1. Mental health functions of dreaming and sleeping @ Raija-Leena Punamäki, University of Tampere, Finland

2. © Raija-Leena Punamäki 2007 What psychological theories say about dreaming? I  Psychoanalysis: The king road to unconsciousness; a window to veiled mental life & meaningful messages Cognitive psychology: Possibility to learn about memory, attention, thinking & feeling in altering states of mind (sleeping & waking) Cognitive psychology: Possibility to learn about memory, attention, thinking & feeling in altering states of mind (sleeping & waking)

3. © Raija-Leena Punamäki 2007 What psychological theories say about dreaming ? II Psychophysiology: Psychophysiology: (a) Communication between brain locations differs in dream & waking (b) Brain activation in dependent of experience (b) Brain activation in dependent of experience Evolution psychology: Evolution psychology: (a) Humans capable to form mental imagery, (b) Ability to process threat & danger facilitated survival, (c) rehearsal of traumatic events enhances success in life

4. © Raija-Leena Punamäki 2007 MENTAL HEALTH FUNCTION OF DREAMING? I Psychoanalysts: To restore the the sleep from disturbances To gratify wish fulfilment To integrate traumatic experience Dream content is symbolic & meaningful II Cognitive theorists: To reorganize memories Dream content is similar to daytime thinking III Neurophysiological research: To tide up memory stores Dream content is random Sleeping decrease arousal

5. © Raija-Leena Punamäki 2007 Research about trauma & dreaming among children How does exposure to war trauma associate with remembering dreams? How does exposure to war trauma associate with remembering dreams? How does trauma impact dream content and structure? How does trauma impact dream content and structure? Which dream characteristics associate with good mental health? Which dream characteristics associate with good mental health? What kind of dream structure & content can protect child mental health from negative impact of war trauma? What kind of dream structure & content can protect child mental health from negative impact of war trauma? Can dreaming compensate for daily life, traumatic & dangerous experiences? Can dreaming compensate for daily life, traumatic & dangerous experiences?

6. © Raija-Leena Punamäki 2007 Participants 413 Palestinian children Trauma group n=279 living in Gaza (subjected to military violence) Trauma group n=279 living in Gaza (subjected to military violence) Control group n=144 living in Galilee Control group n=144 living in Galilee (not subjected to military violence) Age 6-16 Age 6-16 121 Kurdish children Northern Iraq Orphan Children n=60 Orphan Children n=60 Children from intact families n=61 Children from intact families n=61 Age 7-15 Age 7-15 Method: 7-day dream diary

7. © Raija-Leena Punamäki 2007 Scoring the dreams Structure of dreams: Fantasy - Documentary Structure of dreams: Fantasy - Documentary Bizarre - Mundane Bizarre - Mundane Narrative - Broken story Narrative - Broken story Content of dreams: Anxiety & threat Content of dreams: Anxiety & threat Covert & overt aggression Persecution dreams Saviour dreams Develop. problem solving Behaviour of the dreamer: Behaviour of the dreamer: Passive - active Fearful - heroic Fearful - heroic Relying on others - alone Relying on others - alone Emotional repertoire & intensity Emotional repertoire & intensity Repetition of theme, characters, scenes, ending Repetition of theme, characters, scenes, ending

8. © Raija-Leena Punamäki 2007 Main results I Characteristic dreams of children with severe trauma: Dream content: Persecution dreams, sense of falling, physical vulnerability Persecution dreams, sense of falling, physical vulnerability Kurdish children dream about death; Orphans about their parents Kurdish children dream about death; Orphans about their parents Dream structure:  Concrete & content-less dreams (”I dreamt about a dog”, ”Somebody was chasing me”)  Lack of narratives & happy endings

9. © Raija-Leena Punamäki 2007 Main results II Many somatic feelings & action dreams Many somatic feelings & action dreams (”I was running to escape, but my feet were glued to the ground”) (”I was running to escape, but my feet were glued to the ground”) Lack of emotional expression (both negative & positive: ” I fall down because of a killed body, and run away ”) Lack of emotional expression (both negative & positive: ” I fall down because of a killed body, and run away ”) Exposure to trauma increases recall of dreams in the morning -> Human mind works actively during the night Exposure to trauma increases recall of dreams in the morning -> Human mind works actively during the night Symbolic, narrative, and emotional dreams protect the child mental health Symbolic, narrative, and emotional dreams protect the child mental health

