THE
JOURNAL OF
PSYCHOLOGICAL MEDICINE AND
MENTAL PATHOLOGY.
r Art. I.?NIGHTMARE AND DREAMING. BY J. M.
WINN, H.D., H.R.C.P., &c.
Nightmare and
dreaming are so closely entangled, that it is their phenomena apart. It is the subject study impossible of nightmare to which I would especially direct attention. Having been myself a martyr to this distressing complaint, I have been in the habit, during a period of twelve years, of making notes of my mental state and physical condition before and during the attacks, in the hope of throwing some light on its origin, and thereby leading to the discovery of some means for preventing or mitigating the horrors of an affection to which we are all more or less liable. I have also preserved some memoranda relative to dreams unattended with nightmare, thinking they might perhaps afford some slight clue towards the solution of some of the most difficult questions in psychology and physiology. Recent writers on the practice of physic, in this country, have all but tabooed the subject of nightmare?on which the old authors were so fond of expatiating?as if prompted by the desire to consign a matter so obscure to the limbo of the incomprehensible, the inexplicable, and the irremediable. I find no mention of it in the works on medicine by Sir Thomas Watson, or Drs. Reynolds, Aitken, and F. Roberts; and the late Sir Henry " Holland, in his eloquent article on Sleep and Dreams," which in the Edinburgh Review, in 1873, and originally appeared was subsequently published by his son, among Sir Henry's fragmentary papers, dismisses the subject of nightmare with a very few words. He merely observes that nightmare is a familiar example of the troublous sensations, and troubled dreams which to
PART II.
VOL. II.?NEW SERIES.
N
2
186 are
NIGHTMARE AND DREAMING. so
often the effect of the
ceding day.
But the
undigested
dinner of the pre-
of any matter is no excuse for ignoring of the most interesting problems in physiology and pathology might at once be abandoned. For example, how little is known of the nature of epilepsy! and yet there is no disease that at the present time is receiving more scientific attention. Dr. John Bond, who published an essay on "Incubus, or Nightmare," in 1753, and who appears, like myself, to have had his attention drawn to it by his own sufferings, makes the following remark: " Being much afflicted with nightmare, self-preservaIn consulting tion made me particularly inquisitive about it. ancient physicians I found little information except dreadful " prognostics." McNish, in his interesting work on the Philoin a of 1830, gives Sleep," published graphic descripsophy tion of the horrors of nightmare as experienced by himself: u Imagination cannot conceive the horrors it gives rise to, nor They are a language describe them in adequate terms hundred times more frightful than the visions conjured up by The whole mind during the necromancy or diablerie to a is worked up pitch of unutterable despair." paroxysm Shakspeare, in "Richard III.," describes troubled dreams in language which is equally applicable to nightmare:
it; if it
obscurity
were,
some
I have pass'd a miserable night, So full of fearful dreams, of ugly sights, That, as I am a Christian faithful man, I would not spend another such a night, Though't were to buy a world of happy So full of dismal terror was the time.
O,
days:
The Greek writers are among the earliest who have left us any account of nightmare. They termed it Epliialtes (from sQaXXopxi, to leap upon). The Romans gave it the name of Incubus, from the notion that it was accompanied by a sensation of external pressure. According to Bosworth, mara is an old Saxon word, signifying nightmare; and Shakspeare, in " " Henry IV.," makes Dame Quickly say, I'll ride you like the mare." In this country it was formerly called by the peasantry witch-riding, and in France it was termed coque-mare. Many of the old writers believed it to be a fairy. ncubus (from incubo, I sit upon) appears to me to be a misnomer. Nightmare is a nervous disease, sui generis, and in the worst attacks that I have myself had there was no sense
NIGHTMARE
AND
187
DREAMING.
on the chest so generally complained of: it was vague, supernatural horror and dread. Until more is known of its pathology, perhaps night-terror would be a more appropriate term. Real nightmare must not be confounded with the troubled dreams which are caused by the stomach being oppressed by undigested food. The symptoms of nightmare are variously described by different writers. McNish considers the essential features of it to be an active state of the memory and imagination, an impaired condition of the respiratory functions, and a torpor of the power of volition. Many writers refer it to some disorder of the organs of respiration. The late Dr. Hodgkin, who suffered acutely from it, published in the British Medical Journal, for May 16, 1863, an account of his own experience, and gave a description of his feelings. It appeared to him that the voluntary movements of respiration were suspended, whilst On at the same time the chest seemed passively to collapse. making a strong effort to breathe at the moment of waking, he found that the diaphragm would not descend. He also observed, as I have myself done, what is in opposition to the commonly received opinion, that there was no material derangeThe only other symptom ment of the heart or circulation. he records is, occasionally a sensation of pricking, as from pins and needles, in the lower extremities. He gives no analysis of his mental state during the attacks. I will now select from my memoranda of 112 attacks some of the most noteworthy instances of nightmare in my own individual experience. My attacks have been of various degrees of intensity and duration?some slight and transient, others protracted and agonising. On two occasions they Were accompanied by an intolerable feeling, which I can only describe as that of dying, and I felt that if no one came to rouse me I
of that
weight
chiefly
a
must inevitably expire. 1. This is the first attack I have recorded, and was one of the two aggravated instances to which I have alluded. It was No physical marked by an inexpressible sensation of dying. cause could be assigned for the attack, but at that time I had
great
mental
anxiety.
