“There are two ways of testing and revealing the truth. One is to soar from the idea and the detail immediately to the general laws and to compose and expound from these all-important postulations, as from the invincible truth, the intermediate laws. This is the usual way at the present time.
“The other is to draw from the constructive and the particular ideas, to proceed gradually and steadily upwards and only at the very end, to reach the ultimate generalisation. This is the true but unused way”.
–From THE NEW ORGANON, by Bacon.
The tendency to fatigue and the power of the individual to respond to the average demands of life are generally considered to be the measure of the constitution and its susceptibility to disease; according to the same line of reasoning, the subjective sensation, “fatigue,” which, in many cases, is the expression of objective weariness and favors sleep, but which is, when excessive, detrimental to sleep, is also a measure of the constitutional peculiarity of an individual. Therefore, knowledge concerning the importance of sleep to the healthy and to the sick and to those made ill by drugs, can be a source of valuable biological information.
Sleep does not depend so much upon fatigue as upon subjective weariness. Neither physical nor psychical exhaustion and fatigue lead to a quantitatively definite measure of sleep.
For a long time, sleep has been explained as the result of a chemico-organic change in the organism. This point of view is contradicted by the fact that many individuals fall asleep quite independently of fatigue or, by means of a definite determination to awake, can interrupt sleep; that often a short sleep is more refreshing than a long one; that fatigue often directly prevents one from going to sleep; that individuals, under the same degree of physical and mental strain, need a different amount of sleep for their restoration, some five or six hours, others eight hours, etc. Moreover research in regard to so-called “sleep” induced by suggestion or hypnosis does not bear out the chemico- organic theory.
By the suggestion of wakefulness or by hypnosis, a sensation of weariness can be induced which will cause sleep quite regardless of the actual sensation of fatigue; further, under hypnosis the dose of a sleep-producing medicine can be greatly reduced, and under certain conditions, the “Hypnotic Force of Suggestion” is used instead of narcotic drugs, with complete success in cases of surgical operations. The dependence of the organism on sleep, however, must not be over-looked, for we certainly know that man and also many animals, die if subjected to a continued period of sleeplessness–a healthy man in eight days–in other words, sooner than if deprived of nourishment.
We do not know the cause of this. It is a remarkable fact that the sick can often exist without sleep for a much longer period without being seriously affected, especially is this so with hysterical patients. An interesting observation has been made in a case of a patient, addicted to the morphine habit, where the drug was entirely withheld and the patient was sleepless for twenty-three days and nights without causing death.
Observations, made upon animals and recently published by Zell, indicate that sleep is to a great extent independent of fatigue. Zells observations show, that in all probability, there are certain animals, for instance the whale, which very seldom or never sleep although they often expend themselves in severe bodily effort. The chemico-organic process which induces fatigue in man, predisposes to sleep, but sleep, itself probably an instinctive process, is directly dependent upon psychical processes. As every normal function depends upon a certain integrity of an organ or a system of organs, so does the possibility to exert the sleep-instinct or the conscious will be sleep, depend upon the condition of the organs.
If to the psychical battle for sleep is added an organic difficulty, then will the disturbance of sleep be especially intensified. Here is shown how far physical and psychical changes, induced by disease or by drug experiment, can bring about sleep or cause it to remain absent. They are able to influence the conditions necessary to sleep. According to the degree of pain, fever, dyspnoea, intestinal disturbance, spasm, etc., that they cause, will the defect in the integrity of the organism be an unfavorable condition for sleep and it will depend upon the strength of the sleep-instinct and the conscious will to sleep, as to whether this condition will be easily conquered or whether it can be conquered at all.
On the other hand, a psychical state which is unfavorable to sleep will be intensified by any disturbing symptoms, no matter how slight they may be. Furthermore, natural disease as well as that artificially produced, i.e., by drugs, will, according to its particular type, bring about in the psychical sphere an actual change in the will to sleep or the sleep-instinct, as, for instance, certain forms of affections due to the disturbance of the thyroid gland or to poisoning by alcohol or opium.
In order to gain more insight, let us collect the facts concerning the physiology and psychology of sleep.
Motor impulses are dulled or abolished in sleep, the reflexes are difficult to obtain, above all, the functions of the vegetative nervous system are restricted with the exception (according to Pawlow and Hoeber) of the activity of the glands influencing digestion. As pigeons and dogs, from which the cerebrum had been removed, have been known to sleep, it cannot be assumed that the occurrence of sleep is dependent solely upon the cerebrum. This is another fact, indicating the correctness of the assumption that an instinctive function plays a particular important role in regard to sleep.
