I had a dream one week ago. In it, I had returned to medical school at NYU as an adult. It was the first week of classes. The first course, taking up the first half of the week, was in hypertension. I was sitting in the second course, on rehabilitative medicine, next to a student I had been jealous of 45 years ago. He suddenly put on his baseball cap, and cracked a joke which made me laugh even in the dream. He said he needed to look good for the nuns who had just into the back of the classroom. I remarked to myself how very clever and smart he really was, unlike the negative attitude I'd had for him previously. After class, I walked in the hallway with a female peer who was sitting on my other side in the class. I uncharacteristically put my arm around her in a friendly manner. I felt a little more accepted in medical school than I had been years earlier. Upon awakening I felt both the unease of having felt as if I was an outcast during my first tour of medical school, as well as the slight new satisfaction of feeling a somewhat greater sense of actually belonging there.

Whatever other understandings may be derived from my dream, certain conclusions were clear to me. The dream was prompted by my daughter having returned home for a visit. She had just had one of several medical residency interviews, and was staying with us for several days on her way  back from Washington. Greeting her, I truly admired her self confidence, her success in school, and, perhaps most of all, the ease with which she was able to navigate medical school. My experience of medical school was intense and terrifying. I was a fish out of water, I felt a pariah. I was sure I did not belong.  My consequent low self-esteem left me chronically anxious. I studied and ate constantly.I ended up a good 55 pounds heavier at graduation than my current weight.

Another clear understanding was that my "dream mind, " whatever that constitutes, was in some sense reworking the emotional trauma I had endured years earlier and which were now being reawakened by my daughter's foray into medicine. The feelings in the dream were intense and obvious. These lingered with me through much of the day, and, more attenuated, for days thereafter. Indeed, I discussed the dream with my wife that morning. She reminded me that, weeks before, I had shared with her a series of nightmare which seemed to have lasted all night. In these, I had also returned to redo all four years of medical school. The emphasis here was the "re-do." These nightmares were a direct result of my son's angst in his residency and, previously, in medical school. I so identified with his pain, which rekindled my own.

So what after all are dreams? We have some partial answers, but by no means the full picture.

Dreams occur during REM sleep(rapid eye movement sleep). Sleep itself consists of five distinct phases, labelled Stages I-IV, followed by the REM period. The entire sequence lasts approximately one and a half hours, and is repeats itself four times throughout the night. Stages III and IV are the deep sleep phases. These are what make us feel rested in the morning. (Parenthetically, theses  two phase are disturbed by alcohol consumption, which is why we awaken tired and confused after heavy drinking  despite having "slept.'). Time spent in REM increass over the course of the night. It is also extremely high in infancy. 

During REM sleep, the midbrain has blocked all motor(voluntary muscle) activity. We are literally paralyzed during our dreams, with the exception of our diaphragm(so we can still breathe) and our eyes, which are moving back and forth as we dream. It is unclear why our eyes dart back and forth, but this phenomenon is likely connected to the act of visualizing our dreams, as the same temporal lobe firings occur in waking life when we see familiar images. Indeed, REM is not a restful phase, despite our near-total paralysis. It is like being awake and conscious even while asleep.

So what is the purpose of all this activity? Truthfully, no one knows for sure. Whatever functions are carried out by dreaming(and for that matter by sleep as well), these must be physiologically important. Consider that one third of our lives is spent sleeping, and how much of that is spent dreaming. Consider, too, that all animals from birds and above go through essentially the same sleep and REM phases. Nature is doing something very important here, something clearly  worth our study and attention.

Here is one interesting and commonly accepted hypothesis regarding the purpose of dreams The dream is actually a by-product, or perhaps a secondary manifestation, of the primary function of dreams, which is to store new information. After all, we are exposed to new information on a daily basis. Some of this information is important, some of it less so, some  rrelevant. During REM, the brain is "triaging" new information, storing what's important and discarding the chaff.

But how does it carry out this function? Here is my conjecture: In order to store a new piece of data, the brain must "open up" the "cubby hole" in the brain to which that piece of information belongs.In the brain, all information is likely stored as a particular network of neuronal firings. This may be likened to the constellations in the night sky. The network of "firing" of Andromeda is patently different from the pattern made by the constellation Cassiopeia. In similar fashion, each information network has its own signature network pattern. Adding new information will require adding  new neuronal connections to the original pattern,. In order to add  new connections, the specific  network must be "opened" before the new information can be added.