was preceded by some palpitation of the heart and tinnitus aurium. 3. The accompanying dream was singular ; I was conscious of being in my bedroom, and saw everything in it as if I had
2. This attack
been awake. 4. A severe attack ; no palpitation of the heart. 5. This attack occurred after severe bodily ascending a mountain in Switzerland.
fatigue,
in
188
NIGHTMARE AND DREAMING.
6. Knew in my sleep that it was nightmare from which I suffering, and longed for some one to rouse me. 7. Again I was conscious of being under the influence of nightmare, and I experienced dread without cause. 8. Marked by inability to expand the lungs. 9. Very bad attack. I had gone to bed in good bodily health. The chief feature of the dream was a fear lest I should not be roused out of my sleep, as I was accustomed to be. 10. Preceded by neuralgic pains, probably of gouty origin. 11. Occurred about 1 a.m., at a time when I was in anxious attendance on a friend who was dangerously ill. I screamed so loudly during the paroxysm that the person in the In the mornhouse came to my bedroom to enquire after me. ing I had no recollection of screaming, or of having had a nightwas
mare.
12. Went to bed in apparently good health. Lying on my back when the attack came on. Sensation, simply the consciousness of being in a nightmare. It was protracted from there being no one at hand to rouse me. 13. Twice in one night, after slight stomach derange-
ment. 14.
Very bad?after anxiety ; followed by palpitation of the heart. 15. Marked by feelings of great exhaustion and inability A thunderstorm occurred the same night. to articulate. 16. Felt as if I should never pull through. After great anxiety.
After neuralgic 17. Twice in one night. 18. Three times in one night. 19. Knew in my sleep that I was
mare, and that I should be able to a
deep inspiration. 20. A sharp attack
get
pain
of
leg.
under a nightrid of it if I could draw
labouring
whilst sleeping in a cramped position armchair. 21. I overcame an incipient nightmare by force of will, being conscious that a paroxysm was coming on. I was aware in my sleep that I was dreaming. 22. This was one of the two terrible attacks to which I have referred, and was similar to the first on my list. It came on, after a comparatively long interval of freedom from any acute attack. I was lying on my right side, and I thought I should never recover the power of volition, and that if relief did not come I should not live another second. After waking I turned on my back and had scarcely fallen asleep when I had another short, sharp attack, and screamed so loudly that I heard my own screams. I had gone to bed in good health, though in
an
NIGHTMARE
I had
previously
had
some
AND
DREAMING.
anxiety
and
189
slight dyspeptic
symptoms.
In these brief sketches I have not thought it necessary to give the details of the dreams which have generally accompanied my attacks of nightmare. They mostly had reference to some unseen agent on the point of attacking me, whom I was powerless to resist, and of late years have been mostly limited to a consciousness that I was suffering from nightmare, and are remarkable because they have been free from frightful spectra, though sometimes associated with a vague dread of something supernatural. Is it possible that as we get older the imagination becomes less vivid, so that even our dreams
If this be so, it must be inferred that realistic ? life is not the most favourable period for studying the In endeavouring to intricate phenomena of nightmare. shall I them, chiefly be-guided by my own experience ; analyse for nightmare and dreams are both so entirely subjective that it is only through the individual consciousness that we can become cognisant of them. Moreover, it is to the members of the medical profession, who, like myself, are victims to nightmare, that we must look for reliable accounts of the malady, for we cannot expect that the vague reports of those who are unaccustomed to physiological and psychological observations will help to solve an obscure and difficult problem. In investigating a subject so overrun with error and superstition as that of nightmare, the first step is to endeavour to separate the true from the false, so as to circumscribe the field of enquiry. If we can ascertain what it is not, it may help us to the knowledge of what it is; and if my remarks do no more than this, my labours may not be wholly in vain. The generally received opinion that nightmare is simply a sensation of weight on the chest, and that it consists essentially are
more
early
in
an
arrest of respiration, is, as far as my experience extends, That the voluntary power over the respiratory
erroneous.
muscles is often momentarily suspended is no doubt correct; but it is not only the power over these muscles that is affected, but also that which extends over all the voluntary muscles. In only two instances of my attacks, as I have before stated, were the respiratory symptoms so prominent as to induce me to make note of them. In one it did appear to me that if I could only respire I should recover ; in the other, I felt that incapacity to inflate the lungs to which Dr. Hodgkin has referred. It is a common mistake to suppose that lying on the back is a fertile source of nightmare. From repeated observations I feel quite convinced that the posture of the body has little I have had attacks whilst lying on either side, to do with it.
