Symposium on Neurotic Disturbances of Sleep1

The average nervous patient who comes to see the psychiatrist complains mostly of anxiety, of a state of depression, of headaches or of disturbances of sleep.

Anxiety was made a paramount subject of psycho-analytical research from the very beginning. It took a longer time before the psychology of depression was studied and to some degree understood. But disturbances of sleep and headaches have found nowhere near so much attention among psycho-analysts. The reasons for this apparent lack of interest are to be found in Freud's (1917)Introductory Lectures in the chapter dealing with 'Ordinary Nervousness'. These two types of symptoms are—or may be—of an actual-neurotic nature, which explains why analysts who study the unconscious contents of symptoms have been less interested in them. Actual-neurotic symptoms are indicative of the fact that a disturbance in instinctual life is at work; but they do not reveal anything (or not enough) of the nature of the disturbance. Since they are more or less a somatic expression of an instinctual disturbance, they disappear during psycho-analytic treatment, if the disturbance in question is of a psycho-genetic nature, without it being necessary to make them an explicit object of analytic attention. They disappear when the repression, which is the cause of the state of damming up and which is responsible for the symptom, is undone. Let us leave the question of headaches for another time. As regards sleep disturbances, these facts certainly constitute no contra-indication against a psycho-analytical approach.

• 1Not all neurotic disturbances of sleep are entirely actual-neurotic in their nature. Sometimes they have a specific psychical meaning. There are 'sleep phobias', in which the state of being asleep is more or less avoided because of a definite significance which that state has acquired in the unconscious mind of the patient; or there are 'sleep rituals' in which certain compulsive measures serve the purpose of