MORBID DREAMS.
Morbid or pathological dreams are divided by Macario[85] into three
classes: the prodromic, or those which precede diseases; the symptomatic,
or those which occur in the course of diseases; and the essential, or
those which constitute the main features of diseases. As this
classification is natural and simple, I propose to follow it in the
remarks I shall have to make on the subject.
Prodromic Dreams.—There appears to be no doubt that diseases are
sometimes preceded by dreams which indicate with more or less exactitude
the character of the approaching morbid condition. Many instances of the
kind which have been reported—especially by the earlier authors—are,
however, in all probability merely coincidences; and in others the
relation between the character of the dream and that of the disease is by
no means clear.
Many cases of dreams indicating the nature of a malady which had not yet
developed itself are referred to by Macario.[86]
The instance of Galen’s
patient, who dreamed that his leg had become converted into stone, and who
was soon afterward paralyzed in that member, has already been cited.
The learned Conrad Gesner dreamed that he was bitten in the left side by a
venomous serpent. In a short time a severe carbuncle appeared on the
identical spot, and death ensued in five days.
M. Teste, formerly minister of justice and then of public works under
Louis Philippe, and who finally died in the Conciergerie, dreamed three
days before his death that he had had an attack of apoplexy. Three days
afterward he died suddenly of that disease.
A young woman saw in a dream objects apparently confused and dim as
through a thin cloud, and was immediately thereafter attacked with
amblyopia, and threatened with loss of sight.
A woman, who had been under the care of M. Macario, dreamed at about the
period of her menstrual flow that she spoke to a man who could not answer
her, for the reason that he was dumb. On awaking she discovered that she
had lost her voice.
Macario himself dreamed one night that he had a severe pain in his throat.
On awaking he felt very well; but a few hours subsequently was attacked
with severe tonsillitis.
Arnold, of Villanova, dreamed that a black cat bit him in the side. The
next day a carbuncle appeared on the part bitten.
Dr. Forbes
Winslow[87] gives several similar instances. A patient had, for
several weeks before an attack of apoplexy, a series of frightful dreams,
in one of which he imagined he was being scalped by Indians. Others dreamt
of falling down precipices, and of being torn to pieces by wild beasts.
One gentleman dreamed that his house was in flames, and that he was
gradually being consumed to a cinder. This occurred a few days before an
attack of inflammation of the brain. A person, prior to an attack of
epilepsy, dreamt that he was severely lacerated by a tiger; and another,
just before a seizure, dreamt that he was attacked by murderers, and that
they were knocking out his brains with a hammer.
A barrister, for several years before an attack of cerebral paralysis, was
in the habit of awaking from sleep in a condition of great alarm and
terror without being able to explain the reason for his apprehension. Dr.
Beddoes attended a patient whose first fit succeeded a dream of being
crushed by an avalanche.
Gratiolet[88] cites additional examples. Thus, Roger d’Oxteryn, Knight of
the Company of Douglas, went to bed in good health. Toward the middle of
the night, he saw in a dream a man affected with the plague and entirely
naked, who attacked him with fury, threw him to the ground after a severe
contest, and, holding him between his thighs, vomited into his mouth.
Three days afterward he was seized with the plague and died. He also
alludes to a case detailed by Gunther, in which a woman dreamt that she
was being flogged with a whip, and on awaking found that she had marks on
her body resembling the scars made by the lash.
The existence of diseases of the heart and larger vessels is often
revealed by frightful dreams when there is no other evidence of their
presence. Macario states that a young lady was under his care in whom
violent palpitations of the heart were preceded by painful dreams. She
subsequently died of disease of the heart.
Moreau (de la Sarthe),[89] in a very elaborate treatise on dreams, relates
the case of a French nobleman, whom he had attended during several months
for threatened chronic pericarditis, and who was at first tormented every
night by painful and frightful dreams. These dreams, attracting attention,
gave the earliest indication of the real condition, and excited fears as
to the result, which were soon verified.
He cites another case in illustration of the fact that periodical
hemorrhages are sometimes preceded by morbid dreams. A physician had, in
his youth, been subject to periodical hemorrhages, but without dreams or
other trouble during sleep. As he advanced in years, the hemorrhages were
not so frequent, but were always preceded by a condition of general
irritation, characterized during wakefulness by heat of skin and frequency
of the pulse, and during sleep by painful dreams. These dreams almost
always related to violent actions, such as giving and receiving heavy
blows, walking on a volcano, or being precipitated into lakes of fire.
Many cases of insanity being preceded by frightful dreams are on record.
Falret,[90] in calling attention to the remarkable analogy which exists
between mental alienation and dreams, says that it is an incontestable
fact that insanity is often preceded by significant dreams, and that these
constitute the whole essence of the disorder by becoming firmly fixed in
the patient’s mind. Thus, he relates that Odier of Geneva was consulted in
1778 by a lady, who, during the night preceding the outbreak of her
insanity, dreamed that her step-mother approached her with a dagger in
order to kill her. This dream made so strong an impression upon her that
she ultimately accredited it as true, and thus became the victim of a
delusion which rendered her a lunatic. He declares that numerous similar
instances have come under his observation, and refers to the case of a
young lady, subject to periodical attacks of mental derangement, whose
paroxysms are always preceded by notable dreams.
Morel[91]
affirms that many patients before becoming completely insane
have frightful dreams, which they regard as evidences that they are about
to lose their reason. Sometimes they are afraid to go to sleep on account
of the terrifying apparitions which then visit them.
