up the latent dream content.
Before we proceed to a discussion of the part played in the dream work
by the ego's defenses, we may pause to ask whether that part of the dream work which we
have already discussed is responsible for any part of the disguise and distortion which we
have said characterizes most manifest dreams and, if so, how great a role it plays in this
direction. It is understandable that expressing concerns of waking life in the
language of the primary process should result in a considerable degree of distortion of
their meaning and content. However, the reader may well ask why this psychic operation
should have the effect of rendering its end result unintelligible to the dreamer. After
all, the person who composes a cartoon, a charade, or a rebus can understand the
meaning of its images, despite the fact that the meaning has been expressed in the
language of the primary process. In fact, the meaning of these creations is grasped by
many persons other than the composer himself. Moreover, ideas which are expressed in the
language of the primary process are intelligible to us in other situations, as for example
in the case of witticisms, as we saw in Chapter VI. Why then should a manifest dream be
unintelligible, simply because it contains ideas which are expressed via the primary
One part of the answer to this question would appear to be the
following. Wit, cartoons, rebuses, and even charades, are composed with a special
requirement, namely that they be intelligible. They must communicate a meaning to an
actual or potential audience if they are to be "good." A manifest dream, on the
other hand, is subject to no such restriction. It is merely the end result of a process
which aims at the fantasied gratification of a wish, or, alternatively expressed, at the
discharge of enough of the psychic energy associated with the latent dream content to
prevent this content from awakening the sleeper. It is not surprising, therefore, that the
manifest dream is not generally immediately comprehensible even to the sleeper himself.
However, the second of the principal factors which we have mentioned as
participating in the dream work plays much the more important role in disguising the
latent dream content and making the manifest dream unintelligible. This second factor, as
the reader will remember, is the operation of the defenses of the ego. We may note in
passing that Freud's first description of this factor long preceded his formulation of the
structural hypothesis concerning the psychic apparatus, of which the terms "ego"
and "defenses" are a part. For that reason he had to devise a name for the
factor in question and the one that he chose, as we said above, was "the dream
censor, a most apt and evocative term.
In order to understand clearly the operation of the ego's defenses in
the process of the formation of the manifest dream, we must first recognize that it
affects the different parts of the latent dream content to different degrees. The part of
the latent content consisting of nocturnal sensations is ordinarily subject to no
defensive operations of the ego, unless, perhaps, we should consider that the ego attempts
to deny all such sensations in consequence of its wish to sleep. However, we are really
not certain whether this attitude of the sleeper toward nocturnal sensations is an ego
defense in the usual meaning of the term and we may safely leave it out of consideration
for the purposes of our present discussion.
In marked contrast to nocturnal sensations, the part of the latent
dream content which consists of wishes or impulses from the repressed is directly opposed
by the defenses of the ego. We know indeed that this opposition is a long-standing and
essentially permanent one and that its presence is the reason for our speaking of
"the repressed." We have no difficulty, therefore, in understanding that the
ego's defenses tend to oppose the appearance of this part of the latent dream content in
the conscious, manifest dream, since they are permanently opposed to its appearance in
consciousness in waking life as well. It is the opposition of the defenses of the ego to
this part of the latent content of the dream which is principally responsible for the fact
that the manifest dream is so often incomprehensible as such and quite unrecognizable as a
wish-fulfilling, fantasy image.
The remaining part of the latent dream content, that is, the current
concerns of waking life, occupies a position with respect to the ego's defenses which is
intermediary between those of the two parts which we have just discussed. Many of the
concerns of waking life are unobjectionable to the ego except, perhaps, as potential
disturbers of sleep. Some are even considered by the ego to be pleasurable and desirable.
However, there are other current concerns which are directly unpleasurable to the ego as
sources of either anxiety or guilt. During sleep, therefore, the ego's defense mechanisms
attempt to bar from consciousness these sources of unpleasure. The reader will remember
from our discussion in Chapter IV that it is unpleasure, or the prospect of unpleasure,
that calls into action the ego's defenses in general. In the case of such latent dream
elements as we are presently discussing, we believe that the strength of the ego's
unconscious opposition to them is proportional to the intensity of the anxiety or guilt,
that is, of unpleasure, which is associated with them.
