I have given in the previous chapters many reasons why human beings are
compelled to seek at regular intervals an escape from reality which is
made possible by the unconsciousness of sleep.
Why is it then, that many people suffer from insomnia?
Many physical factors are generally mentioned as the direct causes of
sleep disturbances. None of them should be dismissed as unimportant; nor
should any one of them, however, be accepted as an exclusive and
all-sufficient explanation of sleeplessness.
Coffee, tea and cocoa (the latter even in the shape of chocolate candy)
taken in large quantities, particularly before retiring, affect our
sympathetic or safety nerves. They make us, therefore, more sensitive to
slight sound, light, pressure, smell, etc., stimuli, which under ordinary
circumstances we would not notice consciously.
In other words, they create imaginary “emergencies” which require the
usual preparation for fight or flight, that is, keen observation of our
environment, arterial tension, etc., all conditions which make sleep
impossible.
Yet we cannot say that coffee, tea or cocoa, without some other
contributing cause would always bring about sleep disturbances.
Bleuler writes: “I had been in the habit of drinking every night several
cups of very strong tea which never prevented me from sleeping. Since I
have had the influenza, things have been very different. I must be careful
not to partake of such stimulants before going to bed. But even then,
their effect depends on my mental condition. They affect me more at
certain times than they do at others. If I am the least bit excited their
effect is increased. When I am perfectly relaxed, I may not feel any bad
effects.”
A bedroom into whose windows flashes of light or waves of sound may pour,
is the not ideal place in which to seek escape from reality. Yet thousands
of people sleep soundly in Pullman berths or even in day coaches,
unmindful of the noise, light and bustle.
We must keep in mind an observation made by Bleuler at the Zürich clinic:
“When many people sleep in the same room, as in an insane asylum, some
complain that they cannot sleep because their neighbour is snoring.
Whoever tries to prevent the snoring or to move the snorer to another bed
will have an endless task. The trouble is with the patient who is
disturbed by snoring. It is not the noise itself but the attention he pays
to it which disturbs him. One can see in wards for agitated patients most
of the patients sleeping peacefully while some one disturbs the ward with
the most savage howling.
“The trouble lies, not in a special sensitiveness of the nervous system,
but in the attitude we take toward a certain noise.”
Lack of exercise during the day will often cause us to toss and turn many
times in our bed after retiring. There seems to be in every living being a
craving for activity without any positive aim, activity which accomplishes
nothing besides using up unused energy or relieving certain inhibitions.
Children and all young animals seem to be unable to remain motionless for
any length of time. In children and puppies, for example, the gleeful
shouts and barking which accompany that display of muscular activity show
unmistakably that it vouchsafes them a great amount of gratification.
The satisfaction of the free activity urge which is one of the aspects of
the ego-power urge is probably submitted to a strong repression in men and
animals at a rather early age by the safety urge; frightened children and
animals stop playing and become at times paralysed by fear.
On the other hand there are many sluggish individuals who lead an most
inactive life and yet sleep long hours without any interruption.
Indigestion causes insomnia and so does hunger but it is also a fact that
many indiscreet eaters are made drowsy by their very indiscretion and
sleep soundly after a meal which would distress many other people. Also we
find in the sayings of many races statements to the effect that sleep
assuages hunger; the average prisoner sleeps in spite of the insufficient
meal served at night in the majority of jails.
Constipation seems at times to bear the guilt for restless nights and so
do cathartics which, with some subjects, produce intestinal tension
several times during the night but whose effect is not noticeable in other
subjects until they wake up in the morning at the regular time.
Toothache will keep some people awake while others will go to sleep in
order to forget their toothache.
Examples of that sort could be cited ad infinitum.
In case of sleeplessness, the first thing to do is to remove all the
possible physical causes which can be reached directly or with the help of
a physician.
Thyroid irritation for instance may at times make one more sensitive to
even faint noises and a thorough medical examination should be undergone.
The dentature should be examined with the help of X-ray photography in
order that pus pockets, impaction, and other defects, not observable with
the naked eye, may be revealed and remedied.
The diet should be regulated so as to exclude indigestible foods while
assuring, especially at night, sufficient nourishment.
