Popular Science Monthly/Volume 31/September 1887/Sleep and its Counterfeits
|SLEEP AND ITS COUNTERFEITS.|
By A. de WATTEVILLE, M. D.
THE Frenchman, whose long trance or sleep attracted extraordinary attention in the latter part of March and the beginning of April, was commonly spoken of as "the Soho sleeper"; but when we speak of a man "sleeping" for several days or weeks consecutively, it is obvious that we do not use the term in its ordinary sense. We all know by experience what sleep is, and we can not conceive ourselves as sleeping for an indefinite time. Yet it is difficult to draw a line between normal and abnormal sleep; the physiological condition merges by insensible degrees into all kinds of pathological states, known as lethargy, trance, stupor, coma. Through the usual phenomena of dreaming, we pass likewise into those of nightmare, somnambulism, hypnotism, ecstasy, and the like. Yet it is important sharply to define typical instances of these conditions, so as to avoid hopeless confusion in an already obscure field of scientific inquiry, and though we may for the sake of convenience occasionally use the term sleep in the wider sense, yet the distinction between the various states included under it must be kept present to our minds.
From the immense number of strange phenomena observed at the Salpêtrière Hospital in Paris, where this subject of hypnotism, especially in hysterical patients, has been investigated with the greatest care, and where I have had the opportunity of studying it, I shall adduce only such instances as have a direct bearing upon the case of "the Soho sleeper."
It is often possible to distinguish between a somnambulistic, a lethargic, and a cataleptic condition of the hypnotized hysterical subject; and by appropriate manipulations (all based on the theory of influencing the brain-centers by sensory impressions) to make the subject pass from one to another of these states. Supposing we have, by intently staring or by "passes," induced the lethargic state, we find that the muscles and nerves of the subject are in a state of extreme hyper-excitability. If we press through the skin with the finger, or a pencil, upon a nerve-trunk, all the muscles supplied by that nerve are instantly thrown into a state of violent contraction. This contraction, strange to say, may, if unchecked, persist not only during the whole of the period of lethargy, but may last for hours, or even days, after the patient has awoke, and does not then relax even during the interval of normal sleep. On the other hand, the rigidity immediately gives way under the influence of gentle stroking of the skin over the contracted muscles.
By catalepsy is meant a condition of suspended psychical manifestations on the part of the subject, during which the limbs exhibit no muscular or nervous hyper-excitability, but possess the singular property, while remaining flexible, of preserving indefinitely any attitude imparted to them; hence the name of "waxy flexibility" given to this condition by old writers. Unlike the rigid spasms of the lethargic muscle, the plastic fixity of the cataleptic limb can not be relaxed by friction over the skin. The aspect of the patient in the two conditions, moreover, offers striking differences, the sleep-like immobility of lethargy contrasting vividly with the petrified attitudes of catalepsy. In both conditions, however, there often is the same absolute insensibility even to the most painful stimuli. A most remarkable phenomenon may be observed in some instances: by merely opening one eye of the lethargic patient the corresponding side of the body is cataleptized. And so in the same subject these two phases of the hypnotic sleep may coexist side by side, with the fullest display of their contrasted characteristics.
The third condition, that of somnambulism, may easily be brought about by light pressure or rubbing on the top of the head. The hysterical patient then passes into a state somewhat between the lethargic and the cataleptic condition. The muscles have lost the hyper-excitability of the former state, and do not possess the plastic adaptability of the latter. Still they react abnormally to light external stimuli; if we very gently stroke or blow upon a limb, it becomes somewhat rigid. We can not then relax it by a mere touch as we can in lethargy, and, unlike catalepsy, it offers some resistance when we attempt to move it into a different attitude. Insensibility to pain may persist, but there often is in the somnambulistic phase a singular exaltation of memory and of sensorial perception, which has caused it to be called the "lucid state," and which has been described by the devotees of mesmeric delusions as "second-sight." Our readers will recognize in this description the ordinary "magnetic" or "mesmeric" sleep into which not only hysterical, but many other individuals may be more or less completely plunged by the usual "passes" of operators.
It is especially in the somnambulistic state that the astonishing phenomena of suggestion are observed. By this we mean that the patient in whom every spontaneity is in abeyance, who does not "sleep," and who yet does not move or think, can be so impressed through some sensory channel as to enter upon some definite train of ideas or movements. He is under the control of the experimenter, whose will is his will, so to speak. He is a machine ready to go, but unable to start of itself.