Psychical: When an individual through habit, fatigue, or the will to sleep, etc., is ready to go to sleep, a change is noticed in his alertness. The ego divides into a sleep-ego and an ego that watches over sleep in order to protect it from disturbances as far as possible and, thus, normal unconsciousness occurs, during which, however that portion of the ego which watches over sleep takes notice of whatever is necessary to the continuation of sleep or, if it seems more desirable, to its interruption. (The mother who, although asleep, is aware of every breath drawn by her sick child.).
The miller who awakens when the sound, to which he is accustomed, ceases. This “sleep-watcher,” as Landauer calls this portion of the ego, regulates, instinctively and suitably, the demands made by a sleepers impulses and the utilization of the stimuli from his environment. The change in attention is, in other words, an alteration in the emotional behavior. This is portrayed for the most part, in dreams whose relation to the conscious and to the subconscious in the healthy and in the sick and in those poisoned by drugs, and will be given consideration in a later article.
Sleep is, therefore, a condition in which almost all of the psychical stimuli of the environment have been withdrawn. Therefore recuperation through sleep cannot, according to the foregoing, be a purely chemico-physical reaction, but must be in extremely close relation to a psychical recuperation. To produce sleep normally, as well as by means of extraordinary psychical influences (hypnosis suggestion, etc.), or with drugs one must pay attention to the changes in the manner of reaction to stimuli–to the so-called mood-changes–as they are observed in all living organisms and also in the vegetable kingdom.
Herwig in his discussion of color psychology, refers to the “reverse” of certain psycho-physical processes and points out the appearance of a negative instead of a positive mimicry with advancing age. According to him, one differentiates in biology between the “antigen,” a change in mood as the result of external influences and the “autonomen,” change in mood through adjustment from within itself. To the latter, he reckons also the reversion of the habit of mind occasionally to be noticed in old age.
He draws attention to the fact that this last condition should indeed be associated with a large circle of biological facts and produces as an illustration analogous to the reversion of mimicry, the following observation: The hypokotyl member ( the trunk portion or the internode of the germ of a plant which carries the seminal leaves and the small roots) of the germ- plant of the gourd is, in the beginning, positive geotropic; later, negative geotropic. In cases of especially strong reversion of habit of mind as in many cases of cyclothaemia, sleep in deep and prolonged during the period of melancholia as if the loss of sleep during the maniacal period was being compensated for.
With regard to the sleep of the sick, the physiological processes depend upon the type of the patients and of their disease and upon the physical processes as well as upon the psychical reaction.
Psychological observations teach us that the conscious wish to sleep and the instinctive or subconscious wish to remain awake, especially in cases of nervous insomnia, are very often antagonistic to one another. As one speaks of the will to be sick, so can one speak of the will to sleep (Steckel) and the will to insomnia. Many patients suffering from insomnia recall instances when they were at times sleepless through conscious will in order to experience certain phantasies and memory pictures, others because they were afraid of their dreams. So many sick people, do not fall asleep for the reason that they are subconsciously distressed by elementary urges and instincts that become active during their sleep, in other words, because the censorship which exists during the day enters into conflict with the wishes of the night.
Therefore we may say that sleep comes when the instinctive conquers the conscious. In many cases of illness, on account of physical debilitation and psychical fission, the subconscious is so powerful with its primeval wishes that the establishing of its mastery, as we have remarked in the case of sleeping, causes a conflict. The patient will consciously, perhaps, have the desire to fall asleep, but it is impossible for him to do so. On the other hand, another is over powered with sleep as an expression of strong suppression of conscious desires, a refusal to recognize the conflict in which his psyche is involved, an example of contrary reaction.
We are of the opinion that insomnia develops when in reality unrealizable, forbidden wishes are feared by ones conscience even during sleep; somnolence, when wishes are feared which though truly realizable are at the same time objectionable and forbidden. Conscious conflict makes rather for insomnia when it is painful to dwell upon, for somnolence, perhaps, when the conflict is associated with a pleasurable sensation. This can go so far that hysterical persons may, for years, suffer from insomnia or somnolence which will have quite the appearance of insomnia with an organic basis.
