Pathological Sleep1

My paper has to do with that particular kind of pathological sleep which occurs in some patients during the analytic hour. Feelings of sleepiness in the hour are probably very common; but real, sound sleep occurring day after day is not common, or at least we must judge this to be so from the few reports in the literature. Not only is there very little to be found on this particular form of pathological sleep, but sleep itself has been the specific subject of very few studies. Non-specifically, sleep has of course been the centre of psycho-analytic work from the very first, but in that work the dream—not the sleep—received prior attention.

Perhaps the clearest exposition by Freud (1) on the general subject of sleep is in his 1916 paper on the Metapsychological Supplement to the Theory of Dreams. There he points out that little thought is given to the nightly laying aside of both physical and mental acquisitions, which brings the human being remarkably close each night in sleep to the situation in which life began. Somatically, sleep reproduces intrauterine existence, and psychologically it is a narcissistic state in which there is an almost complete withdrawal of cathexis not only from the outside world but from all the systems of the mind as well.

This much Freud states in the introductory paragraphs of his paper. He then proceeds to an extremely profound discussion of metapsychology, which, while it is essential to a thorough understanding of sleep, is much beyond the scope of this particular presentation.

Articles on sleep by other authors are few, and mostly have to do with disturbances in which patients cannot sleep. In such cases of sleeplessness patients are afraid to go to sleep—control by the ego of id impulses is so reduced during sleep that the risk cannot be taken.

In most studies repeated reference is made to the oral nature of sleep, and this is given its greatest elaboration by Lewin in his paper, "Sleep, the Mouth, and the Dream Screen" (2) and in