ON THE NIGHTMARE. ABSTRACTS Ernest Jones, M.D., M.R.C.P. (Lond.) American Journal of Insanity, January, 1910. IN this article, the subject of nightmare receives from the able pen of Dr. Jones a most admirable exposition. Under the heading, Pathological, Jones discusses the curious indifference with which the subject has been viewed by medical science, and the consequent failure to treat victims of the disorder with success. The reason for this state of affairs, he finds to be a lack of appreciation of the intensity of the mental suffering entailed, ignorance of the underlying reality, and a general materialistic attitude toward mental symptoms in general, and of dreams in particular. Even regarded from a physical standpoint, the condition is certainly not neglectable, as shown, for example, by the presumable occurrence of cerebral hemorrhage during sleep as a consequence of alterations in the circulation induced by the agony of bad dreams. An interesting description of nightmare as given by various appreciative writers on the subject, most of whom were themselves victims of the disorder, gives the reader a vivid idea of the mental suffering induced by the condition. The dread occurring in nightmare is, according to Jones, best denoted by the untranslatable word Angst. It appears that the cardinal features of the malady are: 1. Agonizing dread. 2. Sense of oppression or weight at the chest which alarmingly interferes with respiration. 3. Conviction of helpless paralysis. The Angst has been variously described by writers, among whom perhaps Shakespeare stands pre-eminent; as, for example, "I, trembling, waked, and for a season after Such terrible impression made my dream." The second cardinal feature is a sense of oppression, with a dread of suffocation, often reaching an extreme degree of intensity. The third element is a sense of powerlessness, often amounting. to complete paralysis, representing an effort on the part of the victim to free himself from the suffocation. When the dream has reached its culmination, there are evidences of the struggle through which the afflicted person has been; as, for example, an outbreak of cold sweat, heart palpitation, ringing in the ears, a sense of pressure about the forehead, and a terror-stricken countenance. The following day it is not unusual for the patient to suffer from depression, dread, lack of confidence, pain, and weakness. In some instances, in fact, the attack may continue for some time after clear consciousness has been regained. There has been much speculation as to the circumstances under which the attack takes place. It appears that the most probable times for nightmare to appear are either in the early part of sleep, or in the semi-waking state toward morning. It has been generally accepted that nightmare is more likely to occur when the person is sleeping on his back, hence the therapeutic suggestion that other attitudes are desirable. Certain writers, however, attach relatively little importance to this factor in the causation of the attack. The pathogenesis of nightmare is the matter of chief interest, and regarding this a vast variety of hypotheses have been advanced, to certain of the more important of which Jones alludes. In general, it appears that writers have mistaken for the true. cause of the malady factors which simply play a part of varying importance in the genesis of a given attack. As in other conditions, it is altogether probable that an underlying abnormal predisposition is excited to activity by a variety of relatively superficial causes. Jones strongly maintains that the predisposition is the matter of cardinal importance, contrary to the opinion. of certain other writers who believe that nightmare may also be aroused when certain superficial conditions (e.g., indigestion) are present. The alimentary, the respiratory, the circulatory, and the nervous systems have all been blamed as causative of nightmare. Many of the fanciful descriptions of the early writers may be dismissed without detailed mention. Others of ancient. date still retain some popularity, as, for example, the view originally advanced by Galen, and later elaborated, that the affection. arose from gastric disturbances, on the ground that an over-full stomach, by pressing on the diaphragm, may act as a source of irritation to the nervous system. The supine position has been regarded as an efficient agent on the basis of a complicated hypothesis concerning the mechanism of circulation. A second series. of hypotheses is concerned with the state of the cerebral circulation, gastric disturbances in the view of the adherents of this theory playing merely a subsidiary role. A reaction from these purely physical views took place in 1855, when Moreau began to lay stress on the psychological aspect of the problem. This reaction was entirely justified, since an examination of the physical theories shows that very frequently the alleged causative factors occur without being followed by nightmare; and, on the other hand, that attacks of nightmare occur without being preceded by any of the supposed causative factors. From such critical observations, it appears that, in the first place, such alleged causes often occur in persons who never show any symptom of nightmare, as, for example, in a person suffering from gastric cancer, who may even add to this causative factor the habit of sleeping on the back without the slightest trace of nightmare; whereas, other sufferers, scrupulously regarding their diet and methods of sleeping, may still suffer to the same degree as if no such precautions had been taken. It therefore follows on empirical grounds that the phenomenon of nightmare is inadequately explained by the foregoing physical factors. The essential manifestations of nightmare must be regarded as mental, dominated by an acute feeling of Angst, which in this connection must be considered a distinctly pathological phenomenon. Angst is, in general, closely connected with sexual feeling, and especially with its pathological