190
NIGHTMARE AND DREAMING.
as I have noted, I had a paroxysm whilst chair. sleeping Some writers allude to its being accompanied by disorder of the circulation, marked by great palpitation of the heart. On carefully examining the state of my pulse immediately after attacks 1 have as a rule found it very little affected, although I have in a few instances experienced a slight palpitation. With regard to the influence of an overloaded stomach in producing nightmare, whilst admitting that it may be an exciting cause in some persons, I cannot recall in my own experience a single instance in which I could attribute it to any irregularity as to diet; quite the reverse. I can recollect attacks coming on at times when I have eaten very slight meals, and consequently was, perhaps, in want of food. Spasm of the diaphragm has been supposed to be the exciting cause of the symptoms of nightmare; but no sufficient reason has been assigned for this notion, and I never suspected it in my own case. Some writers have surmised that angina pectoris, asthma, It is well known that and hydrothorax produced nightmare. these affections give rise to horrible dreams, such as falling off precipices, etc., but these must not be confounded with the peculiar nervous disease under consideration. Boerhaave thought that nightmare was a precursor of apoplexy ; if it were so, apoplexy would be far more frequent
and
on one
in
than
we
occasion,
a
find it to be.
the years when my sufferings were the most severe, it seemed to me that the attacks had somewhat
Formerly, during
of a periodical character, occurring on an average once or twice month ; longer observation, however, convinced me that it was not so, although they showed some approximation to regularity. Dr. Hammond mentions a remittent case which was benefited a
by quinine.
one time it occurred to me that a predisposition to gout own case have some relation to in my nightmare, as I have might frequently experienced neuralgic pains which I have suspected to have a gouty origin; but, on the other hand, I have never had a fit of gout, and my health has been exceptionally good, having never been confined to bed by illness for a single day since I was a child. If, then, nightmare cannot be traced to any of these causes, what are the chief agents concerned in producing it ? I am induced to think, from my individual experience, that the causes are mainly of a psychological character. In so many instances have I suffered from nightmare when under great mental anxiety, that I am drawn to the conclusion that that state of mind is
At
NIGHTMARE
more
likely
to be
a
AND
predisposing
DREAMING.
cause
191
than any of those that
The late Dr. Elliotson suggested that have been enumerated. the seat of nightmare was in the brain. The fact that literary
of a nervous temperament, and those undergoing mental strain, are prone to it, favours this opinion. And now comes the vexed question,?What is the nature of this mysterious and fearful disease, which often attacks people apparently in good health suddenly, and, like a thief, in the dead of night ? What are the mental and physical conditions on which depends a disease so terrible as to be, as Dr. Bond describes " " of a boon, " is it, such a source of misery that sleep, instead " ? This question a source of inexpressible dread and suffering is more easily asked than answered; nevertheless, a careful analysis of the symptoms during a paroxysm may help in some degree towards its solution. The symptoms generally complained of and described by those who have been the victims of nightmare are inability to move, articulate, or respire, accompanied by a sensation of weight on the chest, by screams, or indistinct sounds; some also have a feeling of numbness; and, in my own case, twitching of the muscles of the lower limbs (of which I was unconscious) and faint moanings have been observed for two or three minutes by a watchful friend, before the misery has come to an agonising crisis. The mental symptoms detailed by authors are as varied as the dreams which accompany the malady, and often refer to some horrible monster sitting on the chest, visions of robbers or assassins, etc., etc. As regards myself, of late years, as I have already stated, the horrible dread has been unattended by spectra, but associated with a vague fear of something supernatural. Sometimes I have simply had a distressing feeling of being in a nightmare, as if, after a countless number of attacks, my mind had become so familiar with its phenomena that my consciousness recognised them as being the symptoms of a coming attack as readily as if I had been awake, and
men, those
accepted
them
as
such.
The most intolerable of ail the symptoms that I have experienced is that which I have mentioned as a horrible feeling of dying, in conjunction with the sense of utter helplessness. There is no physical pain, but a conviction that if not speedily roused I must expire. The only explanation of the phenomena of nightmare that I can venture to offer is, of course, entirely hypothetical. Is it possible that from some abnormal condition during sleep the motor ganglia have temporarily ceased to supply the nerve force necessary for the due performance of the voluntary moveIs not this notion more conceivable than the generally ments ?
