Kitabı oku: «Psychotherapy», sayfa 84

I remember having a patient who insisted that he could not sleep so near the elevated. At the end of a week he had lost so many nights of sleep that he was almost in despair. If he did get sound asleep he said he used to hear the thunder of the elevated train coming toward him in his dreams and he would begin to pull his feet up so as to get them out of the way of the train, yet always with the feeling that he could not get them quite far enough, until his knees were almost to his chin. Under the influence of a little bromides, two hours more of outdoor air than he had been accustomed to before, and some reassurance that noise need not disturb sleep at all if taken philosophically, he learned in the course of two weeks to sleep quite peacefully and now has lived for ten years where the elevated passes within ten feet of his window, which is wide open for seven months in the year and always at least slightly open, except in the most stormy weather. It is a question, then, of the individual much more than his surroundings. The problem is to predispose the mind to sleep and then the senses will not disturb it except under special circumstances.

As a matter of fact, noises usually disturb people very little at night. The most surprising things can happen between 12 and 3 o'clock and attract no attention. Burglars calmly blow up a safe in a hotel confident that if there is no one awake when the explosion occurs there will be no investigation, because even though people wake up at the noise, they will wait for its repetition in order to see what it means, will not get up to investigate, especially in cold weather, and usually promptly go to sleep again.

Lying Awake.—There are many people to whom lying awake carries with it a sense of discouragement and dread. They seem to forget that lying awake and occupation with pleasant thoughts may be made a very agreeable pastime by those who are not over-anxious to sleep and who let the pleasant thoughts that may be suggested by the environment or the noises that are heard flow through consciousness. Everyone knows how pleasant it is or may be to listen to the rain patter on the roof of a country house, or to hear the murmur of the ocean or of the wind through the trees when there is not too much anxiety about to-morrow and to-morrow's occupations and the necessity for sleep to be ready for them. Stewart Edward White, in his series of essays on "The Forest," has a chapter on Lying Awake at Night that can well be recommended to the attention of those who complain bitterly of an hour of sleeplessness. Of course, in his case the lying awake is in the midst of the forest with all the witchery of wind in the trees and the unusual sounds of forest life, while ordinary lying awake is in the rather monotonous environment at home, but still there is much that can be said for his insistence that in peaceful brooding, faculties revive while soft velvet fingers are laid on the drowsy imagination and you feel that in their caressing vaster spaces of thought are opened up. The impatience that comes to so many almost at once if they fail to go to sleep promptly only serves to keep them awake just that much more surely.

Very often, as suggested by Mr. White, this wakefulness occurs just when a good night's rest is surely expected. There is sometimes even a preliminary period of drowsiness. Then some little noise that ordinarily would not be noticed at all floats into the consciousness with a vigor that indicates that one sense is thoroughly awake. The very surprise of it wakes up the other senses with a start and then comes the thought that there is to be no sleep for some time. If this is resented, the period of wakefulness will be all the longer. If, when it has proved to be inevitable, one sits up quietly, reads a book for a time, plays a quiet game of solitaire, it may be on a board kept beside the bed for such purposes, or in some quiet way succeeds in bothering away the thought of insomnia, then almost surely sleep will come after a time, quietly and restfully, and the lost period will not prove harmful. If nature does not want to sleep she must not be forced into it, but gently led and after a time the wakefulness will disappear.

Night Terrors.—One of the troubles of sleep that is more often called to the attention of the physician than almost any other, is the so-called "night terrors" of children. Little ones wake with a scream, sit up in bed, evidently terrified, usually trembling, and ready to seek refuge from something that has seriously disturbed them. Under Dreams we have called attention to the fact that usually these terrors are due to a dream. Sometimes the dreams are the ordinary experience of supposed falling in sleep, from which the patients wake very much startled, or they are repetitions of exciting scenes through which they have passed, or of stories that they have heard, or, above all, plays that they have seen. Ghost stories, for instance, told shortly before they go to bed will often disturb children. Fairy stories and the ordinary myths of childhood, usually with a happy ending and without any serious terrors in them, are not so likely to disturb them. Melodramatic theatrical performances to which children lend themselves and their attention with great concentration of mind, have nearly as much effect on them as if they passed through the actual scenes. Every physician knows how much a fright is likely to disturb a child and cause it to wake many a night afterwards in a state of terror.