Now, we have not one, but many stimulated("opened") neuronal networks, presumably in the brain's cortex where information is stored.  After all, we have learned all sorts of new information during the daytime, and have stored this information in a shirt-term-only section of the brain's cortex In some sense, the cortex is not comfortable with many random networks being simultaneously stimulated. In truth, the cortex seems compelled to put these otherwise random firings into a pattern of its own, much as the brain is uniquely and exquisitely designed, and compelled,  to find patterns in our waking lives, often within split seconds. I would posit that the new pattern assembled by the cortex is, in fact the "story" of our dreams. It takes random network firings and makes them into a coherent, if often bizarre, story- our dream. The dream is thus the by-product of the brain transferring newly learned information from short- to long-term storage.

This story, the dream, can only be authored based on prior patterns already known to the brain, i.e., prior patterns of feeling, thinking, and acting,  This is what the brain "knows." These patterns are what form our personalities, many or most of them outside of our consciousness. Herein was Sigmund Freud correct in averring that the dream is the "royal road to the unconscious." Dream work thus became an integral technique of Freudian psychoanalysis. The stories of our dreams tell us about our deepest inner emotional, behavioral, and motivational leanings, many of which are unconscious and hard to access during our waking hours.

Left unanswered are many questions. One of these: Why do we apparently need to forget our dreams upon awakening? One possibility is that perhaps Freud was correct after all in positing a "dream censor" whose physiological function  it is to keep the  painful aspects of our unconscious lives out of our waking awareness, This would allow our awake and conscious minds to be better able to manage the challenges of the day without being constantly burdened by the emotional pains evoked in our nighttime dreams.That the brain is actively shutting the dream out of our waking lives is indisputable. Frankly, all of this seems plausible to me. 

Given this, why did I remember my above dream, and why am I, in recent years, recalling many more dreams and more vividly than ever? In truth, I find myself, as I age, living ever more so in two seemingly immiscible realities. I have my daytime work, learning, social and family life. At night, though, I find myself entering into the nether world of my dream life, which is equally and often more intensely vivid that my awake experiences. From this I surmise that my dream censor may weaken with age and leaving me more conscious of my dreams. No matter. I also find it challenging, in an interesting sort of way, to reconcile my two realities into a comprehensive whole. Try it youselves.


  1. I also find I dream more vividly, and have more recall about my dreams as I age. I find that the subject and plot line of these dreams are easily connectable to some anxiety I have experienced in the past. In other words, I would hardly need Sigmund Freud to tell me that my recalled dreams are a pathway to my unconscious. That much is obvious to me now that I am experiencing recall of dreams with much detail. I wonder though whether there are psychological aids to help with dream recall. I know, for example, that if I do not articulate a dream as soon as I awake I am likely to completely forget it. I also wonder whether dream management like this and dream analysis can aid current anxiety issues.


  2. Thanks for sharing this personal insight into the ever elusive experience of dreams. I especially like your statement "Consider, too, that all animals from birds and above go through essentially the same sleep and REM phases. Nature is doing something very important here, something worth our study and attention.".

    Yes, even though we (as humans) have a super ego that apparently transcends the capabilities of the other animals, when it comes to dreams, I've noticed that dogs seem to have these same experiences during sleep, and also seem to wake up just as confused as we are: going through a short period of not knowing which world is 'real' (the dream world we were just in, or the awake/conscious mode that is sure to overcome it). I take the point of view that both are equally real. The fact that the other animals have this experience too lends credence to the idea that nature truly is doing something important, because it makes the experience of dreaming a more ubiquitous part of the experience of life.

    What fascinates me most about my dreams is that often, I awake in amazement as I don't feel like I have the internal capability of constructing such a fantasy given what I know about the limitations of my own creativity. In fact, I often wonder if I'm not tapping into an autonomous 'realm' and receiving information that is EXTERNAL to myself. Since there's no measurable/tangible evidence of such a realm, the scientific community (understandably) has a hard time taking this point of view; instead they usually start from the assumption that everything we dream is coming strictly from our own minds and experiences (not from an outside, alien, collective dream pool). But the 'non-scientific' kid in me doesn't want to rule out such a realm. I believe it would be a great contribution to human knowledge if we could find a way to make this concept more open to scientific scrutiny. Even the giants Freud and Jung were unable to do this effectively (in my opinion), so evidently, there is not going to be a simple or obvious idea at the root of it.

  3. Insightful..enjoyed. Any experience with lucid dreams?

  4. I have always believed dreams were residual strands of experience in a more or less chaotic manner -- I love that you discuss the brain's ability to organize this information in patterns. I also love the reminder that all creatures have REM sleep... I don't know why, but it comforts me. Thanks for the very stimulating pose.

  5. i tend to forget the physical functionality of dreams. It’s not an arbitrary act. I do wonder why there are times my dreams are so mundane! While I’ve only had an instance or two of lucid dreaming, I’m curious to re-examine it as well! All that being said, this made for an interesting post to read before bed!


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