192
NIGHTMARE
AND
DREAMING.
that the will* is in abeyance, and entirely voluntary muscles which are ordinarily under its control. I have felt, during these attacks, that I bad the will, but not the power to shake off the death-like torpor. The fact, also, that I distinctly recollect having, on one occasion, overcome a nightmare in my sleep by sheer force of will, supports the theory. If sleep be, as is commonly supposed, a state of inaction, or rest of the organs of sense and motion, either partial (as in somnambulism) or entire (as in deep sleep), it is reasonable to infer that, in nightmare, the sleep of those organs actively engaged in communicating nerve force to the voluntary muscles has become so profound that they do not respond to the prompting of the will. As soon, however, as the motor ganglia become aroused by the waking state, the nerve force is sent along the motor tracts, and the nightmare spell is broken. May not the nightmare agony be a provision of nature to awaken the sleeper, and thus provide for the due performance of the muscular movements, both voluntary and involuntary, which, if not restored, would cause death by apnoea. Dr. Hodgkin thought that, in his own case, the paroxysm of nightmare sometimes continued after he was awake. In this I think he may have been mistaken : perhaps he had a dream so vivid as to lead him to imagine himself awake; for I have myself frequently noticed that my nightmare dreams have had an extraordinary appearance of reality. I have dreamt that I was lying in the very bed in which I was really sleeping, and that I saw everything in my bedroom exactly as if I had been awake. It is much to be desired that some medical man should have the opportunity of watching some one under the influence of nightmare, in order to ascertain whether the circulation and respiration are materially affected or not; such observation would greatly assist the enquiry into the nature and cause of the disease. Dr. Hodgkin felt so convinced of the gravity of the symptoms of nightmare, from his own experience, that he thought it probable that many persons died during the paroxysm. I think differently, for, as I remarked before, I look upon it rather as an effort of nature to restore the equilibrium of the nerve force. I have little to offer in the way of treatment; all remedies hitherto suggested have been found of little avail. The main object is to cut short the paroxysm, and this may be done by a
received
separated
opinion
from those
* Some of the materialistic physiologists -who confound mind and brain, and who, with all their contempt for metaphysics, make use of metaphysical terms in an unphilosophical manner, attempt to reason away the idea of a Will; but while consciousness lasts, it is impossible to divest ourselves of the conviction that we have a Will, call it by what name we may.
193
NIGHTMARE AND DREAMING.
companion who is a light sleeper, quick to detect the of an attack, and prompt to rouse the sleeper by shakI am convinced that by this means I have been saved protracted misery. watchful
approach ing him.
subject of dreaming is so closely blended with that of nightmare that a few remarks on the former may not be out of place. Eecent writers on dreaming?I refer to the modern materialistic school?have fallen into the error of losing sight of its psychical aspect. They confound mind and brain, and imagine that all the phenomena of dreaming are the result of physical changes in the nervous system. In dreaming, consciousness and memory are not lost; the emotions and imagination are in full force ; whilst judgment and comparison are in abeyance. It is, I think, a mistake, as I have previously observed, to suppose that the will is absent during sleep. Dr. Hammond says that volition or will is entirely suspended during sleep. Dugald Stewart, on the other side, states it as his opinion that the efforts we are conscious of making in our sleep, proves the contrary. The chief feature of dreaming, as in incoherent insanity, is a want of controlling power over the thoughts, and an inability to perceive the incongruity of the hallucinations conjured up by the imagination. The most incongruous dream I ever had, was that I was Charles I. on the way to execution; but the strangest of all dreams is that of McNish, who dreamt that he was riding on The
his
own
back.
It has been noticed that at
we are
not startled in
our
dreams
the friends who have been
long dead still alive ; but there is a still more extraordinary psychological fact of my own experience, that I never by any chance dream of departed friends as dead, the circumstance of their decease being utterly seeing
obliterated from my memory. The most obscure problem connected with sleep and dreaming, and the one respecting which there are such conflicting opinions, is that which relates to the state of the mind in what is called dreamless sleep. Some assert that at such times the mind is a perfect blank ; others, as it appears to me, with more probability, that the profoundest sleep is not unattended with dreams, though sometimes they are as utterly forgotten as if they had never occurred. Sir William Hamilton entertained the latter opinion. Sir Henry Holland, whose elaborate and brilliant paper on " Sleep " and Dreams has been already referred to, leans to the former and materialistic view of this question. He observes that there
194
NIGHTMARE AND DREAMING.
" may be times in which there is a complete absence of images and trains of thought;" in other words, dreamless sleep. This is unexpected and contradictory, as the general tone of his writings would lead us to infer that he recognises an immaterial principle ; and he says in the same article, referring to dreams, that " no less a problem than the intimate nature of the human soul is concerned in the phenomena." It would almost seem as if Sir Henry, in spite of his characteristic caution, had allowed himself to be somewhat influenced by the scientific materialism of the present day. For a long period I have been in the habit of observing that if I am suddenly roused up just as I am falling off to sleep, I never can recover the train of thought which occupied my mind in the transition state. I have often tried in vain.. If, then, it is so difficult to recall the ideas of the semiwaking state, is it not probable, a fortiori, that we should utterly forget the images and trains of thought carried on in deep sleep ? In attempting to unravel the mysteries of dreaming, we find ourselves face to face with some of the most difficult and profound problems of mental philosophy, and as yet we have discovered little more than the fact that while the bodily organs are in a state of repose, the mind, as in a reverie, is left to wander, fancy free, amongst the images and memories of the past.