repression. If the analysis of dreams shows, as maintained by Freud, that in all cases they represent the fulfilment in the imagination of some desire, usually repressed during the waking hours and that violent mental conflicts result therefrom, it naturally follows that "the malady known as nightmare, is always an expression of intense mental conflict centering about some form of repressed sexual desire." Under this view Jones believes that the diverging theories of nightmare may best be reconciled. He brings in support of his argument a number of significant cases described in the literature, which under a searching psychoanalysis fall into the category of the Angst neurosis in the Freudian sense. The conclusions of this erudite paper are summarized in the closing paragraph, as follows: "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 overestimated as a factor in the production of the affection." E. W. TAYLOR. REVIEW'S ELEMENTS OF PHYSIOLOGICAL PSYCHOLOGY. By George Trumbull Ladd and Robert Sessions Woodworth. New York, Charles Scribner's Sons, 1911. Illustrated; pp. xix, 704. THE subtitle of this timely revision of Professor Ladd's book of like name, published twenty-five years ago, is "A Treatise of the Activities and Nature of the Mind, from the Physical and Experimental Points of View." It is, however, characteristic of the trend of things psychological that this treatise of "the mind" is very largely a discussion of the functions of the nervous system physiology, if there be any physiology; and for progress this is certainly well. Nine pages of the 723, the last chapter in the book, is concerned with "the reality and unity of the mind," and has a minimum of neural reference. The book consists of three parts, respectively "The Nervous Mechanism," "Correlations of the Nervous Mechanism and Mental Phenomena," and "The Nature of Mind," the first two constituting 625 pages. As a treatise on mental process, then, as something distinct and different from consciousness, one is somewhat surprised to read in the second page of the text: "Recent researches into so-called 'subconsciousness' as involving mental processes which go on 'below the threshold,' and theories of double and triple selves have served further to confuse or discredit the timehonored concept of a soul, or mind, as a permanent and quasiindependent entity. It would be aside from the course of our inquiries to consider these objections in detail at this time.” One cannot help wondering why it "would be aside from the course of the inquiries," since the book aims otherwise at completeness in the discussion of mind. One wonders how long so many of the unmedical psychologists will retain their prejudice against a normal group of basal phenomena simply because the average subject in the college psychologic laboratories does not wear them. diurnally on his sleeve. Is not the normal mind as one sees it in the nerve-clinics, then, as human, as good material, and withal as instructive, as enlightening, as are those aspects of the mind so much studied in the college laboratories? And surely one wonders why Professor Ladd (for it does not sound like Professor Woodworth) sees fit to pronounce that researches into subconsciousness and theories of double and triple personality “have served further to confuse or discredit the time-honored concept of a soul, or mind, as a permanent and quasi-independent entity." On the contrary, to the present reviewer for one, at least (and possibly to some others?) these very researches and theories have helped like nothing whatever else to explain and to clarify the inherent personality of man in his relations both to the individual organism and to the eternal verities and values around him here and hereafter. Dominant in this matter, of course, is one's metaphysic, one's philosophy-dualistic or monistic-only a point of view, a matter of definition or of temperament. But as we come by way of physical science to comprehend matter in terms of mind perhaps we shall learn to understand mind in terms of matter the soul in its bodily relationships, and therefore all the more soul. But even leaving out the important matter of the subconscious aspects and their relations to neurility on the one hand and to clear "pure" consciousness on the other, this treatise on the bodily aspects of mind is elaborate and replete with the information every devotee of psychology needs, be he amateur or professional, student or physician. The illustrations are both many and to the point. The references to collateral literature are very numerous; there is an index of authors at the end of the volume that would be more useful and less misleading were the initials of the writers given. One of the best chapters in the book is that on feeling, emotion. and expressive movements. It is complete and unbiased. The discussion of cerebral localization, too, while leaning perhaps unduly to the Ferrier side, is, on the whole, safe and sane, as is fitting for a text-book, which should give the details of whatever localization has been reasonably suggested. One certainly misses Bastian's viewpoint in the book as an explicit doctrine, especially since recent advances (such, for example, as the work of MacDougall, Head and Holmes, etc.) make for a much broader phrasing of the new phrenology of Ferrier, etc., in terms of a totally psychomotor great brain, a motor spinal cord, and a mediating cerebellum and brain-stem. One sees from this complete and connected description and discussion, and usually better than from the compendious Lewandowsky or von Bechterew, how completely advance in psychophysiology is blocked until the appointed genius shall discover the recondite secret of the action of the brain. It cannot come through "localization" we may more and more confidently assume, but it will come, sometime, when occurs the right revealing combination of insight and of understanding of the integrated neural plan. Such books as this of Ladd and Woodworth will help to this great end better than |