All stimulants should be avoided.
A walk before retiring is very beneficial in all cases, not because it
“tires” the subject, but because it absorbs the chemical products thrown
into the blood for emergencies which did not arise in the course of the
day. A long walk or any arduous exercise, on the other hand, might do more
harm than good if they brought about the phenomenon of the second wind.
Any form of physical or mental exercise involving rivalry or competition
is to be avoided at night. The excitement caused by the “fear of losing”
would again fill the blood with “fight or flight” products. Heated
discussions, the witnessing of exciting films or plays, drives with a
daredevil chauffeur, etc., are not conducive to peaceful sleep.
When all those means fail, many devices have been offered to insomnia
sufferers, such as prayer or counting sheep, reading, listening to some
monotonous stimulus like the buzzing of a faradic inductor, or of an
electric fan.
A distinction must be made between stereotyped prayer (such as the Lord’s
Prayer) and personal prayer rehearsing one’s worries and asking for help.
The latter kind is not unlikely to revive all the day’s problems and to
set the would-be-sleeper solving them over again at the very time when he
should forget them.
The repetition of some passage which was memorized in childhood and which,
from long familiarity has become perfectly impersonal, may go a long way
toward creating the monotony, and hence the feeling of safety, without
which there cannot be any sleep.
After following all the rules I have laid down a number of people will
still be unable to sleep. When the physico-psychic causes have been
removed without improving the condition of the subject, the
psychico-physical factors should then receive attention.
As I said before, normal people can sleep under almost any conditions
because their vagotonic activities function regularly, while neurotics
cannot sleep well even under ideal conditions because their
sympathicotonic activities are constantly raising a signal danger and
imagining emergencies amidst the safest surroundings, mental and physical.
The insomnia sufferer is suffering from some fear. That fear has to be
determined and uprooted by psychoanalysis.
Some people cannot sleep because they have gone through a period of
sleeplessness and expect it to endure for ever. The men of the Emmanuel
movement often had the following experience: a subject would explain that
he could not sleep under any circumstances. The Emmanuel healer would ask
him to sit in a chair in which, he said, many people had fallen asleep,
and after a few minutes of soothing conversation or concentration, the
insomniac would doze off peacefully. In certain cases, such a cure may be
permanent; in other cases, when the results are obtained through
transference and suggestion, the help of the psychological adviser or
hypnotist may be too frequently required.
Other subjects are prevented from sleeping by “worry.” Telling a careworn
insomniac not to worry is as silly and useless as telling a lovelorn
person to stop being in love.
Discussing a patient’s worries with him, however, often accomplishes much
good, for it compels him to sift all his evidence, which may be
convincing to him but to no one else. The worried person who is beginning
to experience doubts as to the magnitude of his trouble, is like the
patient suffering from delusions who has lost faith in his delusions.
The parasitic fears and cravings which attach themselves to some small
worry and, at times, magnify it out of proportion, may in such a way be
disintegrated and dissociated from the actual, justified fear.
Giving the patient “good reasons” why he should not worry, is again a sort
of suggestion of the most futile and least durable type.
Obsessive fear which is at the bottom of every worry is due to certain
complexes, at times apparently unrelated to the actual disturbance, and
which cannot be unearthed and uprooted except by a thoroughgoing
psychological analysis.
This is especially true of certain cases of insomnia which the patient
reports as follows. “I fall asleep with difficulty and with a certain
apprehension. I sleep an hour or two during which I have awful dreams
which I cannot remember. After which I hardly dare to close my eyes
again.”
This is what I would call the fear of the unknown nightmare, and the
anxiety dreams responsible for it must be patiently reconstituted from
the scraps which invariably linger in the subject’s memory, even when he
imagines that he cannot remember any dreams. The procedure will be
explained in the next chapter.
While the psychoanalytic treatment is being applied, however, the patient
must be made aware of a fact which will comfort him to a certain extent.
Patients often fear that if their sleeplessness is not relieved “at once”
they will “loose their minds.” Thereupon they beg to be given some
narcotic.