JOURNAL OF
PSYCHOLOGICAL MEDICINE AND
MENTAL PATHOLOGY.
r Art. I.?NIGHTMARE AND DREAMING. BY J. M.
WINN, H.D., H.R.C.P., &c.
Nightmare and
dreaming are so closely entangled, that it is their phenomena apart. It is the subject study impossible of nightmare to which I would especially direct attention. Having been myself a martyr to this distressing complaint, I have been in the habit, during a period of twelve years, of making notes of my mental state and physical condition before and during the attacks, in the hope of throwing some light on its origin, and thereby leading to the discovery of some means for preventing or mitigating the horrors of an affection to which we are all more or less liable. I have also preserved some memoranda relative to dreams unattended with nightmare, thinking they might perhaps afford some slight clue towards the solution of some of the most difficult questions in psychology and physiology. Recent writers on the practice of physic, in this country, have all but tabooed the subject of nightmare?on which the old authors were so fond of expatiating?as if prompted by the desire to consign a matter so obscure to the limbo of the incomprehensible, the inexplicable, and the irremediable. I find no mention of it in the works on medicine by Sir Thomas Watson, or Drs. Reynolds, Aitken, and F. Roberts; and the late Sir Henry " Holland, in his eloquent article on Sleep and Dreams," which in the Edinburgh Review, in 1873, and originally appeared was subsequently published by his son, among Sir Henry's fragmentary papers, dismisses the subject of nightmare with a very few words. He merely observes that nightmare is a familiar example of the troublous sensations, and troubled dreams which to
PART II.
VOL. II.?NEW SERIES.
N
2
186 are
NIGHTMARE AND DREAMING. so
often the effect of the
ceding day.
But the
undigested
dinner of the pre-
of any matter is no excuse for ignoring of the most interesting problems in physiology and pathology might at once be abandoned. For example, how little is known of the nature of epilepsy! and yet there is no disease that at the present time is receiving more scientific attention. Dr. John Bond, who published an essay on "Incubus, or Nightmare," in 1753, and who appears, like myself, to have had his attention drawn to it by his own sufferings, makes the following remark: " Being much afflicted with nightmare, self-preservaIn consulting tion made me particularly inquisitive about it. ancient physicians I found little information except dreadful " prognostics." McNish, in his interesting work on the Philoin a of 1830, gives Sleep," published graphic descripsophy tion of the horrors of nightmare as experienced by himself: u Imagination cannot conceive the horrors it gives rise to, nor They are a language describe them in adequate terms hundred times more frightful than the visions conjured up by The whole mind during the necromancy or diablerie to a is worked up pitch of unutterable despair." paroxysm Shakspeare, in "Richard III.," describes troubled dreams in language which is equally applicable to nightmare:
it; if it
obscurity
were,
some
I have pass'd a miserable night, So full of fearful dreams, of ugly sights, That, as I am a Christian faithful man, I would not spend another such a night, Though't were to buy a world of happy So full of dismal terror was the time.
O,
days:
The Greek writers are among the earliest who have left us any account of nightmare. They termed it Epliialtes (from sQaXXopxi, to leap upon). The Romans gave it the name of Incubus, from the notion that it was accompanied by a sensation of external pressure. According to Bosworth, mara is an old Saxon word, signifying nightmare; and Shakspeare, in " " Henry IV.," makes Dame Quickly say, I'll ride you like the mare." In this country it was formerly called by the peasantry witch-riding, and in France it was termed coque-mare. Many of the old writers believed it to be a fairy. ncubus (from incubo, I sit upon) appears to me to be a misnomer. Nightmare is a nervous disease, sui generis, and in the worst attacks that I have myself had there was no sense
NIGHTMARE
AND
187
DREAMING.
on the chest so generally complained of: it was vague, supernatural horror and dread. Until more is known of its pathology, perhaps night-terror would be a more appropriate term. Real nightmare must not be confounded with the troubled dreams which are caused by the stomach being oppressed by undigested food. The symptoms of nightmare are variously described by different writers. McNish considers the essential features of it to be an active state of the memory and imagination, an impaired condition of the respiratory functions, and a torpor of the power of volition. Many writers refer it to some disorder of the organs of respiration. The late Dr. Hodgkin, who suffered acutely from it, published in the British Medical Journal, for May 16, 1863, an account of his own experience, and gave a description of his feelings. It appeared to him that the voluntary movements of respiration were suspended, whilst On at the same time the chest seemed passively to collapse. making a strong effort to breathe at the moment of waking, he found that the diaphragm would not descend. He also observed, as I have myself done, what is in opposition to the commonly received opinion, that there was no material derangeThe only other symptom ment of the heart or circulation. he records is, occasionally a sensation of pricking, as from pins and needles, in the lower extremities. He gives no analysis of his mental state during the attacks. I will now select from my memoranda of 112 attacks some of the most noteworthy instances of nightmare in my own individual experience. My attacks have been of various degrees of intensity and duration?some slight and transient, others protracted and agonising. On two occasions they Were accompanied by an intolerable feeling, which I can only describe as that of dying, and I felt that if no one came to rouse me I
of that
weight
chiefly
a
must inevitably expire. 1. This is the first attack I have recorded, and was one of the two aggravated instances to which I have alluded. It was No physical marked by an inexpressible sensation of dying. cause could be assigned for the attack, but at that time I had
great
mental
anxiety.