There are many different ways of imparting suggestions to a hypnotized subject; and as, in the other phases of hypnotism, hysterical patients present the greatest variety of manifestations, when subjected to suggestive influences. The most characteristic phenomena are those known as "muscular" suggestions. If we analyze an emotional attitude, such as that of sending kisses to a loved person, or that of threatening an enemy with the fist and outstretched arm, we notice that the whole frame takes part in the special action. The eyes dilate, the muscles of the face move, and an appropriate play of the features accompanies the leading gesture. This collaboration of several parts of the body in the production of a common effect depends upon the existence in our nervous system of certain mechanisms subservient to the function of mimetic language or physical expression. Now if in the hypnotized subject we throw a limb into such an expressive attitude, we immediately see the usual concomitants of the movement follow suit; the trunk and other limbs fall into a harmonious posture, the carriage of the head is modified likewise, and the expression assumed by the face and eyes is so perfect as to equal or surpass the best efforts of the most consummate actor. It is difficult for any one who has not witnessed the spectacle to realize the perfection of mimicry reached by the hypnotized hystero-epileptic. The cause of this phenomenon is not far to seek: the impression conveyed by the nerves from the part placed in the attitude has called into action the whole nervous mechanism presiding over the movements generally associated with this attitude. But this is not all. Duchesne has analyzed minutely the anatomy of the expression of the human face, and by means of electric currents localized in certain muscles or combinations of muscles, imitated with great success the facial play indicative of the various emotions and feelings of the mind. Now if in our subject we likewise electrically stimulate certain muscles, and artificially produce an expression of anger, or terror, or love, or disdain, the corresponding attitude is at once assumed by the neck, arms, and body generally. Those of our readers who have access to the book will find remarkable illustrations of these phenomena in Dr. Richer's beautiful work, for the accuracy of which all those who have had the opportunity of studying hypnotic manifestations in hystero-epileptics will be ready to vouch.
Whole series of muscular actions may be initiated by appealing to the so-called "muscular sense" by similar methods of suggestion. Thus, if a hanging rope is placed in the hands of the patient, she begins to climb with incredible energy and alacrity; when placed on all-fours, she runs in that position all over the room, regardless of knocks and collisions. Or, if the movements of washing with invisible soap be communicated to her hands, she will persist in the mimicry for an indefinite time. It is sometimes difficult to check an action so started except by waking the patient up, or making her pass into lethargy. The hypnotized patient therefore is much in the state of the frog, which when thrown into a pond, even after its brain has been removed, begins to swim on touching the water, aimlessly, automatically.
Sometimes a movement repeatedly executed by the operator in front of the patient will be imitated and carried out by the patient until stopped: this is a case of suggestion through the organ of sight. Or more complicated trains of movement may be initiated by presenting to the patient objects suggestive of certain actions, such as a plate and spoon, a brush and comb, and the like. The sight of a boot will start an endless repetition of putting it on, lacing and unlacing, taking it off, putting it on again, and so forth indefinitely.
The field of suggestions through the ear by means of language is boundless. Such words as "rats," "bird," "flower," wake up a train of imagery in the patient's brain which is immediately projected outward in an expressive display of appropriate gestures of aversion or desire, and corresponding movements of avoidance or capture. If in deep hypnotism, the subject is immediately wrapped up in those creations of the imagination; if slightly hypnotized only, repetition of the suggestive words is needed to neutralize the controlling influence of the senses. The ordinary phenomenon of hypnotism, the impossibility which the subject feels of escaping the prohibiting influence of a suggestion, belongs to this category. You assure him that he can not move his arm, for instance; he feels that he can, and yet he can not. The volitional current from his higher brain-centers is neutralized, as it were, by the current from other centers in which the suggestion has created a fixed idea of his own incapacity. As hypnosis becomes deeper, every trace of resistance disappears, and the fixed idea reigns supreme.
Such are the leading phenomena of hypnotism as observed in those highly sensitive subjects, the sufferers from the graver form of hysteria, or hystero-epilepsy. It would take us too far to describe the various symptoms of this form of nervous derangement, which, though comparatively common in France and among certain other nations, seems to be very rare, at least in its full development, among the Germanic races. In Dr. Richer's work, already mentioned, a full account is given of the appalling violence of the convulsive seizures and of the delirium that characterize the disease. Epidemics of hystero-epilepsy were rife in the middle ages, especially among the members of religious bodies; and even now it seems to be closely related to superstitions or mystical beliefs and practices.
