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Another way of stating the patient's difficulty is that he can dream, but that even any ‘good’ dream (i.e. one that lends itself to interpretation) is evidence of a breakdown in dream-work alpha. The point with any patient is not whether he suffers or does not suffer from insomnia – does or does not sleep – but whether he can or cannot do α, is or is not capable of α, for whatever reason. It may be because he
lacks whatever the necessary apparatus is that is required, or that he fears the synthesizing activity of α if all dream work is not inhibited. But the result is he may not be able to sleep because of fear of α, and then find he cannot keep awake for the same reason, for as I have pointed out, α operates in sleeping and in waking. Since the patient, if he is to live, must sleep and must wake, he can oscillate rapidly from one to the other to destroy α.