was preceded by some palpitation of the heart and tinnitus aurium. 3. The accompanying dream was singular ; I was conscious of being in my bedroom, and saw everything in it as if I had
2. This attack
been awake. 4. A severe attack ; no palpitation of the heart. 5. This attack occurred after severe bodily ascending a mountain in Switzerland.
fatigue,
in
188
NIGHTMARE AND DREAMING.
6. Knew in my sleep that it was nightmare from which I suffering, and longed for some one to rouse me. 7. Again I was conscious of being under the influence of nightmare, and I experienced dread without cause. 8. Marked by inability to expand the lungs. 9. Very bad attack. I had gone to bed in good bodily health. The chief feature of the dream was a fear lest I should not be roused out of my sleep, as I was accustomed to be. 10. Preceded by neuralgic pains, probably of gouty origin. 11. Occurred about 1 a.m., at a time when I was in anxious attendance on a friend who was dangerously ill. I screamed so loudly during the paroxysm that the person in the In the mornhouse came to my bedroom to enquire after me. ing I had no recollection of screaming, or of having had a nightwas
mare.
12. Went to bed in apparently good health. Lying on my back when the attack came on. Sensation, simply the consciousness of being in a nightmare. It was protracted from there being no one at hand to rouse me. 13. Twice in one night, after slight stomach derange-
ment. 14.
Very bad?after anxiety ; followed by palpitation of the heart. 15. Marked by feelings of great exhaustion and inability A thunderstorm occurred the same night. to articulate. 16. Felt as if I should never pull through. After great anxiety.
After neuralgic 17. Twice in one night. 18. Three times in one night. 19. Knew in my sleep that I was
mare, and that I should be able to a
deep inspiration. 20. A sharp attack
get
pain
of
leg.
under a nightrid of it if I could draw
labouring
whilst sleeping in a cramped position armchair. 21. I overcame an incipient nightmare by force of will, being conscious that a paroxysm was coming on. I was aware in my sleep that I was dreaming. 22. This was one of the two terrible attacks to which I have referred, and was similar to the first on my list. It came on, after a comparatively long interval of freedom from any acute attack. I was lying on my right side, and I thought I should never recover the power of volition, and that if relief did not come I should not live another second. After waking I turned on my back and had scarcely fallen asleep when I had another short, sharp attack, and screamed so loudly that I heard my own screams. I had gone to bed in good health, though in
an
NIGHTMARE
I had
previously
had
some
AND
DREAMING.
anxiety
and
189
slight dyspeptic
symptoms.
In these brief sketches I have not thought it necessary to give the details of the dreams which have generally accompanied my attacks of nightmare. They mostly had reference to some unseen agent on the point of attacking me, whom I was powerless to resist, and of late years have been mostly limited to a consciousness that I was suffering from nightmare, and are remarkable because they have been free from frightful spectra, though sometimes associated with a vague dread of something supernatural. Is it possible that as we get older the imagination becomes less vivid, so that even our dreams
If this be so, it must be inferred that realistic ? life is not the most favourable period for studying the In endeavouring to intricate phenomena of nightmare. shall I them, chiefly be-guided by my own experience ; analyse for nightmare and dreams are both so entirely subjective that it is only through the individual consciousness that we can become cognisant of them. Moreover, it is to the members of the medical profession, who, like myself, are victims to nightmare, that we must look for reliable accounts of the malady, for we cannot expect that the vague reports of those who are unaccustomed to physiological and psychological observations will help to solve an obscure and difficult problem. In investigating a subject so overrun with error and superstition as that of nightmare, the first step is to endeavour to separate the true from the false, so as to circumscribe the field of enquiry. If we can ascertain what it is not, it may help us to the knowledge of what it is; and if my remarks do no more than this, my labours may not be wholly in vain. The generally received opinion that nightmare is simply a sensation of weight on the chest, and that it consists essentially are
more
early
in
an
arrest of respiration, is, as far as my experience extends, That the voluntary power over the respiratory
erroneous.
muscles is often momentarily suspended is no doubt correct; but it is not only the power over these muscles that is affected, but also that which extends over all the voluntary muscles. In only two instances of my attacks, as I have before stated, were the respiratory symptoms so prominent as to induce me to make note of them. In one it did appear to me that if I could only respire I should recover ; in the other, I felt that incapacity to inflate the lungs to which Dr. Hodgkin has referred. It is a common mistake to suppose that lying on the back is a fertile source of nightmare. From repeated observations I feel quite convinced that the posture of the body has little I have had attacks whilst lying on either side, to do with it.
