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SYMPTOMATOLOGY, PSYCHOGNOSIS, AND DIAGNOSIS OF PSYCHOPATHIC DISEASES
Boris Sidis, Ph.D., M.D.
Boston: R. Badger, 1914
THE VIVIDNESS OF HALLUCINATIONS AND DREAMS
STATES of dissociation, light sleep, and especially the intermediary states occurring in the course of falling into deep sleep or coming out of it are favorable to the formation of hallucinations. Such conditions occur in abnormal mental states, in hypnosis, in somnambulism, in hypnoidal and hypnoidic states, in the so-called psychic equivalents of epilepsy, in pure psychic epilepsy, and, generally, in states of functional psychosis. In the intermediary states between waking and sleeping, dissociated systems awake and become accessible to the influence of external stimuli.
This is clearly shown in the hypnagogic hallucinations, as well as in the frequent dreams often taking place in the lighter sleep states usually before waking. I have often observed in myself, when being fatigued. and becoming drowsy and closing my eyes, how fast phantoms and scenes flit before he mental gaze, most of them being formed by the flitting masses of light in the field of vision. Often in closing my eyes and keeping quiet, so as to become somewhat drowsy, and watching the field of vision, not directly, but, so to say, from the corner of the eye, animals, figures, faces, can be seen forming and dissolving into mist. These have an important influence in the guidance of the mental content of the dream consciousness.
These dream phantoms can be directly traced to specks of light and masses of color, coming from the retina and especially from the macula lutea. In many psychopathic cases, not only vision, but also sounds and voices are experienced as in some of my cases that have hypnagogic hallucinations of voices. The dimly lighted up regions that lie on the borderland of sleep and waking states are peopled with phantoms, ghosts, and apparitions.
Statistics seem to confirm this point of view, since about 50 per cent of cases of hallucinations may be classed as ‘borderland hallucinations.’ Some recent critics in this field of inquiry strongly favor the view that hallucinations occur in dream states, hallucinations being but vivid dreams, the percipient not being conscious of having fallen asleep. This view is not new, it is favored by Hobbes. ‘The most difficult discerning,’ Hobbes tells us, “of a man’s dream from his waking thoughts is then when by some accident we observe not that we have slept.”
Many cases no doubt admit of such an explanation. I myself had an experience of such a character. While sitting and studying one evening, I felt myself suddenly transported into my father’s house and looking out of the window, seeing the scenery characteristic of the locality and hearing the voices of my parents in the next room, but I could not discriminate the words. The vision was so real that I was surprised to find myself again at my book and in a place hundreds of miles away from home whither my hallucinatory state had so suddenly transported me. The hallucination was so strong and real that had I not critically analyzed the conditions of its occurrence I should have been fully certain that the hallucination appeared in the waking state.
As a matter of fact, I was fatigued from my studies and dropped off. The actual surroundings, the room, the table, the book, the voices of my friends present, all disappeared from my view during the intermediary state, and when I came out of it I gave a start in realizing once more the actual situation.
According to records, hallucinations take place when the percipient is in bed, just after retiring, or about to wake up, or after waking. The percipient is really asleep, only he is not aware of it, so brief is the state and so intense and vivid is the hallucination. It may, therefore, be maintained with some show of truth that hallucinations are dreams and take place in sleep states.
We must guard, however, against carrying a generalization too far. This contention that hallucinations occur in dissociated dream states is somewhat overstated. It is true that hallucinations require states of dissociation, but this does not necessarily mean sleep states. Not all states of dissociation are dream states taking place in sleep, although it may be safely asserted that all dissociative states have many traits in common and are at bottom of the same nature. Hallucinations and dreams may be analogous, may be of the same structure requiring the same general conditions, but it does not for that reason follow that they occur in the same states, in sleep states.