The following cases, related by Dr. Forbes Winslow,[92] are interesting in
this connection:
“A gentleman, who had previously manifested no appreciable symptoms of
mental disorder, or even of disturbed and anxious thought, retired to bed
apparently in a sane state of mind. Upon arising in the morning, to the
intense terror of his wife, he was found to have lost his senses! He
exhibited his insanity by asserting that he was going to be tried for an
offense which he could not clearly define, and of the nature of which he
had no right conception. He declared that the officers of justice were in
hot pursuit of him,—in fact, he maintained that they were actually in the
house. He begged and implored his wife to protect him. He walked about the
bed-room in a state of great agitation, apprehension, and alarm, stamping
his feet, and wringing his hands in the wildest agony of despair. Upon
inquiring into the history of the case, his wife said that she had not
observed any symptoms that excited her suspicions as to the state of her
husband’s mind, but upon being questioned very closely, she admitted that
during the previous night he appeared to have been under the influence of
what she considered to be the nightmare, or a frightful dream. While
apparently asleep he cried out several times, evidently in great distress
of mind, ‘Don’t come near me!’ ‘Take them away!’ ‘Oh, save me; they are
pursuing me!’ It is singular that in this case the insanity which was
clearly manifested in the morning appeared like a continuation of the
same character and train of perturbed thought that existed during his
troubled sleep when, according to the wife’s account, he was evidently
dreaming.”
Dr. Winslow’s second case is equally to the point: “I am indebted to a
medical friend for the particulars of the following case. During the
winter of 1849 he was called to see H. B., about five or six o’clock in
the morning. The patient was the wife of a tailor and mother of three
children. At this time she was rather emaciated and debilitated in bodily
health, and anemic in appearance. She was of a religious turn of mind, and
belonged to the Wesleyan persuasion. On the morning of the narrator’s
visit, he found the woman in a state of great mental excitement and under
the influence of hallucinations. She had gone to bed apparently well, but
during the night was the subject of a vivid dream, imagining that she saw
her sister, long since dead and to whom she was much attached, suffering
the pains of hell. When quite awake, no one could persuade her that she
had been under the influence of an agitated dream. She stoutly persisted
in maintaining the reality of her vision. During the whole of that day she
was clearly insane; but on the following morning her mind appeared to have
recovered its balance. She continued tolerably well, mentally, for four
years, with the exception of her occasionally having moments of
despondency arising from real or fancied troubles.” * * *
The further particulars of this case, relating as they do to another
division of the subject,—“sleep-drunkenness,” as the Germans designate
it,—will be considered under that head.
Without pretending to indorse all the conclusions of Albers,—as set forth
in the following summary, and which I quote from a very learned and
philosophical writer,[93]—there is no doubt that some of his dicta are
well founded.
“Lively dreams are in general a sign of the excitement of nervous action.
“Soft dreams are a sign of slight irritation of the head; often in nervous
fevers announcing the approach of a favorable crisis.
“Frightful dreams are a sign of determination of blood to the head.
“Dreams about fire are in women signs of an impending hemorrhage.
“Dreams about blood and red objects are signs of inflammatory conditions.
“Dreams about rain and water are often signs of diseased mucous membranes
and dropsy.
“Dreams of distorted forms are frequently a sign of abdominal obstructions
and diseases of the liver.
“Dreams in which the patient sees any part of the body especially
suffering, indicate disease in that part.
“Dreams about death often precede apoplexy, which is connected with
determination of blood to the head.
“The nightmare (incubus ephialtes), with great sensitiveness, is a sign of
determination of blood to the chest.”
A very interesting paper on dreaming, by Dr. Thomas More Madden,[94] has
been recently published, and from it I make the following extract:
“Intermittent fever is often announced, several days before any of the
recognized symptoms set in, by persistent dreams of terrifying character.
I have experienced this in my own person, and heard it confirmed by other
sufferers on the African Coast. The following case of morbid dreaming
ushering in yellow fever, I subjoin in the words of the gentleman to whom
it occurred, himself a medical man holding a high official position on the
Gold Coast where it occurred.
“‘In the early part of 1840, I was an inmate of Cape Coast Castle, and as
some repairs were then being made in the castle, the room assigned to me
was that in which the ill-fated L. E. L. (Mrs. Maclean), the wife of the
governor of Cape Coast, had been found dead, poisoned by prussic acid, not
very long previously. I had known her in London, and had been intimately
acquainted with her history and much interested in it. Her body had been
found on the floor near the door and in front of a window. After a
fatiguing excursion to some of the adjoining British settlements on the
Coast, having retired to rest, I awoke disturbed by a dream of a very
vivid character, in which I imagined that I saw the dead body of the lady
who had died in that chamber lying on the floor before me. On awaking the
image of the corpse kept possession of my imagination. The moon was
shining brightly into the part of the room where the body had been found,
and there, as it seemed to me on awaking, it lay pale and lifeless as it
appeared to me in my dream.
“‘After some minutes I started up, determined to approach the spot where
the body seemed to be. I did so, not without terror, and walking over the
very spot on which the moon was shining, the fact all at once became
evident and obvious that no body was there—that I must have been dreaming
of one. I returned to bed, and had not long fallen asleep when the same
vivid dream recurred; the same waking disturbance occurring while awake.
As long as I lay gazing on the floor I could not dispossess my mind of
that appalling vision; but when I started up and stood erect it vanished
at the first glance.
“‘Again I returned to bed, dozed, dreamt again of poor L. E. L.’s
lamentable end, and of her remains in the same spot; again awoke, and
arose with the same strange results.
“‘There was no more disturbance that night of which, at least, I was
conscious, but when morning came fever was on me in unmistakable force in
its worst form, and partial delirium set in the same night. I was reduced
to the last extremity about the third or fourth night of my illness, when
a conviction seized on my mind that it was absolutely essential to my life
that I should not pass another night in Cape Coast Castle. I caused the
negro servant I had fortunately brought out with me from England to have a
litter prepared for me at dawn, and stretched on this litter, hardly able
to lift hand or foot, I was carried out of my bed by four native soldiers,
and was conveyed to the house of a merchant, and countryman of mine, to
whose care and kindness I owe my life. So much for a visionary precursor
of fever on the west coast of Africa.’
“In neuralgia, disturbed dreaming is occasionally a prominent symptom. In
an obscure case I was led to make what I believe to be a true diagnosis
from the indications furnished by the patient’s dreams. The individual in
question is a man, aged about 45, of an anemic habit, confined by a
sedentary occupation, who, for many years, had suffered from hemicrania,
which lately had become more intense, and the intervals shorter. A couple
of days before the attack his sleep becomes broken by unpleasant dreams,
and when the paroxysm has attained its height, he invariably dreams that
he is the helpless victim of a persecutor, who finishes a series of
torments by driving a stake through his skull. During his recovery from
each attack, he states that his dreams are of a most agreeable character,
though so vague that he cannot give any account of them. The frequent
repetition of his dreams leads me to conclude that there is some osseous
growth within the cranium, and that the vascular distention accompanying
the neuralgic attack occasions pressure upon this, giving rise to the
sensation I have referred to, while the subsequent feeling of comfort
results from that pressure being removed.”