We see then that the ego's defenses strongly oppose the entry into
consciousness of the part of the latent dream content which derives from the repressed and
oppose more or less strongly, as the case may be, various of the concerns of waking life
which are also a part of the latent content. However, by definition, the unconscious
thoughts, strivings and sensations which we call the latent content of the dream do in
fact succeed in forcing their way into consciousness, where they appear as a manifest
dream. The ego cannot prevent this, but can and does influence the dream work so that the
manifest dream is unrecognizably distorted and consequently unintelligible. Thus the
incomprehensibility of most manifest dreams is not due simply to the fact that they are
expressed in the language of the primary process with no regard for intelligibility. The
major reason for their incomprehensibility is that the ego's defenses make them that way.
Freud (1933) called the manifest dream a "compromise
formation," by which he meant that its various elements could thought of as
compromises between the opposing forces of the latent dream content, on the one hand, and
those of the defenses of the ego, on the other. As we shall see in Chap. VIII, a neurotic
symptom is likewise a compromise formation between an element of the repressed and the
defenses the ego.
Perhaps a simple example might be helpful at this point. Let us assume
that the dreamer is a woman and that the part the latent dream content deriving from the
repressed is a wish, originating in the dreamer's Oedipal phase, for a sexual relationship
with her father. This might be represented in the manifest dream, in accordance with an
appropriate fantasy from that period of life, by an image of the dreamer and her father
fighting together with an accompanying feeling of sexual excitement. However, if the ego's
defenses oppose such an undisguised expression of this oedipal wish, the sexual excitement
may be barred from consciousness, with the result that the manifest dream element becomes
merely an image of fighting with father, with no attendant sexual excitement. If this is
still too close to the original fantasy to be tolerated by the ego without anxiety or
guilt, the image of the father may fail to appear, and instead an image may appear in
which the dreamer is fighting with someone else, for example, with her own son. If the
image of fighting is still too close to the fantasy, it may be replaced by some other
physical activity, as, for example, dancing, so that the manifest dream is that of the
dreamer dancing with her son. Even this may be objectionable to the ego, however, and
instead of the manifest dream element just described there may appear in the dream an
image of a strange woman with a boy who is her son, in a room with a polished floor.
We should really end this series of examples with the words 'and so
on,' since the possibilities for disguising the true nature of any element of the latent
dream content are, for practical purposes, infinite in number. In fact it is the balance
between the strength of the defenses and that of the latent dream element which will
determine how closely or how distantly related is the manifest to the latent dream, that
is, how much disguise has been imposed on the latent dream element during the dream work.
Incidentally, in the example given in the previous paragraph, the reader should understand
that each of the manifest dream images which were described is a separate possibility
which might appear in a particular dream under the proper circumstances. The example is
not intended to imply that, in a particular dream, manifest content "A" is tried
first, then, if the ego will not tolerate "A," "B" is substituted, if
not "B," then "C," and so forth. On the contrary, depending on the
balance of forces between the defenses and the latent dream element, either "A"
or "B" or "C," etc., will appear in the manifest dream.
As might be expected, our example did not exhaust, or even suggest, the
variety of "compromise formations" that are possible between defense and latent
content. Anything approaching a complete list of such possibilities would be quite beyond
the scope of the present chapter, but there are a few important or typical ones that we
should mention. For one thing, things that belong together in the latent content may
appear in widely separated parts of the manifest content. Thus, the dreamer of the example
which we gave above might have seen herself fighting with someone in one part of the
manifest dream, while her father was present in quite a different part. Such disruptions
of connections are common results of the dream work.
Another common "compromise" phenomenon is that a part, or
even all, of the manifest dream is very vague. As Freud pointed out, this invariably
indicates that the opposition of the defenses to the corresponding element or elements of
the latent dream is very great. True, the defenses were not quite strong enough to prevent
the part of the manifest dream in question from appearing in consciousness altogether, but
they were strong enough to keep it from being more than half or vaguely conscious.
The affects or emotions which belong to the latent dream content are
also subjected to a variety of vicissitudes by the dream work. We have already illustrated
the possibility that such an emotion, which in the case of our example was sexual
excitement, might not appear in the manifest content at all. Another possibility is that
the emotion may appear with greatly diminished intensity or somewhat altered in form.