10. © Raija-Leena Punamäki 2007 Main results III Mental health function of dreaming Exposure to trauma increases recall of dreams in the morning -> Human mind works actively during the night Exposure to trauma increases recall of dreams in the morning -> Human mind works actively during the night High dream recall associated with good mental health High dream recall associated with good mental health Symbolic, narrative, and emotional dreams protect the child mental health Symbolic, narrative, and emotional dreams protect the child mental health

11. © Raija-Leena Punamäki 2007 Protective dream content Parental shield Parental shield I dreamt that the soldiers intruded our neighbours’ house. They broke the door and took their son. I put the lights on, and soldiers came to my room and asked why I had put the light on. I was afraid and shivering all over my body. They hit me on my face. I called for my mother. She came and took me away from the soldiers, and said to them: ”But he is only a little boy". (Boy of 12, Gaza) (Boy of 12, Gaza) Vulnerable dream content No protective shield I dreamt that I was collecting shellson the beach. Suddenly the soldiers appeared and started to follow me. Other children were running away, but I could not run. My feet were glued to the ground. I shouted for help, but nobody heard me. The waves of the sea rose, and were very high, the waves approached me, the waves covered me. (Boy of 11, Gaza)

12. © Raija-Leena Punamäki 2007 Protective dream structure Symbolic, emotional Symbolic, emotional & fantasy I dreamt that sea had dried up. I walked in the middle of the dried sea. Suddenly I saw a huge fish in front of me, and I got scared. I asked the fish why he is able to speak, unlike other fish. He said: I talk to you, because I want to protect you from the anger of other fish and from the rageful sea. I asked him: how can the sea can be rageful if it has dried up? The fish asked me to hurry up, since the sea was just sleeping, and when it wakes up it will return to its real nature. I dreamt that sea had dried up. I walked in the middle of the dried sea. Suddenly I saw a huge fish in front of me, and I got scared. I asked the fish why he is able to speak, unlike other fish. He said: I talk to you, because I want to protect you from the anger of other fish and from the rageful sea. I asked him: how can the sea can be rageful if it has dried up? The fish asked me to hurry up, since the sea was just sleeping, and when it wakes up it will return to its real nature. (Girl 13, Gaza) (Girl 13, Gaza) Vulnerable dream structure Repeats reality & unemotional I dreamt that soldiers followed me in the streets of the camp. I ran as much as I could. They followed and ran more until they caught me. They tied my hands and took me to prison. They told me that I had thrown stones. I said that I did not. They asked if I had prepared a molotov-coctail. I said that no, and they sent me to prison. (Boy 13, Gaza)

13. © Raija-Leena Punamäki 2007 Orphan girl, 16 (Kurdistan) 2 nd night: I dreamt that my mother hit me because I went to the room. At that time my mother washed herself and my hand became green coloured. My mother told me "you are very good because your hand became green, but now you are more afraid", but I was not afraid. 3 nd night I dreamt that my mother wore a white dress, she talked nice things, then she cried & then I told her: "Why do you cry?" - she said: "where are you?" - I said I am in my grandmother's house. 4 nd night I dreamt that the fire rains; I was with my mother & sister in a room, near a camp. Suddenly a man entered the room & I asked about this fire which rains - he answered that this is the end. 5 nd night I dreamt that my father stands in the grave & I told him: "why did you die so early?" He said "you will die also and everyone should die whether early or late".

14. © Raija-Leena Punamäki 2007 Orphan girl, 13 (Kurdistan) 2 nd night I dreamt that my friend T. burnt her legs, I asked why this happened. She cried and was in big pain because of the burn. Then the headmaster came and wanted to hit her, but her condition was very bad, I looked at her and I cried. 3 nd night I dreamt that my father and me were going to the orphanage; I cried and screamed that I did not want to go to the orphanage. There was rain and strong wind. My father told me: "because you cry, I come back tomorrow to return you to my house".