190
NIGHTMARE AND DREAMING.
as I have noted, I had a paroxysm whilst chair. sleeping Some writers allude to its being accompanied by disorder of the circulation, marked by great palpitation of the heart. On carefully examining the state of my pulse immediately after attacks 1 have as a rule found it very little affected, although I have in a few instances experienced a slight palpitation. With regard to the influence of an overloaded stomach in producing nightmare, whilst admitting that it may be an exciting cause in some persons, I cannot recall in my own experience a single instance in which I could attribute it to any irregularity as to diet; quite the reverse. I can recollect attacks coming on at times when I have eaten very slight meals, and consequently was, perhaps, in want of food. Spasm of the diaphragm has been supposed to be the exciting cause of the symptoms of nightmare; but no sufficient reason has been assigned for this notion, and I never suspected it in my own case. Some writers have surmised that angina pectoris, asthma, It is well known that and hydrothorax produced nightmare. these affections give rise to horrible dreams, such as falling off precipices, etc., but these must not be confounded with the peculiar nervous disease under consideration. Boerhaave thought that nightmare was a precursor of apoplexy ; if it were so, apoplexy would be far more frequent
and
on one
in
than
we
occasion,
a
find it to be.
the years when my sufferings were the most severe, it seemed to me that the attacks had somewhat
Formerly, during
of a periodical character, occurring on an average once or twice month ; longer observation, however, convinced me that it was not so, although they showed some approximation to regularity. Dr. Hammond mentions a remittent case which was benefited a
by quinine.
one time it occurred to me that a predisposition to gout own case have some relation to in my nightmare, as I have might frequently experienced neuralgic pains which I have suspected to have a gouty origin; but, on the other hand, I have never had a fit of gout, and my health has been exceptionally good, having never been confined to bed by illness for a single day since I was a child. If, then, nightmare cannot be traced to any of these causes, what are the chief agents concerned in producing it ? I am induced to think, from my individual experience, that the causes are mainly of a psychological character. In so many instances have I suffered from nightmare when under great mental anxiety, that I am drawn to the conclusion that that state of mind is
At
NIGHTMARE
more
likely
to be
a
AND
predisposing
DREAMING.
cause
191
than any of those that
The late Dr. Elliotson suggested that have been enumerated. the seat of nightmare was in the brain. The fact that literary
of a nervous temperament, and those undergoing mental strain, are prone to it, favours this opinion. And now comes the vexed question,?What is the nature of this mysterious and fearful disease, which often attacks people apparently in good health suddenly, and, like a thief, in the dead of night ? What are the mental and physical conditions on which depends a disease so terrible as to be, as Dr. Bond describes " " of a boon, " is it, such a source of misery that sleep, instead " ? This question a source of inexpressible dread and suffering is more easily asked than answered; nevertheless, a careful analysis of the symptoms during a paroxysm may help in some degree towards its solution. The symptoms generally complained of and described by those who have been the victims of nightmare are inability to move, articulate, or respire, accompanied by a sensation of weight on the chest, by screams, or indistinct sounds; some also have a feeling of numbness; and, in my own case, twitching of the muscles of the lower limbs (of which I was unconscious) and faint moanings have been observed for two or three minutes by a watchful friend, before the misery has come to an agonising crisis. The mental symptoms detailed by authors are as varied as the dreams which accompany the malady, and often refer to some horrible monster sitting on the chest, visions of robbers or assassins, etc., etc. As regards myself, of late years, as I have already stated, the horrible dread has been unattended by spectra, but associated with a vague fear of something supernatural. Sometimes I have simply had a distressing feeling of being in a nightmare, as if, after a countless number of attacks, my mind had become so familiar with its phenomena that my consciousness recognised them as being the symptoms of a coming attack as readily as if I had been awake, and
men, those
accepted
them
as
such.
The most intolerable of ail the symptoms that I have experienced is that which I have mentioned as a horrible feeling of dying, in conjunction with the sense of utter helplessness. There is no physical pain, but a conviction that if not speedily roused I must expire. The only explanation of the phenomena of nightmare that I can venture to offer is, of course, entirely hypothetical. Is it possible that from some abnormal condition during sleep the motor ganglia have temporarily ceased to supply the nerve force necessary for the due performance of the voluntary moveIs not this notion more conceivable than the generally ments ?
