Dreams and psychosis share overlapping features in symptoms and brain activity, offering a testable model for conditions like schizophrenia and delirium. This review examines two key concepts: insight and dissociation. Insight in dreams is central to lucid dreaming, where dreamers become aware they are dreaming and often try to control the narrative, alongside dissociative experiences similar to depersonalization and derealization. These concepts also apply to psychotic illness. While insight may be harmless in lucid dreaming and even beneficial in psychosis, dissociation remains poorly understood. Comparing these phenomena helps clarify their psychological and neurophysiological roles.
In acutely psychotic patients with a single fixed delusion, fragments of that delusional thought appear in their dreams, suggesting continuity between waking delusions and dream content. Ten patients reported dreams during an acute psychotic break. Sixteen judges, with varying familiarity with each patient's delusion, tried to group the dreams by matching them to the correct patient. Most judges performed only slightly above chance, and no significant differences emerged between groups with different levels of acquaintance. Scoring dreams for specific delusional themes revealed continuity for Grandiosity and Religion. The findings indicate that some delusional contents recur within patients' dreams, possibly reflecting ongoing memory consolidation processes relevant to delusion formation.
The subjective experience of dreaming and psychosis share features: periodicity, hallucinatory phenomena, and a lack of awareness of detachment from reality. Both are considered fully conscious states of the brain/mind, with non-conscious elements influencing them due to impaired interaction with the external world. Inducing lucidity in dreams through psychological or pharmacological methods may aid understanding of acute psychoses and have clinical applications.