We know that in the city of Oknoe in Sweden, a young woman continued in an hysterical somnolent condition for thirty-two years (this case was described in the Nouvelle Iconographie de la Salpetriere, 1912) For the particulars of this case, see “Der Wille zum Schlaf,” Steckel. Verlag Paul Knepler, Vienna, Austria. and we conclude that this peculiar rejection of reality was the result of subconscious, suppressed psychical processes of the young woman.
It seems natural to associate the physical effect of the hysterical disturbances with the phylogenetic portion of the brain, lying deep in the cerebrum, especially with the thalamus optics whose importance with regard to sleep has been definitely established, especially through the observations made in cases of encephalitis epidemica. In this affliction, there is also sleeplessness and somnolence, likewise sleepiness during the day and wakefulness during the night, as is sometimes the case with beginning dementia paralytica. I refrain purposely, at this point, from speaking of a “sleep-center.” We know indeed that sleep automatism, similarly to the automatism of the vegetative centers, originates in the subcortex; but it is improbable that there exists a “sleep-center” in the sense of a group of brain cells, it seems more reasonable to speak rather of definite “associations” that lead to sleep.
In experiments with drugs in which an artificial illness is created, sleep disturbances are brought about in a similar way as those seen in natural illness. Certain drugs disturb the integrity of the organs, so that sleep is organically prevented. In the experiment with the poison from the Lachesis serpent, the following symptom appears: “sleepy throughout the day as well as at night; he sleeps well when the cough does not annoy him.” To be sure Lachesis has, along with the above, still other symptoms which speak for the fact that under its effect there is also an influence exerted upon the subconscious, as expressed in the symptom that has often been found in experiments and confirmed ate the bedside: “The state of mind is always worse after sleeping”.
In the first number of the commemorative addresses of the North American Academy for Homoeopathic Therapy, entitled: “Effects of Snake Poison,” Constantine Hering has gathered together numerous symptoms found during drug experiments. He relates, among many others, the following symptoms observed in healthy persons who submitted themselves to the drug tests: “It is extremely difficult for him to pay attention to others even though his sense of hearing be not diminished–the words that have just been spoken to him are as though wiped away without his noticing them himself. This happened in one who usually, even when in the greatest hurry, would not make such mistakes.Dull in the head, so that he could not remember what had happened just a short time before”.
Lachesis belongs also to that group of drugs among whose actions are to be enumerated definite disturbances in the emotions. The following well-known drugs are to be included in this list: Alcohol, cocaine, opium, morphinum, carbon monoxide, bisulphide of carbon, ergotin, lead, mercury,. We know from the materia medica at which numerous reliable research workers have labored since Hahnemann as, for instance, the Viennese under Watzke and Fleischmann and the Americans under the great drug prover, Hering, that mental symptoms were observed to quite a remarkable extent under the action of various drugs, among which can be counted numerous sleep and dream symptoms.
It is not necessary that I should present to you here the clinical picture of the different exogenous intoxication psychoses, nor the fine details making up the picture of the emotional disturbances produced by gold and lead. All these changes are comparable to the “eruption waves” (Einbruchswellen) of Schilder which project the processes of metabolism and of the internal secretions into the psychical. The toxic eruption of the physical into the personality and, on the other hand, of the psychical into the physical, shows that at bottom the physical and psychical are both functions of a common vital quality.
Not a few drugs strengthen or eliminate inhibitions, there are also those which with the sleep-wish, stand in relation to the “sleep-associations.” Others affect the regions of the senses whose somatic and psychical stimulation produces hallucinations, delirium, disorientation, vertigo, etc. Still others, as for instance, alcohol, cause, by acting upon the cortex a release of the inhibitions and a breaking through of the dormant passionate impulses.
If Bonhoeffers assumption is correct, that alcoholic hallucinations occur especially in people with a marked inherited acoustical analogue, similarly as the psychical disturbances in a case of Basedow occur almost exclusively in those of a psychopathic disposition, then we can understand certain observations made in drug experiments; for in these experiments it is shown that certain substances develop remarkable and characteristic symptoms in particular constitutions or races, for instance: Phosphorus in an asthenic constitution or sulphur in the black races.
The activation of the mechanics of delirium or of hallucinations depends therefore upon the specificity of the poison and upon the susceptibility of the individual, and most of all, upon the state in which the individual is in, when the toxic eruption takes place. We understand, therefore, why all trustworthy researchers in drug-proving lay so much stress upon the value of knowing, as accurately as possible, the previous personal and family history of the individuals who act as provers and why it is always insisted upon that the same drug should be proven upon different constitutions, various ages, etc.
