Discussion

DR. ALEXANDER HAS REVIEWED for us instances of patients falling asleep during psychoanalytic treatment that have been reported by various authors, along with their explanations for this occurrence. He reports that he has observed the phenomenon in his own practice and proposes to add to the literature on the subject. He explicitly recognizes the need to document the matter at hand but dismisses the possibility of presenting an adequate case history. Instead he offers a composite profile of an (unspecified) number of patients who fell asleep during therapy with him. During the course of the development of his paper he outlines more specifically the psychodynamics involved in the phenomenon of the patient falling asleep during psychonalysis.

Alexander is cavalier in his diagnosis of the composite patient. The latter seems to span from "a reactive depression" to "thought disorder" to "manic state, " "depressed state, " "hallucinosis, " and "manic depressive illness." Alexander nevertheless describes the chronology and specifics of the treatment strategies required for the "sleep patient" and the matters to be interpreted, complete with