Though essentially a disease of the female nervous organization, many instances are found of men suffering from more or less modified forms of hystero-epilepsy. The less striking symptoms of it, such as various forms of paralysis, loss of sensation, loss of speech (aphasia), are often sufficiently developed in male subjects to justify us in classing them in the hysterical category of nerve-sufferers.
In this category "the Soho sleeper" deserves to hold a high place, as will become manifest on reading the following condensed résumé of his history as given by Professor Charcot, in the "Progrès Médical" for March, 1886, and completed by some further details, published in recent numbers of the "British Medical Journal":
During the fifteen months that elapsed till his arrival in London, he seems several times to have gone through his usual ordeal of sleep, followed by loss of speech and paralysis of the left leg. The attack which he has just had, seems to have been excited by the emotion he experienced on being robbed of all his money (March 24th). The somnolent stage lasted about a fortnight, and was followed with the usual paralytic and aphasic condition. During his torpor his eyes were shut, and his general appearance was that of a man in a profound sleep. He did not react to the loudest sounds; but if a ray of light was cast upon the pupil the eyelids gradually opened, and the eyeballs converged toward the bright object. The results of various experiments made upon the patient in his trance-like state illustrate several of the hypnotic phenomena already described as observed in hystero-epileptic patients. His muscles presented both the hyper-excitable and the plastic peculiarities that characterize the lethargic and the cataleptic phases respectively of artificially-induced sleep, but with the difference that they both coexisted, whether the eyes were shut or opened. Certain phenomena of suggestion through the "muscular sense" could easily be elicited. For instance, a series of movements imparted to the face, arm, or leg was automatically repeated, and continued for an indefinite time. Again, on imparting to his upper extremity an attitude of menace with outstretched arm and clinched fist, his eyes (previously opened) suddenly turned toward the limb, and he assumed an expression of anger verging on ferocity. I noticed that on interposing an opaque object between the eyes and the arm, the latter speedily relaxed and fell, the eyes closed, and the patient relapsed into his accustomed slumber.
During the second week of the trance he began to obey orders repeatedly given, such as "Open your eyes," "Sit up," etc., and to answer simple questions by writing. He could be made to write anything to dictation; but whenever ordered to indite a letter, he constantly reproduced one he had written shortly before this attack.Finally, be was found to have lost sensation in the left side; and the application of magnets to the skin produced some of the alterations of feeling characteristic of hysterical hemianæsthesia. Powerful electrization, though it failed to rouse him up, induced convulsions and spasms, typical of the regular hystero-epilectic seizure.
There is thus no doubt left us as to the nature of the case of "the Soho sleeper." Among other instances of attacks of sleep in the course of hystero-epilepsy, I may mention a patient whom Professor Charcot has had under his observation for many years:
In order to illustrate further the intimate connection between certain morbid forms of sleep and the hysterical state, I shall briefly allude to the so-called "hysterogenic" and "hypnogenic" pressure-points discovered by Professors Charcot and Pitres.
A very remarkable phenomenon connected with grave hysteria is the artificial production and arrest of attacks by pressure on certain points on the surface of the body. The number and distribution of these points are very variable, and they differ in every case. They usually can only be found out by careful search, the patients themselves ignoring the existence of them.
On pressure being exerted upon one of these "hysterogenic" spots, the patient falls into a convulsive or tetanic spasm, and the various phases of the attack succeed one another much in the same order as in a spontaneous fit. Now it is a curious fact that a repetition of the pressure on the same spot, or on some other spot experimentally discovered, will often abruptly modify or arrest the attack. The great theoretical and practical importance of this singular property of certain circumscribed cutaneous areas, has directed the investigations of several careful observers, and led to the discovery of similar spots, called "hypnogenic," pressure upon which determines, not a muscular spasm or convulsion, but an attack of hypnotic sleep.
These hypnogenic areas are likewise irregular in their number and distribution; and along with them are usually found other spots, usually on the opposite side of the body, pressure upon which awakes the patient. We have here an undoubted argument in favor of the view according to which attacks of sleep in certain hystero-epileptics are mere modifications of the typical convulsive and delirious seizure.
