lucid dreams

told my tdoc I have lucid dreams. He said it is quite rare. He also said i didnt have concrete thinking which he explained as step by step thinking and not being able to visualise, but i looked it up and it seemed to be more about not thinking 'lend a hand' was meant literally, so im a bit confused about what he did mean.

i feel a bit at a loss as to what is going on in tdocs head atm. i know it doesnt really matter, but i like to be able to see where he is going and i dont really know any psychology so i cant.

and he said he had no idea what the different classifications of delusions were, so im not sure if i trust him now becuase htey would have definitely done that on his clinical psychology course. I have had really bad expereinces of professionals in hte past so i think i am very paranoid about this one. i would feel much more comfortable if i wasnt seeing someone in hte nhs but sadly i cant afford anything else

I don't know anything about dreams and I hope you can find what is really happening. I hope you and your t can come to terms with how you should go on from here. take care.

BB

Hope your T can help you become more comfortable with him so you can form a good relationship.

Dreaming became a topic of much fascination back around the time of Freud and Mesmer and the like. Hypnotic states more generally too. Seances and trances and dissociative fugues and mediums and dreaming... Someone (can't remember who) wrote about keeping a dream diary and about how doing that can increase the frequency of remembered lucid dreams. The more attention you pay to your dreams (to run them through working memory) etc the more you are likely to become aware of your dreams and remember them. And you kind of have to do that in order to remember having lucid dreams.

> He also said i didnt have concrete thinking...

It can be used in a couple of different ways. One notion is concrete as opposed to abstract. I'm quite good at figuring out how emotions and thoughts are supposed to go very abstractly (with regards to all people) but pretty crappy at applying that abstract knowledge to concrete (practical) situations that I actually face in my daily life.

Another notion (maybe a bit tangential) is a distinction between loose associations and linear thinking. It is possible he might have meant that. Looser / freer associations are more tangential and flowing and holistic (more of a dreamlike quality to them). Linear thinking is step-by-step logical deduction in its most extreme form. Progressively working towards some goal or aim.

> he said he had no idea what the different classifications of delusions were

Typically clinical psychologists / psychiatrists learn how to distinguish different disorders (e.g., schizophrenia, bi-polar, depression etc) from the DSM / ICD criteria. The DSM / ICD don't have very salient lists of different kinds of delusions, however. There is one in the back appendix, but it really is credible to me that he isn't familiar with that list - the majority of clinicians aren't. One doesn't have to know the sub-types in order to spot whether someone is delusional or not.

There are other sources of different ways to classify delusions too. I tried... To come up with a more comprehensive list than any I'd seen (including what was in the back of the DSM) and I got this:

1. Capgras - 'My wife has been replaced by an imposter'
- can be for persons, pets, and / or personal objects e.g., cufflinks
2. Fregoli - 'People I know are disguising themselves as strangers and are following me around'
3. Unilateral Neglect - 'Thats not my arm! Its yours!'
4. Reduplicative Paramnesia - 'My husband died long ago but he is also a current patient on this ward'
- can be for place, person, time
5. Mirrored Self MisIdentification - 'There is a person in the mirror who follows me around'
6. Thought Insertion - 'Someone else is inserting thoughts into my mind'
7. Alien Control - 'Someone else is initiating my actions'
- 6&7 sometimes jointly referred to as 'delusions of control'
8. Cotard - 'I am dead'
9. Thought Broadcast - 'Other people can hear my thoughts'
10. Thought Withdrawal - 'Someone is taking thoughts from my mind'
11. Grandeur - 'I am God' 'I am Napolean'
12. Persecution / Paranoia - 'The FBI are after me'
13. Jealousy - 'My husband is cheating on me'
14. Erotomania - 'President Bush is in love with me'
15. Somatic - 'I don't have any internal organs'
16. Reference - 'The tables signified the world was coming to an end'

The sample utterances don't really explain what the crucial feature of the type is, though. Some would classify 'Cotard' as a variety of somatic (an extreme varient). But some people (with schizophrenia / psychosis) have Somatic without getting Cotard so I put them down seperately.

Delusions can arise in response to acquired cerebral injury, exposure to toxins, in the context of a mental disorder, as a result of an endocrine disorder, in response to drugs etc. Garety and Hemsley (1994) say that they arise across at least 54 disorders (taken from the ICD, I guess). Some of the deluisons are more common with certain conditions than others.

1-5 tend to arise in response to acquired cerebral injury. (though 1 and 2 occur in the context of psychosis / schizophrenia sometimes too - though the explanation is likely different depending on the cause)

There are fairly (though not perfectly) good explanations of these kinds of delusions by cognitive neuro-psychologists. Localised brain injury etc.

8 isn't very common anymore - but it tended to occur when depression went untreated. People would start out with 'I don't feel real, I feel disembodied' (depersonalisation / derealisation) then sometimes progress to somatic deluisons 'my internal organs are rotting' and eventually conclude they were dead.

6, 7, 9 and 10 are typically schizophrenia / psychosis. The explanation for these is thought to be similar (problems with self-monitoring)

11 is typically mania though schizophrenia / psychosis sometimes too. Same with 14.

16 is classically schizophrenia (paranoid and reference being the two most common types of deluison)

The others are schizophrenia / psychosis mostly, I think.

But there are of course exceptions like how too much methamphetamine causes paranoid deluisons...

toffeellen, I think it is cool you have lucid dreams. I have heard that people can train themselves to do that.

I'm not quite sure what your T meant by concrete thinking either. Your T says you don't do it? I know what abstract reasoning is, and maybe it is the opposite of that? I know that in children, they are unable to think abstractly until a certain age, and then begin to gain that ability, I think around age 10-12, some earlier than others. This ability continues to develop through adolescence. Even in some adults, abstract reasoning is not well developed. So perhaps your T was complementing you on your abstract thinking abilities when he says you are not a concrete thinker!

I hope you will be able to forge a trusting relationship with your T. It takes time. How long have you been with him? If you feel unsure and insecure about his direction in therapy, can you ask?