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Observations on four narcoleptic patients, studied in repeated interviews by free association and with intravenous sodium amytal injections, indicate that the narcoleptic patient is in an insoluble conflict between the need for self-differentiation from a life pattern laid down for him by others and the psychological ties that hold him to that pattern. Whenever the patient is confronted
with life situations which tend to provoke behavior unacceptable to him, narcoleptic symptoms are precipitated and serve to interrupt integrated activity. A series of such symptom-provoking situations plus the ensuing reactions are recreated in the interviews with each of the patients. Narcoleptic symptoms also ensue whenever the patient's interest in the environment slackens and tension from internal needs is minimal, since the narcoleptic patient's hold on wakefulness is tenuous as a result of his unsatisfactory, boring existence. Barker views narcolepsy as 'a pattern of discontinuous organism … environment integration in which interruptions occur whenever intolerable distress arises in the course of the existing integration or whenever chronic distress and immediate decrease of biologic tensions reduce the degree of integration below the waking level'.