Dream interpretation: a possible diagnostic method during the “prodromal” phase of psychosis

The shift from the identification of first episode psychosis to the prodromal phase has revealed a critical blind spot in our classificatory systems. UHR state has been defined as pluripotent: baseline UHR psychopathology may reflect the emergence of psychotic disorders, of other non-psychotic conditions, i.e. depression or may be psychopathological variations that spontaneously remit. It is well known that correct diagnosis is the first step for suitable therapy. We think that one way to try to go beyond this blind spot might be to evaluate not only rational thinking and behavioural symptoms, but also assess not conscious content of mind, in particular dreams. Since historically psychoanalysis has not contributed to psychiatric research, we propose a different approach to dreams and their interpretation. According to Massimo Fagioli's Human Birth Theory, dreams are a not conscious way of thinking through images, which expresses an original and creative transformation of interpersonal experiences felt during wakefulness. Dreams might be considered a kind of x-ray of patients’ mental health condition: they might reveal healthy conditions or very early subtle signs of detachment from reality and fragmentation of inner self, when manifest symptoms are subjective, a-specific or even absent. Fagioli described a psychopathological dynamic, called negazione, which negatively modifies and deformed (at a non conscious level) positive qualities felt in human relationships and might be considered a first step of thought disturbances. Thus, dreams’ images, disclosing failures or vacuums in personal relationships in early phase of illness, might be an important therapist's diagnostic guide.