Elsevier

Medical Hypotheses

Volume 73, Issue 4, October 2009, Pages 572-579
Medical Hypotheses

In two minds? Is schizophrenia a state ‘trapped’ between waking and dreaming?

https://doi.org/10.1016/j.mehy.2009.05.033Get rights and content

Summary

This paper proposes that schizophrenia is a state of mind/brain ‘trapped’ in-between waking and dreaming. Furthermore, it suggests that both waking and dreaming are functional. An in-between state would be disordered; neither waking nor dreaming would function properly, as the mind/brain would be attempting two, ultimately incompatible, sets of tasks simultaneously. In support of this hypothesis, evidence is synthesised across four different domains: the chemistry of the dreaming state; work on dreaming as functional for memory; the membrane theory of schizophrenia; and chaos theory.

The brain produces itself; self-organizing through its modulatory systems. Differentiation between dreaming and waking is achieved through aminergic/cholinergic/dopaminergic reciprocity. Chaos theory indicates that self-organizing systems function most creatively on the ‘edge of chaos’; a state which lies between order and disorder. In the mind/brain ‘order’ represents rigid differentiation between waking and dreaming, whereas ‘disorder’ results from their interpenetration. How could the latter occur?

In sum, the causal sequence would be as follows. Genetic susceptibility to schizophrenia is expressed through fatty acid deficiencies which precipitate neuronal cell membrane abnormalities. In consequence, all neurotransmitter systems become disrupted. Ultimately, the reciprocal interaction between aminergic/cholinergic neuromodulation breaks down. Disrupted cholinergic input interferes with the reciprocal relationship between mesolimbic and mesocortical dopaminergic systems. Loss of reciprocity between aminergic, cholinergic and dopaminergic neuromodulation results in chronic interpenetration; a ‘trapped’ state, in-between waking and dreaming results. This would be ‘schizophrenia’.

Currently, imaging techniques do not capture dynamic neuromodulation, so this hypothesis cannot yet be tested inductively. However, the paper suggests that further evidence would be gained through a closer attention to the phenomenology of schizophrenia in the waking and dreaming states.

Introduction

Schizophrenia is a disordered global state of mind. Assuming mind/brain isomorphism, it is also a disordered ‘brain state’. This assumption does not have to be reductionist (minds are nothing more than chemical brain states) if mind is taken to be a consequence of brain processes [1]. Mind emerges from the brain’s complex non-linear interactive networks [2], [3]. So schizophrenia is not only a disordered global state of mind it’s also a disordered brain state. Where does it come from?

A reasonable starting point for thinking about this question is to consider the other global states of mind/brain that human beings inhabit. There are pathological brain states, coma, for example. But coma is unconsciousness- it is not a state of mind. There are two normal, active, global mind/brain states: waking and dreaming. What if these two mind/brain states got chronically and chaotically ‘mixed up’?

The hypothesis is: ‘Schizophrenia’ is a global state of mind/brain ‘trapped’ between waking and dreaming; it’s a disordered ‘in-between’ state, neither waking nor dreaming works properly because the mind/brain is attempting two, ultimately incompatible, sets of functions simultaneously.

The paper synthesises evidence from four different domains in support of this hypothesis: the chemistry of the dreaming state; work on dreaming as functional for memory; the membrane theory of schizophrenia; and chaos theory.

Section snippets

Dreaming and waking as global mind/brain states

Dreaming and waking are different global states of mind/brain because they are constituted through different neuromodulators. Neuromodulators ensure unified, coherent mind/brain responses. The aminergic group of neuromodulators (noradrenergic, serotonergic and histominergic) are most active during waking and the cholinergic (acetylcholine) in dreaming [1], [4]. But although the ‘drivers’ of waking and dreaming vary and different brain regions are involved, both states are more or less equally

Is dreaming functional for memory?

Most research on memory is actually about memorizing; it has been advocated that researchers should return to the fundamental question of what memory is for [10]. Memory maintains a sense of self. To be myself I must remember things that are relevant to my concerns (or ‘motivated ideas’). There is evidence that concerns appear in dreams [11], [12], [13], [14] and, as argued above, dopaminergic neuromodulators may ensure that dreams reflect concerns. As understood here a ‘concern’ is not only a

Chaos theory, creativity and schizophrenia

The brain is a complex non-linear dynamic interactive system of connected neurons; it is capable of self-organization through utilising sensory signals and its modulatory systems [50]. A self-organizing system exhibits the properties of emergent order; it self-organizes into a coherent whole, producing itself through autopoiesis [49], [51]. This self-production isn’t stable or fixed; there is a attractor [52] that leads the system to settle dynamically at the ‘edge of chaos’.