Respiratory Interference.—It is particularly important to remember that any interference with breathing will almost surely wake the child in a seriously startled condition. Adults are often affected by this same sort of dream, due very often to some pathological condition in the throat around which a series of dream ideas collect with somewhat poignant results. I have known a man suffering from elongated uvula wake up thinking that he was suffocating because, as he thought, he had nearly swallowed his tongue, or at least had been trying to do so. The sensation was so startling that it brought him to his feet at once. I have known a patient traveling a long five-days' railroad journey and suffering severely from train catarrh, come to the persuasion that he might suffocate during sleep because his nose was completely stopped up and he had not the habit of sleeping with his mouth open. As a result his sleep was as much disturbed by his mind as his breathing. If these affect adults so strongly, it is easy to understand why children should be so frightened by them. Children who are mouth-breathers from adenoids or nasal obstruction, and still more those whose nasal breathing apparatus is not completely stopped up, but who are frequent intermittent mouth-breathers, are especially likely to be troubled in this way. The neurosis known as nervous croup, due to a spasm of the vocal cords, occurs oftenest in this class of children and is an associated phenomenon to that of night terrors.

Sleeping in the Light.—The habit of accustoming children to sleep with a light in the room nearly always lessens the depth of their sleep. They are more easily wakened and their sleep is not so refreshing. Besides, if they do not grow accustomed to the dark when they are young, they may always retain a dread of the dark and will require some light in the room where they sleep. Nature intended that the eyes and the optic nerve should have as complete a rest as possible and even with the lids lowered some light stimulus, if it is present, finds its way to the nerve fibers. Hence the desirability of having as far as possible an absolutely dark room. For some very timorous children, this may seem impossible. Many mothers will recall how awful the dark seemed to them and what shadowy shapes loomed up in it. It will usually be found on inquiry, however, that in these cases the children, after having been accustomed to sleep with some light and after having had all sorts of exciting pictures shown them and stories told them, were asked to sleep in the dark. From the very beginning they should be accustomed to sleeping in the dark and then it has none of the terrors thus pictured.

CHAPTER IX
DREAMS

Dreams, that is, thoughts and illusions and mental phenomena of various kinds that occur during sleep, have always been interesting to the psychologist, and have usually been related to physicians by patients either because they were thought to have a significance related to disease, or because something in them disturbed the patient's mind. This is almost as true in the modern time as it was long ago. It is curiously interesting to note that the very latest development of psychotherapy includes the use of hints obtained from dreams in order to determine the origin of psycho-neurotic conditions and certain of the minor psychic disturbances, and also as a foundation for treatment. The oldest stories of therapeutics that we have are those of patients waited on by the priest physicians of the olden times in the temples, who were supposed to be greatly helped by information obtained from the patient's dreams. It is interesting to read such recent studies as that of "Incubation in the Old Temples," by Miss Ingersoll, with the thought in mind that we are once more analyzing dreams in order to accomplish a similar purpose.

Dreams are so often a source of disturbance of mind for patients, lead to such disturbed sleep, or even so affect the bodily health that it is important for anyone who wants to influence patients through their minds to know the significance attributed to dreams by the most recent studies of them. This is all the more important because dreams are such a universal phenomenon. From our earliest years we dream. The night terrors of children are probably due to dreams and show that even as early as the age of three we dream vividly. Doubtless some of the terrifying dreams of childhood are similar to those that we experience later. Dreams of falling, dreams of being cold, of being out of breath, with vivid repetitions of exciting scenes through which they have gone during the day, or which they have seen in picture or been told in story, form the substance of these dreams. Children are likely to be much disturbed by them. They wake in a terror of anxiety, in cold sweat, and crying bitterly because of their dream visions. Older people are not so much disturbed at the moment, but often brood over dreams and may be seriously affected by them.