The symptom-complex of paralysis, tuberculosis, tabes, etc., is dependent for part of the symptoms, even in their anatomical aspect, upon the previous physical wear and tear and upon the symptoms is dependent upon the specific action of the disease toxin; similarly in drug experiments, do the personality, the drug, and the constitution shape the symptom-complex. We know much more concerning the foregoing than we do of the bio- chemical processes in the brain or spinal cord of a sleeping man, for of these we know practically nothing.
When we speak of sleep and drug experiment, two further observations are of interest. Oppenheim observed that sleep itself can cause pains which the afflicted one never had when awake, or which he felt again later (Hypnalgien); further, the recognition of symptoms which occur in cases of long-continued insomnia: Increase in the acuteness of vision, disturbance of the alertness and the attention, and hallucinations, especially those of vision.
In drug experiments, sleep disturbances are therefore, an expression of self-defense on the part of the individual against eruptions of a toxic nature which, through their dynamic action on the subconscious as through the derangement of the integrity of the organs, call forth characteristic symptoms in different constitutions.
As in the list of physical symptoms, we recognize the point of least resistance of the organism, a certain oversensitiveness of the organs or organ systems, an inherited or acquired lack of resistance of the organs in their ontogenetic or phylogenetic development, so also does it seem that a number of earlier experiences in the subjective existence of the prover are again lived through. In the action of Baryta, for instance, a trait that reminds one of a neurotic symptom- complex is met with repeatedly. As the neurotic decides, when he cannot avoid a conflict, to pursue the way of regression and finds his relief by withdrawing into one of the stages of his development that has already been established, so it appears that under the influence of Baryta, the toxic eruption has its greatest effect on the personality in a regressive sense.
In Baryta provers, one notices among many other symptoms the following: “Great mental and bodily weakness, childish department, shy before others, she imagines that strangers are laughing at her or are criticising her, therefore she is so timorous that she does not want to look up”.
Remedies for inducing sleep, outside of the hypnotics and the narcotics which induce a narcosis or a sleep that is not normal (at the most, they only prepare the way for a true sleep), are all those drugs and measures which influence the organism in the sense of organ integrity or in the sense of carrying through the will to sleep. Therefore, hypnotics and narcotics should only be thought of when a patient is so disturbed mentally that he becomes dangerous to himself or to the environment and must, for this reason, be quieted for the time being; or when all other measures have proven useless and the life and health of the patient are more endangered through the lack of sleep than through the hypnotic remedy.
The danger of not using soporifics conscientiously lies, on the one hand, in the psychical injury to the patient who through the artificial dulling will, fundamentally, becomes still more restless, and, on the other hand in the physical injury. Substances foreign to the system cause, as a reaction the formation of antagonistic substances. Weigert was able to demonstrate quite generally that the reaction was always longer and more severe than the stimulation. “Antagonistic substances” in a chemical sense are also often antagonistic in a functional sense as well. Experience shows, moreover, the after the torporific effect, an intensified reaction of excitement sets in.
With regard to somnolence or insomnia, one must decide in individual cases whether the shortest way to relief is through the use of drugs or by means of psychical treatment. It is indeed striking how a patient will exclaim in regard to a drug or some other measure that has been peculiarly suited to his case: “That must have been a strong sleep remedy! I have not slept so well for a long time.” It was in this connection that Samuel Hahnemann, with his inspired appreciation of the psycho-physical working of the organism, showed the selective action of drugs by giving special emphasis to the mental state of his prover or patient as the guiding symptom for the selection of the remedy, and, more than a hundred years ago, pointed out the fact that, under certain premises, every drug–regardless of any suggestive effect in its administration–can serve as a sleep-producing remedy; this effect, in certain cases, can be interpreted as a dynamic action on the subconscious processes.
In most cases of disordered sleep caused by a disturbed psyche, either the drug is insufficient, or the improved sleep conditions which it inaugurated are constantly being annulled through the urge exercised by repressed psychical activities upon the physical system. This indicates that we must bring order into the psychical life of the patient. According to an old adage: “A clear conscience makes a good nights rest.” This homely wisdom coincides with the interpretation of the modern psychology of sleep as being as thymogenic process, the mechanics of which were revealed especially through the research of Liebault, Bernheim, Kraft-Ebing, Vogt and Forel, that psychology which was so brilliantly broadened and developed by Sigmund Freud, the creator of psychoanalysis as a method of research and healing.