The researches of Althaus have led him to formulate the axiom that "nervous diseases are not, as is commonly asserted, more frequent, but on the contrary less numerous, in large towns than in the country, and it is probable that their occurrence is powerfully influenced by race." He adduces a table in which the percentages of deaths from nervous diseases (as recorded in the Registrar-General's returns) for London, the southwestern counties, and Wales are 10·66, 11·20, 15·38, respectively. He has found that "Wales exceeds all English counties so strikingly in this respect that neither density of population, nor climate, nor difference of occupation will account for that circumstance." He is therefore inclined to attribute this difference to another circumstance, viz., the difference of race—a conclusion that is borne out in a certain measure by the undoubted greater prevalence of hysteroid symptoms among the Latin, and perhaps also the Slav and other Eastern races, as compared with those of Germanic origin.
It is probably in considerations of this nature that we shall find an answer to the question often asked in this country by those who do not roundly attribute all or most of the symptoms of hystero-epilepsy to shamming or exaggeration, "How is it that such cases never come to our notice?" Is it not because of those racial differences which run deep in the nervous constitution of individuals? At any rate the presence of "the Soho sleeper" among us will, let us hope, modify the somewhat insular skepticism still lurking among medical men on this side of the Channel.
The subject of prolonged sleep and trance is intimately connected with that of apparent death. Though there is no doubt that most of the dreadful tales concerning the premature burial of persons supposed to be dead have no foundation, save in the imagination of the public, we have ample proof of the possibility of such mistakes occurring in the absence of a careful examination of the body. Every one has heard of the fatal tragedy in which the greatest anatomist of his time, Vesalius, played such an unfortunate part. Being called upon, during his stay in Spain, to perform the autopsy of a patient who had died suddenly, he proceeded to open the body, when, to the horror of the bystanders, at the second sweep of the knife unmistakable signs of life were given!
It is difficult to imagine how in the case of patients subject to cataleptic seizures, and known by their friends to be so, periods of suspended animation, however protracted, could ever lead to premature burial. Pfendler, however, states, that he has known two cases in which a disastrous result was barely averted:
Catalepsy, though intimately allied to hysterical neurosis, often occurs in patients who offer no other symptoms of nervous derangement. Emotions are often the exciting cause of an attack in a cataleptic subject. Many curious instances are related by authors:
It is certain that many of the saintly women in the Roman Catholic hagiology were victims of this disease: St. Catherine of Siena, St. Elizabeth of Hungary, St. Theresa; not to speak of Joan of Arc, Madame Guyon, Marie Alacoque, and many others. Cataleptic seizures were also a common feature among the victims of the great hystero-epileptic manifestations so common in the middle ages, which we find described as "possessions" in the curious and abundant literature of the subject.
Among the sickening descriptions of the awful episodes known as "the possession of the Ursulines of Loudun," we find a graphic description of cataleptic phenomena:
Though, as already mentioned, the Latin races appear to offer a much more favorable field for the spread of nervous epidemics, we read that England has not always been free from such manifestations:
"During Wesley's sermons at Bristol," says Dr. John Chapman, in his work "On Christian Revivals, their History and Natural History," "many used to fall as if struck to the heart by the word of God. Men and women by the score were lying on the ground, insensible like dead bodies." Singular nervous accidents were likewise frequent among the American fanatics known as Shakers or Jumpers, as well as among the Irish revivalists of Ballymena.
As late as 1861, at the village of Morzine, a secluded commune in the Alps of Savoy, there occurred a curious epidemic of hysteria with all the characters of "demoniacal possession." The population of these regions is extremely neurotic and superstitious. In a short time nearly all the female population, excited by the exorcismal practices of the clergy, fell a prey to the disease, and the scenes recalled the worst days of Loudun. But at the beginning, when young girls were chiefly affected, phenomena of ecstasy, catalepsy, and somnambulism prevailed. The Government had finally to interfere, and the temporary dispersion and seclusion of the patients speedily restored their mental equilibrium, and the locality has since resumed its habitual tranquillity.
As an instance of trances of a more contemplative tendency, I shall give a short account of Louisa Lateau, of whose attacks Dr. Lefebvre has given a good description:
I will, in conclusion, venture upon a few suggestions as to the explanation of the phenomena of hypnotism and its allied states.
Our cerebral life depends upon the associated activity of innumerable nerve-cells grouped into clusters or centers, each center being more directly related with some sensory or some motor function. Thus there are visual centers, auditory centers, tactile centers, which form the terminal stations of the nerve-fibers leading from the organs of sight, hearing, and touch. There are also so-called motor centers, the nervous discharges from which, traveling down to the spinal cord, determine movements of the head, trunk, and limbs.