Dissociation with consequent hallucinations may also take place in waking states. Those who have studied hallucinations in different forms of mental diseases know that most of the hallucinations occur under widely different conditions, and they further know that it is precisely in the waking states that hallucinations are most commonly present, while in the sleeping states they are more frequently absent. Insanity may be compared with dream states, but they are by no means identical. The important condition requisite for the occurrence of hallucination is dissociation, and this condition often occurs in waking states, such as the hallucinations found in many forms of insanity, as for instance paranoia, hebephrenia, katatonia, general paralysis and other states of mental aberration.
Even hypnotic and post-hypnotic hallucinations can hardly be claimed to have been really induced in dream states. They who have devoted time and labor to hypnosis know that the hypnotic state can by no means be identified with sleep, and that in the very deepest stages of hypnosis the subject is to all intents and purposes fully awake; he is full of activity, his eyes are open, his senses are on the alert—he is far more awake to external stimuli than even in his normal state. The mind is active and the subject carries on long trains of reasoning, argumentations and discussions with the people around him; in short, the subject in the deep somnambulic state is in a condition the very opposite from that of the sleeping state. Hallucinations occur both in the waking and sleeping states and require dissociation as an indispensable condition.
If we inspect more closely the relation of the stimulus to the hallucination, especially to the dream hallucination, we find that the intensity of the content is disproportionate to the intensity of the initiating stimulus, to the peripheral sense impression. A comparatively slight stimulation often gives rise to a dream of a highly dramatic character. This exaggerated character of the dream hallucination is well known.
Thus a prick of a pin may give rise to a dream of being attacked by robbers, and finally being run through by a thrust of a dagger. The application of a warm bottle to the feet may develop a dream of ascending a volcano and walking on molten lava, while a cold stimulus may give rise to a dream of participating in a dangerous expedition to the North Pole. Pain in the head, impeded respiration and pressure in the region of the neck may develop, as in the case of a friend of mine, the horrible dream of being dragged into a narrow dungeon and then beheaded.
To explain this dream exaggeration a theory is advanced based on dissociation. It is claimed by James that dissociation tends to convert the physiological “ideational currents” into sensory “currents” and thus intensify and exaggerate the psychic states.
Before discussing the theory it may not be amiss to examine the facts which the theory is called to explain. It is questionable whether the general relation of dream stimulus is quite correctly stated. It appears that the generalization is stated somewhat in the form of the well-known question: Why do great rivers flow by great cities? It is by no means generally true that the characteristic of dream consciousness is to exaggerate stimuli received and work them up to a pitch so as to convert “ideational into sensory currents.” The relation is far simpler.
The dream does not necessarily exaggerate incoming stimuli and make of them exciting and sensational dream hallucinations. What happens is this: the commonplace, non-exaggerated, unaffective, dreams tend to fade away almost immediately on waking, while the impressive dreams are usually remembered. I have observed a number of dreams in my own case as well as in others and have found that the number of ordinary commonplace dreams far predominates over the striking and extraordinary dreams.
Even in psychopathic cases in which subconscious dream life is often well developed, even in such states I have found in the cases which have been under my observation and experimentation that the commonplace dreams far predominate over the dramatic and extraordinary ones. The only way to convince oneself of it is to try to write down the dream immediately on waking. I find that the ordinary dream is hard to hold in memory, it is elusive and is constantly slipping away from us, a special effort of attention is requisite to hold on to it; it is usually hazy, vague, and confused.
On the whole, the indifferent dreams really predominate, but it is only the impressive ones that remain in memory. Even the freshness and recency of the dream do not save it from falling into oblivion. Now while commonplace and indifferent dreams are forgotten, older dreams, but more impressive, more awakening our emotions, especially emotions of fear, will be clearly and vividly remembered.
Still the fact that exaggeration and intensification of the sense impressions received by awakening a greater volume of secondary sensory elements and representations more often than in the waking state requires an explanation. This intensification is partly due to the fact that in sleep sensory impressions often enter consciousness suddenly. This brings about a shock, awakening emotions which are conducive to a stimulation of a greater volume of secondary sensory elements and their accompanying representations. Even in the normal waking state sense impressions suddenly introduced into consciousness may cause a shock and give rise to an illusion, the object appearing as something strange and formidable.
