Insomnia; and Other Disorders of Sleep

by Henry M. Lyman

“This first cigarette terminated, he prepared to make another, when we stepped up and began to interpose obstacles.... He searched vainly in his pocket for his tobacco, as we had filched it. He searched for it in another pocket, going through all his clothes until he came back to look for it in the first pocket, when his face expressed surprise. I offered him his tobacco-pouch, but he did not perceive it; I held it near his eyes, yet he still did not perceive it; even when I shook it just in front of his nose, he did not notice it. But when I placed it in contact with his hand, he seized it and completed his cigarette directly. Just as he was about to light his cigarette with one of his matches, I blew it out and offered him instead a lighted match which I held in my own hand; he did not perceive it; I brought it so close to his eyes as to singe a few lashes, yet he still did not perceive it, neither did he make the slightest motion of blinking.... The patient sees certain objects and does not perceive others; his sense of sight receives impressions from all objects in personal relation with himself through the touch, and does not receive impressions, on the contrary, from things external to him; he perceives his own match, but does not perceive mine.”

During the course of this observation the patient gave evidence that the memory of his former occupation as a professional singer had been revived. He began to hum some of the familiar airs, and then proceeded to his room in the hospital, where he carefully dressed himself as if for a public performance. “On his bed he chanced to meet with several numbers of a periodical romance, which he turned rapidly over without finding that for which he was searching.... I took one of those numbers, rolled it up, and putting it into his hand in that condition, satisfied his want by this semblance of a roll of music, for he then took his cane, and traversed the ward with a slow step, well contented. When stopped on his way, for the purpose of taking off the coat he was wearing (which had been foisted on him by one of the observers), he permitted it without offering any resistance.... At this moment the sun lit up with a bright ray a glass window that closed the lodge on the side towards the court.... This ray must have given him the impression of a footlight, for he at once placed himself before it, readjusted his toilet, opened the roll of paper which he carried in his hand, and softly hummed an air, running his eyes over the pages as he slowly turned them, and marking with his hand a measure that was perfectly rhythmical. Then he sang aloud, in a highly agreeable manner, giving his song the correct expression, a patriotic ballad to which we all listened with pleasure. This first selection terminated, he sang a second, and afterwards a third. We then saw him take out his handkerchief to wipe his face. I offered him a wine-glass of a strong mixture of vinegar and water, which he did not notice; I placed the glass under his nose without his perceiving the smell of the vinegar; I put it into his hand, and he drank it without complaining of any unpleasant sensation.”

The conclusions which may be drawn from this remarkable history have been sufficiently expressed by Dr. Mesnet[85] in the following words:

“The disturbance which these functional perversions of the nervous system bring into the course of life, extends not only to the organs of sense, and to intellectual actions properly so called, but it also sometimes awakens some instinctive excitation which surrenders the individual without any defence, and destitute of rational discernment, to the most deplorable impulses. He acts with the semblance of a freedom which he does not possess; he seems to prepare and to combine certain actions in the light of conscious volition, when he is in reality only a blind instrument, obedient to the irresistible mandates of an unconscious impulse.”

The bearing of these conclusions upon the question of the moral responsibility of the somnambulist needs no further advertisement.

The likeness of certain features of such cases to the phenomena of hypnotism is worthy of note. In this particular there is an evident likeness between the cerebral susceptibility of the ordinary dreamer, the somnambulist, and the hypnotised subject. All are alike in a condition which renders their imagination and their volition subservient to guiding sensations from without, so that their movements may be directed by the will of another. We have seen how the course of an ordinary dream may be modified by such suggestions. The history of the patient just related, illustrates the manner in which the actions of a somnambulic dreamer may be controlled by the will of a spectator. The ordinary phenomena of hypnotism exhibit the same subjection to the will of another. It is probable that a considerable part of the superior notoriety which belongs to this feature of hypnotism, is due merely to the fact that natural somnambulism is rarely made the object of such experiments and observations as are daily applied to the subjects of artificial somnambulism.

Somnambulic Life.—We come now to the last term of the series, the simplest, yet perhaps the rarest form of the affection. In this form, the patient seems perfectly awake; he is in possession of all his senses; he is capable of sustained and rational volition; he lives and behaves, in short, like any other person. But his life is divided into periods which are, so far as consciousness is concerned, completely distinct from each other. This double-consciousness may be exhibited but once in a lifetime, or it may be frequently repeated, so that the patient oscillates between the two states until it becomes doubtful which is the natural condition and which is the acquired. These states of double-consciousness are divided from each other by a more or less complete break in the chain of memory. The residual strata which, so to speak, have been deposited from the sea of events upon the floor of memory, have become broken and “faulted.” The line of rupture marks the division between the two fields of consciousness; they no longer lie in the same plane, consequently there can be little or no continuity of memory between them. The events which transpire in one state affect the mind so long as, and whenever it is in connection with the cerebral register which is fitted to that state; as soon as the connection is shifted, the mind takes cognizance of the events that are recorded upon the other portion of the register, but, for want of physical continuity between the different portions of the record, the mind cannot at once receive a continuously connected report from the entire organ of recollection. From this results a mode of life essentially similar to the life of certain epileptics who are ushered by each seizure into a state of apparently conscious activity of which they have no recollection after recovery. Thus, one of my epileptic patients, who was subject to seizures, both of the convulsive and the non-convulsive form of the disease, on one occasion left home, after a fit, and traveled a considerable distance into the country, putting up for the night at taverns and farm houses, and apparently behaving like any other respectable citizen. It was three weeks before he came to himself. On recovering his normal consciousness, the period of his wanderings was a perfect blank in his memory. Such attacks are usually of shorter duration, and are more frequently associated with hysteria; bearing to the hysterical paroxysm the same relation which they share with the epileptic fit. When the predisposing temperament exists, a great variety of excitations may serve to produce the phenomena, so that unless careful observation is employed, the truly somnambulic character of the paroxysm may easily be overlooked. Thus, the true nature of the affection was not suspected by the early attendants of the patient who became the subject of lethargic stupor, as related on [page 173]. Under the influence of powerful drugs acting upon a highly sensitive nervous organization, she became, at first, “hystericky.” She manifested great distress, complained bitterly of her sufferings, passed through the ordeal of several consultations, was subjected to a considerable surgical operation, and only ceased to appear conscious at the expiration of five weeks, when she passed into the lethargic state previously described. At the time of my first visit, just before the commencement of stupor, she walked into the room where I was waiting, greeted me with her usual affability, gave me some account of her sensations, and neither did nor said anything that could lead me to suspect that she was not in her normal frame of mind. But, with the exception of the single incident mentioned on [page 193], the entire period from the commencement of her medication to the close of the lethargic stupor was utterly blotted out of her recollection.