A case has been recently published[95] in which the dream immediately
preceded, or perhaps even accompanied, the morbid action. A German, aged
45, of a nervo-sanguineous temperament, went to bed at 11 P. M., feeling
as well as usual. Between 12 and 1 o’clock he dreamed that he saw his
child lying at his side, dead. He was very much frightened, and at once
awoke, to find that his tongue was paralyzed, and that he could not talk.
The faculty of speech and the ability to move the tongue remained impaired
for four months.
For several years past I have made inquiries of patients and others
relative to their dreams, and have thus collected a large amount of
material bearing upon the subject. With reference to the point under
consideration, the data in my possession are exceedingly important and
interesting. Among the cases which have come under my observation of
diseases being preceded by morbid dreams, are the following:
A gentleman, two days before an attack of hemiplegia, dreamed that he was
cut in two exactly down the mesial line, from the chin to the perineum. By
some means union of the divided surfaces was obtained, but he could only
move one side. On awaking, a little numbness existed in the side which he
had dreamed was paralyzed. This soon passed off, and ceased to engage his
attention. The following night he had a somewhat similar dream, and the
next day, toward evening, was seized with the attack which rendered him
hemiplegic.
Another dreamed one night that a man dressed in black and wearing a black
mask came to him and struck him violently on the leg. He experienced no
pain, however, and the man continued to beat him. In the morning he felt
nothing, with the exception of a slight headache. Nothing unusual was
observed about the leg, and all went on well, until on the fifth day he
had an apoplectic attack, accompanied with hemiplegia, including the leg
which he had in his dream imagined to have been struck.
A lady, aged forty, who had been a great sufferer from rheumatism for many
years, dreamt one afternoon, while sitting in her chair in front of the
fire, that a boy threw a stone at her, which, striking her on the face,
inflicted a very severe injury. The next day violent inflammation of the
tissues around the facial nerve as it emerges from the stylo mastoid
foramen set in, and paralysis of the nerve followed, due to effusion of
serum, thickening, and consequent pressure.
A young lady dreamt that she was seized by robbers and compelled to
swallow melted lead. In the morning she felt as well as usual, but toward
the middle of the day was attacked with severe tonsillitis.
A young man informed me that a day or two before being attacked with acute
meningitis, he had dreamed that he was seized by banditti while traveling
in Spain, and that they had taken his hair out by the roots, causing him
great pain.
A lady of decided good sense had an epileptic seizure, which was preceded
by a singular dream. She had gone to bed feeling somewhat fatigued with
the labors of the day, which had consisted in attending three or four
morning receptions, winding up with a dinner party. She had scarcely
fallen asleep, when she dreamed that an old man clothed in black
approached her, holding an iron crown of great weight in his hands. As he
came nearer, she perceived that it was her father, who had been dead
several years, but whose features she distinctly recollected. Holding the
crown at arm’s length, he said: “My daughter, during my lifetime I was
forced to wear this crown; death relieved me of the burden, but it now
descends to you.” Saying which, he placed the crown on her head and
disappeared gradually from her sight. Immediately she felt a great weight
and an intense feeling of constriction in her head. To add to her
distress, she imagined that the rim of the crown was studded on the inside
with sharp points which wounded her forehead, so that the blood streamed
down her face. She awoke with agitation, excited, but felt nothing
uncomfortable. Looking at the clock on the mantle-piece, she found that
she had been in bed exactly thirty-five minutes. She returned to bed and
soon fell asleep, but was again awakened by a similar dream. This time the
apparition reproached her for not being willing to wear the crown. She had
been in bed this last time over three hours before awaking. Again she fell
asleep, and again at broad daylight she was awakened by a like dream.
She now got up, took a bath, and proceeded to dress herself with her
maid’s assistance. Recalling the particulars of her dream, she
recollected that she had heard her father say one day, that in his youth,
while being in England, his native country, he had been subject to
epileptic convulsions consequent on a fall from a tree, and that he had
been cured by having the operation of trephining performed by a
distinguished London surgeon.
Though by no means superstitious, the dreams made a deep impression upon
her, and her sister, entering the room at the time, she proceeded to
detail them to her. While thus engaged, she suddenly gave a loud scream,
became unconscious, and fell upon the floor in a true epileptic
convulsion. This paroxysm was not a very severe one. It was followed in
about a week by another; and, strange to say, this was preceded as the
other by a dream of her father placing an iron crown on her head and of
pain being thereby produced. Since then several months have elapsed, and
she has had no other attack, owing to the influence of the bromide of
potassium which she continues to take.
In the case of a gentleman now under my treatment for epilepsy, the fits
are invariably preceded by dreams of difficulties of the head, such as
decapitation, hanging, perforation with an auger, etc.
A lady, previous to an attack of sciatica, dreamed that she had caught her
foot in a spring-trap, and that before she could be freed it was necessary
to amputate the member. The operation was performed; but as she was
released, a large dog sprang at her and fastened his teeth in her thigh.
She screamed aloud and awoke in her terror. Nothing unusual was perceived
about the leg; but, on getting up in the morning, there was slight pain
along the course of the sciatic nerve, and this before evening was
developed into well-marked sciatica.
Insanity is frequently preceded by frightful dreams, and I have advanced
several examples to this effect from the experience of others. We should
naturally expect that very often the first manifestations of a diseased
brain should appear during sleep. But dreams are of such a varied
character, and so thoroughly irreconcilable with the normal mental
phenomena of the wakeful state, that it is difficult to say that such or
such a dream is evidence of a diseased mind. As, in some of the cases I
have brought forward, a dream may take so firm a hold of the reason as to
be the exciting cause of insanity, and not simply a sign of its approach,
I am disposed, from my own experience, to regard the frequent repetition
of the same dream as often indicative of a disordered mind, when very
close observation would fail to reveal other evidences. There are,
however, exceptions to this statement, as has been shown in the previous
chapter.