Thus, for instance, what was rage in the latent content may appear as annoyance, or as a
mild dislike in the manifest content, or may even be represented by an awareness of not
being annoyed. Closely related to the last of these alternatives the possibility that an
affect belonging to the latent dream may be represented in the manifest dream by its
opposite. A latent longing may therefore appear as a manifest repugnance, or vice
versa, hate may appear as love, sadness as joy, and so on. Such changes represent a
"compromise," in Freud's sense of the word, between the ego and latent content
and introduce an enormous element of disguise into the manifest dream.
No discussion of affects in dreams would be complete without including
the particular affect of anxiety. As we mentioned earlier in the course of this chapter,
some of Freud's critics have attempted to disprove his statement that every manifest dream
is a wish fulfillment on the basis that there exists a whole class of dreams in which
anxiety is a prominent feature of the manifest content. In the psychoanalytic literature
these dreams are usually called anxiety dreams. In nonanalytic literature the most severe
of them are referred to as nightmares. The most extensive psychoanalytic study of the
latter is that by Jones (1931). In general we may say of anxiety dreams that they signal a
failure in the defensive operations of the ego. What has happened is that an element of
the latent dream content has succeeded, despite the efforts of the ego's defenses, in
forcing its way into consciousness, that is, into the manifest dream content, in a form
which is too direct or too recognizable for the ego to tolerate. The consequence is that
the ego reacts with anxiety. On this basis we can understand, as Jones pointed out, that
oedipal fantasies appear in the manifest content of the classical nightmare with
relatively little disguise and that, indeed, sexual gratification and terror are not
infrequently present together in the conscious or manifest portion of such dreams.
There is another class of dreams which is closely related to anxiety
dreams and which are often referred to as punishment dreams. In these dreams, as in so
many others, the ego anticipates guilt, that is, superego condemnation, if the part of the
latent content which derives from the repressed should find too direct an expression in
the manifest dream. Consequently the ego's defenses oppose the emergence of this part of
the latent content, which is again no different from what goes on in most other dreams.
However, the result in the so-called punishment dreams is that the manifest dream, instead
of expressing a more or less disguised fantasy of the fulfillment of a repressed wish,
expresses a more or less disguised fantasy of punishment for the wish in question,
certainly a most extraordinary "compromise" among ego, id, and superego.
At this point we must pose a question which may already have occurred
to the reader. We have said that in dreams an unconscious wish or impulse from the
repressed appears in consciousness, though more or less disguised, as the wish fulfilling
fantasy image which constitutes a manifest dream. Now, by definition, this is precisely
what an impulse belonging to the repressed cannot do. That is to say, we have defined
"the repressed" as comprising those id impulses, with their directly associated
fantasies, memories, and so forth, which the ego's defenses permanently bar from direct
access to consciousness. How then can the repressed appear in conscious. ness in a dream?
The answer to this question lies in the psychology of sleep (Freud,
1916b). During sleep, perhaps because the path to motility is effectively barred, the
strength of the ego's defenses is considerably diminished. It is as though the ego said,
"I don't have to worry about these objectionable impulses. They can't do anything as
long as I'm asleep and stay in bed." On the other hand, Freud assumed that the drive
cathexes at the disposal of the repressed, that is, the strength with which they push
toward becoming conscious, is not significantly reduced during sleep. Thus sleep tends to
produce a relative weakening of the defenses vis-a-vis the repressed, with the result that
the latter has a better chance of becoming conscious during sleep than during waking life.
We should realize that this difference between sleep and waking life is
one of degree rather than one of kind. It is true that during sleep an element of the
repressed has a better chance of becoming conscious than it has during waking life, but,
as we have seen, in many dreams the ego's defenses introduce or compel such a high degree
of distortion and disguise during the dream work that the access of the repressed to
consciousness is hardly a very direct one in those cases. Conversely, under certain
circumstances, elements of the repressed may gain fairly direct access to consciousness
during waking life. For example, in Chapter VI, the case of the patient who
"accidentally" knocked down an old man with his car at a busy intersection
illustrates how an oedipal impulse from the repressed may momentarily control behavior and
thus achieve rather direct expression even during waking life. Since other phenomena which
illustrate the same point are by no means rare, it is clear that we cannot directly
contrast sleep and waking life in this respect. However, the fact remains that by and
large the repressed will appear in a manifest dream more directly than it is apt to do in
the conscious thought or behavior of waking life.
