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Neuropsychoanalysis: An Interdisciplinary Journal
for Psychoanalysis and the Neurosciences
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Confabulation in Dreaming, Psychosis, and Brain
Injury: Commentary by Mark J. Blechner (New York)
Mark J. Biechner Ph.D.



145 Central Park West, New York, NY 10023
Published online: 09 Jan 2014.

To cite this article: Mark J. Biechner Ph.D. (2000) Confabulation in Dreaming, Psychosis, and Brain Injury: Commentary by
Mark J. Blechner (New York), Neuropsychoanalysis: An Interdisciplinary Journal for Psychoanalysis and the Neurosciences,
2:2, 139-144, DOI: 10.1080/15294145.2000.10773296
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Psychosis. in press." It surprises me that this is not usually surprising to people. 1998. There is a disjunction between appearance and identity.. I would prefer to keep dreams and schizophrenia in our consideration. and yet. Even in nonpsychoanalytic approaches to dreaming.. The definition of confabulation adopted initially by DeLuca from Moscovitch and Melo (1997) is very broad: "statements or actions that involve unintentional but obvious distortions . In recent years. but not necessarily in dreams. The dreamer recognizes a character's identity. there is much to be learned from a comparison of dreams and waking confabulation. at least to start. the kinds of cognitive peculiarities that cannot occur in dreams (Blechner. even though the person's appearance does not match the identity. This is one example of what I call "disjunctive cognitions. including the toleration of opposites and contradictions. He eschews confabulation in dreams and schizophrenia rather summarily. and Brain Injury Commentary by Mark J. many elements of the story can be based on actual experiences drawn from different time periods in our lives." But when people see someone in a dream whose identity does not match their appearance. DeLuca then narrows his gaze by some selections that seem arbitrary. most sane people would assume that they missaw or misidentified the person. we may get lost and miss important details. and examine the phenomenology of all confabulations as thoroughly as possible. we may see some details well but miss the big picture. it is like a brain administering a TAT to itself." Two aspects of cognition do not match each other. which is. As I have noted (Blechner. equally significant in my view. Like Solms. the dreamer is aware of the disjunction. "It was the strangest thing .. when reporting a bizarre experience in a dream. Solms points out the similarity between aspects of confabulation and those properties of the unconscious identified by Freud. I have been identifying the kinds of cognitive peculiarities that can occur in dreams. and the aspects of timelessness.. It is a commonplace bizarreness of dreamlife. Hobson and McCarley's (1977) activation-synthesis hypothesis of dreaming is very much about confabulation. 1998). although she didn't look like her.. we will be in a better position to categorize confabulations and refine our model of the way or ways that confabulation can occur. in effect. and the cortex invents a story based on them (i. If our gaze is too wide. with something like: "I knew she was my mother. there is always the choice of how wide an area to investigate. Many people.." or "I don't really understand how this could happen. confabulates). and. . In their model. and correct for it.e. I would like to outline my findings briefly. When we have specified the differences between all kinds of confabulation and the significant dimensions involved. It has been my hope to specify the processes involved in dreaming and to make comparisons with some of the cognitive distortions that occur in various psychopathologies and in brain-injured populations. even though they arguably fit into his definition of broad sense confabulation while also sharing certain significant characteristics of narrow sense confabulation. Disjunctive Cognitions in Dreams One of the most common contradictions that is tolerated in dreams is the difference between a person's apparent identity and his or her actual identity. They may also suggest ways of revising and updating Freud's description of the operation of the system unconscious (Ucs. . I would like to consider how those two factors are characteristic of dreams. yet that does not prevent it from remaining. although there are certain important constraints on them. . with the hope that they may suggest some ways of structuring further study of confabulation. or heard a dream. we are all confabulators-we work out stories that never happened. Blechner (New York) In science." But having subscribed to such a sweeping definition. they usually do not need a qualifying preface to describe the experience-at least my patients do not. too. In our dreams. They take it for granted that I will know what they mean. In waking life. If our gaze is too narrow. although.). the pons produces an image or a set of images. as with waking confabulation in those who are brain injured. For example. a). a model of intrapsychic confabulation. Almost everyone has dreamt.. will prepare the listener by saying.139 Commentary on Confabulation Downloaded by [Gazi University] at 22:48 18 August 2014 Confabulation in Dreaming.