Several cases, in which insanity was preceded by terrifying dreams, have
come under my observation. In one of them a lady dreamed that she had
committed murder, under circumstances of great atrocity. She cut up the
dead body, but could not, with all her efforts, divide the head, which
resisted her blows, with an axe and other instruments. Finally she filled
the nose, eyes, and mouth with gunpowder, and applied a match. Instead of
exploding, smoke issued slowly from the orifices of the skull, and was
resolved into a human form, which turned out to be that of a police
officer sent to arrest her. She was imprisoned, tried, and sentenced to
execution, by being drowned in a lake of melted sulphur. While the
preparations were being made for the punishment she awoke. She related the
particulars of her dream to several friends, but it apparently made no
great impression on her mind. The next night she dreamed of somewhat
similar circumstances, and for several nights subsequently. On the sixth
day, without any premonition, she attempted to kill herself by plunging a
pair of scissors into her throat, and since that time to her death, which
took place a few months subsequently, was constantly insane.
In this case there was no direct analogy between the character of her
dream and the type of insanity which ensued. It cannot, therefore, be said
that the dream produced the mental aberration. On the contrary, the dream
was in all probability the first evidence of deranged cerebral action,—a
condition which subsequently became developed into positive insanity.
The following case is similar to the foregoing in its general features:
A gentleman who had been unfortunate in some business speculations,
shortly afterward became insane. Previous to this event he was troubled
with frightful dreams, which gave him a great deal of annoyance, and
frequently caused him to awake in terror. One of them occurred several
times, and was of the following character. He dreamed that he was engaged
to be married to a lady of beauty and wealth, and who was, moreover,
possessed of great musical talent. One evening, as he in his dream was
paying her a visit, she placed herself at the piano and began to sing. He
remarked that he did not admire the piece of music she was singing, and
asked her to sing something else. She indignantly refused. Angry words
followed, and in the midst of the dispute she drew a dagger from her bosom
and stabbed herself to the heart. As he rushed forward, horror-struck, to
her assistance, her friends entered the room, and found him with the
dagger in his hand. He was accused of murdering the lady, and,
notwithstanding his protestations of innocence, was tried, found guilty,
and sentenced to be hung. He always awoke at the point when preparations
were being made for his execution.
A dream may make such a strong impression on the mind as to subsequently
constitute the essential feature of the insane condition. This point has
already been elucidated to some extent in the preceding pages. The
following cases, however, are from my own records of practice.
A gentleman awoke in the middle of the night, and, calling his wife, told
her he had dreamed that a large fortune had been left him by a miner in
California. He then went to sleep again, but in the morning again repeated
the dream to his wife, and said that “there might be something in it.” She
laughed, and remarked that she “hoped it might prove true.” About the time
the California steamer was expected, the gentleman was observed to become
very anxious and excited, and was continually talking of his expected
fortune. At last the steamer arrived. He then began asking the postman for
letters from California, went several times a day to the post-office to
make like inquiries, and finally went aboard the steamer and questioned
the officers on the same subject. Then he was sure the letter had
miscarried, and would sit for hours in the most profound melancholy. He
was now recognized by his family as a monomaniac, and strenuous efforts
were made to cure him of his delusion, but they were unsuccessful; and
although now apparently sane on other subjects, he still holds the
erroneous idea which was first given him in his dream of several years
ago.
A young lady was brought to me in July, 1868, who had been rendered insane
by a dream which took place a few months before I saw her. She went to bed
one night in good health and spirits, though somewhat fatigued in
consequence of having skated a good deal the previous afternoon. In the
morning she told her mother she had committed the “unpardonable sin,” and
that there was consequently no hope of her salvation. She based her idea
on a dream she had had, in which an angel appeared to her, and sorrowfully
informed her of her sin and her destiny. When asked to tell what her sin
was, she refused to do so, saying it was too shocking and atrocious to
talk about. She kept to her delusion, and soon settled into a sort of
melancholic stupor, from which it was impossible entirely to rouse her.
Under the use of arsenic, and the acid phosphate of lime of Prof.
Horsford, she gradually recovered her reason.
The manner in which prodromic dreams are excited is very simple. The
ancients and some modern writers have regarded them as prophetic; but the
true explanation does not require so severe a tax on our powers of belief.
In the previous chapter, it was shown that very slight impressions made
upon the senses during sleep are exaggerated by the partially awakened
brain. The first evidence of approaching paralysis may be a very minute
degree of numbness—so minute that the brain when awake and engaged with
the busy thoughts of active life fails to appreciate it. During sleep,
however, the brain is quiescent, till some exciting cause sets it in
uncontrollable action, and dreaming results. Such a cause may be the
incipient numbness of a limb. A dream of its being turned into stone, or
cut off, or violently struck, is the consequence. The disease goes on
developing, and soon makes its presence unmistakable.
This explanation applies mutatis mutandis to all prodromic dreams. They
are invariably based upon actual sensations, unless we except the rare
cases which are simply coincidences.
Symptomatic Dreams.—Morbid dreams are so generally met with in the course
of disease, especially in that of the brain and nervous system, that I
never examine a patient without questioning him closely on this point. The
information thus obtained is always valuable, and sometimes constitutes
the most important feature of the investigation.
Fevers are very often accompanied by frightful dreams. According to
Moreau (de la Sarthe),[96] their occurrence indicates that the attack will
be long, and that there is probably some organic affection present. My own
experience agrees with that of Macario,[97] to the effect of not
confirming these opinions. I have, however, generally observed that the
frequency and intensity of the morbid dreams were in proportion to the
severity of the fever.
Diseases of the heart are very generally attended with disagreeable
dreams. They are usually short, and, as Macario remarks, relate to
approaching death. The patient starts from sleep in terror, and sometimes
it is difficult to convince him of the reality of his visions.
