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THE PALGRAVE LACAN SERIES
SERIES EDITORS: CALUM NEILL · DEREK HOOK

Lacanian
Perspectives on
Blade Runner 2049
Edited by
calum neill
The Palgrave Lacan Series

Series Editors
Calum Neill
Edinburgh Napier University
Edinburgh, UK

Derek Hook
Duquesne University
Pittsburgh, USA
Jacques Lacan is one of the most important and influential thinkers of
the 20th century. The reach of this influence continues to grow as we
settle into the 21st century, the resonance of Lacan’s thought arguably
only beginning now to be properly felt, both in terms of its application
to clinical matters and in its application to a range of human activities
and interests. The Palgrave Lacan Series is a book series for the best new
writing in the Lacanian field, giving voice to the leading writers of a new
generation of Lacanian thought. The series will comprise original mono-
graphs and thematic, multi-authored collections. The books in the series
will explore aspects of Lacan’s theory from new perspectives and with
original insights. There will be books focused on particular areas of or
issues in clinical work. There will be books focused on applying Laca-
nian theory to areas and issues beyond the clinic, to matters of society,
politics, the arts and culture. Each book, whatever its particular concern,
will work to expand our understanding of Lacan’s theory and its value in
the 21st century.

More information about this series at

http://www.palgrave.com/gp/series/15116
 Calum Neill
Editor

Lacanian Perspectives
on Blade Runner
2049
Editor
Calum Neill
School of Applied Sciences
Edinburgh Napier University
Edinburgh, UK

The Palgrave Lacan Series

ISBN 978-3-030-56753-8 ISBN 978-3-030-56754-5 (eBook)
https://doi.org/10.1007/978-3-030-56754-5

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Switzerland AG 2021
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher,
whether the whole or part of the material is concerned, specifically the rights of translation, reprinting,
reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical
way, and transmission or information storage and retrieval, electronic adaptation, computer software,
or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specific statement, that such names are exempt
from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this
book are believed to be true and accurate at the date of publication. Neither the publisher nor the
authors or the editors give a warranty, expressed or implied, with respect to the material contained
herein or for any errors or omissions that may have been made. The publisher remains neutral with
regard to jurisdictional claims in published maps and institutional affiliations.

Cover illustration: Pictorial Press Ltd/Alamy Stock Photo

This Palgrave Macmillan imprint is published by the registered company Springer Nature Switzerland
AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
 For Claire,
with one more kiss, dear.
 Contents

1 From Voight-Kampff to Baseline Test: By Way

of an Introduction 1
Calum Neill

2 Do Filminds Dream of Celluloid Sheep? Lacan,

Filmosophy and Blade Runner 2049 13
Ben Tyrer

3 Blade Runner 2049: A View of Post-Human

Capitalism 41
Slavoj Žižek

4 Between the Capitalist and the Cop: The Path

of Revolution in Blade Runner 2049 53
Todd McGowan

5 ‘To Be Homesick with No Place to Go’: The Phantom

of the Sinthome and the Joi of Sex 83
Daniel Bristow

vii
viii Contents

6 Home Bodies: Prosthetic People and Economies

of Desire 103
Timothy Richardson

7 Object Oriented Subjectivity: Capitalism and Desire

in Blade Runner 2049 121
Matthew Flisfeder

8 What Happens When the Replicants Become

Extimate? On the Uncanny Cut of the Capitalocene
in Blade Runner 2049 139
Alexander Bove

9 In Anxious Anticipation of Our Imminent

Obsolescence 167
Scott Contreras-Koterbay

10 “Before We Even Know What We Are, We Fear

to Lose It”: The Missing Object of the Primal Scene 189
Isabel Millar

11 Women Between Worlds: A Psychoanalysis of Sex

in Blade Runner 2049 209
Sheila Kunkle

Index 229
 Notes on Contributors

Alexander Bove is an associate professor of English at Pacific Univer-

sity, where he teaches courses in nineteenth-century British literature,
critical theory, and film theory. His articles have appeared in several jour-
nals, including LFQ: Literature/Film Quarterly, Mediations: Journal of the
Marxist Literary Group, ELH: English Literary History, and V21 Collec-
tive. He is author of the book Spectral Dickens: The Uncanny Forms of
Novelistic Characterization, forthcoming on Manchester University Press,
and is currently at work on a book entitled Extimate Materialism that
Explores the Relation Between Film and the novel through critical theories
of comedy, the uncanny, and characterization.
Daniel Bristow is a psychoanalyst and writer, and co-creator of the
Everyday Analysis project. He has published widely on Lacanian psycho-
analysis, critical theory, and politics, and is author of Joyce and Lacan:
Reading, Writing, and Psychoanalysis, and 2001: A Space Odyssey and
Lacanian Psychoanalytic Theory, which is also in the Palgrave Lacan Series.
Scott Contreras-Koterbay received his Ph.D. from the University of St
Andrews and is a professor in both the Department of Art & Design

