et jolie personne; les organes de la génération sont alors excités par cet objet imaginaire; ils entrent en action et la crise a lieu." 161 162 Hallucinations of exactly the same nature as those described above, are extremely common in many forms of mental disorder, and almost every asylum contains patients who bitterly complain of the attentions forced on them by various nightly visitors. Simon, in speaking of erotic hallucinations, points out the same alternation between hateful and attractive visitations that we have just mentioned in connection with Nightmare. He says: “Tantôt le spectre hallucinatoire est de forme agréable: c'est un mari, un amant, une femme aimée et, dans ces cas, la sensation éprouvée par l'halluciné est voluptueuse. Plus souvent, peut-être, l'hallucination visuelle est repoussante: il s'agit du démon, de quelque être difforme, d'une vieille femme à l'aspect hideux dont les embrassements sont pour l'aliené un objet d'horreur; d'images dégoûtantes qui poursuivent le malade et qui l'obsèdent. Dans ces cas, l'hallucination génitale consiste en une impression douloureuse, à tout le moins, pénible ou desagréable." Chaslin 1 relates an interesting case in which the one type of hallucination appeared in Angst attacks in the waking state, and the other during dreams. The case well illustrates how much more effective is the "repression" during the waking state, so that when the inhibitions of consciousness have been to some extent abrogated, as during sleep, the desire may be gratified without any concealment. The patient was a woman of 23. "Les attaques d'hystérie sont précédées d'une hallucination: un homme se précipite sur la malade avec un couteau. Grande frayeur. Rêves fréquents de l'homme au couteau n'anemant jamais d'attaques, mais quelquefois le réveil en sursaut. Rêves voluptueux dans lesquels elle voit un homme imaginaire, mais toujours le même. Jamais d'autres rêves pénibles.' It is important in this connection to remember how frequent is a voluptuous trait in the Angst attacks of the waking state; indeed this often passes on to actual emission during the attack, a phenomenon to which attention was first drawn by Loewenfeld in the case of men, and by Janet in the case of women. 164 181 Simon. Le Monde des rêves, 1882, pp. 183, 184. 163 16 Chaslin. Du rôle du rêve dans l'évolution du délire, 1887, p. 54. 163 Loewenfeld. Zur Lehre von den neurotischen Angstzuständen, Münch. med. Woch., 1897, No. 24, 25. 164 "Janet. Les obsessions et la psychasthénie, 1903, I, p. 222. It is clear that the great rarity with which Nightmare attacks persons who are sleeping in any other posture than the supine or prone one is readily explicable on the psychological view here maintained, for these are the postures in which the love embrace is normally consummated. Burton's 16 observation, then, concerning those who are "troubled with incubus, or witch-ridden (as) we call it) if they lie on their backs, they suppose an old woman rides and sits so hard upon them, that they are almost stifled for want of breath," needs no detailed elucidation. In significant accord with this explanation is the well known fact that most sleepers experience voluptuous dreams far more often when in the supine posture than when in any other. Paulus Aeginata laid great stress on this in the treatment of satyriasis and allied conditions. 167 108 In exactly the same way may be explained the mode of operation of all the other physical factors besides posture, namely as external stimuli which evoke a body of feeling that is already present and very ready to be evoked. It has generally been supposed that they actually create this feeling, a view well expounded for instance by Rousset: Qu'une sensation isolée telle que celle d'un poids pesant au creux épigastrique, sensation que donne la gêne croissante de la respiration, que cette sensation, dis-je, parvienne à ébranler le sensorium ainsi assoupi; aussitôt elle fera naître l'idée d'un objet dont la forme sera en rapport avec l'espoir, la crainte, le mysticisme, le sensualisme en un mot avec les idées habituelles ou dominantes de l'individu à l'état de veille; ce sera un chat, un singe, une vieille femme, une sorcière, un monstre hideux, un revenant ou bien enfin un amant redouté ou désiré, qu'il s'appelle le diable ou qu'au contraire il porte un nom moins terrible." On the contrary it is here maintained that these sensations will arouse the emotions in question only in persons in whom the emotions are already fully developed and, as it were, lying near the surface. What we have called the predisposition is thus the all-important essential in the production of the attack; the external stimuli are of minimal significance. We thus have the key 165 Burton. Op. cit., Vol. I, Pt. I, Sec. 2, Mem. 3, Subsect. 2, p. 134. 100 Paulus Aeginata. Op. cit., pp. 594, 596. 197 Rousset. Op. cit., p. 50. 