but I was there as an adult. even though he can see that the stranger looks nothing like the person he believes him to be. too. at least in my clinical experience. 1947). we would like a much larger sample. isn't it odd to feel so certain about the identity of the person. Time Distortion DeLuca notes that one of the most common areas of distortion in confabulation has to do with time. going to New York City. The features are recognizable. it is a significant fact. from experimental brain research with humans and animals. This division of function can be found in subhuman primates. and none has. with the recognition of the identity of that person. Blechner Downloaded by [Gazi University] at 22:48 18 August 2014 140 Such dream reports qualify as confabulations by DeLuca's adopted definition. Of course that is not the most systematic research. We also have the phenomenon of Capgras syndrome. If such a dream does not occur. Gorno Tempini et al. for people to report a dream. the past can be experienced as if it is the present. VR's wife confirms that this had actually happened. but the person's identity is not. but I was my current age. identifying unfamiliar faces activates unimodal visual association areas in the fusiform region while the recognition of familiar faces also activates transnodal regions. saying: "It looked like my mother. It may mean that not all contradictions are tolerated unconsciously. A more precise model may result from a collaborative synthesis of data of clinicians immersed in the phenomenology of dreams. 1998). the dreamer is not shocked. And in Fregoli's syndrome. (1998) found that in humans." In fact. as VR claimed. in which a person may feel that a close relative is actually an impostor." It is much less common to dream that "I was in my current house. there is an important asymmetry to this phenomenon. It might indicate a division in the brain.Mark J. I have asked several audiences of clinicians and dream researchers if they can provide a verbatim account of such a dream. experimental dream researchers and neurobiologists. I have not been able to find a single example of this in my records of patients' dreams or my own. It suggests an important relationship between the cognition of the person who dreams and the person with brain damage. not on that day. It is less common. And yet. we have come to recognize that the process of facial recognition is indeed very complex and may be achieved by a part of the brain that is different from the brain areas involved in general visual analysis. But is there any other evidence that those processes are separate in our minds? Indeed. We may ask. although I knew it was not my mother. Time distortion is also quite common in dreams. but years earlier. Perrett. and then stopping by to say hello to a manager at the Jimsburg store. we know that a prosopagnosic man may look at his wife of 50 years. see all of her features clearly. the process of seeing is intact. and neurologists and neuropsychologists studying related phenomena in brain-injured populations. but the process of facial recognition is not (Bodamer. and from dreams. In both. there is a specific region of the cortex responsive to faces. in the face of contradictory physical evidence? What does this division tell us? It suggests that the processes of seeing the physical attributes of a person are not identical. Dreamers frequently report something like: "I was at my parents' house. that seeks to identify the parts of the brain that are responsible for different aspects of face recognition (see Mesulam. something more constrained and systematic than Freud described may be involved. We have thus a case of several kinds of data converging on a single phenomenon. collected not only from clinicians but also from experimental dream researchers. If this tendency is true for the general population of dreamers." The transposition of time is another aspect of dream bizarreness that usually does not surprise people." In fact. all showing how the processes of visual feature perception and facial identity recognition are separated. According to my records. Rolls. From these findings. of our . it would be significant for our theory. it is not unusual to dream that "I was back in the house I grew up in. We also can find relevant data from research on visual perception in animals and humans. It looked like it did 20 years ago. perhaps not even isomorphic. a person may feel convinced that a stranger is someone he knows. but I was a child. But it is worth noting that not all disjunctions in time are equally tolerated in dreams. and Cohn (1982) have found that in the macaque monkey. However. when awake. and yet not know who the person is. to state definitively that such a dream does not occur or occurs only very rarely. there is. nor have requests to several audiences produced any examples. I have no record of the latter sort of dream. In such people. we have data from human neuropathology. including those in the lateral midtemporal cortex. DeLuca's patient VR talks about a friend visiting. From neuropsychology.