We must remember that the results of sleeplessness depend mostly upon the
attitude which we assume toward that condition. It may seem paradoxical to
state that its bad results are mainly due to our fear of them but it is
true nevertheless.
We assume that we shall be exhausted by a sleepless night. We go to bed in
fear and trembling, wondering whether we will or will not sleep. That
anxiety is sufficient to liberate secretions which produce an unpleasant
muscular tension and a desire for activity. This keeps us awake until the
chemical contained in those secretions have been eliminated. In the
meantime, we develop a fit of anger which releases some more of the
identical chemicals. After which we are doomed to many hours of unrest and
agitation.
During those restless hours we toss about angrily and exhaust ourselves
physically. About dawn, when sleepiness generally overtakes even the most
restless, we finally doze off and are awakened by our alarm clock or some
other familiar disturbance and once more relapse into anger at the waste
of our sleeping hours and the disability which we feel is sure to result
from it.
We naturally feel worn out. If, on the other hand, we would resign
ourselves to our sleeplessness, realize that rest, even in the waking
state, will relieve our organism of all its “fatigue” and that, by
complete relaxation in the waking state, we can liberate almost as many of
our unconscious cravings as in the unconsciousness of sleep; if we were as
careful not to waste uselessly our inner secretions as we are not to touch
live wires, we would lie down as motionlessly as possible, and would
consign to the scrap heap all the absurd notions as to the dire results of
a sleepless night; we would then awaken in the morning as refreshed by the
two or three hours of sleep that would finally be vouchsafed us as by the
usual eight or ten.
The amount of sleep one needs varies with every individual and increases
or decreases according to unconscious requirements. Hence, statements to
the effect that one needs eight or ten hours’ sleep are absurd and
dangerous.
Many people are worried over the fact that their sleep is irregular, that
is, that they sleep six hours one night and ten the next night and
possibly only four hours the third night.
This is probably as it should be. Our requirements vary with varying
conditions. After eating salt fish one may need several glasses of water
to slake one’s thirst, while one may not need to drink a drop of any
liquid after partaking of juicy fruit.
One should also dismiss as an idle superstition the dictum according to
which sleep before midnight is more beneficial than sleep after midnight.
Hundreds of newspapermen, watchmen, policemen, printers, railroadmen,
etc., work nights and sleep in the day time and do not contribute more
heavily than other professions to the ranks of the mentally deranged.
Older people, whose urges are at low ebb and do not require the
satisfaction vouchsafed by dream life should become reconciled to the fact
that they need few hours sleep; they should refrain from taking narcotics
and go to bed later than they do, so as not to “lay awake all night,”
which generally means that after dozing an hour or two in an armchair and
retiring at ten they wake up normally about one or two in the morning.
Sleep is important in health but even more so in mental disturbances. The
solution for the complicated problems of the neurotic’s life depends upon
the wealth of facts contained in the unconscious rising freely to the
surface in dreams and relieving the uncertainty. The tragedy is that
except in cases of sleeping sickness, the neurotic who needs more sleep
than the healthy subject, generally gets much less.
The neurotic should sleep preferably at night and avoid day sleep. This
for two reasons. He should keep in touch with reality when reality is
active and obvious, as during the day. With the falling of the shadows,
reality acquires a tinge of indefiniteness which lends itself to many
misinterpretations and to fancies of the morbid type.
Sleeplessness in the ghostly hours of the night is a poison for the
neurotic, for everything at such times is exaggerated, distorted and the
slightest worry is transformed into a terrible danger. Many children could
be spared fits of “night terrors” if they were not forced to go to bed
very early, after which they are likely to wake up in the middle of the
night, disoriented and fearful.
It has been said that insomnia was the cause of insanity and experiments
such as those made at the University of Iowa show that men kept awake for
a prolonged period of time begin to have delusions and hallucinations
similar to those of dementia praecox. But it must be remembered that the
men who submitted to those experiments were not allowed to “rest.”
The contrary proposition, that is, that insomnia is induced by insanity is
more plausible psychologically.
And indeed every psychiatrist has made the observation that some insane
people sleep very little, so little in fact that such protracted periods
of sleeplessness would kill the average normal person. That observation
has been confirmed by Bleuler, who as the head of the Zurich psychiatric
clinic and one of the most tireless psychological experimenters in the
world, is in a position to speak with authority.
