Charles Fisher

A Psychophysiological Study of Nightmares

HE PROBLEM OF THE DREAbr of the traumatic neurosis seems to have preoccupied and puzzled Freud through most of his scienT tific life, and consideration of this phenomenon had rather fateful consequences for him leading to his major theoretical formulations about the repetition compulsion and the death instinct. Freud (1920) noted that dreams occurring in traumatic neuroses have the characteristic of repeatedly bringing the patient back into the situation of his accident from which he awakens in fright. This, he commented, “astonishes people far too little,” and remarked further, “Anyone who accepts it as something selfevident that their dreams would put them back at night into the situation that caused them to fall ill has misunderstood the nature of dreams. It would be more in harmony with their nature if they showed the patient pictures from his healthy past or of the cure for which lie hopes” (p. 13). Freud referred to the posttraumatic dream as a “dark and dismal subject” because he could not reconcile it with the wish fulfillment theory and, in fact, finally had to admit that it constituted an exception. He felt forced to admit that traumatic dreams

The sleep characteristics of the normal aged male.

In order to study the sleep characteristics of the normal elderly male, 16 volunteers aged 71 to 95 years (mean age, 80.2), slept in the laboratory for at least 2 or 3 base line nights each. Age correlated positively (r = .64, p < .01) with number of awakenings and negatively (r = −.43, .05 < p < .1) with percentage of time asleep, indicating increasing sleep disturbance between the ages of 71 and 95 years. Mean rapid eye movement sleep (REM) percentage was 20.1; total REM time, 74 minutes; and mean REM period length, 17 minutes. Age correlated negatively with each of these measures (−.50, −.47 and −.51, respectively, all p < .05); however, REM sleep did not appear markedly reduced until late old age. Mean percentage of stage 4 sleep was 4.5 and stage 3, 17.2. In comparison to the young adult, stage 4 sleep appeared decreased and stage 3 sleep, increased. The amplitude of delta waves in the aged was reduced, a finding which probably contributed to the lowered amounts of stage 4 sleep. The latency from sleep onset to the first REM period in the elderly seemed shortened. This reduced latency probably resulted from decreased stage 4 sleep during the first non-REM period. REM sleep increased in the latter part of the night, and this was due to decreased intervals between REM periods and not to increased REM period lengths. Finally, with increased age there were more frequent interruptions of REM periods by stretches of stage 2 sleep.

A psychophysiological study of nightmares and night terrors. I. Physiological aspects of the stage 4 night terror.

Anxious arousals originate from all sleep stages and can be classified as: a) stage 4 night terrors; b) rapid eye movement (REM) nightmares; c) stage 2 awakenings; and d) hypnagogic nightmares. We have confirmed Broughtons finding that the night terror, the most severe type of episode, does not occur in sleep but as part of the “arousal response,” a complex of autonomic discharge and behavioral symptoms. The full blown night terror is a fight-flight episode combining sleep utterances, sleep walking and hallucinated or delusional mental content associated with terror. There is a significant positive correlation between intensity of night terror and the amount of delta sleep preceding arousal, e.g., stage 4 arousals designated as night terrors are preceded by longer periods of stage 4 than arousals of lesser intensity (p <.05). About two-thirds of both stage 4 and night terrors occurs in the first non-REM (NREM) period. The night terror arises out of physiologically quiescent sleep as indicated by the normal or slightly less them normal cardiorespiratory rates during the first NREM period and absence of skin resistance changes prior to the attack. The night terror is ushered in by sudden loud piercing screams, the subject passing into an aroused state characterized by alpha rhythm, motility, often somnambulism, intense autonomic discharge (precipitous doubling or even tripling of heart rate, great increase in respiratory amplitude, marked decrease in skin resistance), brief duration (1 to 3 minutes), varying degrees of amnesia for the episode, and rapid return to sleep. The night terror is a much more severe phenomenon than the REM nightmare although the latter is far more frequent. The nightmare occurs in REM sleep, is characterized by slight autonomic fluctuations, compared to the night terror, and, in half of instances, a “desomatization” of the anxiety response, that is, absence of its physiological concomitants. The REM state is physiologically activated to begin with, constituting a preparation for fright, possibly a buffer against the extreme terror of the stage 4 variety. The important problem of the triggering mechanisms of the night terror remains unsolved: whether the attack is precipitated by ongoing mental content during delta sleep, or represents a psychosomatic “arousal response“ (Broughton). The fact that it can be induced artificially by sounding a buzzer speaks in favor of the latter, the finding of significant mental content in favor of the former. The night terror is not a dream but a symptom emerging from stage 3-4 sleep, associated with a rift in the egos capacity to control anxiety.