Macnish[86] relates a similar case of a young lady who “unexpectedly, and without any forewarning, fell into a profound sleep which continued several hours beyond the ordinary term. On waking, she was discovered to have lost every trace of acquired knowledge. Her memory was tabula rasa—all vestiges, both of words and things, were obliterated and gone. It was found necessary for her to learn everything again. She even acquired, by new efforts, the art of spelling, reading, writing, and calculating; and gradually became acquainted with the persons and objects around, like a being for the first time brought into the world. In these exercises she made considerable proficiency. But, after a few months, another fit of somnolency supervened. On rousing from it, she found herself restored to the state she was in before the first paroxysm; but was wholly ignorant of every event and occurrence that had befallen her afterward. During four years and upwards she has passed periodically from one state to the other, always after a long and sound sleep.... The former condition of her existence she now calls the Old State, and the latter the New State; and she is as unconscious of her double character as two distinct persons are of their respective natures. For example, in her old state she possesses all the original knowledge; in her new state only what she acquired since. If a lady or gentleman be introduced to her in the old state, or vice versa (and so of all other matters), to know them satisfactorily she must learn them in both states. In the old state, she possesses fine powers of penmanship, while in the new, she writes a poor, awkward hand, not having had time or means to become expert. Both the lady and her family are now capable of conducting the affair without embarrassment. By simply knowing whether she is in the old or new state, they regulate the intercourse, and govern themselves accordingly.”

Another remarkable case was reported at length by Dr. Azam, of Bordeaux.[87] The principal facts are given in a translation by Dr. J. I. Tucker in the Chicago Journal of Nervous and Mental Disease.[88] The patient was a young woman who began to exhibit the symptoms of hysteria at the age of puberty, and from that time till the present, a period of nearly thirty years, she has lived a double life, passing alternately from normal life into somnambulic life. These transitions were ushered in by a sharp pain in both temples, followed by a species of stupor, lasting about ten minutes. She would then open her eyes, apparently awake, and would remain in the condition of somnambulic life for an hour or two, when the languor and sleepiness would reappear for a few minutes, after which she would awaken in her normal state. At first these paroxysms were renewed every five or six hours; but, as she grew older, they occurred less frequently, and were greatly prolonged, until, finally, the periods of somnambulic life considerably exceeded the duration of normal life. During normal life she was hypochondriacal, hysterical, and a sufferer with neuralgia. During somnambulic life she was free from pain, lively, imaginative, and coquettish. While in this state of existence she remembered the events of her entire life—normal or otherwise; but on returning to her natural mode of life, she retained no recollection of her somnambulic periods. Memory, during normal life, was limited to anterior normal periods. As time advanced, this peculiar mode of existence became an increasing source of inconvenience and mental distress, often leading the superficial observer to suppose that she was insane.

This case differs from the others in the circumstance that the period of somnambulic life was more vigorous and healthy than the ordinary condition. This seems to suggest an explanation of the forgetfulness which marked the period of normal life. During that period the functions of the brain were depressed, so that its molecular movements could not reach the level of the field of consciousness occupied during the second period. Other observations, such as that of Sir Henry Holland,[89] who, while exhausted by fatigue, lost all recollection of the German language until he was restored by rest and food, indicate that such defects of memory depend upon a deficient nutrition of the brain substance—a condition which is undoubtedly associated with an enfeebled cerebral circulation. We may, therefore, suppose that in Dr. Azam’s case the paroxysms of somnambulic life were induced by periodical discharges of force within the brain, causing an improvement in the circulation of blood, and a corresponding gain in health and general vivacity. Such exaltation of the faculties would be perfectly consistent with an exercise of memory covering all the events of life. But, when, as in cases like that reported by Macnish, and by myself, somnambulic life is the result either of disease or simple somnambulic sleep, it is a condition in which, as in physiological sleep, the cerebral functions, taken as a whole, are depressed rather than exalted. The resulting train of ideas is developed upon a plane below the level of ordinary consciousness, and is, consequently, as easily forgotten as the dreams which are developed during sleep.