15. © Raija-Leena Punamäki 2007 Orphan girl, 13 (Kurdistan) continues 6 nd night I dreamt that I fight with my father & I told him that "you are the cause of death, and my mother & you damage our life & made us live in the orphanage & damage our future. Then my sister came & brought a nice thing to my father. Then my father said to us: "I am not your father. Your father died a long time ago". Then we came back to the orphanage. 7 nd night I dreamt that I and my friend T stand on the grave of my mother. I hit the grave by a piece of wood. My friend told me: "Why do you do this? I love your mother more. We should go to buy something for her". But I did not go with her. I came back to the orphanage.

16. © Raija-Leena Punamäki 2007 Main results IV Communication between Dreaming & Waking reality Fear & anxiety interrupt dreaming: no narratives (”I was shouting for help, but I woke up to my own screeming”) Fear & anxiety interrupt dreaming: no narratives (”I was shouting for help, but I woke up to my own screeming”) Dreaming shows a compensatory function: Children with active and heroic coping during the day, reported helpless and fearfull dreams Dreaming shows a compensatory function: Children with active and heroic coping during the day, reported helpless and fearfull dreams

17. © Raija-Leena Punamäki 2007 Broken dreams – healing interrupeted (boy, 11, Gaza) 6 th night I dreamt that I was climbing a very high mountain full of valleys around it. I sat waiting for the coming of my bother, my mother and brothers. I went to play up the mountain but I found a big snake surrounding my little brother. I tried to force it to go by throwing stones on it, but I was afraid that my brother would be injured by the stones. I began shouting, but nobody heard me. I was shouting till I woke up. 7 th night I dreamt that the soldiers entered my school, they took me and I began shouting, but something came out from the hands of the soldiers. It was like a monster with big eyes and big mouth and long teeth, like beasts have, and all horrified. I began shouting in a loud voice and shouting till I woke up, terrified of the view.

18. © Raija-Leena Punamäki 2007 Example of coping measurement 1)War-time traumatic stress: ”We will teach you to trow stones, you evil” 2) Childhood stress: ”We do not want to play with you any more”

19. © Raija-Leena Punamäki 2007 Passive coping responses during the day The army has destroyed neigbour house...I wish that the soldiers find their own house destroyed. The army has destroyed neigbour house...I wish that the soldiers find their own house destroyed. We are under curfew… I feel like a bird in his cage. We are under curfew… I feel like a bird in his cage. I see soldiers… I am frightened and horrified, and I try to hide. I see soldiers… I am frightened and horrified, and I try to hide. I hear about shooting of people … We are all lost. I hear about shooting of people … We are all lost.

20. © Raija-Leena Punamäki 2007 Active & fearless dream content I dreamt that the soldiers broke into my house, attacking us including my mother and elder brother. This was awful, and I attacked the soldier and took his weapon. Then I ran away and became wanted. Everyday they used to come and look for me in vain. Once I came back to check up on my family and there were the soldiers, waiting for me…

21. © Raija-Leena Punamäki 2007 Active coping mechanisms in daytime The army has destroyed neigbour house… I go and prevent the soldiers to destroy more.. The army has destroyed neigbour house… I go and prevent the soldiers to destroy more.. We are under curfew… I join my friends and we demonstrate against the soldiers. We are under curfew… I join my friends and we demonstrate against the soldiers. I see soldiers… I join the demonstrations and hope that it is my stone that will hit them well. I see soldiers… I join the demonstrations and hope that it is my stone that will hit them well. I hear about shooting of people … I am very angry and sad, and carry a knife with me. I hear about shooting of people … I am very angry and sad, and carry a knife with me.

22. © Raija-Leena Punamäki 2007 Passive & fearful dream content I dreamt I was standing at the door during a general strike. I saw the soldiers behind the wall looking at the boys. I was scared because I am a little boy, and I can't run. The soldiers laughed at me, and they caught me. I was frightened. (Boy of 10, Gaza).

23. © Raija-Leena Punamäki 2007 Aims: Fragmented & broken dreams to complete narrative Exploring and expressing emotions, especially absent or numbed feelings Facing horror & monsters in a safe place Change the end of the dream story Change the position of the dreamer (victim hero, active passive, helped helper) Form friendship with your dreams Dreams as intervention material