On the Occurrence of the Isakower Phenomenon in a Schizoid Disorder1

IN A NOW CLASSIC PAPER, Otto Isakower (1938) described a relatively rare but intriguing complex of sensory phenomena recalled and reported by certain of his patients as occurring in the twilight state of consciousness just prior to entering sleep. These phenomena, taken together, appeared to so closely recapitulate precognitive elements of nursing at the breast, they were considered by Isakower, and thereafter, as parts of a single experience. The predominant theme in the subsequent psychoanalytic literature on the subject has been an effort to more precisely establish the psychodynamic nature and etiology of this hypnogogic event by examining the personality structure of those patients who, during the course of an analysis, either report it as a childhood memory or re-experience the event itself.

The Isakower phenomenon, as it is referred to, is characteristically remembered or re-experienced by the individual as the visual sensation of a large, doughy, shadowy mass, usually round, growing larger as it comes nearer and nearer to his face, swelling to a gigantic size and threatening to crush him, and then gradually growing smaller and moving further away. Often there is an indistinct perception of a purplish shape like the nipple area of the breast. The approaching mass slowly seems to become a part of him, obscuring the boundaries between his body and the outside world, and blurring his sense of self more and more. All of this is