University of Virginia Library

ANALYSIS OF A CASE OF SLEEPLESSNESS

Once when traveling I made the acquaintance of a naturalist who not long before had completed a famous exploring expedition in distant countries. During this expedition he had been almost constantly in peril of his life. Almost every night he had had to stay awake and watch so as not to be set upon and killed. He had been back in England a short time and had completely recovered from the privations and sufferings he had experienced, but he suffered desperately from insomnia. On his return he had slept well, but a month before his sleep had suddenly begun to be disturbed.

Knowing me to be a neurologist, he asked my advice. I inquired about the patient's former life, but discovered that my traveling companion was little inclined to be communicative in this direction, in fact he was strikingly reticent. To my inquiry about the immediate origin of the insomnia, he told me it was immediately connected with a miserable dream which he had dreamt a month past, and from which he had awakened in terrible anxiety. I asked him to tell me this dream and gave him hope that perhaps the analysis of this might succeed in laying bare the cause of the insomnia. The substance of the dream was as follows:

"I was in a narrow gorge, formed by almost perpendicular walls of rock. This made me think of a similar narrow gorge which, during my journey, I had passed through at peril of my life. Upon a jutting rock a hundred yards high above the abyss, I saw a man and woman standing, shoulder to shoulder, both covering their eyes with their hands. They step forward and I see them plunge downwards together, and hear their bodies falling to destruction. Screaming wildly I awoke. Since that time I dare not let myself sleep for fear of the repetition of this dream.

The patient, accustomed to deadly peril on his long expedition, could not explain to himself the anxiety caused by this dream. I called Mr. X's attention to the fact that in my opinion an erotic conflict was concealed in the dream, and asked him point blank whether he had taken part in a love story. At this the patient grew deadly pale, struck

the table with his fist and said "That you should have guessed it!" Now the confession followed, how he had had a love affair in which he had not cut a good figure and which ruined a woman's life, and that afterwards he had been violently remorseful and had lived with the idea of suicide. Then he had seized upon the opportunity offered him to lead a dangerous expedition. He wanted to die and here he would not find death ingloriously.

It is clear that the two people upon the rocks above symbolized the two, who went to meet destruction.

Soon afterwards the travelers parted. A year later the newspapers contained the report of the marriage of the famous explorer. The surmise is allowable that the analysis of this dream was the cause of this fortunate solution.

As I have already pointed out, the original cathartic method of Breuer and Freud, explained to some extent, is still followed by some investigators, by Muthman, Bezzola, Frank and many others. I had the opportunity in June and July, 1912, of observing for some time the treatment of patients by Dr. Frank in Zürich at his private clinic, and of gaining for myself a satisfactory idea of his technique. Frank by no means rejects the Freudian psychoanalysis with all its helps, but uses it only when he does not succeed in hypnotizing his patient. Preferably, and in a great number of cases, he uses, in a state of hypnotism, a cathartic method he originated.

Where Breuer and Freud profited from the spontaneous or the provoked somnabulistic state of the patient, and by questioning dug up the hidden depths, Frank decided to be satisfied with a light hypnose, a state of hypotaxie, which might be termed analogous to the half-conscious state of the person who after taking a mid-day nap frequently denies having been asleep. In this condition we can give an account on waking of what happened around us. One sleeps and one does not sleep; the upper-consciousness then can control what the sub-consciousness brings up.

Frank says that, except in the peculiarity that he is satisfied with a lighter degree of hypnose, his method differs from that of Breuer and Freud in that generally he does not question the patient when under hypnotism, neither suggests.

Experience has taught him, he says, that the ideas loaded with affect, spontaneously discharge. They are the very ones which would do so in a dream, but are differentiated from the occurrences in the dream in the sense that these last enter phantastically dressed, while the first express themselves with the mental affects belonging to them, precisely as they were lived through.

Precisely as in the primitive-cathartic method, the affects pushing in here are disemburdened here, but at the same time, the connection between the existent sick-phenomena and the causes having a place here were automatically conscious to the patient. In some cases suggestion is called upon for help in order to free an affect or to direct the attention to the expected scene.

In most cases the process goes on itself, after the introduction of hypnosis. If the sleep is too deep, then the ideas are transferred into real dreams, which the patient immediately recognizes as such, or the production of scenes discontinues; the superconsciousness no longer works.

The scenes described are usually recalled by the patients, just as they were experienced by them, even when taken from the earliest youth. The reality of the events which happened in childhood, lived over again in hypnose, are substantiated as much as possible by the patient's parents or associates. He succeeds best in inducing this semi-sleep by exhorting the patient as he closes his eyes not to bother about whether he sleeps or not, but to fasten his attention upon the scenes which are about to present themselves; that is, to think himself, so to speak, into the state of someone at a moving picture show.

As an example I give a fragment of a Frankian analysis of a case of