192
NIGHTMARE
AND
DREAMING.
that the will* is in abeyance, and entirely voluntary muscles which are ordinarily under its control. I have felt, during these attacks, that I bad the will, but not the power to shake off the death-like torpor. The fact, also, that I distinctly recollect having, on one occasion, overcome a nightmare in my sleep by sheer force of will, supports the theory. If sleep be, as is commonly supposed, a state of inaction, or rest of the organs of sense and motion, either partial (as in somnambulism) or entire (as in deep sleep), it is reasonable to infer that, in nightmare, the sleep of those organs actively engaged in communicating nerve force to the voluntary muscles has become so profound that they do not respond to the prompting of the will. As soon, however, as the motor ganglia become aroused by the waking state, the nerve force is sent along the motor tracts, and the nightmare spell is broken. May not the nightmare agony be a provision of nature to awaken the sleeper, and thus provide for the due performance of the muscular movements, both voluntary and involuntary, which, if not restored, would cause death by apnoea. Dr. Hodgkin thought that, in his own case, the paroxysm of nightmare sometimes continued after he was awake. In this I think he may have been mistaken : perhaps he had a dream so vivid as to lead him to imagine himself awake; for I have myself frequently noticed that my nightmare dreams have had an extraordinary appearance of reality. I have dreamt that I was lying in the very bed in which I was really sleeping, and that I saw everything in my bedroom exactly as if I had been awake. It is much to be desired that some medical man should have the opportunity of watching some one under the influence of nightmare, in order to ascertain whether the circulation and respiration are materially affected or not; such observation would greatly assist the enquiry into the nature and cause of the disease. Dr. Hodgkin felt so convinced of the gravity of the symptoms of nightmare, from his own experience, that he thought it probable that many persons died during the paroxysm. I think differently, for, as I remarked before, I look upon it rather as an effort of nature to restore the equilibrium of the nerve force. I have little to offer in the way of treatment; all remedies hitherto suggested have been found of little avail. The main object is to cut short the paroxysm, and this may be done by a
received
separated
opinion
from those
* Some of the materialistic physiologists -who confound mind and brain, and who, with all their contempt for metaphysics, make use of metaphysical terms in an unphilosophical manner, attempt to reason away the idea of a Will; but while consciousness lasts, it is impossible to divest ourselves of the conviction that we have a Will, call it by what name we may.
193
NIGHTMARE AND DREAMING.
companion who is a light sleeper, quick to detect the of an attack, and prompt to rouse the sleeper by shakI am convinced that by this means I have been saved protracted misery. watchful
approach ing him.
subject of dreaming is so closely blended with that of nightmare that a few remarks on the former may not be out of place. Eecent writers on dreaming?I refer to the modern materialistic school?have fallen into the error of losing sight of its psychical aspect. They confound mind and brain, and imagine that all the phenomena of dreaming are the result of physical changes in the nervous system. In dreaming, consciousness and memory are not lost; the emotions and imagination are in full force ; whilst judgment and comparison are in abeyance. It is, I think, a mistake, as I have previously observed, to suppose that the will is absent during sleep. Dr. Hammond says that volition or will is entirely suspended during sleep. Dugald Stewart, on the other side, states it as his opinion that the efforts we are conscious of making in our sleep, proves the contrary. The chief feature of dreaming, as in incoherent insanity, is a want of controlling power over the thoughts, and an inability to perceive the incongruity of the hallucinations conjured up by the imagination. The most incongruous dream I ever had, was that I was Charles I. on the way to execution; but the strangest of all dreams is that of McNish, who dreamt that he was riding on The
his
own
back.
It has been noticed that at
we are
not startled in
our
dreams
the friends who have been
long dead still alive ; but there is a still more extraordinary psychological fact of my own experience, that I never by any chance dream of departed friends as dead, the circumstance of their decease being utterly seeing
obliterated from my memory. The most obscure problem connected with sleep and dreaming, and the one respecting which there are such conflicting opinions, is that which relates to the state of the mind in what is called dreamless sleep. Some assert that at such times the mind is a perfect blank ; others, as it appears to me, with more probability, that the profoundest sleep is not unattended with dreams, though sometimes they are as utterly forgotten as if they had never occurred. Sir William Hamilton entertained the latter opinion. Sir Henry Holland, whose elaborate and brilliant paper on " Sleep " and Dreams has been already referred to, leans to the former and materialistic view of this question. He observes that there
194
NIGHTMARE AND DREAMING.
" may be times in which there is a complete absence of images and trains of thought;" in other words, dreamless sleep. This is unexpected and contradictory, as the general tone of his writings would lead us to infer that he recognises an immaterial principle ; and he says in the same article, referring to dreams, that " no less a problem than the intimate nature of the human soul is concerned in the phenomena." It would almost seem as if Sir Henry, in spite of his characteristic caution, had allowed himself to be somewhat influenced by the scientific materialism of the present day. For a long period I have been in the habit of observing that if I am suddenly roused up just as I am falling off to sleep, I never can recover the train of thought which occupied my mind in the transition state. I have often tried in vain.. If, then, it is so difficult to recall the ideas of the semiwaking state, is it not probable, a fortiori, that we should utterly forget the images and trains of thought carried on in deep sleep ? In attempting to unravel the mysteries of dreaming, we find ourselves face to face with some of the most difficult and profound problems of mental philosophy, and as yet we have discovered little more than the fact that while the bodily organs are in a state of repose, the mind, as in a reverie, is left to wander, fancy free, amongst the images and memories of the past.