is derived from clang associations and from morphemic interchanges that often sound like plays on words. 1995). ideas of reference. Their examples of reduplication of place and person could be considered thought disordered. they concluded from their data that "thought disorder may be a contributor to the severity of the confabulation rather than to its presence" (p. in my reading of their work. Consider. but. you are supposed to be dead!" Many of the changes in schizophrenic confabulations reported by Nathaniel-James and Frith also seemed to reflect persecutory fantasies of the patient. when asked to repeat a story which contained the words passengers. "Get out of here. instead of the dream thoughts converging on a single familiar object in the manifest dream. Thus. and only one kind of storage was damaged. although not all. to be sure. This is true of the examples of confabulation in brain-injured patients provided by Weinstein and Lyerly (1968) as well. 397). he does not see it as being locked there by a made-up force. We would then want to know if there is a similar asymmetry with respect to time transpositions in brain-injured patients. There are no examples of the opposite phenomenon. Category Boundaries There is another characteristic of dreams and schizophrenic speech that also differentiates them from the confabulations of the brain-injured patients described by DeLuca and Solms. "It was something between a phonograph and a balance" (Meltzer. in which a recent experience is thought to have occurred in the distant past. This is the violation of category boundaries. but with a very specific kind of distortion that is different from the thought disorder of many schizophrenics. While all of these phenomena may have compelling personal reasons. Some distortions of schizophrenics fit DeLuca's adopted definition of confabulation. all events lose their' 'time markers" and everything becomes transposed into the recent present. but. as reported. but these need to be spelled out. If this asymmetry of transposition holds up for certain or all brain-injured populations. or that radio signals are being transmitted to his brain with messages that guide his behavior. we can combine objects in new ways." He cites the study of Nathaniel-James and Frith (1996). A schizophrenic may draw causal connections between forces of nature or other people and himself that are distorted. there may be certain identifiable characteristics that differentiate schizophrenic confabulation. And is not confabulation itself a kind of thought disorder? There are differences. and may be based on actual experiences of feeling controlled by others (Blechner. Thus. Nevertheless. how would we understand it? One possibility is that older events are stored in a different location than recent events. for example. Solms's patient sees the clock as always being a 5 o'clock. 1995).141 Downloaded by [Gazi University] at 22:48 18 August 2014 Commentary on Confabulation sense of the time or our self representation separate from our sense of time about other aspects of our experience." Such morphemic interchange is characteristic of dreams as well. It may have a vague structure that is described as "something between an X and a Y. Like Solms. He may assume that voices are telling him to do things. one schizophrenic's confabulated version added "a passing boat. If we go back to the Nathaniel-James and Frith (1996) study. they found that much of schizophrenic confabulation. In DeLuca's and Solms's examples. I would prefer to consider further the structural and experiential nuances of confabulation seen in schizophrenic and brain-injured populations. Sometimes. Confabulation in Schizophrenia DeLuca eliminates confabulations of schizophrenics from his consideration because "such a presentation appears to be related to a thought disorder. although there may be comparable examples from other brain-injured confabulators." The addition of persecutory material and of morphemic interchanges seem more characteristic of schizophrenics than of the confabulators described by DeLuca and Solms. the story of "A farmer whose sons were always quarreling tried to make them see how pointless their arguing was" was changed by the schizophrenic to "A farmer whose sons were quarreling tried to beat them. The patient dreamt of throwing a pot at the doctor and saying. 1984) or "something between a swimming pool and an aqueduct" (States. Reiser (1990) reports a patient whose friend was involved with marijuana (pot) and committed suicide. they are a sort of confabulation that does not seem to be typical of the brain-injured patients described by DeLuca and Solms. An alternative explanation might be that in these patients." The dreamer may say. they converge and create a new object that could not occur in waking life. and an asymmetry in how these can be combined. Hobson (1988) dreamt of "a . In dreams. there are reports of patients who presume that an experience of the distant past happened relatively recently. For example.

