Dr. Hans Steiner is Professor Emeritus of Psychiatry at Stanford and continues to practice psychiatry, mainly with adolescents. Much of his career has focused on this age group and he has written several books, including one on becoming and being a doctor. Most recently, he wrote two articles published in The Intima: A Journal of Narrative Medicine this spring. One is titled “Talking in Toys” and the other is titled “The Cat Doctor.” He is a founding member of Pegasus Physicians at Stanford, where he works with other physicians and students to explore the intersection of the humanities, the arts and the sciences. He is originally from Vienna and was exposed to psychoanalysis and dream interpretation early on in his career, both of which he is passionate about discussing in lectures around the world.
The Stanford Daily (TSD): In what ways have your background in psychiatry and past life experiences driven your interest and research in psychoanalysis and dream interpretation?
Dr. Hans Steiner: I had an English professor when I was in high school who spent a lot of time in England during World War II, and he would just basically give us Freud to read and said, “Get going.” And then we spent a lot of time reading about dream analysis, and from then on, I thought it was fun to do and someone pays you money for doing this.
See, when I was a young doctor, psychoanalysis used to be the new thing and then faded away into the background. When I was training, you basically had to deal with analysis in one way or another.
TSD: How do these two areas contribute to your own clinical practice and do you have any personal stories that have shown how effective these two methods are for treating patients?
Steiner: This is one of the things that really pisses me off about the field these days is that they always criticize Freud. They rarely give him credit and yet when you look at some of the studies that spun off from him, about half of them are showing that what he thought was correct.
There was a professor in Colorado named Jonathan Shedler who did a meta-analysis of a bunch of studies and that showed a couple of things: Number one was that the most effective intervention in psychiatry for things like anxiety disorder, substance abuse and eating disorders is based on psychodynamic thinking. The effect size is huge compared to remedial and behavioral treatments.
Second of all, when you then take the endpoint of treatment and follow the patients out, drugs and behavioral treatments deteriorate over time. The effects essentially disappear, whereas with psychoanalysis, they keep growing because what you’ve done is reset the filter. And now, they make better decisions whether they are aware of it or not. CBT [Cognitive Behavioral Therapy] and all of those other types of treatments require you only to figure out how to change behavior, which is cookbook type of stuff.
TSD: Do you practice dream interpretation in your own life and if so, has it been influential? How would you advocate for dream analysis in the general population and how do you believe this could be influential in the lives of others?
Steiner: I don’t do it as much as I used to. It’s only when I really have some sort of current, disturbing thing where I will sit down and write it down in my diary and look at it and then think what the heck is this all about.
All of us have these recurring dreams that we’ll have for years sometimes. For instance, whenever I give a big lecture, I inevitably have this dream where there is some obstacle and I cannot get to the place where the lecture is held and it’s usually stupid stuff like the plane is late and then I catch a train and the train has an accident. The net effect is I never get to the lecture. To deal with this kind of dream, I just remind myself that maybe I haven’t gone through my slides in the way I should’ve and pay more attention to it.
All this dream is is a little tap on the shoulder. For instance, it helps me decide if I want to put a little more work in or if I just sort of want to cruise through the lecture. I still get to make the decision. It depends on my audience, how much I have to prepare for how well to know my stuff.
You have to validate dream interpretation and it’s difficult to do so because you’re still relying on narratives. There’s no way to project dreams onto a wall and in the process of narrating, you realize that stories are not facts and that can be problematic.
I think that if you’re in the middle of a lot of issues with setting life up like in high school or university, I would pay a lot attention to your dreams. When you are making big time decisions that will affect the years to come, the importance of the dreams you may have is massive.
So, I would definitely say that it’s important for mental hygiene, just keeping house and making sure that things are ok. I always say that when people are having recurring dreams, they really need to pay attention to them, especially if they’re dreams that are powerful enough to wake them up. There’s something not right.
TSD: Why have you chosen to work with children and adolescents throughout your career and has this shaped your choice to apply psychoanalysis and dream interpretation?