On The Presence of a Rhythmic, Diurnal, Oral Instinctual Drive Cycle in Man A Preliminary Report

HE PAST DECADE’S research in the area of the sleep-dream cycle already comprises a vast bibliography that will not be reviewed i here. Instead, its main details and more pertinent facets will be noted as corollary to this study. Reference can be made to recent reviews of the field by Dement (5) and Fisher (S), each of whom evaluates the current state of knowledge from a different point of view. The current understanding of the sleep-dream cycle is that of two qualitatively different forms of sleep. The first comprises EEG Stages 2,3, and 4. The second occupies EEG Stage 1 and can be characterized by its REMPs,l inhibition oE motor discharge, physiological changes, and dreaming. REM sleep has also been described as a more archaic form of sleep, controlled by pontile centers and the Iimbic system (IS). In addition, this cycle of REMNREM sleep is phylogenetically old, present in all subjects, regular in its occurrence, and tenacious in the sense that efforts to block REM sleep are countered with an increasing tendency on the. subject’s part to re-enter this type of sleep. With the development of knowledge of this omnipresent cycle during sleep and of the neurological complexity of its operation,

Dreams and perception; the role of preconscious and primary modes of perception in dream formation.

An important contribution to the part played by recent material in the construction of dreams has been made by Poetzl (1917) in a paper which carries a wealth of implications. In a series of experiments Poetzl required the subjects to make a drawing of what they had consciously noted of a picture exposed to their view in a tachistosco&an-instrument for exposing an object to view for an extremely short time). He then turned his attention to the dreams dreamt by the subjects during the following night and required them once more to make drawings of appropriate portions of these dreams. It was shown unmistakably that those details of the exposed picture which had not been noted by the subject provided material for the construction of the dream, whereas those details which had been consciously perceived and recorded in the drawing made after the exposure did not recur in the manifest content of the dream. The material that was taken over by the dream-work was modified by it for the purposes of dream-construction in its familiar ‘arbitrary’ (or, more properly, ‘autocratic’) manner. The questions raised by Poetzl’s experiment go far beyond the sphere of dreaminterpretation as dealt with in the present volume. In passing, it is worth remarking on the contrast between this new

Psychoanalytic Implications of Recent Research on Sleep and Dreaming: Part I: Empirical Findings:

REUD’S earliest program was to develop a general psychology on neurophysiological lines (53). Although this attempt failed F and.Freud concluded that the theory of behavior must be a psychological one, he never gave up the belief that ultimately the link between psychoanalysis and physico-chemico-biological processes would be found. During the past decade some revolutionary discoveries have been made on the nature of sleep and dreaming, the full implications of which have not yet been integrated into psychoanalytic theory. These discoveries involve significant correlations between dreaming as a psychological process and the physiological and neurophysiological events that are concomitant and synchronous with it. They constitute what Snyder (150) has called “The New Biology of Dreaming.” Most of what we know about dreams and dreaming we have learned from Freud, but it must be admitted that not many basic advances in our understanding have occurred since Freud’s time. As revealing as the psychoanalytic method has been, the answers to many simple questions are beyond its investigative reach. How much dreaming occurs each night? When during the night does it occur? In what stage of sleep? Are there age and sex differences? Are there fluctuations in the amount of dreaming in various types of mental disease? Can drugs affect the nature and quantity of dreaming? What are the physiological and neurophysiological concomitants of

Studies on the Nature of Suggestion1: Part I Experimental Induction of Dreams by Direct Suggestion

