“To show the fly the way out of the fly-bottle.”*

*from Philosophical Investigations (German: Philosophische Untersuchungen), by the philosopher Ludwig Wittgenstein. The book was published posthumously in 1953. Julian Baggini: “Philosophers were stuck trying to solve problems of their own making, trapped inside a conceptual “bottle” that they mistook for the outside world.”

From: Is the psychotherapist’s authenticity a crucial key to therapeutic change? (Chapter by Dianne Campbell LeFevre in How does Psychotherapy Work? (2005) ):


In this chapter, the author considers whether authenticity might be a key to therapeutic change, whether it contributes to what works, whether it helps—to use Wittgenstein’s metaphor—the fly to escape from the fly-bottle. She examines a number of ways to unravel the question of authenticity as a therapeutic tool and to ask what one is intending to bring about in the patient? The author attempts to combine medical–nutritional, psychotherapeutic, and psycho-educational treatment for illnesses that involve multiple systems—physical, psychological, and social. She uses the terms “psychotic process” and “other mind” to mean the same phenomenon as that described as “internal cohabitation” by Michael Sinason, who first outlined psychoanalytical model. The living whole constantly changes and evolves in a ceaseless evolving process. This is so for the individual, for the therapeutic dyad, for the society, and the universe. All are interrelated. Authenticity is a wholeness that one constantly strives for, to enhance one’s life and the lives of others.”

From: “Insight and Dissociation in Lucid Dreaming and Psychosis”, by Ursula Voss, Armando D’Agostino, Luca Kolibius, Ansgar Klimke, Silvio Scarone, and J. Allan Hobson, in Front Psychol. (2018):


Dreams and psychosis share several important features regarding symptoms and underlying neurobiology, which is helpful in constructing a testable model of, for example, schizophrenia and delirium. The purpose of the present communication is to discuss two major concepts in dreaming and psychosis that have received much attention in the recent literature: insight and dissociation. Both phenomena are considered functions of higher order consciousness because they involve metacognition in the form of reflective thought and attempted control of negative emotional impact. Insight in dreams is a core criterion for lucid dreams. Lucid dreams are usually accompanied by attempts to control the dream plot and dissociative elements akin to depersonalization and derealization. These concepts are also relevant in psychotic illness. Whereas insightfulness can be considered innocuous in lucid dreaming and even advantageous in psychosis, the concept of dissociation is still unresolved. The present review compares correlates and functions of insight and dissociation in lucid dreaming and psychosis. This is helpful in understanding the two concepts with regard to psychological function as well as neurophysiology.


REM sleep dreaming and psychosis share several important features such as hallucinogenic imagery, reduced metacognitive thought and disturbed reality discrimination. Moreover, both dreams and psychosis proceed under a lower level of consciousness, characterized by a sense of presence – dreams are immersive, they involve here and now experience – and an absence of future-oriented planning and reflection of past experience (Hobson and Voss, 2010; Joli, 2011). Usually, both the dreamer and also the psychotic patient assume a first-person perspective, experiencing themselves as active agents instead of passive by-standers. However, dreams and also psychotic episodes may be accompanied by varying degrees of insight and subjective control. They may also include dissociative phenomena such as depersonalization and derealization or out-of-body experiences.

Insight, control, and dissociation represent the defining criteria of lucid dreams (Van Eeden, 1913; Voss et al., 2009; Voss and Hobson, 2014). Insight is considered the core criterion, whereas control and dissociation are often, but not always enhanced in lucid dreams. Control enables dreamers to alter the dream plot, dissociation occurs when the dreamer experiences the dream as if it was displayed on a screen, as in waking derealization, or sees himself from the outside, as in waking depersonalization (Sierra and Berrios, 2001; Falkai, 2015; see also Windt and Voss, 2018).

Similar to insight gained in lucid dreams in healthy adults, some psychotic patients also acquire insight into the internal nature of their hallucinations or into the illness itself. Such insight has been shown beneficial for therapeutic outcome and is associated with higher quality of life and a better prognosis (Watson et al., 2006; Lincoln et al., 2007; Boyer et al., 2012; Chan et al., 2012; Riggs et al., 2012). Likewise, perceived control over psychotic illness is associated with less co-morbid depression (Birchwood et al., 1993) and need for care (Peters et al., 2017). Dissociation is also common in psychosis (Allen et al., 1997; Moskowitz et al., 2005; Touskova et al., 2018). Its functionality, though, especially with regard to coping with illness, is less clear. Mostly, the concept of dissociation serves to differentiate psychotic from neurotic thought (Bürgy, 2010; Peters et al., 2017).

The purpose of this review is to discuss the prospects of self-induced manipulation of conscious states and to explore the boundaries of possible therapeutic interventions in psychosis. We will give special consideration to the role of lucid insight and dissociation and debate the transferability of research findings from lucid dreams to insightful psychosis.”

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