66 to the easily verifiable observation that these external causes can bring about an attack only in persons who are subject to the malady, and that on the other hand the most scrupulous avoidance of all these alleged "causes" will not prevent attacks with those in whom the predisposition is sufficiently pronounced. It is probable that most of the causes that have been given by various writers in this connection may play some slight part in the manner we have indicated, though I am convinced that the significance of them has in the past been enormously exaggerated. For instance, that a heavy repast is apt to be followed by an accession of erotic desire is an observation acted on by every roué; that it, like alcohol, tends to dull the activity of the conscious inhibitions of the waking state and so release suppressed mental trends is so well known as to make it comprehensible that it may occasionally play some part in the evocation of Nightmare. A full stomach may also act by arousing the sensation of a heavy weight lying in, and therefore on, the abdomen. The relation of diet in general to erotic dreams is fully pointed out by Spitta. Thus the observations made in this connection by the older writers almost always contain a certain modicum of truth, although the explanations of them offered have been wide of the mark in attributing to physical factors ninety-nine per cent of importance in the production of Nightmare, whereas in reality less than one per cent should be so attributed. 188 We have last to say a little about the clinical significance of Nightmare. I shall say nothing about the occurrence of Nightmare in children, for the subject has such special features, and the psycho-sexual life of children is so enshrouded in obscurity, as to demand treatment in an article devoted to it alone. I shall further take the definition of Nightmare in its strict sense, as a distressing dream necessarily showing, amongst other features, the three cardinal ones that were described above. A large variety of distressing dreams, equalling in intensity the classical Nightmare attack but not having the sense of direct physical oppression characteristic of this, will thus be excluded. It is impossible to reach even an approximate estimate of the 168 Spitta. Die Schlaf- und Traumzustände der menschlichen Seele, 1882, S. 252. 173 frequency of the malady. Waller's 100 statement that there are few affections more universal among all classes of society is certainly untrue if the above definition is adhered to, for true Nightmare is beyond doubt much rarer than the more complex forms of Angst dreams. Waller 170 and Macnish both state that men are more subject to it than women, and of these unmarried women more than the married. In judging from my own experience I would say that the second statement is true; as to the first, I have no decisive evidence, though I would agree with Cubasch when he says that the manifestations of Nightmare are generally more stormy and vehement among men and the agony correspondingly greater. Waller "" and Macnish "" also state that sailors are of all men most subject to Nightmare, the former attributing this to their coarse unwholesome food; there is, however, a clue to another explanation in Macnish's remark, made in the days when long voyages were common, that the attacks more often occurred at sea than on shore. Bond "" quaintly observes that “Melancholy persons, profound Mathematicians, and fond pining Lovers, are most subject to this affection," and Bell, a still earlier writer," says that it affects those who "are Melancholly, of few and gross Spirits and abounding with Phlegm." 173 175 174 In subjects who pass as being mentally normal, Nightmares rarely occur as isolated morbid phenomena; on investigation it will always be found that other manifestations of Angst neurosis are present, with or without evidences of hysteria. In short, Nightmare may in such a subject be regarded as a symptom of this affec tion, and should be treated accordingly. This fact was partly realized nearly a century ago by Waller when he wrote that "Nightmare may be considered only as a symptom of great nervous derangement or hypochondriasis." I might add that in my 16 Waller. Op. cit., p. 14. 172 Cubasch. Op. cit., S. 8. 173 Waller. Op. cit., p. 66. 176 Andrew Bell. Op. cit., 177 Waller. Op. cit., p. 7 experience "repression" of the feminine or masochistic component of the sex instinct rather than of the masculine is apt to engender the typical Nightmare, a fact which probably explains why the malady is usually more severe, and possibly even more frequent, in men, with whom this component is more constantly and more intensely repressed than with women. In subjects who deviate still more from the normal, more alarming evidences of a lack of harmonious control of the psycho-sexual activities may be present, such as satyriasis or nymphomania, as in a case recorded by Ribes.1T This however is decidedly uncommon. Also, as was previously mentioned, the affection is frequently met with in various forms of mental alienation, particularly manic-depressive insanity and dementia præcox, and especially during the early stages of the disease. We may summarize the conclusions reached in the statement that Nightmare is a form of Angst attack, that it is essentially due to an intense mental conflict centering around some repressed component of the psycho-sexual instinct, and that it may be evoked by any peripheral stimuli that serve to arouse this body of repressed feeling; the importance however of such peripheral stimuli in this connection has in the past been greatly over-estimated as a factor in the production of the affection." 178 Ribes. Observation d'un cauchemar causé par la nymphomanie. Mém et observ. d'anat., de phys., etc., 1845, T. III, p. 127. 17 It is intended that this part be followed by two others, one detailing a number of cases of Nightmare studied by the psycho-analytic method, the other dealing with the role played by the Nightmare in history and in mythology. |