ix
x Notes on Contributors

and the Department of Philosophy & Humanities at East Tennessee

State University, where he teaches aesthetics, the aesthetics of tech-
nology, artistic identity and contemporary art history as well as being
the Director of the Bert C. Bach Fine & Performing Arts Scholars
program in the Honors College. He is the author of The Potential Role
of Art in Kierkegaard’s Description of the Individual (2004) and co-author
with Łukasz Mirocha of The New Aesthetic and Art: Constellations of the
Postdigital (2016).
Matthew Flisfeder is associate professor of Rhetoric and Communica-
tions at The University of Winnipeg, Canada. He is the author of Algo-
rithmic Desire: Toward a New Structuralist Theory of Social Media (2021),
Postmodern Theory and Blade Runner (2017), and The Symbolic, The
Sublime, and Slavoj Žižek’s Theory of Film (2012), and co-editor of Žižek
and Media Studies: A Reader.
Sheila Kunkle is associate professor of Individualized Studies at
Metropolitan State University. She has published numerous articles on
psychoanalysis and culture, and contributed chapters on the psychoanal-
ysis of film to Psychoanalyzing Cinema (Jan Jagodzinski, ed. 2012) and
Lars Von Tier’s Women (Rex Butler and David Denny, eds., 2017), as
well as edited the collection, Cinematic Cuts: Theorizing Film Endings
(SUNY Press, 2016).
Todd McGowan teaches theory and film at the University of Vermont.
He is the author of Universality and Identity Politics, Emancipation After
Hegel , Only a Joke Can Save Us: A Theory of Comedy, Capitalism and
Desire, and other works. He is the co-editor of the Diaeresis series with
Slavoj Žižek and Adrian Johnston at Northwestern University Press and
editor of the Film Theory in Practice series at Bloomsbury.
Isabel Millar recently received her Ph.D. in psychoanalysis and philos-
ophy from Kingston University. Her thesis is entitled “The Psychoanal-
ysis of Artificial Intelligence.” Her work has appeared in Stillpoint Maga-
zine, Psychoanalytische Perspectieven, Vestigia, JCFAR journal , and forth-
coming publications for the Courtauld Institute of Art and Precog Maga-
zine. She is also a screenwriter and psychoanalytic script consultant for
film and TV.
 Notes on Contributors xi

Calum Neill is associate professor of Psychoanalysis & Cultural Theory

at Edinburgh Napier University, Scotland, and Director of Lacan in
Scotland. He has written a number of monographs, including Without
Ground: Lacanian Ethics and the Assumption of Subjectivity (2011) and
Jacques Lacan: The Basics (2017). He is the co-editor of both the Palgrave
Lacan Series the three volume guide Reading Lacan’s Ecrits (2018–2021).
Timothy Richardson is associate professor of English at the University
of Texas at Arlington, where he teaches courses in theory, media, and
writing. He is the author of Contingency, Immanence, and the Subject of
Rhetoric (2013) as well as articles in such journals as Kairos, Pre/Text, and
Enculturation.
Ben Tyrer is a lecturer in film theory at Middlesex University. He is the
author of Out of the Past: Lacan and Film Noir (Palgrave, 2016) and
co-editor of Psychoanalysis and the Unrepresentable and Femininity and
Psychoanalysis (both Routledge, 2016 and 2019). He is a member of the
editorial board of the Film-Philosophy journal and co-coordinator of the
Psychoanalysis in Our Time research network.
Slavoj Žižek is senior researcher at the Department of Philosophy,
University of Ljubljana, Slovenia; co-director of the Institute for Human-
ities, Birkbeck School of Law, London; and visiting professor at the
Kyung Hee University, Seoul. Fields of work: philosophy, political theory,
critique of ideology. Latest publications: HEGEL IN A WIRED BRAIN
(London 2020), PANDEMIC (New York 2020).
 List of Figures

Fig. 5.1 Incomplete/incompletable circle of the desire

for completion 88
Fig. 5.2 Assumption of sinthome ‘tying up’ the gap 89
Fig. 5.3 The utopian as non-sinthomic recathexis 97

xiii
 1
From Voight-Kampff to Baseline Test:
By Way of an Introduction
Calum Neill

The original Blade Runner film, set in November 2019, opens with the
now iconic scene of Leon, a replicant, undergoing what appears to be a
psychological association-reaction test. He complains of getting nervous
when he takes tests but is told not to worry. “You’re in a desert,” Holden,
the test administrator, tells him, “Walking along in the sand, when all of
a sudden you look down…”
“What one?” Leon interrupts. He is told it doesn’t matter, that it is
completely hypothetical. But he persists, asking how he would have come
to be there.
“Maybe you’re fed up.” Holden tells him, adding some emotional
flavour. “Maybe you want to be by yourself. Who knows?” Then he
continues with the script. “You look down and see a tortoise, Leon. It’s
crawling toward you…”
“Tortoise? What’s that?”

C. Neill (B)
School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
e-mail: c.neill@napier.ac.uk

© The Author(s) 2021 1

C. Neill (ed.), Lacanian Perspectives on Blade Runner 2049,
The Palgrave Lacan Series,
https://doi.org/10.1007/978-3-030-56754-5_1
2 C. Neill