It is difficult, however, to persuade many people that their dreams have no special significance, either of present or of future evil, and to many the fact that they dream much becomes a suggestion of wakefulness that disturbs sleep and makes them quite unequal to the next day's work, because they have the feeling that, as they have been dreaming all night, they must be quite tired. Tiredness in nervous people is often a matter of the mental state rather than of physical exhaustion or genuine mental weariness. The actual place of dreams in psychology, then, becomes an important consideration in psychotherapeutics.

Our real advances in the knowledge of the significance of dreams have come from the study of the dreams that are common to most people. These show us exactly how and why dreams occur and just what their meaning is. Probably the most familiar dream common to all the human race is that of falling from a height. Everyone has been wakened with a startled sense of intense relief that the sensation of falling was illusory. The waking came just before the bottom was reached. There is a tradition that if one ever did strike the bottom in one's dream it would be the end and that death would result as surely as if the fall were real. So far we have had no one come back to tell us of that, and the tradition is reasonably safe from direct contradiction. It serves without any reason, however, to disturb timorous people and make them dread to fall asleep again. Often this dream-falling so seriously affects sensitive individuals that they do not get to sleep for an hour or more and occasionally those with an inclination to insomnia may even suffer for the rest of the night from the effect of it. It is important to explain, then, what we know about the causation of the dream. In nearly all cases the subject on waking finds himself on his back, and then the inclination is at once to turn over to the side with a sigh of relief. Commonly the dream occurs rather early in the night, when a rather heavy meal has been taken shortly before retiring. The weight in the stomach, particularly if considerable liquid has been taken, seems to press upon the abdominal aorta and interferes, to some extent at least, with the circulation to the legs. This deprives little nerves at the periphery of the body of some of their nutrition and causes a tingling feeling in them. This is quite different from pressure on nerves, which gives the sensation termed "being asleep" to a limb. This tingling feeling resembles that which we experience when going down rapidly in an elevator. It is the falling sensation. This sensation tries to force its way into the consciousness and in this process does not completely wake consciousness up, but brings about an association of ideas connected with falling—hence the dream of being on a height and of falling therefrom out of which we wake so startled. The whole process instead of being injurious is really conservative. It is important that the aorta should not be pressed upon and this is the mode by which awakening is brought about and the position shifted so that further interference is stopped, though we ourselves are quite unconscious of the real purpose that has been accomplished. An explanation of this kind usually makes people who suffer from such dreams and have been disturbed by them much more tolerant of the phenomenon and more ready to go to sleep again, since evidently nature can be trusted to care for them even during sleep.

After the sensation of falling probably the commonest dream that humanity has, at least in the civilized state, is that of being out in some public place without sufficient clothing. Usually we wake just to find that some portion of our anatomy has been exposed to the air and that it is cold. It is this sensation gradually forcing its way into consciousness that has gathered around it a group of ideas that form our dream.

Among men, a familiar dream is that of running for a car, or away from something, or to catch someone, and finding that it is almost impossible to move. We are so out of breath that we are scarcely able to drag one foot after another and, indeed, sometimes we seem to be actually rooted to the spot. We cannot move at all. When we wake after this dream we find that, because of a cold in the head, our nose is stopped up by the secretion and that our mouths are shut and consequently we were getting no air. When that sensation tries to break into the consciousness there gather around it certain familiar ideas usually associated with being out of breath and hence we have the dream of trying to run without being able to move.

