Make Up Your Mind:
The Use of a Dream to Solve a Problem
Toward the end of my psychiatry residency I was still unsure whether or not I wanted to be a psychiatrist. For fourteen years previously I had been an anesthesiologist. After a time I had started dabbling in treating patients who had chronic pain and it became clear to me that I needed to learn a little basic psychiatry to be able to interview the patients, distinguish between organic and psychogenic pain, and make an appropriate dispensation. Certainly the motivation must have been more complicated than that, to take a year out of my career to do what turned out to be such a drastic thing. One year led to three as I began to linger a little longer in psychiatry, making excuses that I really should at least get my Boards before going back. But when friends would say that they heard I had switched to psychiatry, I would say, “Well, sort of, ” meaning that I was not really in it like the others, was there temporarily, and was planning to go back, to use what I had learned, in some way, only as an anesthesiologist, when I finished. I felt like the guy who couldn’t decide if he wanted to marry his girlfriend, and so he gave her a diamond ring. When he still couldn’t decide, he got her pregnant. My anxiety began to take hold in the final days of the residency. I began to look for any sign from my analyst as to what he thought I should do. Finding no reassurance from him, I began to tell my classmates that I would be returning to anesthesiology. Alarmed at my announcement one classmate—who had never really been a close friend and so I credited him with being more objective—said that he couldn’t imagine me as anything other than a psychiatrist and added with a plea to my conscience that my psychiatric patients needed me more than my surgical ones. He said that he felt sorry on behalf of my future patients for the loss of me. I felt surprised that he thought the field suited me so well, flattered that he did, and guilty both for leaving either one or choosing either one. It was something like trying to choose a favorite child. I was unsure what I was going to do but knew that the decision would change the course of my life. That night I had the following dream:
I was riding a horse aimlessly through the desert, singing the hit song by America, “Oh I’ve been through the desert on a horse with no name…” I came up to a giant Saguaro cactus and stared up in the sunlight at it with awe for a long time. On the tip of one of its arms was a beautiful pink flower. A voice was screaming at me, “Wake up, wake up!”
Riding the horse with no name reminded me of the feeling that I had had for a long time of having no identity. Riding the horse in the desert reminded me that I had in actuality leisurely ridden a horse at the hotel stables in Scottsdale, Arizona (a “different state”) at the last anesthesiology conference I had been to before the switch to psychiatry. On that ride they informed us that it was against the law to cut or injure a cactus. They also impressed us with the fact that it takes fifty years before a cactus grows an arm. The flower in my dream was where the hand would have been if the arm were human. I thought then of an elderly, much admired but prickly psychoanalyst and teacher, fifty years in the field, who had lost the fingers of one hand in a traumatic accident before I met him. He seemed to accept his loss without looking back and seemed to be saying that we should all do the same, that is, go on and contribute something, whatever we can, despite the understandable wish to give up. I cried as I thought of his pain, my pain, the beauty of the struggle, and the eventual success despite the difficulty. The pink flower could also represent me, my lengthy struggle with giving up anesthesiology, coming late in life to psychiatry and making a contribution there. And finally it came to mind that “Wake up, wake up” was what I used to say to my patients when their anesthetic was over with. “Are you awake? What’s your name? OK, you can go.” Maybe I was telling myself now in the dream that that phase of my life was over with. It was time to emerge from that anesthetizing, feeling-less, desert-like state of the past to a new state of confidence, conviction, and definition in the present.
Dreams can serve many functions. There is wish fulfillment, transference expression, self-state, attempt to contain or defend against anxiety, and attempt to negotiate the sides of a conflict. In this case I think that, possibly in response to my classmate naming it first, I allowed myself to see myself as a psychiatrist and eventually a psychoanalyst. I was finally able to feel a certain respect for the field that I had not before, a more permanent and comfortable owning of that particular identity. I was now able to claim it as being me. Since then I have not looked back with much regret over the loss of the path not taken, because once you dream it, you know it.