Dyspepsia and other diseases of the intestinal canal often give rise to
morbid dreams. They are usually accompanied by a sense of impending
suffocation, and ordinarily consist of frightful images, such as devils,
demons, strange animals and the like. The presence of worms in the
intestines is likewise a frequent cause of such dreams.
In chlorosis dreams are very common. Occasionally they are of a pleasant
character, but in the majority of cases they are the reverse of this.
It would be difficult to mention a disease which is not, at some time or
other of its career, an exciting cause of morbid dreams. The most
interesting examples, however, are met with in cases of insanity and
other cerebral affections, and frequently the delusions of the dreams are
so mixed up with those which arise during the waking condition, that the
patient is unable to separate them and to determine which are the
consequence of erroneous sensations received when awake, and which are the
results of dreams. The careful examination of almost any insane persons
will also show that they incorporate the fancies of their dreams with the
realities of everyday life. Indeed, the relations of dreaming to insanity
are so interesting and important as to have attracted the marked attention
of alienists and psychologists.
Cabanis[98] gives Cullen
the credit of being the first to point out the
similarity between the phenomena of dreaming and those of delirium, and
himself enters at length into the full discussion of the several questions
involved. A very little reflection will suffice to convince the reader
that the two conditions are strikingly alike. In dreams we never
distinguish the false from the real; the judgment, if exercised at all,
acts in the most erratic manner; we are rarely surprised at the occurrence
of the most improbable circumstances; our characters for the time being
often undergo a radical change, and we perform imaginary acts in our sleep
which are altogether at variance with our actual dispositions. The
hallucinations of sleep we accept as realities just as the insane
individual believes in all the erroneous impressions made upon his senses.
The dreaming person is, in fact, the victim of delusions which, during the
existence of his condition, have a firm hold on his mind and render him in
no essential particular different from the one who suffers from mental
unsoundness. The incoherence present in dreams, and the evident dependence
of the various images upon the suggestion of previous images, are likewise
phenomena of the insane state.
Even in persons perfectly sane, dreams often produce a very powerful
influence on the mind. Most of us have, on awaking, felt pleased or
disturbed from reflecting upon the circumstances of a dream we have had
during the night, and occasionally the impression has remained through the
entire day. With children this influence is still more strongly shown. As
Sir Henry Holland[99] remarks, the corrections from reason and experience
are less complete in them than in adults. As a consequence, they not
infrequently confuse their dream-visions with the facts of their lives,
and regard the former as real events. The hallucinations of dreams are
also occasionally continued during wakefulness, and hence some persons
have, on awaking, seen the images which had been present to them in their
sleep.
The celebrated Benedict de Spinoza[100] was once the subject of an
illusion which had its starting-point in a dream. He dreamed that he was
visited by a tall, thin, and black Brazilian, diseased with the itch. He
awoke, and thought he saw such an image standing beside him.
Muller,[101] in referring to such instances, says:
“I have myself also very frequently seen these phantasms, but am now less
liable to them than formerly. It has become my custom when I perceive such
images, immediately to open my eyes, and direct them upon the wall or
surrounding objects. The images are then still visible, but quickly fade.
They are seen whichever way the head is turned, but I have not observed
that they moved with the eyes. The answers to the inquiries which I make
every year of the students attending my lectures as to whether they have
experienced anything of the kind, have convinced me that it is a
phenomenon known to comparatively few persons. For among a hundred
students, two or three only, and sometimes only one, have observed it.
This rarity of the phenomena is, however, more apparent than real. I am
satisfied that many persons would perceive these spectres if they learned
to observe their sensations at the proper times. There are, however,
undoubtedly many individuals to whom they never appear, and in my own case
they now sometimes fail to show themselves for several months at a time,
although in my youth they occurred frequently. Jean Paul recommended the
watching of the phantasms which appear to the closed eyes as a means of
inducing sleep.”
If such phenomena take place in persons of healthy brains, the greater
liability of the insane to experience them will readily be admitted.
The character of dreams,
as Macario[102] remarks, varies according to the
type of insanity to which the patient is subject. In melancholia they are
ordinarily sad and depressing, and leave a deep and lasting impression; in
expansive monomania they are gay and exciting; in mania they give evidence
of the extraordinary mental excitement and activity of the subject, and in
duration they are vague, fleeting, and occur but seldom.
Essential Morbid Dreams.—Under this head are comprehended the various
forms of frightful dreams which are ordinarily designated under the name
of nightmare. It has been my good fortune to have had the opportunity of
carefully studying the phenomena of this singular affection in several
persons of intelligence, and I propose, therefore, detailing the results
of my own experience, after a short historical retrospect, which I hope
will not prove uninteresting.
Nightmare is characterized by the existence during sleep of a condition of
great uneasiness, the principal features of which are a sense of
suffocation, a feeling of pain or of constriction in some part of the
body, and a dream of a painful character. There are thus two essential
elements of the affection—the bodily and the mental.
At a very early period the phenomena of nightmare attracted the attention
of physicians.
Hippocrates[103] describes it in the following words: “I
have often seen persons in their sleep utter groans and cries, appear as
if suffocated, and throw themselves wildly about until they finally waked.
Then they were in their right minds, but were, nevertheless, pale and
weak.”
The general opinion held at that time was that the phenomena of nightmare
were due to excess of bile and dryness of the blood. This view originated
with Hippocrates, but was more or less modified by subsequent writers.
After the establishment of Christianity, the conviction began to prevail
that during an attack of nightmare the subject was visited by a demon,
who, for the time being, took possession of his body. Oribasius, in the
fourth century, combated this idea, and endeavored to show that it was a
severe disease, which, if not cured, might lead to apoplexy, mania, or
epilepsy. He located it in the head.
Aetius also denied the existence of demoniacal agency in nightmare. He
considered it as a prelude to epilepsy, mania, or paralysis.
During the middle ages nightmare was attributed to the power of the devil.
Imps, male and female, called incubi and succubi respectively, were
supposed to be the active agents in producing the affection. The treatment
was in accordance with the theory, and consisted of prayers and exorcisms.
Not unfrequently the subject of the disease perished at the stake for the
alleged crime of having sexual intercourse with incubi or succubi,
according to sex.