Holden asks him if he has seen a turtle and tells him it is the same
thing. When Leon says that he’s never actually seen a turtle, Holden
begins to show irritation. Leon picks up on this and reassures Holden,
saying “But I understand what you mean.”
Holden resumes, “You reach down and you flip the tortoise over on
its back, Leon.”
But Leon is having trouble focusing. “Do you make up these ques-
tions, Mr. Holden? Or do they write them down for you?”
“The tortoise lays on its back,” Holden continues, the audio track
reverberating, presumably allowing us, the viewer, to enter into Leon’s
disorientation, “its belly baking in the hot sun, beating its legs, trying
to turn itself over. But it can’t. Not without your help. But you’re not
helping.”
“What do you mean, I’m not helping?”
“I mean, you’re not helping. Why is that, Leon?”
Leon’s distress is now quite clear. Holden changes his tone and
attempts to reassure him.
“They’re just questions, Leon. In answer to your query, they’re written
down for me. It’s a test, designed to provoke an emotional response.”
It appears to have succeeded. “Shall we continue?” Holden asks. He
continues.
“Describe in single words only the good things that come into your
mind, about your mother …”
“My mother?”
“Yeah.”
“Let me tell you about my mother,” replies Leon, leaning forward, his
hands under the table. And he shoots Holden.
The Voight-Kampff test is, as Holden says, designed to provoke an
emotional reaction. The apparatus Holden unfolds at the outset of
the test, functioning a little like a lie-detector, measures physiological
changes, with a particular emphasis on eye movement. The logic of
the test appears to be rooted in emotion. Replicants, the humanoids
manufactured by the Tyrell Corporation, emerge as fully formed adults.
They have no childhood and therefore no childhood memory. They do,
however, appear to be capable of desire, with the suggestion, then, of
some kind of emotional attachment. The test, in the small samples we
 1 From Voight-Kampff to Baseline Test … 3

are shown of it, seems to operate on the basis of provoking the expo-
sure of the gap between the awareness of the appropriacy of emotion
and the lack of such appropriate emotion. When Holden describes the
overturned tortoise, Leon appears to know that a reaction is expected of
him and yet he doesn’t know, or doesn’t feel, what this reaction is.
The dénouement of the scene, with the invocation of the mother,
seems pertinent in a psychoanalytic context. Where the tortoise merely
provokes discomfort, the mention of his mother provokes a strong,
violent, or murderous, reaction. Except Leon doesn’t or didn’t have a
mother. It is plausible that Leon’s reaction is nothing at all to do with
the specific content of Holden’s questions and is simply a pre-emptive
reaction to the obvious point that he is about to be found out as being a
replicant. And yet, the content cannot be ignored.
The test can be understood to operate on a logic of difference. The
presence of an appropriate reaction––whatever that might be––would,
presumably, indicate a likelihood that the subject is not a replicant. We
might assume then, that the absence of an appropriate reaction would
indicate that the subject is a replicant. However, this is not the case. It is
the anticipation of the absence of an appropriate emotional reaction on
the part of the subject themselves which appears to be the true point of
confirmation. The test centres on the subject’s own knowledge of their
status, whether this knowledge is consciously known or not. It is not,
however, a knowledge of what is but, rather, a knowledge of what might
not be.
This point of anticipation exposes something crucial of the Carte-
sian core of the original film. The three central characters each occupy
a particular stance towards the question of their knowledge of their
own essence. Roy Baty, the leader of the rogue gang of replicants
knows that he is a replicant. Rachel, a prototype of a newer model
of replicant, appears to know that she is a replicant but struggles to
acknowledge this knowledge. She knows but does not believe (Neill,
2018; 218). Deckart, the Blade Runner, we might, then assume, knows
he is not a replicant. A key driver of the film, however, is the uncer-
tainty of this knowledge. We, the spectator, are led to doubt the veracity
of Deckart’s knowledge, without this doubt ever settling into a new
certainty. Forty years after the original film’s release, through various
4 C. Neill

alternative cuts and sequels (Blade Runner 2049 was preceded by three
interim short films), both Deckhart’s ontological and epistemological
status remain uncertain. Even the screenwriters and directors are not in
agreement.
The status of replicants, by the time of 2049, appears, on the surface
at least, more definite. The new model of replicant, the Nexus 9s, and
the older models, whom the Nexus 9 Blade Runner, K., is deployed to
terminate, are equally aware of their replicant status. Like Rachel, they
have their own memories, developed since their inception, and they have
implanted childhood memories. Like Roy Baty, they are clear as to their
replicant status, both in terms of their fundamental being and in terms
of their subordinated social position. Where, however, Roy’s certainty is
an unhappy one, and one which motivates the failed rebellion he insti-
gates, the Nexus 9 replicants have been designed such that they can sit
with their status and will obey humans unfailingly. To ensure this obedi-
ence and safeguard against the risk of revolt, the Nexus 9s are subject to
routine tests, referred to as the Baseline Test.
The Baseline Test consists of a disrupted recitation of a section from
the central poem from Vladimir Nabakov’s Pale Fire. After the repli-
cant’s initial recitation of the section, selected words are abstracted and
repeated, intercut with provocative questions. The task appears to be for
the replicant is to repeat the abstracted words without being drawn into
or disturbed by the questions.
The section of the poem from Pale Fire, lines 703–707, reads as
follows:

And blood-black nothingness began to spin

A system of cells interlinked within
Cells interlinked within cells interlinked
Within one stem. And dreadfully distinct
Against the dark, a tall white fountain played.

The first time we see K. subjected to the test, the repeated words are
‘within’, ‘cells’ and ‘interlinked’, either alone or as phrases. The second
time we see him take the test, the words ‘dreadfully’, ‘distinct’ and ‘dark’
are added. The abstraction of the words, and the questions which follow
them, draw our attention to two sides of language. On the level of
what we would, in a Lacanian idiom, call the symbolic, language has no
 1 From Voight-Kampff to Baseline Test … 5