A network of the finest nerve-fibrils of astounding complexity brings the individual cells of each center into relationship with one another, and with the cells of the other centers. This physical association of our brain-elements is the material substratum of the psychical process of association of ideas which forms the groundwork of our intellectual life. All the higher manifestations of mind are correlatives of the harmonious co-operation of numerous brain-elements. Even what appear to be simple states of consciousness are often the result of association. Hence any disturbance in the mutual equilibrium of the cerebral centers speedily leads to alterations of those resultants of forces of which perception, thought, will, emotion, are the subjective manifestations.
One of the most striking properties of the nervous system is that by which the activity of one portion may be arrested or prevented "inhibited" by the activity of another. To give a familiar instance, the action of the respiratory centers is suddenly inhibited by certain excitations of the sensory nerves, as we have all experienced on receiving the first splash of a cold shower-bath. In the cerebral sphere, inhibition of one tract by another is the mechanism which lies at the root of the higher exercise of our faculties."When we choose, for instance, or exercise will-power, the corresponding state of our nervous organism is one involving more or less complex inhibitions. The sense of moral effort is the subjective equivalent of powerful inhibitions of brain-tracts in a state of high tension. The power of mental concentration rests likewise upon similar inhibitions. When we attend closely to a sensory impression, or to a train of thought, the excitability of every part of the brain except that actually engaged in the act is diminished by an inhibitory action of the working portion. Thus, when we say that anger or fear paralyzes, we allude in very accurate language to the inhibitory influence which powerful emotion exercises upon the other cerebral functions.
I have said that physiological sleep can be induced by certain monotonous impressions from without. The same may be said of an order of stimuli that has hitherto not received its due share of attention. I mean the afflux of those confused, mostly unfelt, impressions from the viscera and tissues generally. Under certain conditions—after a meal, for instance—these may set up, in the cerebral centers to which they converge, an excitation that leads to an inhibition of the higher brain-regions, and so to a state of sleep.
Similar considerations will assist us in explaining the effect of the usual methods of hypnotization. The stimulation of one of the cerebral sensory centers by repeated gentle and monotonous sounds or touches, or, in the case of the visual organs, by the convergence of the eyes and persistent gazing at a small object, so interferes with the activity of the higher centers as to lead to various perverted motor and mental manifestations. Certain "nervous" individuals, but above all hysterical subjects, are more amenable to these effects than are others. Repetition in all cases increases the liability to hypnotization, and in extreme cases the recollection of the processes previously used becomes sufficient to induce sleep. Finally, there are subjects, such as "the Soho sleeper," in whom, owing to the extreme instability of their cerebral equilibrium, a kind of spontaneous hypnotization may be observed.
It would be premature, in the actual state of our knowledge, to speculate upon the nature of the changes in the nervous system upon which the phenomenon of inhibition depends. It has been ingeniously compared to that of the mutual interference of two rays of light or two waves of sound. But this analogy does not account for all the facts; and in connection with this topic we may mention the views recently propounded by Professor Brown-Séquard upon what he calls nervous "dynamogeny." It is a well-known fact that under the influence of various sensorial or emotional stimuli, of moderate intensity or pleasurable quality, our nervous energy, as measured by the muscular effort we are enabled to put forth, is increased to a considerable extent. Recent researches by Dr. Féré have thrown additional light upon these "dynamogenic" or "force-producing" processes, of which the reviving effect of smelling-salts is a familiar illustration. In this instance a diffusive wave invades the whole brain from the olfactory centers, and produces such a change in its constituents as to restore its functions. It has likewise been shown that every form of mental activity is accompanied with increased nerve-power as directly measured by the squeeze of the hand on the dynamometer. It would thus seem that nervous cell-matter is liable to undergo certain modifications under the influence of various impressions derived from other nerve-regions, in virtue of which it becomes more powerful. But, without even attempting to define more closely the "dynamogenic" change, we may perhaps assume it to be the counterpart of what takes place in inhibition, and describe the latter as a nervous process in which a group of nerve-cells so acts upon another group as to lower its capacity for work.
Inhibition in one nervous sphere is often accompanied with dynamogeny in another: the removal of cerebral influence, for instance, exalts the autonomy of the spinal cord. A good instance of the co-existence of the two processes is found in "expectant attention," which depends upon the high tension of the centers involved in anticipating the phenomena, with a corresponding inertia of the others. The reader will readily perceive how similar considerations may be employed in the elucidation of such phenomena as ecstasy, suggestion, muscular hyper-excitability, and intensified perception.—Fortnightly Review.
- "Études Cliniques sur la Grande Hystérie," second edition, p. 668.