Even in later times many persons have been found who believed implicitly
in the reality of the visions which they experienced during an attack of
nightmare. Thus Jansen[104] relates that a clergyman came to consult him.
“Monsieur,” said he, “if you do not help me I shall certainly go into a
decline, as you see I am thin and pale,—in fact, I am only skin and bone;
naturally I am robust, and of good appearance; now I am scarcely more than
the shadow of a man.”
“What is the matter with you?” said Jansen. “And to what do you attribute
your disease?”
“I will tell you,” answered the clergyman, “and you will assuredly be
astonished at my story. Almost every night a woman, whose figure is not
unknown to me, comes and throws herself on my breast, and embraces me with
such power that I can scarcely breathe. I endeavor to cry out, but she
stifles my voice, and the more I try the less successful I am. I can
neither use my arms to defend myself, nor my legs to escape. She holds me
bound and immovable.”
“But,” said the doctor, “what you relate is not in the least surprising.
Your visitor is an imaginary being, a shade, a phantom, an effect of your
imagination.”
“Not so!” exclaimed the patient. “I call God to witness that I have seen
with my own eyes the being of whom I speak, and I have touched her with my
hands. I am awake, and in the full possession of my faculties, when I see
this woman before me. I feel her as she attacks me, and I try to contend
with her, but fear, anxiety, and languor prevent me. I have been to every
one asking for aid to bear up against my horrible fate, and, among others,
I have consulted an old woman, who has the reputation of being very
skillful, and something of a sorceress. She directed me to urinate toward
daylight, and to immediately cover the pot de chambre with the boot of
my right foot. She assured me that on the very day I would do this the
woman would pay me a visit.
“Although this seemed to me very ridiculous, and although my religion was
altogether against my making any such experiment, I was finally induced,
by reflecting on my sufferings, to follow the advice I had received. I did
so, and, sure enough, on the same day the wicked woman who had so
tormented me came to my apartment, complaining of a horrible pain in the
bladder. All my entreaties and threats, however, were unavailing to induce
her to cease her nocturnal visits.”
Jansen at first could not turn this gentleman from his insane idea, but,
finally, after two hours’ conversation, he made him have some just
conception of the nature of his disease, and inspired him with the hope
of a cure.
Epidemics of nightmare have been noticed, and it likewise sometimes
prevails endemically under certain peculiar forms. Thus vampirism, a
belief in which exists in different parts of the world, is nothing but a
kind of nightmare. Charles Nodier[105] gives some interesting details on
this point, which I do not hesitate to transcribe.
In Morlachia there is scarcely a hamlet which has not several vukodlacks
or vampires, and there are some, every family of which has its
vukodlack, just as every Alpine family has its cretin. The cretin,
however, has a physical infirmity, and with it a morbid state of the brain
and nervous system, which destroys his reason, and prevents him
appreciating his degraded condition. The vukodlack, on the contrary,
appreciates all the horror of his morbid perception; he fears and detests
it; he combats it with all his power; he has recourse to medicine, to
prayers, to division of a muscle, to the amputation of a limb, and
sometimes even to suicide. He demands that after his death his children
shall pierce his heart with a spike, and fasten his corpse to the coffin,
so that his dead body, in the sleep of death, may not be able to follow
the instinct of the living body. The vukodlack is, moreover, often a man
of note, often the chief of the tribe, the judge, or the poet.
Through the sadness which is due to the recollection of his nocturnal
life, the vukodlack exhibits the most generous and lovable traits of
character. It is only during his sleep, when visited with his terrible
dreams, that he is a monster, digging up the dead with his hands, feeding
on their flesh, and waking those around him with his frightful cries.
The superstition is that during this state of morbid dreaming the soul of
the sleeper quits the body to visit the cemeteries, and feast upon the
remains of the recently dead.
In Dalmatia the belief is current that there are sorcerers whose delight
is to tear out the hearts of lovers, and to cook and eat them. Nodier
relates the story of a young man about to be married, who was the constant
victim of nightmare, during which he dreamed that he was surrounded by
these sorcerers, ready to pluck his heart from his breast, but who often
awakened just as they were about to proceed to extremities. In order to be
effectually relieved from their visitations, he was advised to avail
himself of the company of an old priest, who had never previously heard of
these horrible dreams, and who did not believe that God would give such
power to the enemies of mankind. After using various forms of exorcism,
the priest went peacefully to sleep in the same room with the patient whom
he was commissioned to defend against the sorcerers. Hardly, however, had
sleep descended upon his eyelids than he thought he saw the demons
hovering over the bed of his friend, alight, and, laughing horribly,
throw themselves on his prostrate body, and with their claws tear open his
breast, and, seizing his heart, devour it with frightful avidity. Unable
to move from his bed, or to utter a sound, he was forced to witness this
terrible scene. At last he awoke to see no one but his companion, pale and
haggard, staggering toward him, and finally falling dead at his feet.
These two men, adds Nodier, had had similar attacks. What the one dreamed
he saw, the other dreamed he had experienced.
As an instance of like dreams occurring to many persons at the same time,
the circumstances related by Laurent[106] are worthy of notice.
“The first battalion of the regiment of Latour d’Auvergne, of which I was
Surgeon-major, while in garrison at Palmi, in Calabria, received orders to
march at once to Tropea in order to oppose the landing from a fleet which
threatened that part of the country. It was in the month of June, and the
troops had to march about forty miles. They started at midnight, and did
not arrive at their destination till seven o’clock in the evening, resting
but little on the way, and suffering much from the heat of the sun. When
they reached Tropea, they found their camp ready and their quarters
prepared, but as the battalion had come from the farthest point, and was
the last to arrive, they were assigned the worst barracks, and thus eight
hundred men were lodged in a place which, in ordinary times, would not
have sufficed for half their number. They were crowded together on straw
placed on the bare ground, and being without covering, were not able to
undress. The building in which they were placed was an old, abandoned
abbey, and the inhabitants had predicted that the battalion would not be
able to stay there all night in peace, as it was frequented by ghosts,
which had disturbed other regiments quartered there. We laughed at their
credulity; but what was our surprise to hear, about midnight, the most
frightful cries issuing from every corner of the abbey, and to see the
soldiers rushing terrified from the building. I questioned them in regard
to the cause of their alarm, and all replied that the devil lived in the
building; that they had seen him enter by an opening into their room,
under the figure of a very large dog, with long black hair, and, throwing
himself upon their chests for an instant, had disappeared through another
opening in the opposite side of the apartment. We laughed at their
consternation, and endeavored to prove to them that the phenomenon was due
to a very simple and natural cause, and was only the effect of their
imagination; but we failed to convince them, nor could we persuade them to
return to their barracks. They passed the night scattered along the
sea-shore, and in various parts of the town. In the morning I questioned
anew the non-commissioned officers and some of the oldest soldiers. They
assured me that they were not accessible to fear; that they did not
believe in dreams or ghosts, but that they were fully persuaded they had
not been deceived as to the reality of the events of the preceding night.