meaning. Language, and constituent bits of language, such as words or

phrases, may have functions and links, but there is no meaning which is
inherent to them. Meaning requires interaction with language. Meaning
has to be, and routinely is, imputed to language. This allows what we
would usually understand as the human dimension of language. Conven-
tionally, we might even assume that the meaning precedes the language
which then functions as a kind of vessel for the meaning. I express myself
with (the tool of ) language. Even in this conventional model, the sepa-
ration between the base materiality of the language component––what
it looks or sounds like––and the meaning that is supposed, is evident. I
pick what I think are the best words to convey what it is I want to say
but there is always room for misunderstanding. What the words mean
to me, may not be what they mean to you. In fact, if we think about it,
the words are highly unlikely to mean exactly the same thing to you and
me. We will have learned the words in different situations, encountered
them in different context, used them differently, heard them in different
voices, associate them with different experiences and bits of the world.
All these aspects which would allow us the possibility of receiving words
with the impression of meaning may overlap to a greater or lesser extent,
but the configuration will remain unique.
Requiring the replicant to recite the words of the poem, and only the
words of the poem, even if abstracted from the poem and presented out
of order, is to require the replicant to operate on a purely symbolic level.
A replicant is, after all, a machine. They ought to be able to function
in this machinic manner. The insertion of the questions, articulated to
or echoing the words of the poem, appears, then, to execute a number
of overlapping functions. The questions seek to engage the replicant in
something akin to a conversation, expressing an interest in the replicant’s
life, perspective, feelings etc. The questions, that is, perform the engage-
ment with the replicant as a human being. In so doing, the questions
invite the replicant to identify; to identify as one who may have a life,
a perspective, feelings etc. or one who might hold such things as some-
thing of value. On a seemingly more mundane level, the questions, by
repeating elements from the small section of the poem, seem clinically
designed to distract. This obstacle to concentration, combined with the
invitation to identify, functions to provoke a reaction. What it doesn’t
18 B. Tyrer

the last three hundred years of Western philosophy in general [1998:

11]).
This is where the philosophical import of Lacan’s project—as a science
of the subject—becomes apparent. The Lacanian subject is not the
ego and—for that matter—neither is the psychoanalytic ego equiva-
lent to the subject of modern philosophy (qua “cogito”); it is not an
autonomous agent but an illusory wholeness formed through alienating
identification with the image of the other. Nor is the Lacanian subject
equivalent to modern philosophy’s “cogito”, but then—for Lacan—this
“cogito” is not equivalent to Descartes’ cogito, the I of the “I think”,
either (cf. Dolar 1998). Lacan’s resituation of the cogito is largely beyond
the scope of this chapter—although Žižek elaborates this idea in rela-
tion to Blade Runner (Scott, 1982) in particular in Tarrying with the
Negative (see 1993: 12, and below)—but for now we can observe that
when Frampton rejects anthropomorphism for filmosophy, psychoanal-
ysis would be in agreement: the Lacanian “subject”—as the subject of
the unconscious—is not an anthropomorphic model, either. Frampton’s
understanding of the individual holds no place for the unconscious, just
as his vision for filmosophy hold no place for psychoanalysis: but in both
instances the Lacanian subject haunts the scene.
As Lacan states, “the unconscious is the Other’s discourse” or “the
unconscious is the discourse of the Other” [discours de l’Autre] (2007:
10; 1977: 45). Lacan moves understanding of the Freudian unconscious
away from an individual unconscious grounded in speech to a transindi-
vidual unconscious related to the Symbolic. He states that “this so-called
internal monologue [the individual unconscious] is entirely continuous
with the external dialogue, and indeed this is why we can say that
the unconscious is also the discourse of the Other” (1993: 113). The
Other is thus constituted not as a person but as a place—“it must
first of all be considered a locus” (1993: 274)—and the register of the
“truth” of the subject, moreover, is “situated somewhere else altogether:
at the very foundation of intersubjectivity” (2007: 13). It is the locus
from which the subject “receives his own message in an inverted form”
(2007: 30); whence the symbolic Other “returns” the message in its
true form, as formations of the unconscious. In this context, therefore,
where Frampton asserts that film creates its world “not from a ‘point
Another random document with
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child who has scarcely coughed at all during his waking hours.
Witness the voiding of urine in the bed by nervous children during
the early hours of sleep. Witness the phenomena of night-terrors,
which always occur at the time of night when sleep should be most
tranquil.

It appears, therefore, that the harmonious activity of all parts of the

nervous system is indispensable to the highest exercise of the
conscious mind. Healthy intellectual life is the perfectly-balanced
outcome of the complex polygon of forces which has its seat within
the brain. But the suppression of certain lines of this polygon does
not suppress life, nor does it necessarily destroy consciousness. It
only occasions a redistribution of force and a proportionate
narrowing of the stream of related ideas. Since the suppression just
mentioned is not an absolute quantity, but a variable factor, the
polygon of forces in the brain and the corresponding succession of
ideas in consciousness must necessarily be in a state of continual
change. Accordingly, our dreams are as variable as the clouds that
drift upon the currents of the air. As on a hot day in summer, when
the steady equatorial draught has ceased to guide the wind, we may
observe all manner of local tides in the masses of vapor which arise
from the earth, so in sleep, when the guiding influence of the senses
is withdrawn from the brain, the ideas that still arise are chiefly
dependent upon its automatic and reflex action for their origin and
association. Undisturbed by impulses from the external world, the
brain seems then more sensitive to impressions that originate within
the body. An overloaded stomach, an enfeebled heart, a turgid
sexual apparatus, or an irritable nervous ganglion may become the
source of irregular and uncompensated movements which may
invade the cerebral cortex, and may there set in motion a whole
battery of mechanisms whose influence upon consciousness would
be quite unnoticed were the external senses in full operation.