Frequency of Dreams.—Nervous people often complain that they dream all night or else very frequently, and that as a consequence their sleep is not restful. It is probable that there are always ideas in the mind and that literally we dream without ceasing. These ideas, however, do not get into our consciousness except just during the process of waking. All those who have investigated the subject of dreams are practically agreed on this. In subsequent paragraphs we quote a number of good observers on this subject. Certainly this is what we should expect from what we all know about day-dreaming. We can never catch ourselves during the day without finding some thought wandering through our minds. If we want to understand dreaming during sleep this day dreaming is instructive. We jump from one idea to another, apparently without a connection; yet there is always some connecting link. We have just read in the paper of someone in Cairo, and we think of old Egypt, and then of old Babylonia, and the Code of Hammurrabi, and the laws of the Medes and the Persians, and Xenophon and our school days, and of an old schoolmaster now a missionary in Japan, and of Japanese art and of an American artist much influenced by it, and of one of his great windows in a church in New York and of social work in connection with that church, and of settlement houses and then Hull House, Chicago, and then of the Adamses in Massachusetts, and so on.

Thus, also, do our minds go flitting round apparently during the night. We remember only such things as are brought into our consciousness directly and emphatically during the process of wakening. During our day dreaming we recall only those things which for some reason led us to think consciously about them and then follow out our thoughts to definite conclusions. It is an interesting study to follow back our day dreams through their wanderings to the origin. As a rule, however, we lose track of the connections and after a time remember only some of the wonderful transformations and transmigrations of thought; and so it is in our dreams.

With regard to the frequency of dreaming. Sir Arthur Mitchell in his book "Dreaming, Laughing, and Blushing" (London, 1905), insists on the great probability of the constancy of our dreaming during sleep. He says:

It seems to me that there is no such thing as dreamless sleep. During the whole continuance of sleep, the mind, I believe, is occupied with a certain kind of thinking which works round what I have called hallucinations. I do not expect to be able to prove the correctness of this opinion as to the persistence of dreams all through sleep, but I think that it can easily be shown to be possibly correct. I go further, and say that many things show that it is probably correct. I may not be able to prove absolutely its correctness, but it is proper to bear in mind that it is quite as difficult to prove absolutely that it is not correct. My difficulty is frankly avowed. Many things, however, are taught in biology as being certainly true. In regard to which a like avowal could be made but is not made. There is what has been called a "conjectural biology."

We do not and we cannot remember much of what we have been thinking about while we are awake. This is unquestionably true in a large sense. But, nevertheless, we do not doubt that we have been thinking continuously. We do not suppose that at any time all thinking had ceased, though we may be completely unable to recall what it was about.

He shows further that many writers on dreams and careful students of the subject in the past have come to the same conclusion. Robert Dale Owen, for instance, deliberately endeavored to find out whether he had always been dreaming just before he awoke. After months of observation he records that in every instance he was conscious of having dreamed. Hazlitt, a century ago, tried the same thing for a prolonged period and notes that whenever he was waked, and immediately recollected himself as to possible dreaming, he was always aware that he had been dreaming. Sir Arthur Mitchell himself has tried this same experiment on himself and for a considerable time has scarcely ever failed to put to himself this question about dreaming when he awoke and always got a satisfying affirmative answer. Personally, for several years, I have been interested enough in this subject to recur frequently to it immediately on awaking and I cannot say that I have ever, under those circumstances, failed to find that there had been some vague dream fancies at least running through my mind before I was fully awake. This opinion as to the constancy of dreaming during sleep has many authorities in its support. Sir Arthur Mitchell has quoted a number, some of them distinguished physicians, who add the weight of their testimony to this view:

It is not a new thing to hold that there is no sleep without dreaming—in other words, that dreaming goes on unceasingly all through sleep. I have stated my own opinion strongly, but the same opinion has been nearly as strongly expressed by others. Sir Benjamin Brodie, for instance, may be said to express it when he writes, "I believe that I seldom if ever sleep without dreaming." Sir Henry Holland expresses it still more plainly when he says: "No moment of sleep is without some condition of dreaming." Goodwin says much the same thing when he asserts that "sleep is not a suspension of thought"—in other words, that dreaming is sleep-thinking. Dr. John Reid still more clearly holds the opinion, though he does not furnish me with a short apt quotation. Hazlitt, too, may be taken as holding that there is no such thing as dreamless sleep.

