Monotony symbolizing safety _enables_ us to withdraw our attention from
our environment, from a reality which we no longer fear, but it does not
_compel_ us to do so. There is in sleep a certain amount of compulsion
which is not accounted for by the mere monotony of environmental stimuli.
We go to sleep willingly but not entirely of our own free will. We yield
to sleep.
A consideration of abnormal sleep states will help us considerably in
determining the actual cause of sleep.
Abnormal states always throw a flood of light on normal states of which
they are only an exaggerated variety. The neurosis is the best magnifying
glass through which to watch normal life, provided of course that we
afterward reduce our observations to the proper scale.
The average person sleeps from six to ten hours out of the twenty four,
some time between eight at night and ten in the morning. In abnormal
cases, on the other hand, we see the duration of sleep considerably
prolonged and the onset of sleepiness appearing at times when complete
wakefulness is usually the rule.
The circumstances surrounding those abnormal cases are never pleasant. We
never hear of any one falling asleep while witnessing a very amusing play,
while in the company of a very interesting person or while busy with some
extremely attractive occupation.
One incident from Napoleon's biography will make my meaning clear. During
his days of glory Napoleon never slept more than four or five hours out of
the twenty four. His physical and intellectual activities were prodigious.
He would, at times, ride on horseback for ten hours at a stretch, then
hold conferences with his staff until late into the night, then dictate
innumerable letters. Yet he did not feel tired or sleepy and a few hours
of sleep were sufficient to "relieve his fatigue."
On the other hand, let us remember what happened after the battle of
Aspern, the first he lost after a series of seventeen victories: He fell
asleep after a long, unsuccessful struggle with drowsiness and for
thirty-six hours could not be aroused.
His biographers also mention that when his life dream was shattered at
Waterloo and he was sent into exile on a remote island, he began to sleep
as many hours as the average, normal man.
After Aspern and after Waterloo, reality had become such, that an escape
from it, via the unconsciousness of sleep, must have been welcome. That
the reaction of defeat must have been more keenly felt by the young man
who lost Aspern and who presented strong neurotic traits, than by the more
settled man who lost Waterloo, can be easily understood.
Nansen in his Polar exile slept twenty hours a day. He certainly was not
in need of rest or recuperation, for his idleness was complete, but the
reality of ice and snow which kept him a prisoner, was one from which he
was glad to withdraw his attention.
I personally observed two cases in which sudden fits of sleepiness could
be interpreted as an escape from reality.
A gambler could go for several days and nights without sleep, _provided he
was winning_. After a heavy loss or a period during which his earnings
were offset by his losses, he would go to bed and sleep as much as four
days and four nights at a time, arising once or twice a day to partake of
some food and returning at once to his slumbers.
A neurotic with a strong inferiority complex was overwhelmed by
sleepiness every time he encountered a defeat of a sexual or egotistic
nature. After a quarrel, or whenever a discussion in which he took part
turned to his disadvantage, he had to lie down and "sleep it off."
This is probably the key to the enigma of Casper Hauser's case. He was
born in Germany at the beginning of the last century and brought up in
complete solitude, in a small dark room. At the age of seventeen, he had
never seen men, animals or plants, the sun, moon or stars. He then was
taken out of his cell, and abandoned on the streets of Nuremberg, dazed
and helpless.
All the efforts made by kind Samaritans to develop his mentality proved
futile. They had only one result: to make him fall asleep. Accustomed for
years to the peace, quiet and safety of his cell, he reacted to a new,
troublesome and complicated environment as newly born infants do, who in
incredibly long periods of sleep, in no wise explainable through fatigue,
escape reality and return to the perfect happiness of the fetal state.
In certain forms of the disturbance known as sleeping sickness, people
merge into a sleep which continues for weeks, months or even years, and
which sometimes culminates in death. (In many cases, however, the
sleepiness may be totally lacking.)
The sleeping sickness was first observed some hundred years ago on the
West Coast of Africa and, since then, in an area of the African continent
extending from Senegal to the Congo. Negroes are almost the only
sufferers, although a few whites have been affected by this disease which,
at times, extends to large numbers of the population.
According to various medical observers, the sleeping sickness usually
appears among slaves doing _arduous, exhausting work_.
It is the individuals who stand lowest in intelligence who are most
severely affected. In communities where the mental development has been
retarded, imitation easily spreads the contagion and this is probably the
reason why entire villages are decimated by that curious malady.
Whether the sleeping sickness is in certain cases induced by the bite of a
fly or appears without obvious physical cause is immaterial.[1] Paranoia
induced by syphilis is in no way different from ordinary paranoia.
Hence we are justified in linking together certain aspects of the African
sleeping sickness and the lethargic ailment which affects the white races
in Europe and America.
Both have the appearance of normal sleep, the only striking difference,
barring certain physical syndromes, being the unusual length of the
sleeping period or its onset at unusual and unexpected times.
In white subjects, narcolepsy is seldom fatal but has been known to last
for years.
The most famous case on record is probably that of Karoline Ollson
reported in a Salpétrière publication for 1912.