‘For complex

The ‘membrane’ theory of schizophrenia

There is evidence of membrane abnormalities in patients who are being treated for schizophrenia. [59], [60], [61], [62] Membrane deficits occur early in illness and prior to the initiation of treatment, indicating that they may be trait-related [63]. There are now several double blind trials that demonstrate the efficacy of a particular omega-3 EFA, eicosapentaenoic acid (EPA), as an adjunct treatment for already medicated patients with schizophrenia [64], [65], [66], [67] and, indicative

Discussion: schizophrenia as an ‘in-between’ state

This paper proposes that schizophrenia results from the mind/brain becoming ‘trapped’ between dreaming and waking. In sum, this occurs in the following way. Genetic susceptibility to schizophrenia is expressed through fatty acid deficiencies which precipitate neuronal cell membrane abnormalities. All neurotransmitters become disrupted but there will be variability in the extent and involvement of particular systems. The normal reciprocal and mutual relationship between the aminergic and

Concluding comments

Schizophrenia, severe mental illness. Schizoid, in two minds, ‘trapped’ in an ‘in-between world’-waking and dreaming at the same time. The paradox is that waking and dreaming are our normal states of mind- we inhabit them everyday. But in ‘schizophrenia’ they become chaotically and chronically mixed up with devastating consequences.

As yet, imaging techniques cannot demonstrate the dynamics of neuromodulation [79], [80], so this hypothesis cannot be tested inductively. However this paper

Conflict of interest statement

There is no conflict of interest statement.

Acknowledgement

I thank J. Allan Hobson for his helpful and encouraging comments on this manuscript.

References (100)

  • M. Peet et al.

    A dose-ranging exploratory study of the effects of ethyl-eicosapentaenoate in patients with persistent schizophrenic symptoms

    J Psychiatr Res

    (2002)
  • A.J. Richardson et al.

    Red cell plasma fatty acid changes accompanying symptom remission in a patient with schizophrenia treated with eicosapentaenoic acid

    Eur Neuropsychopharmacol

    (2000)
  • W.S. Fenton et al.

    Essential fatty acids, lipid membrane abnormalities and the diagnosis and treatment of schizophrenia

    Biol Psychiatry

    (2000)
  • C. Gottesmann

    The dreaming sleep stage: a new neurobiological model of schizophrenia?

    Neuroscience

    (2006)
  • J.A. Hobson

    Consciousness

    (1999)
  • J.H. Holland

    Emergence: from chaos to order

    (1998)
  • S. Johnson

    Emergence: the connected lives of ants, brains, cities and software

    (2001)
  • J.A. Hobson

    Dreaming: an introduction to the science of sleep

    (2002)
  • Solms M. The interpretation of dreams and the neurosciences, <www.psychanalysis.org.uk/solms4.htm>; 1999 [accessed...
  • M. Solms

    Dreaming: cholinergic and dopaminergic hypotheses

  • J.L. Fudge et al.

    The extended amygdala and dopamine system: another piece of the dopamine puzzle

    J Neuropsychiatry and Clin Neurosci

    (2003)
  • W. Schulz

    Getting formal with dopamine and reward

    Neuron

    (2002)
  • J. LeDoux

    Synaptic self

    (2002)
  • A.M. Glenberg

    What memory is for

    Behavioural and Brain Sciences

    (1997)
  • G.W. Domhoff

    Finding meaning in dreams, a quantitative approach

    (1996)
  • G.W. Domhoff et al.

    Dreams as the expression of conceptions and concerns: a comparison of German and American college students

    Imagination, Cognition and Personality

    (2006)
  • E. Hartmann

    Dreams and nightmares: the new theory of the origin and meaning of dreams

    (1998)
  • W.J. Clancey

    Conceptual coordination bridges information processing and neurophysiology

  • M.S. Archer

    Being human: the problem of agency

    (2000)
  • M.P. Walker

    A refined model of sleep and the time course of memory formation

    Behav Brain Sci

    (2005)
  • R. Stickgold

    Sleep-dependent memory consolidation

    Nature

    (2005)
  • U. Wagner et al.

    Refinements and confinements in a two-stage model of memory consolidation

    Behav Brain Sci

    (2005)
  • N.C. Tronson et al.

    Molecular mechanisms of memory reconsolidation

    Nat Rev Neurosci

    (2007)
  • R. Stickgold

    Inclusive versus exclusive approaches to sleep and dream research

  • A. Revonsuo

    The contents of consciousness during sleep: some theoretical problems

  • A.M. Arkin et al.

    The effects of external stimuli applied prior to and during sleep on sleep experience

  • C. Cavallero et al.

    Memory and dreaming

  • C. Cavallero et al.

    Memory sources of REM and NREM dreams

    Sleep

    (1990)
  • J.M. De Koninck et al.

    Dream content and adaptation to a stressful situation

    J Abnorm Psychol

    (1975)
  • B. Domhoff et al.

