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Throughout most of the 20th century, dreaming was considered at the center of the leading psychotherapeutic approaches to mental disorders. Psychodynamic models of the mind stemmed from Sigmund Freud's Interpretation of Dreams, according to which knowledge of the unconscious foundations of most symptoms could be enhanced by an accurate evaluation of reported dreams. Toward the end of the century, these conceptualizations were challenged by a progressive shift of perspective in the direction of neurobiologically informed, mechanistic models of brain dysfunction. The diffusion of effective psychotropic medications developed to target specific symptoms across different disorders contributed to the requalification of psychiatry itself within the broader domain of medical sciences. A whole generation of psychiatrists turned to biology as a more scientific, rigorous and reliable framework to understand mental disorders. In parallel, new psychological techniques began to emerge that aimed to treat symptoms more directly by addressing dysfunctional cognitive constructs, leading to a relative weakening of the psychodynamic paradigm that is now considered one of several possible models in need of a neuroscientific validation. Neuroscience itself is largely based on cognitive psychology given the major simplicity of its theories in comparison to psychodynamic models, so that neurobiological research paradigms in psychiatry aim to define neural substrates of cognitive mechanisms that differ from the norm (Fusar-Poli and Broome, 2006).  In line with this progression of scientific thought, modern dream research in psychiatry focuses on abnormalities of manifest dream content that can be found within different disorders. Although Post-Traumatic Stress Disorder (PTSD) is the only condition within which specific abnormalities of dream content are considered by clinicians in the diagnostic process—and become a specific target of treatment—several studies have shown that abnormal, disorder-specific dreams are reported by most subjects diagnosed with a mental disorder (Beauchemin and Hays, 1995; Sauteraud and Menny, 1997; Schredl and Engelhardt, 2001; Cartwright et al., 2006; Lusignan et al., 2009). Although several hypotheses on the relationship between dream and waking experiences have been proposed, some of which based on the known abnormalities of sleep rhythms and architecture that occur in psychiatric disorders, no definitive conclusion can be drawn. This difficulty relates to a poor understanding of mechanistic links between psychiatric diagnoses, sleep abnormalities, and chronobiological disruptions that have been recognized and studied for many decades (Wulff et al., 2010).  In this opinion article, we will propose that the progressive refinement of our understanding of dream consciousness could foster significant advances for neuroscience and psychiatry as a whole.

Dreaming and the neurobiology of self: recent advances and implications for psychiatry