Night-Terrors.
The preceding argument will render it easy to comprehend the
phenomena of night-terrors. These are commonly observed in young
children of a highly nervous temperament before the conclusion of
their second dentition. The subjects of the disorder are generally of
neurotic descent. Insanity, hysteria, neurasthenia, epilepsy, chorea,
and nervous dyspepsia are often discovered among their near
relatives. Not infrequently they have been or will become themselves
choreic.

The attack is often preceded by symptoms of indigestion, but it may

result simply from the commotion of a brain wearied by the
excitement and effort of the previous day. The little patient starts up
out of an apparently sound sleep crying with alarm, calling for his
mother, and staring wildly with every possible expression of terror.
Sometimes he springs from his couch and runs headlong into a
corner or seeks to hide under the bed, as if escaping from some
frightful object. The eyes are open, tears flow, perspiration covers
the skin, there is the greatest excitement, and the little one,
convulsively clinging to its parent, will not be quieted. Only after
fifteen or twenty minutes, as tranquillity gradually returns, does the
child seem to recover the power of recognizing his friends. Presently,
however, he lies down and falls quickly asleep, waking in the
morning without the slightest recollection of the unpleasant event.

Such paroxysms occur during the early part of the night, one or two
hours after the child has been put to bed, just at the time when,
according to the previously-quoted experiments of Kohlschütter,
sleep is passing from its maximum intensity to a lesser degree of
depth. This, then, is the time when the controlling power of the
sensory apparatus over other portions of the nervous system has
already reached its minimum. The spinal centres and those
intracranial ganglia which do not share in the full measure of this
repose are therefore in a condition of relative exaltation.
Disturbances of internal organs consequently produce inordinate
excitement of these waking portions of the nervous apparatus. The
morbid quality of this excitement is attested both by the history of the
patient and by the fact that it does not arouse the whole brain. The
distribution of motion in the cerebrum is impeded, so that certain
portions of the organ remain asleep while other regions are thrown
into a state of tumultuous uproar. Disconnection of these different
organs of the nervous system, by withdrawing particular portions
from the inhibitory influence of the remaining parts, gives opportunity
for violent explosions of nervous force analogous to the convulsions
of a headless fowl or to the course of an epileptic paroxysm. Now, in
sleep, in somnambulism, in hypnotism, in delirium, in certain stages
of intoxication with alcohol or with narcotics, such ungearing of the
different nervous ganglia is more or less completely effected. In
narcotic and anæsthetic sleep besides the disassociation of ganglia
there is paresis of the nervous molecules; hence the phenomena
soon merge into insensibility and coma. But in natural sleep, in
somnambulism, or in hypnotism there is no toxic paresis; hence the
dissociated portions of the brain and nervous system, if aroused, are
in a physiological condition to dispense great stores of force. Hence
the vividness of certain dreams and the astonishing vigor of
particular nervous functions in somnambulism and hypnotism.

Somnambulism.

The phenomena of night-terrors constitute merely a special form of

somnambulism, a condition of which the mechanism, so far as the
present state of cerebral physiology will permit, has been already
suggested. The affection should not be ranked by itself as a
particular variety of disease, but should rather be considered a
violent perturbation in the cerebral organs of a neurotic subject
during the period of sleep. In ordinary dreaming the muscular
apparatus usually remains passive, even though the dream be a
nightmare or an incubus of the most terrifying character. But when
the desires and the emotions are powerfully addressed by the
dream, a certain amount of muscular movement may ensue, as
when a dog barks in his sleep, or when a child laughs upon his
nurse's lap, or when a weary soldier marches on though
overpowered by sleep. One night, when parched with thirst during a
voyage at sea,9 I saw in sleep a sparkling fountain, by the side of
which appeared a young girl holding out a cup of cold water.
Awakened by the excitement, I found myself sitting up in bed with my
right arm extended in the direction of the tantalizing vision: my dream
had merged itself in action. In like manner, the victim of night-terrors
not only moves his body, but gives vocal expression of his feeling of
apprehension and alarm. In like manner, projecting his dream into
action, a sleep-walker may arise from his bed; he climbs out of the
window and descends to the ground, executing all manner of
complicated and dangerous movements; he walks long distances,
and finally returns to his couch without waking. In the morning no
recollection of the event of the night survives. Again, the movement
may be less locomotive in its character. The intellectual faculties
chiefly may be aroused, and then only such movements are
executed as may be necessary to give expression to the mental
process.
9 A proclivity to dreaming has often been remarked among the consequences of
partial starvation.

Such, then, are the principal characteristics of somnambulism, a

state in which dreams are supplemented by more or less complete
and appropriate action, ordinarily without subsequent recollection of
either dream or action.

The somnambulistic dream generally occurs during or soon after the

period of deepest sleep, when the influences of the external world
are largely suppressed. Released from the control of its sensory
portion, the remainder of the brain awakes and becomes aroused to
a condition of functional exaltation. No longer distracted by the
recollection of the special senses, the attention is concentrated upon
the hallucinations which constitute the dream. In the simpler forms of
noctambulism only the automatic locomotive apparatus is awakened,
and the sleeper moves in accordance with the impressions derived
from habit aided by exaltation of the muscular sense. But in some of
the more complicated cases a certain amount of special sensibility
seems to exist. The patient is capable of exercising just that amount
of sensation which is necessary to accomplish his purpose, though
blind and deaf and insensible to every other impression. The more
complete the waking of the organs of sense, the closer the
resemblance to the condition of ecstasy in which cerebral exaltation
is the prominent feature. Accordingly, it sometimes happens that the
somnambulist can recall the events of his paroxysm.10 In such cases
the power of recollection is due to the same conditions that control
the recollection of our ordinary dreams. We remember very
imperfectly, if at all, the dreams that occur during sound sleep, but
the visions with which sleep sometimes commences (hypnagogic
hallucinations) and those that occupy the period of morning slumber
are very easily reviewed in memory, because they are associated
with impressions directly derived from the partially-waking organs of
sense. Such dreams are therefore chiefly recalled through their
association with the train of our waking thoughts. But the dreams of
somnambulism and the dreams of night-terrors, and all other visions
during profound sleep, are as completely as possible cut off from all
connection with the mental activities which arise directly from the
action of the senses. By reason of such isolation the ordinary
association of ideas affords no help to the memory, and the dream
remains in the limbo of oblivion.
10 A. Bertrand, Traité du Somnambulisme, p. 80.