    Problems in dream content study with objective indicators: a comparison of home and laboratory dream reports

    Arch Gen Psychiatry

    (1964)
  • D. Foulkes

    Dreams of the male child: four case studies

    J Child Psychol Psychiatry

    (1967)
  • D. Foulkes et al.

    Presleep determinants of dream content: effects of two films

    Percept Mot Skills

    (1964)
  • D.R. Goodenough et al.

    The effects of stress films on dream affect and on respiration and eye-movement activity during Rapid-Eye-Movement sleep

    Psychophysiology

    (1975)
  • C.S. Hall

    Representation of the laboratory setting in dreams

    J Nerv Ment Dis

    (1967)
  • I. Karacan et al.

    Erection cycle during sleep in relation to dream anxiety

    Arch Gen Psychiatry

    (1966)
  • R. Whitman et al.

    The dreams of the experimental subject

    J Nerv Ment Dis

    (1962)
  • H.A. Witkin et al.

    Presleep experiences and dreams

  • M.J. Fosse et al.

    Dreaming and episodic memory: a functional dissociation

    J Cogn Neurosci

    (2003)
  • R.P. Vertes et al.

    The Case against memory consolidation in REM sleep

    Behav Brain Sci

    (2000)
  • Cited by (9)

    • Computational models of the “active self” and its disturbances in schizophrenia

      2021, Consciousness and Cognition
      Citation Excerpt :

      The reduced thalamocortical gamma activity has previously been linked to the occurrence of hallucinations (Gottesmann, 2005; Behrendt & Young, 2004), higher dopamine activity during REM sleep might indicate an explanation for the loss of reflectiveness (Gottesmann, 2006; Gottesmann, 2005), and an increased activity of the Amygdala through higher levels of glutamate that might lead to problems with the perception of emotions (Gottesmann, 2006). Lastly, the levels of Noradrenaline, Serotonin, and Achetylcholine are decreased significantly in REM sleep and schizophrenia, while specifically Achetylcholine might be associated with hallucinations (Llewellyn, 2009) (for an in depth review of the similarities, see Skrzypińska & Szmigielska, 2013). Despite the striking parallels, there are still some unanswered questions.

    • Dissociation and its disorders: Competing models, future directions, and a way forward

      2019, Clinical Psychology Review
      Citation Excerpt :

      Sleep disturbance is common among individuals with schizophrenia, with estimates ranging from 30-80% (Cohrs, 2008), and poor sleep quality is associated with greater symptoms (Afonso, Brissos, Cañas, Bobes, & Bernardo Fernandez, 2014). Llewellyn (2009) described schizophrenia as a “state of mind/brain ‘trapped’ in-between waking and dreaming” (p. 572), whereas Mishara, Lysaker, and Schwartz (2013) translated Mayer-Gross's (1932) comments to read: “The schizophrenia patient may be characterized as an ‘awake sleeper.” ( p.8).

    • Crossing the invisible line: De-differentiation of wake, sleep and dreaming may engender both creative insight and psychopathology

      2016, Consciousness and Cognition
      Citation Excerpt :

      As discussed earlier, enhanced creative insight has been shown to be associated with various forms of mild to moderate psychopathology, this may equate to mild to moderate de-differentiation. However, if de-differentiation is both progressive and enduring, severe psychopathology rather than creative insight may result (Llewellyn, 2009), congruent with research showing that severe mental illness (e.g. schizophrenia) tends not to be associated with creativity (Jaracz, Patrzala, & Rybakowski, 2012; Nemoto, Mizuno, & Kashima, 2005). As discussed above, REM sleep and dreaming may offer insight into the remote associations which identify probabilistic patterns amongst personal experiential memories (Llewellyn, 2013, 2015).

    • Subjective experience of emotions and emotional empathy in paranoid schizophrenia

      2014, Psychiatry Research
      Citation Excerpt :

      The tendency to symbolize emotions by imagination, i. e. to use dream metaphor and reverie for the reflection about oneself and to guide decision-making, was significantly more pronounced in patients with schizophrenia compared to controls. The vividness of mental imagery was proposed as a trait marker across the schizophrenia spectrum (Oertel et al., 2009), the dreaming brain as a model for psychosis (Llewellyn, 2009). Also, imagination could serve to cognitively avoid aversive emotional states.

    • Neurobiology and clinical implications of lucid dreaming

      2013, Medical Hypotheses
      Citation Excerpt :

      Dopamine D2 receptors in the mesolimbic pathway are activated during REMS [9], the same pathway involved in psychosis [10,11]. This could explain why dreams are characterized by a plethora of mental experiences that resembles hallucinations [12,13], suggesting that dreaming would be a good model for psychosis [14–16]. In accordance with this hypothesis, Dzirasa and colleagues [8] showed that reducing dopamine transmission, a therapy used to treat psychosis, also suppresses REMS.

    View all citing articles on Scopus
    View full text