Descartes and his followers may, perhaps, be regarded as holding that the mind is unceasingly at work in sleep—even in the "profoundest sleep," though "the memory retains it not," and Isaac Watts says that "the soul never intermits its activity," and that we may "know of sleeping thoughts at the moment they arise, and not retain them the next moment."

Hippocrates, Leibnitz, and Abercrombie have also been quoted as holding that there is no dreamless sleep, and so far as they express themselves on the subject they appear to do so.

A strong weight of opinion in all ages favors the view that during sleep dream-thoughts are constantly running through our mind, though we recollect only those which are impressed upon us at the moment of awaking. We do not even recall those unless, for some reason, we have paid special attention to them. That is just exactly what is true of day dreaming. After it is over we have no idea at all of the thoughts that occupied our minds for hours, though we are all aware that at any given moment, if we turned our consciousness inwards we found that there was something that we were thinking about.

Short Duration of Dreams.—This view of the constant occurrence of dreams during sleep is confirmed by other things that we have come to know as to dreams and dream states. Probably the most interesting of these is with regard to the length of dreams. As our memory of dreams is only such as we have from the thoughts of sleep getting into our consciousness just at the moment of awaking, dreams are never as long as they sometimes seem to be. As a matter of fact, they occupy but a few moments, though in that time a long story may seem to unroll itself. Probably nothing gives more assurance to people who are persuaded that they are losing much rest because of their dreams than this explanation of the brevity of the phenomena. Nervous people wake frequently. Whenever they wake they find themselves dreaming. As a consequence, they acquire the persuasion that they have been dreaming "all the night long," and it is not hard for them to suggest to themselves in the early morning that they are not rested. Nervous people seldom feel rested in the early morning, it is their worst time, and with the occurrence of dreams as a suggested reason for this, they exaggerate the feeling of tiredness with which they get up. A frank discussion of this question of the duration of dreams is often the best possible therapeutic auxiliary for such cases. It gives them a new series of suggestions and, above all, relieves them of unfavorable suggestions.

Prof. Maury of the University of Paris tells a striking story of a very brief dream of his own which shows how short may be the time occupied by what seems surely a long dream. He had been reading before going to bed a very striking book on the Reign of Terror. He dreamt that he himself was arrested during the Terror, taken to prison, that his name was called on the list of the condemned, that he was carried to the guillotine, fastened to the board, pushed beneath the knife and that he woke just as the knife struck his neck. Of course he awoke with the usual sense of thankfulness and relief that comes at such times. When he awoke he found that a light curtain rod had fallen from the bed above him and had struck just across his neck. His dream evidently had all come to him during the extremely short time necessary for him to become fully awake after the rod had hit him. His mind was occupying itself with the history that he had read before going to bed. When the rod struck him the long story of his arrest and imprisonment, the journey to the place of the guillotine and the preparations for execution, all came to him as a series of rapid ideas during his coming to consciousness.

It is probable that most of our dreams are not much longer than this. One of my earliest recollections is of an old gentleman coming into the country school during my first year as a pupil and telling us the story of a dream of his of the night before quite as brief as that of Professor Maury. He had fallen asleep after dinner in his chair and, having a cold that stopped up his nose and his mouth being shut, he had the usual dream of being out of breath from running. It took him back to the story of the massacre of Wyoming, near the scene of which the school was situated. He dreamt that for hours he had been running away from the Indians and seemed at last utterly unable to escape them because he was out of breath. He made such efforts in his chair that his wife awakened him and then he found that he had been asleep altogether only a very few minutes.