Neurotics sleep very little, and the more severe their case is, the less
they sleep. Return of normal sleep generally coincides with a cure and has
been by many credited with bringing about the cure. Hence the many “rest
cures” suggested for the mentally disturbed patient.
The truth of the matter is that the absolutely insane person who lives all
his absurd dreams in his waking life no longer needs the unconsciousness
which the normal individual requires in order to escape from reality. The
insane man who knows he is a combination of a Don Juan, a millionaire and
a powerful ruler, need not dream of becoming all those characters. He has
attained his goal and it is only the continued conflicts with reality
which may reach his consciousness in his lucid moments which necessitate
the unconsciousness of a few minutes or hours of sleep in which reality no
longer intrudes into his absurd world.
Since insomniacs can rest without sleep and insomnia does not lead to
insanity, there is no reason why narcotics should be administered. There
is a very good reason on the other hand why they should never be
administered except in case some harrowing pain has to be relieved and
shock avoided.
For one thing, their effect is problematic and depends also to a great
extent from the subject’s mental condition.
Kraepelin noticed that large doses of alcohol failed to produce the usual
muscular lameness in subjects who were agitated. Bleuler makes the
interesting suggestion that our central nervous system only “accepts”
narcotics when they are “wanted” and keeps drugs, carried about in the
blood stream, from being assimilated by the organism when the organism is
not “willing” to submit to their influence.
But the most cogent reason why narcotics should never be resorted to in
“nervous” sleeplessness is that they do not relax the organism but
paralyse it by killing it partly. If they only dulled consciousness and
freed the unconscious, they would accomplish some good but we do not know
of any agent besides sleep, which accomplishes that successfully.
Narcotics partly kill both consciousness and unconscious. While their
effect lasts, the very phenomenon which makes the neurotic a neurotic is
exaggerated. In the neurotic’s waking state, unconscious complexes manage
to free themselves, somewhat indirectly. In the stupor of drugged sleep,
the repression is complete. Hence the horrible feeling which is often
experienced when awakening from drug-induced sleep. Normal sleep is
brother to life, but drug induced sleep is indeed akin to death.
Neither can hypnotic suggestion be recommended as a cure for
sleeplessness, except of course, in emergencies.
About the end of the nineteenth century, a Swedish physician,
Wetterstrand, inaugurated a method of treatment which was founded on a
just estimate of the value of sleep, although Wetterstrand himself could
not at the time have understood the psychology of it.
He had in Upsala a “house of sleep” furnished with innumerable divans and
couches on which his patients were allowed to rest for hours in hypnotic
sleep.
Of course this procedure had two glaring defects: hypnotism is a neurotic
phenomenon which should not be applied to the treatment of a neurosis and,
secondly, sleep in the daytime is generally enjoyed at the expense of the
night’s sleep.
At the same time, the sleep which patients enjoyed in Wetterstrand’s
“Grotto of Sleep,” as it was called at the time, must have been of a
somewhat curative kind; for the house was as silent as a grave. Thick
carpets deadened all sounds and all the lights were dimmed. No stimuli
were allowed to produce in the sleepers any fear reactions.
What Wetterstrand really supplied to his patients was an ideal bedroom and
an opportunity for an absolutely uninterrupted sleep of several hours. We
do not know, however, how many of them were robbed of the effect of such
an ideal environment by the anxiety dreams which the quietest bedroom
cannot exclude.
The conclusion to be drawn from what has been said in the preceding
chapters is that the real mission of sleep is to free the unconscious, to
relieve the tension due to repressions and to give absolutely free play to
the organic activities which build up the individual.
Hence the goal is sleep of sufficient duration, sleep undisturbed by
physical stimuli, sleep FULL OF DREAMS but FREE FROM NIGHTMARES.
No more potent curative agent could be found than that kind of sleep,
whether the ills to be remedied are of a “mental” or of a “physical”
nature. Not until all the fear-creating complexes have been disintegrated
by psychoanalysis, however, can the insomniac hope to enjoy that perfect
form of “rest.”