As we have said there is still another process, much less important
than the two which we have discussed so far, which contributes to the final form of the
manifest dream and which may add to its lack of intelligibility. This process might well
be considered to be the final phase of the dream work, although Freud (1933) preferred to
separate the two. He called this final process secondary revision. By it he meant the
attempts on the part of the ego to mold the manifest dream content into a semblance of
logic and coherence. The ego attempts, as it were, to make the manifest dream
"sensible" in just the same way as it tries to make sense of whatever
impressions come within its domain.
We wish now to say a few words about a characteristic of the manifest
dream to which we have already referred several times and which, on a purely descriptive
level, is its most typical feature. This is the fact that a manifest dream nearly always
consists chiefly of visual impressions. Indeed, it not infrequently consists exclusively
of such impressions. However, other sensations may be perceived as part of the manifest
dream as well. Next in frequency to visual sensory experiences in the manifest dream come
auditory ones and occasionally any of the other modalities of sensation may appear in the
manifest dream. It is also by no means rare for thoughts, or fragments of thoughts to
appear as parts of the manifest dream in later life as, for example, when a dreamer
reports, "I saw a man with a beard and I knew he was going to visit a friend of
mine." Nevertheless, when such thoughts do appear in a manifest dream they nearly
always occupy a position in it which is distinctly subordinate to that of the sensory
As we all know from our own experience, the sensory impressions of a
manifest dream command full credence while we are asleep. They are just as real to us as
our waking sensory perceptions. In this respect these elements of the manifest dream are
comparable to the hallucinations which are often present as symptoms in causes of severe
mental illness. Indeed, Freud (1916b) referred to dreams as transient psychoses, though
there is no doubt that dreams are not in themselves pathological phenomena. The problem
therefore arises of accounting for the fact that the end result of the dream work, that
is, the manifest dream, is essentially a hallucination, albeit a normal, sleeping one.
In terms of the present-day psychoanalytic theory of the psychic
apparatus, the so-called structural hypothesis, we should formulate our explanation of the
fact that the manifest dream is essentially a hallucination about as follows. During sleep
many of the ego's functions are more or less suspended. As examples, we have already
mentioned the diminution in the ego's defenses during sleep and the nearly complete
cessation of voluntary motor activity. What is important for our present argument is that
during sleep there is also a marked impairment in the ego's function of reality testing,
that is, in its ability to differentiate between stimuli of internal and of external
origin. In addition to this, there also occurs in sleep a profound regression in ego
functioning to a level characteristic of very early life. For example, thinking is in the
mode of the primary rather than of the secondary process and is even largely preverbal,
that is, it consists largely of sensory images which are primarily visual ones. Perhaps
the loss of reality testing is also merely a consequence of the far-reaching ego
regression that occurs during sleep. In any case, during sleep there is both a tendency
for thinking to be in preverbal, largely visual images and inability on the part of the
ego to recognize that these images arise from inner rather than from outer stimuli. It is
as a result of these factors, we believe, that the manifest dream is essentially a visual
One easily observable fact that speaks in favor of the explanation
which is based on the structural hypothesis as opposed to the simpler explanation based on
the topographic hypothesis is the following. During many dreams, the capacity to test
reality is not entirely lost. The dreamer is aware to some extent even while he is
dreaming that what he is experiencing is not real, or is "only a dream." Such a
partial preservation of the function of reality testing is difficult to reconcile with the
explanation based on the topographic hypothesis. It is, however, perfectly compatible with
the one based on the structural hypothesis.
This concludes what we have to say about the psychoanalytic theory of
the nature of dreams. We have discussed the three parts of a dream, that is, the latent
content, the dream work, and the manifest content, and have tried to indicate how the
dream work operates and what factors influence it. In practice, of course, when one
attempts to study an individual dream, one is confronted by a manifest content and has
then the task of ascertaining in some way what the latent content might be. When the task
is completed successfully and we are able to discover the latent content of a dream, we
say that we have interpreted the dream or discovered its meaning. The task of
interpreting dreams is pretty well limited to psychoanalytic therapy, since it generally
requires the application of the psychoanalytic technique. We shall not discuss dream
interpretation here because it is. in fact, a technical procedure and is properly part of
psychoanalytic practice rather than of psychoanalytic theory.