Thirty years ago Freud (12) commented that, “Now that I once more approach the riddle of suggestion after having kept away from it for some thirty years, I find there is no change in the situation.” Earlier Ferenczi (6) had shown that the capacity to be influenced by suggestion depends upon the possibility of transference taking place, that is, upon the reactivation of repressed, infantile erotic attitudes toward the parent figures. Freud (12) later defined suggestion as a conviction which is not based upon perception and reasoning but upon an erotic tie. He advanced our theoretical understanding in his conception that in suggestion sexua‘l tendencies are inhibited in their aims and the object takes the place of the ego ideal. Jones (16) developed this latter conception further when he showed that in suggestion there is a regression from the ego ideal to the earlier stage of narcissistic identification with the parent. In the thirty years since Freud made his last contribution to the subject, the theory of suggestion has been relatively neglected in spite of considerable work in the field of hypnotism. Nunberg (23) once made the-statement that the place to study hypnosis is in the analytic transference situation. I was much struck by this seemingly paradoxical remark, since it pointed up the similarities between the two states or relationships. It occurred to me that if one were to introduce suggestions into the relatively

Some correlates of rapid eye movement sleep in the normal aged male.

Levels of cognitive functioning and drive have been hypothesized to influence amount of rapid eye movement (REM) sleep. The aim of this investigation was to study the effects of cognitive and drive functioning on amounts of REM sleep in the aged. Level of drive was defined by 1) the individuals proportion of REM periods accompanied by full erection and 2) his reported frequency of sexual outlet. Level of cognitive functioning was defined by each individuals Wechsler Adult Intelligence Scale (WAIS) score and Wechsler Memory Scale score. Strength of grip was also studied as a control measure. Sleep data were available from 16 normal male subjects, aged 71 to 95 years. Amount of erection was measured on strain gauge nights and reported frequency of sexual outlet was obtained from interviews. The WAIS, Wechsler Memory Scale and strength of grip evaluations were completed after the sleep nights. Amount of REM sleep correlated significantly with a) proportion of REM periods categorized as full erection (p < .05), b) the WAIS digit symbol subtest (p < .01) and c) the WAIS performance and Wechsler Memory Scale scores (combined) (p < .05). The significant correlations between amount of REM sleep and frequency of full erection were not considered confirmation of the drive hypothesis because 1) significant correlations were also obtained between REM sleep and nondrive measures, and 2) there were difficulties in interpreting the correlations in terms of a drive theory. We did not find as high correlations between amount of REM sleep and WAIS performance and Wechsler Memory Scale scores for the aged as had been previously reported. Also the significant correlation between amount of REM sleep and the WAIS digit symbol subtest was not considered a clear confirmation of the cognitive hypothesis, since it may have reflected a psychomotor slowing with age as well as lowered cognition. Therefore, it was concluded that the present findings reflect a general physiological decline with age, affecting amount of REM sleep, erection, cognition and other aspects of functioning, and probably due to the deterioration of the central nervous system.

Conversion of psychotherapy to psychoanalysis

N HIS OPENING REMARKS, OREAILAND RAISED the Central isSue Of I the Panel-whether conversion from psychotherapy to psychoanalysis requires transfer of the patient to another analyst. The more historical and conservative view was that a new analyst is required. The idea that a change in analysts is unnecessary is emerging in recent years as the result of significant conceptual shifts concerning the relation between psychotherapy and psyclioanalysis. Oremland described a spectrum of viewpoints regardin

Fugue states in sleep and wakefulness: a psychophysiological study.

the distinctions among the analytic psychotherapies and psychoanalysis proper. The historical dichotomy between exploratory and supportive psychotherapy has conceptual ambiguities in that it leaves unclear what is to be explored and what is to be supported. By and large, noninterpretive interventions, whether exploratory or supportive, are varieties of suggestion. A different dimension, introduced by R. R. Greenson, differentiated “those psychotherapies which use the transference toward therapeutic goals from those, of which analysis proper is the most pure form, in which the transference.. . is the central object of study.” Oremland stated that the panelists vary in their views of the importance of interpretation in psychotherapy-one pole being the viewpoint that psychotherapy utilizes selective and partial interpretations, along with interactive interventions; the other pole being the viewpoint that “psychotherapy for a wide variety of patients can be comprised of predominantly interpretive interventions, similar in mode and manner to the activity of the analyst in analysis.” He asked the panelists to discuss “the qualitative and quantitative range of interaction that can constitute the initial psychotherapy” and still preserve the potential for subsequent conversion. To the Panel at large, and to Ernst Ticho in particular, he ad-