A Clinical Note on the Isakower Phenomenon

In 1938 Isakower (4) carefully arrived at an interpretation of certain predormescent phenomena which now bear his name. The phenomenon consisted of a number of experiences. A patient while in the process of falling alseep may feel as if he is on a revolving disk, may experience a giddiness, a crumpled feeling in his mouth, a disagreeable, yet strangely pleasant sensation overtaking him. There may be a feeling of something large in the mouth and a sensation of heaviness lying on top of him. Some patients stated that it was like a “lump which cannot be swallowed.” On rare occasions there may be a sound—“humming, babbling, murmuring -or unintelligible monotonous speech.” It may be accompanied by an uncanny feeling. Once started, it can be reinstated in order to study it. Frequently it is like something “crumbled, jagged, sandy or dry”—experienced in the mouth and at the same time on the skin of the body. The subject may feel enveloped by it. Often there is an attitude of self-observation which is striking and the experience can be voluntarily prolonged or retained. Most of the Isakower explanation of the phenomenon hinged on his conception that the body ego during the experiencing of these sensations, is in a state “which represents, amongst other things, a very early situation of satisfaction.” He announced that that which was experienced by his patients was a “hallucinatory” revival of the breast.

In 1946 Lewin (5) introduced the term dream screen as representing the breast during sleep upon which the visual contents of the dream are projected, and also representing the wish to sleep. Utilizing Federn's (1) comment that “the ego boundaries are lost in sleep,” he arrived at another conclusion: the sleeper losing his ego boundaries upon falling asleep then “became united with the breast.” Lewin did not fail to see the connection between the phenomena described by Isakower and his dream screen. He stated that “hypnagogic events preceding sleep represent an incorporation