Alfred Maury expresses the opinion11 that the principal cause of

forgetfulness of the events of somnambulism consists in the
exhaustion of the cerebral elements through the intensity of the
excitement to which they are subjected during the paroxysm.
Doubtless this in certain cases may contribute to the loss of memory,
but it should be remembered that the excitement may be relative
rather than absolute. Certain elements wake while others are asleep,
and the waking cells may be aroused to a degree far in excess of
what is usual during the sleep of the brain without attaining to the
level of their diurnal activity. The mind, undisturbed by external
impressions, gives its attention to the activity of these waking
organs, and a dream with all its consequences, somnambulic or
otherwise, is the result. In other words, the plane of consciousness,
so to speak, is lowered during sleep to the level of these molecular
vibrations. But when the whole brain is again awakened after sleep
the residual vibrations of those elements which yielded the physical
basis of the dream, and which, had they occurred during the waking
state, might have persisted with energy sufficient to furnish a
groundwork for recollection of the ideas which they had originally
suggested, are no longer sufficiently energetic to be felt in
consciousness. Recollection of mental states thus generated must
necessarily be impossible so long as the mind is dependent upon the
brain as its register of events. Sometimes, however, the
somnambulist, who while awake had forgotten all the incidents of his
somnambulic experience, can remember in a subsequent paroxysm
all that occurred during the preceding attack. Facts of this kind have
been observed in the waking life of certain hysterical persons,12 but
the apparent interruptions of their personality attach to the waking
state, while in ordinary somnambulism it is only in sleep that the
alternations of memory and forgetfulness occur. A similar recollection
of previous visions is sometimes experienced in dreams, showing
the close relation that subsists between the dreams of sleep and of
somnambulism. The bond of association between these events thus
isolated in time must be sought in a renewal of like conditions of the
brain during the successive periods of somnambulic exaltation. We
must suppose that the molecules which were in a state of functional
excitement during the first paroxysm are again aroused in like
manner after a period of waking quiescence. If, during sleep, their
movements, though of an exalted character, have only just sufficed
to arouse consciousness in the form of a dream, it would not be
probable that during the phase of comparative inactivity which
supervenes when the whole brain is awake their residual motion
could disturb the sphere of consciousness. Hence the time occupied
by their somnambulic vigor must remain a blank in memory during
the waking state. But when the original state of exaltation has been
reproduced by a second period of disorder, if the same molecular
movements be in any way renewed, the conditions of memory are
fulfilled; consciousness is once more aroused as before, and the
patient remembers the dream or the events of the previous attack.
 11 Le Sommeil et les Rêves, p. 226.

12 Annales Medico-psychologiques, 5e Série, t. xvi. p. 5, 1876.

Artificial Somnambulism, or Hypnotism.

The phenomena which have now been passed in review are of

apparently spontaneous origin during the ordinary period of sleep.
But from the remotest antiquity it has been known that certain
persons may be thrown into an artificial sleep which closely
resembles the condition of the somnambulist. During the persistence
of this state certain portions of the nervous system become utterly
insensible to external impressions, while other portions acquire an
exalted degree of sensibility. The subject of the experiment can then
by special methods be placed in such relations with other waking
individuals that his surviving sensations, mental processes, and
physical actions shall be no longer regulated by his own volition, but
by the will of another. Such susceptibility is not common to all
persons. About 20 per cent. of the ordinary population is, by some
observers, considered capable of experiencing this condition.
Heidenhain,13 experimenting upon a class of medical students, found
only one in twelve who was thus susceptible. Charcot, whose field of
observation covers the inmates of the Salpêtrière Hospital, finds the
best exemplars of the hypnotic state among the hystero-epileptic
females in that asylum. To these experimenters we are largely
indebted for the most extended scientific observation of the
phenomena of hypnotism, giving precision and publicity to the
knowledge of facts which, though equally well known within a narrow
circle of investigation14 during the earlier decades of the present
century, have been compelled to await the development of cerebral
physiology before their full significance could become apparent to
the mass of the medical profession.
13 Animal Magnetism: Physiological Observations, by Rudolph Heidenhain.
 14 Braid, Neuro-hypnology considered in Relation with Animal Magnetism, London,
1843.

The antecedent condition most favorable to the production of the

hypnotic state is a highly unstable constitution of the nervous
system. For this reason the larger number of qualified subjects is
furnished by the female sex, especially by those who possess the
hysterical temperament. Frequent repetition of hypnotic exercises
renders the subject still more susceptible. Heidenhain was at first
inclined to believe that such experiences were not prejudicial to the
health of the subject, but the observation of Harting in the University
of Utrecht, and of Milne-Edwards in Paris,15 have demonstrated
danger to the health of animals subjected to similar experiments. It is
easy to discover, in the various clinical narratives published by
Charcot and his pupils,16 evidence that hysterical patients often
manifest considerable exhaustion after hypnotic exhibitions;
consequently, it cannot be admitted that the practice is devoid of risk
to the health of the individual.
15 Lancet, July 29, 1882, p. 164.