Steiner: It’s the most fun, it’s like being an obstetrician for the mind. They’ve got all the tools but they don’t quite know yet how to put them together, so you just help them and they’re off and running. They respond quickly and the real fun part is that you can start seeing these patients when they are 16 and then you see them for a few more years and then they leave for college and then they’ll come back.
Adolescents are very open to dream interpretation and psychoanalysis. From a certain age on, it’s tough though.
TSD: How has Freud’s work had an effect on your application of dream interpretation and psychoanalysis?
Steiner: Freud is a good start and did a lot but when I go back and read his book on dream interpretation, there is so much wrong in it. It’s interesting but he forced it into this model that just doesn’t work. Every dream is not sexual but that’s not the point. Sometimes it’s sexual and sometimes it’s not.
As soon as I caught onto the structured model of psychoanalysis, I couldn’t possibly practice that. That model of bringing analysis to people is just wrong.
TSD: What do you want people to take from the information you share about dream interpretation and psychoanalysis?
Steiner: “In most medicine” means that in order for you to be successful, you better know, number one, what cards mother nature dealt you, what are you stuck with.
Then there are certain constitutional variables that you have and you don’t have, otherwise you’re going to be looking to all of the wrong places for problems that you’re running into.
Then there are some things that you are not aware of that you have. You also need to take into account what you can and can’t get — can we actually analyze what we think you want and implant a different idea in your head to challenge what you think you can get versus what you actually can do?
TSD: For those of us who have experienced recurring dreams, either positive or negative, how do you suggest that we interpret them? Should we look at them as things that may happen in the future or as things indicating how we are thinking and feeling about something?
Steiner: It’s usually the latter. We need to help the person get on with it and not get stuck in thinking that it will actually make it happen.
A sleep journal is useful in helping people cope with recurrent bad dreams. It’s called expressive writing and you can learn it easily. It’s one of the health maintenance things that all of us should do. It’s writing where you mimic what’s going on in therapy and get into the stream and just write and let it flow. You don’t want to spend any time thinking about it.
With someone with PTSD, it’s tougher. You need to show them that their story is probably not the only one. I had a man who was in the Vietnam War and was on a patrol boat in the Mekong Delta and he was a loader for ammunition. To load it, he turned the switch in the back to make sure the gun was charged, and this all needed to be done very quickly.
He was on this boat and he was just coming back up and getting ready to round up and some boy yelled “Incoming fire,” and he saw the stuff coming and knew it was going to hit the boat and was terrified. The boat went out and everybody died except him.
We dug into that narrative a bit and it turned out that at the very bottom of it, he thought because he dropped the ammunition that he was carrying up, because he was so afraid, that it was the explosion from [the ammunition] that killed them. I just needed to listen to him and start bringing up alternate scenarios, other things that could’ve caused it. Then I redefined the narrative as one where he was not so culpable and made it more realistic and that usually helps.
Psychoanalysis was more useful in this situation because it restored his agency. The therapist or psychiatrist should be responsible for showing the patient what his options are and allow them to make the decisions. Most people when they’re done with therapy, the really interesting thing is that they really think that they’ve made all of those decisions themselves.
TSD: Do you think that medication affects whether or not you dream?
Steiner: It depends on what the dream problems are. If it’s a PTSD-like dream, you usually give something like Clonodine. It tends to suppress PTSD dreams and is a blood pressure medication, whereas things like Clonazepam work through inhibition and suppress dreams in a funny way. Your dreams will just go away sometimes which is also not what you want. There is a certain amount of housekeeping that goes on at night that will not happen if dreams are affected for any length of time.
TSD: What can you do to help people dream more?
Steiner: It always helps for people to keep a dream diary. There’s also something called seeding where as you lie down and either think or read very intensively about whatever problem you may be dealing with and want to solve and very often you will dream about it. Through this way, you can find your solution.
One historic example of seeding was when Crick saw the two snakes dancing and all of the sudden realized that that’s how the DNA hooks together. He had been thinking about it constantly, and finally saw the solution in this dream.
This interview has been condensed and edited.
Contact Angelique Dakkak at angeldak ‘at’ stanford.edu.