They said they had not fallen asleep when the dog appeared, that they had
obtained a good view of him, and that they were almost suffocated when he
leaped on their breasts. We remained all day at Tropea, and the town being
full of troops, we were forced to retain the same barracks, but we could
not make the soldiers sleep in them again, without our promise that we
would pass the night with them. I went there at half-past eleven with the
commanding officer; the other officers were, more for curiosity’s sake
than anything else, distributed in the several rooms. We scarcely expected
to witness a repetition of the events of the preceding night, for the
soldiers had gone to sleep, reassured by the presence of their officers,
who remained awake. But about one o’clock, in all the rooms at the same
time, the cries of the previous night were repeated, and again the
soldiers rushed out to escape the suffocating embrace of the big black
dog. We had all remained awake, watching eagerly for what might happen,
but, as may be supposed, we had seen nothing.
“The enemy’s fleet having disappeared, we returned next day to Palmi.
Since that event we have marched through the Kingdom of Naples in all
directions and in all seasons, but the phenomena have never been
reproduced. We are of opinion that the forced march which the troops had
been obliged to make during a very hot day, by fatiguing the organs of
respiration, had weakened the men, and consequently disposed them to
experience these attacks of nightmare. The constrained position in which
they were obliged to lie, the fact of their being undressed, and the bad
air they were obliged to breathe, doubtless aided in the production.”
A gentleman was, not long since, under my professional charge who was very
subject to attacks of nightmare. Though remarkable for his personal
courage, he confessed that during his paroxysms he was the most arrant
coward in the world. Indeed, so powerful an impression had his frequent
frightful dreams made upon him, that he was afraid to go to sleep, and
would often pass the night engaged in some occupation calculated to keep
him awake.
The dreams which he had were always of such a character as to inspire
terror, and generally related to demons and strange animals, which seated
themselves on his chest, and tried to tear open his throat. They came on a
few minutes after he fell asleep, and lasted sometimes for more than an
hour. During their continuance he remained perfectly still and quiet,
giving no evidence of the tumult within, beyond the appearance of a cold
sweat over the whole surface of the body. When he awoke, as he always did
when the climax was reached, he started from the bed with a bound, and
with all the evidences of intense fright. After that he was safe for the
remainder of the night.
I am acquainted with another case in which there are no very obvious
physical symptoms.
Ordinarily, however, the sufferer groans, and tosses about the bed; he
appears to be endeavoring to speak, and to escape from his imaginary
danger; his face, neck, and chest are flushed; a cold perspiration
appears, especially on his forehead, and he is sometimes seized with a
general trembling of the whole body. The respiration appears to be
particularly disturbed; he gasps for air, and occasionally the breathing
is stertorous. As to the pulse, strange as it may appear, there is rarely
any marked change from the healthy standard, beyond the slight
irregularity induced by the disorder of the respiration.
Among the mental symptoms, in addition to the fear with which he is
filled, the sufferer is most sensibly impressed with a sense of his utter
helplessness. His will is actively engaged in endeavoring to bring his
muscles into action, but they cannot be made to obey its behests, and he
consequently feels himself powerless to escape from the enemies which
attack him.
In regard to the kind of images which make their appearance, there is more
or less uniformity. Generally they consist of animals, such as hogs, dogs,
monkeys, or nondescripts created by the imagination of the dreamer. At
other times they are demons of various forms. A gentleman, whose case came
under my notice, was visited almost nightly by a huge black walrus, which
appeared to roll off of a large cake of ice, and, crawling up the bed, to
throw itself on his chest. Another was tormented by an animal, half lion
and half monkey, which seemed to fasten its claws in his throat while
seated on his breast.
At other times there are no images, but only painful delusions, in which
the dreamer is placed in dangerous positions, or suffers some kind of
torturing operation. Thus a lady informs me that she is subject to
frequent attacks of nightmare, during which she imagines she is standing
on the top of a high mast, and in extreme fear of falling off. Again she
is dragged through a key-hole by some invisible power; and again has her
nose and mouth so tightly closed that she can get no breath of air.
The causes of nightmare may be divided into the exciting and the
immediate. The exciting causes are very numerous. Unusual fatigue,
either of mind or of body, recent emotional disturbance, such as that
produced by fright, anxiety, or anger, and intense mental excitement of
any kind may produce it. I have known a young lady to have a severe attack
the night after a school examination, in which she had been unduly tasked.
Another young lady is sure to be attacked after witnessing a tragedy
performed. A young man, who was under my care for a painful nervous
affection, always had a paroxysm of nightmare during the first sleep after
delivering an address, which he was obliged to do every month for a year
or more.
Fullness of the stomach, or the eating of indigestible or highly
stimulating food late in the evening, will often cause nightmare. As
Motet[107] remarks: “One of the best-established causes is repletion of
the stomach, and slowness and difficulty of digestion. Let an individual,
habitually systematic, depart for one day from the accustomed regularity
of his meals, let him change the hour of his dinner, and go to bed before
the work of digestion is completed, and it is probable that his sleep will
be troubled, and that nightmare will be the consequence of his
indiscretion. The painful feeling will be induced by distention of the
stomach, by anxiety, and by the restraint given to the movements of the
diaphragm.”