I hear no such blending of categories in the examples of DeLuca or Solms. in press. If we assume that dreams reflect unconscious processes. through those which are bracketed. safe boat. In confabulations that are logically inconsistent. ranging from those the truth of which is asserted. This phenomenon may have implications for Freud's view of the unconscious so well outlined by Solms. 1983): It is possible that psychotic pathology involves a shift of "bizarre" thoughts from dreaming to waking. we should have to question such a binary distinction. such as one of my patients who said I was consaring (i. so they climbed onto the seal/boat. to make "something between an aqueduct and a swimming pool" into just an aqueduct or just a swimming pool (Blechner. As I wrote (Blechner. This would also imply changing our view of dreams from the expression of content that is latent to the expression of a whole kind of mental processing that may be latent. Schilder (1930. it was huge.e. Solms describes a patient who claimed to have just met his friend. but have since discovered that it had been observed several times before. Other confabulations are logically inconsistent. I would also like to mention here that some patients with borderline personality and ambulatory schizophrenics report dreams that are notably lacking in confabulation." The child. Schizophrenics are also apt to violate category boundaries. Interestingly. we may begin to consider in some patients that that which is unconscious may well be the kind of rational thinking and variegated affect that form the bulk of conscious experience in less troubled individuals [po 497]. while their waking thoughts can be quite distorted. The combination is not fully formed into a new object with a complete "Gestalt" but rather remains incompletely fused. dissociation. which may apply to any forms of thinking and emotional states. children are more adamant than adults about retaining the disjunctive cognition. If we avoid the reified notion of "the unconscious" as an entity. simple unawareness. They thought it was just a seal. and of more rational thoughts from waking to dreaming. a). and adhere to the usage of "unconscious" only as an adjective. to those accompanied by correction tendencies. 1983). In fact. but exists on a continuum that includes dynamic repression. concerned and caring). which I call interobjects (Blechner. nevertheless. without awareness." Several of the cases described by DeLuca and Solms reflect the need for a taxonomy of awareness. 575-576) suggested that in all confabulations. it was a boat. unformulated experience. said. "It was a boat. The confabulatory and other bizarre aspects of dreaming are often absent in these patients. and fully syntaxic awareness. speaking like an adult who cannot tolerate contradictions. but then they looked and under the water it was a whole boat. Level of Awareness DeLuca contrasts aware versus unaware distortion. but it was still a big. a). a big. then the pattern of borderline dream structure may lead us to conclude that it is erroneous to conceptualize unconscious thinking in terms of specific types of content or process as in classical psychoanalytic theory. which is limited to any kinds of structural features or types of contents." In dreams we accept these sorts of intermediate structures.Mark J. In fact. 1998). p. And that which may be latent in psychotic patients may be rational thinking. friendly seal" (Blechner. in press. and it brought them to the shore of the mainland. They tend. how does the patient assess and integrate the logical problem? Some of the patients are aware that their confabulation causes logical difficulties. something like the lock of a door or perhaps a pair of paint-frozen hinges. although I would be interested to know if they have evidence of their occurrence in brain-injured populations. Blechner Downloaded by [Gazi University] at 22:48 18 August 2014 142 piece of hardware. This sort of thing is not tolerated in waking life. yet they have given up the need to therefore consider modifying their views or beliefs. said to him: "So really. When the boy told his father the dream in the morning. for example. holding fast to the integrity of his dream. there is a natural tendency. we have several factors to consider: Does the patient see the logical problem in the confabulation? If so. who had died years . to "regularize" such cognitions. to create neologisms that fuse two words. I wrote on this subject (Blechner. awareness is not an all-or-nothing quality of experience. selective inattention. From a psychoanalytic perspective. As we often see in our clinical work. A child dreamt that a seal swam up to him and his friends. Of what is the patient aware? Some confabulations are logically consistent but false. describing a quality of experience. the father. we consider the levels of the patients' conviction about reality value.. dreams that do not sound like dreams but rather like reports of actual experiences. thinking it to be a new finding. which "form a whole spectrum. when discussing such dreams. going back to Dostoyevky's Crime and Punishment in 1866.