We can often observe it in ourselves, when falling in-to a drowsy condition, a slight stimulus which we otherwise ignore will give us a sudden start. I often observed in myself when in a drowsy state and “dropping off” how an ordinary stimulus, such as a cough, for instance, will produce a shock, affecting the visceral organs, the feeling being somewhat similar to the condition commonly described as a “sinking sensation in the pit of the stomach;” the shock seems to reverberate all through the organism.
To this must be added another important factor, namely, the emotion aroused. When an object is perceived under conditions that do not permit its recognition or its assimilation and consequently its customary reaction, an emotion of fear, is produced. Such is the case, for instance, when some objects impress us in the dark or when we get hold in the dark of some slimy, slippery, and especially of moving objects.
These two factors often work together, inasmuch as an object suddenly introduced into consciousness is also not speedily assimilated so that the shock and emotion due to non-recognition or non-assimilation go together. Now in sleep stimuli entering into consciousness effect it in a sudden way, and from the very nature of the sleeping consciousness the external stimulation is but imperfectly assimilated; both factors, shock and emotion, due to non-assimilation are present and sometimes give rise to a highly wrought up emotional state which is so apt to transform objects by arousing different systems of elements and at the same time to impress the memory powerfully.
It is claimed that the very fact of dissociation brings about an intensification of ideational states converting them into sensory states. Physiologically, the assumption is made by James that the sensory nerve cells can be set into activity not only by peripheral stimuli, but also by central “currents” going from center to periphery. The sensory centres are like a bucket with water, the upsetting of the bucket being likened to the upsetting of the sensory centers, giving rise to sensations. This upsetting can be affected by peripheral “currents.” Small intracellular, ideational currents flow freely through the centers without upsetting them.
Now when an obstruction occurs in the sensory centers the ideational currents which otherwise flow out and disperse may accumulate, and aided by a chance activity of central character may upset the nerve cell in the same way as our bucket may be upset by the accumulation of water from the small incoming currents (like the ideational currents), when the holes and interstices through which they usually flow out are stopped up. The hypothesis, as far as explanation goes, is good enough, the drawback is that it explains too much. For it is hard to understand why intense dreams of this character do not occur more often.
Besides it is hard to realize how an idea can give rise to a sensation of any intensity by the mere agency of ideas, the sensation and its intensity being entirely a function of peripheral stimulation and consequent sense impressions. An idea, a representation, may be very vivid, but does not become a presentation or sensation. A sensation is not an “intense” idea, nor is an idea a weak sensation.
A series of sensations arranged in ascending or descending gradation of intensity may be likened to the continuous series of the spectrum in which there is a qualitative difference from line to line, a difference that admits of no substitution. A sensation the intensity of which is changed is a fallacious percept, an illusion. A thunder clap perceived as a whisper, a whisper perceived as a thunder clap may be equally regarded as fallacious perception as any other change in the content of the percept. The rustling of leaves perceived as an explosion is as much of a fallacious perception as when the paranoiac, for instance, hears in it curses and threats of his enemies. Sensations and percepts cannot change in content or intensity without giving rise to illusions or hallucinations.
The changes that may occur in regard to sen-sations and percepts, without their being qualitatively changed and becoming fallacious, can only be in vividness belonging to the representative elements which cluster round the primary and secondary sensory elements. A less intense sensation may be more vividly represented than one of greater intensity. A weak sound, a pale color, a light pain may be more vividly represented than the ones the intensity of which is far greater. This vividness, however, is not at all a characteristic attribute of the sensory elements, it is rather an attribute belonging to the functioning system of representative elements into which the given sensory elements enter as constituent nuclei. Taking all this into consideration we inevitably arrive at the conclusion that James’ view of dreams is not psychologically valid.
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