Significance of Dreams.—Many people are quite sure that their dreams have a definite significance quite apart from any mere wandering of the mind or the suggestion of half-waking and the ideas that gather round sensations not fully in the consciousness. A number of people, for instance, have dreams of events that are happening at a distance at the moment that they dream. The Psychic Research Society of England has gathered a number of these and it is indeed difficult to understand many of them. There seems no doubt, however, that in many cases there is an illusion of memory, by which, after an event, dreams that might be taken to refer in some vague way to the happening, are clothed with a wealth of detail which appears to make them wonderful premonitory representations of future events or repetitions of simultaneous events. One of the most familiar of this form of dreams is what has been called a phantasm of the dying. People dying at a distance seem to have some wonderful power of making themselves appear to very near friends, especially brothers and sisters, and, above all, twins, and to friends with whom they have been very intimately associated. Occasionally such phantasms are seen during waking hours, or what are supposed to be waking hours, though it must not be forgotten that dreams may come very easily and almost unconsciously in short naps, but much more frequently in what are known to be dreams.

Nearly always these partake of the nature of the ordinary dream, as can be seen by a careful analysis of their conditions, and are mere coincidences occupying a very brief space of time. A typical example of this is to be found in one of the stories told by Camille Flammarion, the French astronomer, in his book "The Unknown." A young man who had fallen in love with a young woman was deeply grieved to be parted from her by the injunction of parents. Separated by a long distance, they kept up a clandestine correspondence for more than a year. For a considerable period, however, he had not heard from her, and he was beginning to be anxious lest anything had happened to her. One night she appeared to him in a dream in his room in white garments with a pale face and, placing her cold hand in his, she bade him good-bye. He awoke with a start. He found it difficult to sleep and was very anxious about her. The next day he learned that she had died the night before and concluded that his dream was a last message from her. The end of the story, however, as it is told, spoils this nice sentimental conclusion. When he awoke he found he had in his hand a glass of ice water which had been standing on the table beside him. The grasping of this had awakened him. During the awakening process the thoughts of her in his mind gathered round the cold sensation in his hand and gave him the dream of her and the last farewell.

There are many instances in which dreams of future events seem to come true. Indeed, so many of these stories have been told that it is hard to persuade some people that dreams have no meaning and can have no meaning. By this we mean that they can by no possibility represent prophetic foresight. What patients need to be made to understand is that dreams represent only straggling sensations trying to get into our consciousness, just barely succeeding, and then arousing trains of ideas unconnected in themselves, but which we connect afterwards when we recollect our dreams. This whole subject has been studied so thoroughly in Maury's work on "Le Sommeil et les Rêves" about the middle of the last century and Freud "Ueber den Traum" and Sante de Sanctis' "I Sogni" Turin, 1899, at the end of the century, that there can be no further doubts about the matter for those who are open to conviction. Most people, however, want to believe that their dreams mean something. They like to think that they are in some way picked out from the multitude and that their dreaming has a significance more than is accorded to other people. It is, indeed, this self-centeredness that makes for the belief in premonitions and prophetic dreams and, as in all cases, these feelings work out their own revenge.

If they will listen to reason, however, most people may be rather readily convinced that their dreams cannot have any serious significance. In the chapter on Premonitions we have already called attention to the situation that exists with regard to the possibility of future events giving information of themselves in advance of their happening. Simultaneous events may perhaps in some way give warnings. The possibility of action on the mind at a distance, especially where minds are involved, has been discussed and admitted. The cases in which it is supposed to have happened are, to my mind, all dubious and are mere coincidences. For future events, however, there is no possible physical explanation. When we turn to explanations in the borderland between spirit and matter we find nothing satisfactory. The future event exists nowhere. No spirit even knows it; it is dependent on human free will. To the Creator it is known only as a contingent possibility dependent on free will. The information does not come from Him, for then there would be more design in these incidents. Such dreams would effect some serious purpose, while usually they have but minor significance in the stories as told and they often concern only the most trivial things.