J. 1951. Psychiatry. the patient's response shows a certain level of insight and lack of confabulation. New York: Basic Books. Hillsdale. namely.. Fromm-Reichmann. ed. J. there is clearly a different level of awareness from those cases of anosognosia. precisely because the man uses a logical process to analyze his premise that is so patently illogical. In fact. Gorno-Tempini. without prejudgment. A stroke patient who has just been unable to lift her left hand may nevertheless deny that this is the case. Indeed. pp. R. The neural systems sustaining face and proper name processing. Pseudologia Fantastica My last point is. & D. that sound plausible. In: The Freud Encyclopedia. In: Organization and Pathology of Thought. ed. The Dream Frontier. . J. is to presume that they are willfully and knowingly making up facts about themselves.. b). 1922. When the financial backing for one of his deals fell through. Delusions. 1912). Lionells. other people often believe these stories. Archiv. 19:485-498. C. the patient replied that "it must create interesting legal complications. who claimed to have a new second family since his entry into the hospital). D.. Bleuler. b).. New York: Garland. Psychoanal.. 1980.. Autistic thinking. Which aspect of experience is confabulated and which is not? It is as if there is a split of experience-one aspect of self confabulates illogically. F.. (1947). clients with stories of his experiences in Vietnam. and at least some such patients seem not to know or to lose track of how much they are making up about their lives (Bleuler. usually of a self-aggrandizing nature. Notes on the developltIent of treatment of schizophrenics by psychoanalytic psychotherapy. In: Final Contributions to the Problems and Methods of Psycho-Analysis. I believe that it might be worth considering whether patients with pseudologia fantastica have a brain disorder that may be linked to other kinds of brain disorders that lead to confabulation. Hobson. NJ: Analytic Press. when people with pseudologia fantastica are found out. 179:6-54. He was ultimately made a consultant for Platoon. in press. (1948). Vandenberghe." While the initial experience may qualify as a confabulation. Psychoanal. and even denial of what is happening in the moment. which can evoke insight in some schizophrenics. ~p. Joseph. patients fabricate stories. Cappa. 1958. the other views the confabulation. C.. . J. he said he would use his family money to replace it. You may object that such a fellow does not fit DeLuca's definition of confabulation. Contemp. M.. 11 :263-274. in the spirit of collaborative empirical investigation (Ferenczi. C. I think that the quotation strikes one as humorous. Rapaport. accepts it. Blechner. E. I acknowledge.(1998). E. (1998). I should like to mention one other psychopathology that seems to me to suggest a potentially important comparison to the kinds of confabulation that occur in brain-injured patients. .. But it is not always clear to what degree that is so.. in which there is downright denial of illness. NJ: Analytic Press.(in press. M. Die Prosopagnosie. Hillsdale. since the first impression. intrapsychic. He also spoke freely about his family's great wealth. There is the famous case of Jeff Beck. Fromm-Reichmann. fails with Solms's patient and similar confabulators (see Robinson and Freeman [1954] for a verbatim description of an attempt to work this way with a reduplicating patient. Only then did it emerge that he had no family money. a). being alive in one location and dead in another. (1912). and neurobiological perspectives. pp.iscalini. (1983).. 1984. Ferenczi. When the analyst questioned how the patient could have just met a man who had died years ago. I. The analysis and creation of dream meaning: Interpersonal. (1922). 212-215. New York: Brunner/Mazel. Paranoia. 34: 181-194. (1988). and that he had never served in Vietnam. F. This approach. In: Handbook of Interpersonal Psychoanalysis. Stern. But in the patient described by Solms. ed. 399-435.. Erwin.(1995). 375-396. Changes in the dreams of borderline patients. that of pseudologia fantastica. quite speculative. Price. Interestingly. Mann. Schizophrenia. 121 :2103-2118. 0. M. Bodamer. Psychiatrische Nervenkrankheiten. Szalita. & Fracowiak.143 Downloaded by [Gazi University] at 22:48 18 August 2014 Commentary on Confabulation ago in Africa.(in press. Brain. along the lines that I have been pursuing with dreams. The Dreaming Brain. 1948. Contemp. S. . one of the psychotherapeutic strategies for addressing delusional beliefs in schizophrenic patients is to approach the question. . yet perceives the complication involved. Kernberg. Oliver Stone's film about the Vietnam War. who worked in a major New York financial institution and regaled IComic Gracie Allen's zany humor often was based on this sort of highly logical approach to totally illogical premises. In this syndrome. A. New York: Columbia University Press. References Blechner.. R.} I would analyze this.. .