Feculent food would appear to be especially powerful in causing nightmare,
and according to Motet, strong liquors and sparkling wines and coffee are
equally so. I have several times known it produced by the New England dish
of baked pork and beans, and by green Indian-corn eaten just before going
to bed.
Various morbid affections, such as diseases of the heart, aneurism of the
large arteries, affections of the brain or spinal cord, and diseases of
the digestive or urinary apparatus are often exciting causes of nightmare.
It may originate from painful sensations in any part of the body. Some
women, about the time of the menstrual flow, are particularly liable to
paroxysms of this morbid dreaming.
Whatever interferes with the respiration or the easy flow of blood to and
from the head may bring on an attack of nightmare. I have known it caused
by the collar of the night-gown being too tight, and by the pillow being
under the head and not under the shoulders, thus putting the head at such
an angle with the body as to constrict the blood-vessels of the neck, and
by the head falling over the side of the bed. I have not been able to
ascertain that sleeping upon the back or on the left side predisposes to
the affection, unless in those cases in which the former position causes
snoring from relaxation of the soft palate.
The immediate cause of nightmare is undoubtedly the circulation of blood
through the brain which has not been sufficiently aerated. The appearance
of the sufferer is sufficient to indicate this, as the condition of the
cerebral vessels and all the exciting causes act either by retarding the
flow of the venous blood from the brain, or by impeding the respiratory
movements. The effects of emotion, of mental fatigue, and of severe and
long-continued muscular exertion are such that the nervous influence to
the muscles of respiration is increased, or the muscles themselves are
debilitated through this general fatigue of the organism. Fullness of the
stomach acts mechanically, by interfering with the action of the
diaphragm, and constriction about the neck directly increases the flow of
blood through the brain. Certain diseases of the heart and lungs act upon
the function of respiration, and thus interfere with the due oxygenation
of the blood.
The treatment of morbid dreams presents no points of any difficulty.
When they are the result of impressions made during sleep upon the nerves,
and are the forerunners of disease, it is not very likely that physicians
will be consulted as to their cure. Undoubtedly, however, much can be done
to abate them when they belong to the category of prodromic dreams, as
well as when they are symptomatic of existing disease. Hygienic measures,
such as open-air exercise, attention to diet, and warm baths, and the use
of the oxide of zinc and bromide of potassium, will do much to lessen the
irritability of the nervous system, and to diminish any hyperæmic
condition of the brain.
Nightmare often requires more active management, though even here we will
ordinarily find the measures above mentioned the most effectual that can
be taken for its treatment. Of course the exciting cause must be
ascertained if possible, and means taken to remove it. This is not always
an easy matter, and frequently cannot be accomplished without a
considerable alteration in the course of life followed by the patient, and
more or less sacrifice on his part. Among hygienic measures, I have
several times found relief follow a sojourn at the sea-shore, and ocean
bathing. Change of air is almost invariably beneficial, and moderate
physical exercise, just to the point of fatigue, can scarcely be dispensed
with. A gentleman, at this moment under my care, has been cured by a
course of gymnastic training, which he took at my instance. The food of
those subject to nightmare should always be plain, easily digestible, and
moderate in quantity. Alcoholic beverages should always be sparingly
taken, especially just before going to bed. Any article of food or drink
known to produce the paroxysm, should of course be omitted altogether.
As to medicines, the whole round of so-called antispasmodics is usually
tried by routine physicians. I have never seen them do any good. Iron and
bitter tonics are indicated in cases of anæmia or exhaustion. As the
disease is sometimes induced in children by the presence of worms in the
alimentary canal, diligent inquiry should be made relative to symptoms
indicating irritation from these parasites, and if they are found to
exist, anthelmintics should be administered.
A case of intermittent nightmare, occurring every alternate night, in a
young lady, was recently under my care. No exciting causes could be
discovered, except the probable one of malaria. The affection yielded at
once to the sulphate of quinia.
Ferrez[108] has published the details of a case of intermittent nightmare
occurring in the person of a Spanish officer, who was attacked after
passing forty-two nights at the bedside of a sick daughter. Every night,
at the same hour, he was awakened by frightful dreams, which, irritating
his brain, produced cramps, convulsive movements, an afflux of blood to
the cerebral tissues, a sadness which he could not conquer, and a
continual and powerful feeling of approaching death.
The patient, though of strong constitution, became enfeebled and
emaciated. His countenance was pale, the pupils contracted, and his whole
appearance showing the exhaustion consequent upon the battle which he was
obliged continually to fight with his disease. He composed at this time
some verses, describing in graphic terms the deplorable condition of his
mind and body.
Gymnastics, temperance in eating and drinking, and the study of poetry,
failed to give him relief. Finally he consulted Dr. Ferrez, who advised
him to reveal his state to his family, who hitherto had been kept in
ignorance of his malady, to continue his gymnastics moderately, not to eat
in the evening, to drink only cold water, to use friction over the whole
surface of the body, to apply mustard plasters to the extremities, to
sleep with his head elevated and uncovered, to bathe his head frequently
during the night with cold water, to give up the study of poetry, and to
devote himself to mathematics and political economy. These measures were
rigorously carried out; but his daughter, who had been the involuntary
cause of his disease, prescribed a better remedy than all the others. She
had him waked at midnight, before the occurrence of his paroxysm, and thus
broke up the habit.
Perhaps no one medicine is so uniformly successful in the ordinary forms
of nightmare as the bromide of potassium, administered in doses of from
twenty to forty grains, three times a day. I have seen a number of cases
which had resisted all hygienic measures, and the simple removal of the
apparent cause, yield to a few doses of this remedy.
When the affection has lasted a long time, it is more difficult to break
up the acquired habit. In these cases, the plan so successfully employed
by the daughter of the Spanish officer will almost invariably succeed.
Finally, persons subject to nightmare should so train the mind as to
employ the intellectual faculties systematically, by engaging in some
study requiring their full exercise. The action of the emotions should be
as much as possible controlled, and the reading of sensational stories, or
hearing sensational plays, should be discouraged. By severe mental
training, individuals can do much to regulate the character of their
dreams. It is a well-recognized fact, that intense thought upon subjects
which require the highest degree of intellectual action is not favorable
to the production of dreams of any kind.
