“There are two ways of testing and revealing the truth. One is to soar from the idea and the detail immediately to the general laws and to compose and expound from these all-important postulations, as from the invincible truth, the intermediate laws. This is the usual way at the present time.
“The other is to draw from the constructive and the particular ideas, to proceed gradually and steadily upwards and only at the very end, to reach the ultimate generalisation. This is the true but unused way”.
–From THE NEW ORGANON, by Bacon.
The tendency to fatigue and the power of the individual to respond to the average demands of life are generally considered to be the measure of the constitution and its susceptibility to disease; according to the same line of reasoning, the subjective sensation, “fatigue,” which, in many cases, is the expression of objective weariness and favors sleep, but which is, when excessive, detrimental to sleep, is also a measure of the constitutional peculiarity of an individual. Therefore, knowledge concerning the importance of sleep to the healthy and to the sick and to those made ill by drugs, can be a source of valuable biological information.
Sleep does not depend so much upon fatigue as upon subjective weariness. Neither physical nor psychical exhaustion and fatigue lead to a quantitatively definite measure of sleep.
For a long time, sleep has been explained as the result of a chemico-organic change in the organism. This point of view is contradicted by the fact that many individuals fall asleep quite independently of fatigue or, by means of a definite determination to awake, can interrupt sleep; that often a short sleep is more refreshing than a long one; that fatigue often directly prevents one from going to sleep; that individuals, under the same degree of physical and mental strain, need a different amount of sleep for their restoration, some five or six hours, others eight hours, etc. Moreover research in regard to so-called “sleep” induced by suggestion or hypnosis does not bear out the chemico- organic theory.
By the suggestion of wakefulness or by hypnosis, a sensation of weariness can be induced which will cause sleep quite regardless of the actual sensation of fatigue; further, under hypnosis the dose of a sleep-producing medicine can be greatly reduced, and under certain conditions, the “Hypnotic Force of Suggestion” is used instead of narcotic drugs, with complete success in cases of surgical operations. The dependence of the organism on sleep, however, must not be over-looked, for we certainly know that man and also many animals, die if subjected to a continued period of sleeplessness–a healthy man in eight days–in other words, sooner than if deprived of nourishment.
We do not know the cause of this. It is a remarkable fact that the sick can often exist without sleep for a much longer period without being seriously affected, especially is this so with hysterical patients. An interesting observation has been made in a case of a patient, addicted to the morphine habit, where the drug was entirely withheld and the patient was sleepless for twenty-three days and nights without causing death.
Observations, made upon animals and recently published by Zell, indicate that sleep is to a great extent independent of fatigue. Zells observations show, that in all probability, there are certain animals, for instance the whale, which very seldom or never sleep although they often expend themselves in severe bodily effort. The chemico-organic process which induces fatigue in man, predisposes to sleep, but sleep, itself probably an instinctive process, is directly dependent upon psychical processes. As every normal function depends upon a certain integrity of an organ or a system of organs, so does the possibility to exert the sleep-instinct or the conscious will be sleep, depend upon the condition of the organs.
If to the psychical battle for sleep is added an organic difficulty, then will the disturbance of sleep be especially intensified. Here is shown how far physical and psychical changes, induced by disease or by drug experiment, can bring about sleep or cause it to remain absent. They are able to influence the conditions necessary to sleep. According to the degree of pain, fever, dyspnoea, intestinal disturbance, spasm, etc., that they cause, will the defect in the integrity of the organism be an unfavorable condition for sleep and it will depend upon the strength of the sleep-instinct and the conscious will to sleep, as to whether this condition will be easily conquered or whether it can be conquered at all.
On the other hand, a psychical state which is unfavorable to sleep will be intensified by any disturbing symptoms, no matter how slight they may be. Furthermore, natural disease as well as that artificially produced, i.e., by drugs, will, according to its particular type, bring about in the psychical sphere an actual change in the will to sleep or the sleep-instinct, as, for instance, certain forms of affections due to the disturbance of the thyroid gland or to poisoning by alcohol or opium.
In order to gain more insight, let us collect the facts concerning the physiology and psychology of sleep.
Motor impulses are dulled or abolished in sleep, the reflexes are difficult to obtain, above all, the functions of the vegetative nervous system are restricted with the exception (according to Pawlow and Hoeber) of the activity of the glands influencing digestion. As pigeons and dogs, from which the cerebrum had been removed, have been known to sleep, it cannot be assumed that the occurrence of sleep is dependent solely upon the cerebrum. This is another fact, indicating the correctness of the assumption that an instinctive function plays a particular important role in regard to sleep.
Psychical: When an individual through habit, fatigue, or the will to sleep, etc., is ready to go to sleep, a change is noticed in his alertness. The ego divides into a sleep-ego and an ego that watches over sleep in order to protect it from disturbances as far as possible and, thus, normal unconsciousness occurs, during which, however that portion of the ego which watches over sleep takes notice of whatever is necessary to the continuation of sleep or, if it seems more desirable, to its interruption. (The mother who, although asleep, is aware of every breath drawn by her sick child.).
The miller who awakens when the sound, to which he is accustomed, ceases. This “sleep-watcher,” as Landauer calls this portion of the ego, regulates, instinctively and suitably, the demands made by a sleepers impulses and the utilization of the stimuli from his environment. The change in attention is, in other words, an alteration in the emotional behavior. This is portrayed for the most part, in dreams whose relation to the conscious and to the subconscious in the healthy and in the sick and in those poisoned by drugs, and will be given consideration in a later article.
Sleep is, therefore, a condition in which almost all of the psychical stimuli of the environment have been withdrawn. Therefore recuperation through sleep cannot, according to the foregoing, be a purely chemico-physical reaction, but must be in extremely close relation to a psychical recuperation. To produce sleep normally, as well as by means of extraordinary psychical influences (hypnosis suggestion, etc.), or with drugs one must pay attention to the changes in the manner of reaction to stimuli–to the so-called mood-changes–as they are observed in all living organisms and also in the vegetable kingdom.
Herwig in his discussion of color psychology, refers to the “reverse” of certain psycho-physical processes and points out the appearance of a negative instead of a positive mimicry with advancing age. According to him, one differentiates in biology between the “antigen,” a change in mood as the result of external influences and the “autonomen,” change in mood through adjustment from within itself. To the latter, he reckons also the reversion of the habit of mind occasionally to be noticed in old age.
He draws attention to the fact that this last condition should indeed be associated with a large circle of biological facts and produces as an illustration analogous to the reversion of mimicry, the following observation: The hypokotyl member ( the trunk portion or the internode of the germ of a plant which carries the seminal leaves and the small roots) of the germ- plant of the gourd is, in the beginning, positive geotropic; later, negative geotropic. In cases of especially strong reversion of habit of mind as in many cases of cyclothaemia, sleep in deep and prolonged during the period of melancholia as if the loss of sleep during the maniacal period was being compensated for.
With regard to the sleep of the sick, the physiological processes depend upon the type of the patients and of their disease and upon the physical processes as well as upon the psychical reaction.
Psychological observations teach us that the conscious wish to sleep and the instinctive or subconscious wish to remain awake, especially in cases of nervous insomnia, are very often antagonistic to one another. As one speaks of the will to be sick, so can one speak of the will to sleep (Steckel) and the will to insomnia. Many patients suffering from insomnia recall instances when they were at times sleepless through conscious will in order to experience certain phantasies and memory pictures, others because they were afraid of their dreams. So many sick people, do not fall asleep for the reason that they are subconsciously distressed by elementary urges and instincts that become active during their sleep, in other words, because the censorship which exists during the day enters into conflict with the wishes of the night.