16 Paul Richer, L'hystéro-Epilepsie, Paris, 1881; Le Progrès médical, 1881-82.

Numerous methods of inducing the hypnotic state have been

employed by different experimenters. The greater number consist in
modifications of the sensory impulses derived from the periphery of
the body. Gentle pressure upon the closed eyelids; convergence of
the axes of the eyeballs upon some object nearer than the proper
focal distance of the eyes; fatigue of the retina by gazing upon any
brilliant or luminous object; monotonous excitation or sudden
surprise of the auditory nerve; various impressions through gentle
friction or pressure upon different regions of the body,—all these are
capable of inducing hypnotic sleep. An appeal to the imagination, or
even the mere attempt to abnegate the possibility of vigorous
thought by confining the attention to the most trivial of things,
sometimes suffices to produce the desired phenomenon. Thus,
Heidenhain put one of his students to sleep at a distance by merely
informing him beforehand that at a certain hour he would hypnotize
him in his absence. The state of ecstatic meditation into which the
monks of Mount Athos plunged themselves by the practice of
omphaloscopy affords an illustration of the hypnotic effects of
concentrated attention.

The duration of hypnotic sleep is exceedingly variable, but if left to

himself the patient usually wakes spontaneously, without recollection
of anything that has happened. If it be desirable to awaken him
before the natural termination of the paroxysm, consciousness can
be restored by almost any sudden and energetic appeal to the
senses, such as an electric shock, a sudden illumination of the eye
with vivid light, or a sharp puff of air upon the face.

According to Charcot,17 three principal types may be remarked

among the hysterical subjects upon whom he experimented: (1) the
cataleptic, (2) the lethargic, and (3) the somnambulic. Of these, the
first may be developed primarily by any abrupt and powerful
impression upon an organ of sense, as a bright light or a loud noise
(gong). Fixing the eyes upon some object may produce the same
result. Dumontpallier, for example, has reported the case of a young
woman18 who accidentally hypnotized herself by gazing at her own
image in the mirror before which she was dressing her hair. The
cataleptic state may also be secondarily induced by merely opening
the eyes of a patient in whom a condition of hypnotic lethargy has
been previously developed. If only one eye is thus opened, the
corresponding side of the body alone becomes cataleptic. Closing
the eyes causes the disappearance of this symptom, with complete
restoration of the purely lethargic state. During the cataleptic
condition the several tendinous reflexes disappear, neuro-muscular
hyperexcitability ceases; the skin becomes insensible, but the
special senses, particularly those of sight and hearing, maintain a
partial activity. In this state the senses may become avenues of
suggestion for the production of muscular movements, but if left to
themselves the limbs remain motionless.
17 Le Progrès médical, Feb. 18, 1882, p. 124.

18 Ibid., March 25, 1882, p. 223.

The lethargic state may be induced by simply closing the eyes of the
patient or by causing him to fix his gaze upon some definite object.
The paroxysm begins with a deep inspiration causing a peculiar
laryngeal sound, followed by the appearance of a little foam on the
lips. The eyelids are either wholly or partially closed, and are in a
state of continual tremulous motion. The eyeballs are generally
turned upward and inward. The muscles are completely relaxed. The
tendinous reflexes are exaggerated; pressure over a muscle or upon
a nerve arouses a peculiar contraction of synergic muscles and of
groups of muscles which are supplied by the excited nerve-trunk.
The facial muscles, however, do not thus become contractured: they
merely contract during the application of the stimulus. If the lethargic
patient be rendered cataleptic by opening the eyes, these
contractions persist even after awaking, and they can only be
dispelled by renewing the lethargic state before resorting to pressure
upon the antagonistic muscles—a process by which the contractures
peculiar to this species of lethargy may always be annulled. By the
approach of a magnet to a contractured limb the phenomenon may
be completely transferred to the corresponding muscles upon the
opposite side of the body. If upon a limb of a lethargic patient who
has been rendered cataleptic by opening the eyes an Esmarch's
band be applied, pressure over the bloodless muscles excites no
contracture until the band is removed. A contracture is then
developed, and it may even be transferred to the opposite limb by
the approach of a magnet. To this phenomenon has been applied the
term latent contracture.

The extraordinary muscular excitability manifested by these

hysterical hypnotics is further illustrated by an observation recorded
by Dumontpallier.19 If one end of a caoutchouc tube one centimeter
in diameter and five or six meters in length be applied over a muscle
in the leg, and if the other end be in like manner connected with a
watch, every movement of the second hand will be followed by a
slight contraction in the muscle. The same result follows connection
with the wire of a telephone, and if a microphone be introduced into
the circuit the incidence of a ray of artificial light upon the instrument,
or even its glancing reflection from the eye, will arouse a responsive
muscular contraction. Charcot has sometimes observed muscular
contractions upon the opposite side of the body when a mild galvanic
current was applied to the parietal surface of the head. During the
manifestation of muscular hyperexcitability there is complete
analgesia, but the senses of sight and hearing seem to preserve
some degree of activity. The patient, however, does not manifest any
susceptibility to influence by suggestion.
19 Ibid., Jan. 14, 1882, p. 25.