New York: Grone & Stratton. Regression and perception in psychotic states. Brain. Weinstein. Moscovitch. 121:1013-1052. J. B. Confabulation in schizophrenia.. E. Dreaming. (1984). Memory in Mind and Brain: What Dream Imagery Reveals. R. (1998). Szalita. Gen.. 519-580.. Neuropsychologia. (1977). NY 10023 A Cognitive Neuroscience Perspective on Confabulation Commentary by Jorge Canestri (Rome) DeLuca's paper presents the psychoanalyst with several interesting points: an accurate examination of a pathological phenomenon (confabulation) whose definition. Amer. CT: Yale University Press. Rapaport. 47:329-342. P. & Caan. W. W. for example.. This is true at the physical level as well as at the level of "mental life. With the addition of examples taken from his clinical experience with bilateral ventromesial frontal lesioned patients. there are "underlying wishes. M. Scotland: Clunie Press. 35:1017-1034. The neurosciences can offer to psychoanalysis some tools that allow one to verify the biological plausibility of certain psychoanalytic hypotheses and to find confirmation or refutation of them in the experimental field. Nathaniel-James. 1900. Psycholog. Freud constructed a hypothetical model of a "mental apparatus. O. The latter emphasizes the fact that behind the "positive" (or "productive' ') manifestations of the organic lesions. Psychiatry. 134:1335-1348. ed. & Freeman.-M. Perrett. My task in presenting these notes is greatly facilitated by Mark Solms's comment. uniqueness. & Frith. what is essential is to note the implicit general concept: in a complex system the global level of functioning of the system cannot legitimately be explained by reference to the "atomic" elements only. while psychoanalysis can supply the neurosciences with a heuristic potential that cannot be underestimated. and causality are still under discussion.. A. we consider the (some- . It is therefore clear that while DeLuca will put the accent on the deficit. (1995). New York: Columbia University Press. New York: Basic Books. Schilder. Arch. In these brief notes I will try to illustrate this viewpoint. Med. Dream-Life. 1911. A deficit (in these cases due to an organic lesion) must be interpreted also as a function of the overall response of the system. which could be significant for the neurosciences also. 145 Central Park West New York." in consonance with the Freudian model of the mind. This is evidenced by the different consideration that the symptoms merit in DeLuca's work and in the discussion by Solms. 21 :53-63. Jorge Canestri Robinson. 18:348-354. Ph. It might perhaps be useful to dwell for a while on this difference in the general line of thinking. W. M. Confabulation following brain injury: Its analogues and sequelae. Reiser.Downloaded by [Gazi University] at 22:48 18 August 2014 144 . and the possibility of comparison with psychoanalytic theories. the psychoanalyst will also emphasize the "productive" aspect of the symptom and its meaning. D. (1997). (1996).. Kernberg. M. Mark Blechner. 1951. The brain as a dream state generator: An activation-synthesis hypothesis of the dream process. (1958). D. specifically relative to this phenomenon as well as in a wider sense concerning the verisimilitude of certain statements of Freudian metapsychology. In: Organization and Pathology of Thought.McCarley. (1954). M. an alternative model constructed on the cognitive neuroscience perspective emphasizing the differences between the various forms of confabulation. D. New Haven. States. From sensation to cognition. Strategic retrieval and the frontal lobes: Evidence from confabulation and amnesia. Mesulam. 5:229-245. D. As we know. Psychiatry.. Studies concerning the psychology and symptomatology of general paresis. (1968). pp." If." Setting aside for the time being the verisimilitude of his construction. Solms highlights what is essential to the Freudian task: the problem of the psychoanalyst is not only to construct a causal hypothesis. (1930).D. (1990). 26:391-399. E. (1984). Perthshire. B. Visual neurones responsive to faces in the monkey temporal cortex. Severe Personality Disorders. (1982). & Lyerly. Experiment. Brain Res. & Melo. Rolls. Meltzer.. Dreaming "accidentally" of Harold Pinter: The interplay of metaphor and metonymy in dreams.. 1915). O. Psychiatry. Psychosurgery and the Self. C. but above all to find meaning in the manifestations of psychic life.. which excuses me from describing the fundamental principles of the Freudian topographical model of the mind (Freud.