Karoline Ollson was born in 1861 in a small town of Sweden. At the age of
14, at the onset of her menstruation, she once came home complaining of
toothache, went to bed and remained bedridden till 1908. For thirty-two
years she slept all day and all night, waking up now and then for a few
minutes, taking dim notice of happenings in her environment and speaking a
few words. Two glasses of milk a day seemed to be sufficient to sustain
her. She was kept for a fortnight in a hospital from which she was
discharged when her ailment was diagnosed as "hysteria."
When her mother died in 1905 she woke up and wept as long as the corpse
remained in the house. Then she became quiet again and resumed her
slumbers. In April, 1908, when her menstruation stopped, she woke up, left
her bed and has led a normal life since.
Dr. Toedenström who describes the case states that she looked incredibly
young. Two weeks after she left her bed she had become strong enough to
take charge of the household.
Stekel, discussing this strange case in one of his lectures, said: "This
woman spent the entire time of her womanhood in sleep, for she fell asleep
at the time of her first menstruation period and her awakening coincided
with her climacteric. She was a child and wished to remain a child. The
first question she asked on arising, 'Where is mama?' shows that she was
suffering from psychic infantilism. It is probable that dreams of
childhood filled her thirty-year sleep and she may even have dreamt that
she was still an unborn child for whom life had not yet begun."
Medical literature contains many reports of freakish cases in which the
subject falls asleep suddenly, while attending to duties of an
uninteresting character; a young waiter, for instance, falling asleep
while waiting on a table, remaining absolutely motionless for a whole
minute and then waking up and resuming his work. Manacéine mentions two
similar cases she observed personally. Both patients were illiterate and
of slow intellect. One of them, a housemaid of nineteen, was a sound
sleeper at night and yet, in the day time, one could never be sure of her
remaining awake. She fell asleep once in the act of announcing a visitor
and while bringing in a tray loaded with cups of coffee. The other was a
woman of fifty, who was employed as a nurse until one day, falling asleep
suddenly, she dropped an infant on the floor and almost killed him. In
both the pulse was remarkably slow (a vagotonic symptom): in the girl it
varied from 50 to 70 when awake, in the older woman from 40 to 60.
An epidemic of sleeping fits, lasting only a few minutes at a time, raged
for several years in a small German town near Würzburg. The attacks took
place at any moment and were liable to leave the patient immobilized in
some curious position. It was the weaker part of the population,
physically and mentally, which was affected by that curious trouble,
apparently transmitted from parents to children, probably, as all neurotic
complaints are, through imitation.
Stekel considers hysterical and epileptic fits as forms of morbid sleep
during which hysterics gratify sexual cravings and epileptics sadistic
cravings.
This is how Dr. Isador Abrahamson describes, from recent cases observed at
Mount Sinai Hospital, the course of lethargic encephalitis which is one of
the scientific names coined to designate the sleeping sickness:
"At the onset of the disease, there is a period of variable duration in
which the patient experiences increasing difficulty in attending to his
work. Next a time of yawning ensues, in which there may be also the
_irritability of the overtired_. Then the eyes close, _chiefly from lack
of interest_.... (The patient's) pulse, temperature, and respiration may
all be of a normal character.... From the depth of this seeming slumber,
he may respond immediately when questioned and his _short but coherent
answers_ show _no loss either of memory or of orientation_.... His answer
given, he straightway resumes his seeming sleep.... _His attitude
expresses a desire to be let alone_, a desire which is sometimes
articulate in him.... The somnolence may deepen into a stupor from which
the patient is not easily aroused to conscious repose.... In the night
watches ... a restless delirium of inconstant severity often appears.
Spontaneous movements and sounds are made. The movements are purposeful
graspings and pointings at unseen things, tossings and turnings...."
The author adds in another part of his article that "The depth of the
somnolence and also its duration are unrelated to the severity of the
cerebral lesions.... _The extent of the mental disturbance bears no
correspondence to the extent of the lesions_, the amount of fever or the
blood picture...." [Italics mine.]
We have a perfect picture of a flight from reality into a somnolence into
which the unconscious complexes force at times a terrifying presentation
of the dreaded reality through nightmares.
The few cases of sleeping sickness reported in recent medical literature
show a decided neurotic trend in the subjects affected and reveal
circumstances in the patient's life which would make a flight from reality
highly desirable.
One typical case reported to me by a Boston physician who personally
considers the sleeping sickness as being "unquestionably an acute organic
disease of the cerebro-spinal system" has all the earmarks of a neurotic
affection:
"The patient, a middle aged woman lost a child she loved dearly one year
and a half before the onset of the disease. The circumstances of the
child's death were particularly sad as the mother was not allowed to visit
the little sufferer at the hospital on account of the contagious character
of his disease. She also felt disturbing doubts as to the competence of
the first physician who attended her child.
"She had been 'nervous and run down' since the child's death. She is
married to a cripple twenty years her senior. She had to go to work in
order to help support the household and to live with relatives of her
husband's who did not contribute to the pleasantness of her home life."
Have we not here all the environmental conditions which would drive a
neurotic to withdraw his attention from reality through a protracted
period of sleep?
From the fact that I have instituted a comparison between sleep and the
sleeping sickness, the reader should not draw the conclusion that I
attribute to sleep any neurotic character.
Sleep is a compromise, as I shall show later, when discussing dream life,
between what the human animal was meant to do and what it can do in
reality.
The neurosis, also is a compromise, but it is a compromise that fails,
while sleep is a compromise which is successful, beneficial and acceptable
to all.