The somnambulic state may be directly induced by fixed attention

with the eyes, by feeble and monotonous excitation of the senses,
and by various other methods of an analogous character. This forms
the most common variety of the hypnotic condition. It may very easily
supervene during either the lethargic or the cataleptic state as a
consequence of pressure or gentle friction upon the top of the head.
Thus, Heidenhain caused muscular paralysis by rubbing the scalp.
Unilateral friction of the same surface produced paralysis of the
opposite side of the body without notable affection of consciousness.
The eye and the eyelids behave as in the lethargic state. The patient
seems asleep, but there is less muscular relaxation than in hypnotic
lethargy. There is no exaggeration of the tendinous reflexes, and
muscular hyperexcitability is absent. But by lightly touching or
breathing upon the surface of a limb its muscles may be thrown into
a condition of rigidity which differs from the contracture of the
lethargic state in the fact that it does not yield to excitation of the
antagonistic muscles, though yielding readily to a sudden repetition
of the same form of excitement by which it was originally produced.
From the immobility of the cataleptic state it also differs by a greater
degree of resistance to passive motion. Though analgesia may be
perfectly developed in this state, there is generally an exalted
condition of certain forms of cutaneous sensibility and of the
muscular sense. Strange perversions of other special senses are
sometimes remarked. Cohn20 discovered that a patient who was
naturally color-blind “when unilaterally hypnotized was able to
distinguish colors which were otherwise undistinguishable.”
Conversely, when the cataleptic state is induced the eye becomes
incapable of discerning colors. Spasm of accommodation is also
present, and is one of the earliest demonstrable symptoms of the
hypnotic condition.
20 Brain, vol. iii. p. 394.

These remarkable exaggerations and perversions of special

sensibility have been the cause of much scepticism on the one hand
regarding the verity of the phenomena of hypnotism, and of much
credulity on the other, extending even to a belief in the existence of
supernatural and miraculous gifts. But when the fact is once
comprehended that in this capacity for uncommon feats of vision,
hearing, touch, etc. we observe merely the exaggeration of a
process which occurs in every act of attention, the miraculous
semblance of the phenomena disappears. Attention implies an
increase of activity in certain portions of the brain, with diminution of
the function in the remainder of the organ. In the wild excitement of a
cavalry charge the soldier feels not the sabre cut which will fill his
consciousness with pain so soon as his attention is released from
the fetters imposed by the more engrossing events of the combat.
So in the somnambulic sleep those parts of the brain which remain
awake perform their functions with a vigor that is enhanced by a
concentration of cerebral energy in certain restricted portions of an
organ that, by reason of its naturally excessive instability, had been
previously fitted for the liberation of an inordinate amount of
molecular motion. Hence the slightest suggestion of sense may
suffice for the most extraordinary perception. Such persons see
through their eyelids and hear at a surprising distance. The memory
of past events, the recollection of long-forgotten words and thoughts,
supplies in this state an abundance of materials out of which an
exalted imagination may construct the most astonishing scenes. By
this method of combination are produced those remarkable oratorical
utterances which by the ignorant have been so widely attributed to
the supervision of guiding spirits from another world. In this condition
the essential characteristics of the mind of the so-called medium
become the real guides of his mental processes. Hence the infinite
variety and contrariety of the utterances of such declaimers.
Among other consequences of this exalted susceptibility of the
waking portions of the brain may be noticed the effect of suggestions
by others upon the mind of the somnambulist. Numerous examples
scattered through the literature of the subject21 illustrate the manner
in which the course of our ordinary dreams may be thus directed.
The hypnotic dream is far more easily modified.22 The simplest
manifestations of such influence are exhibited in movements in
obedience to the command of the hypnotizer. Next in rank are those
more complicated actions that are effected by excitement of the
imitative faculties of the subject. Every suggested movement that
can be in any way perceived by the patient will be at once
reproduced. Various emotions and passions may thus be aroused by
simply placing the sleeper in the appropriately suggestive attitudes.
Under the influence of a pregnant idea intruded upon the mind of the
patient the subsequent association of ideas will suffice for the
evolution of a complicated series of hallucinations, as in the case of
a young woman, who on being directed to put out her tongue
immediately began to feel sensations of uneasiness in her stomach,
followed by nausea and attempts at vomiting, accompanied by the
impression of being on shipboard. In the lowest grades of the
hypnotic state consciousness may remain, and the subsequent
recollection of the events of the paroxysm may be quite persistent. In
such cases illusions that were produced by suggestions from other
minds generally survive in memory and become the causes of
serious delusion. Witness the manner in which susceptible
individuals, partially hypnotized in a so-called spiritual circle, believe
in the reality of the illusions which have occupied their senses during
a séance.
21 Carpenter's Physiology, 8th ed., p. 765; Le Sommeil et les Rêves, par L.-F. Alfred
Maury, 4th ed., p. 153 et seq.

22 Loc. cit., p. 357.

A higher degree of insensibility to ordinary impressions is necessary

to the production of the phenomena of passive obedience and of
automatic imitation. It is probable that the degree of sensory
hyperæsthesia which enables certain hypnotic patients to read the
thoughts of others belongs rather to the first than to the last of these
classes. This capacity is usually associated with preservation of
consciousness and memory, and is, essentially, a mere exaggeration
of that power which all possess in greater or less degree. Numerous
well-authenticated examples of a surprising manifestation of this
faculty have been recorded, so that the possibility of its existence no
longer admits of doubt.23 In all cases it has been remarked that the
hypnotic mediums can only respond correctly to questions for which
the true answer is present in the mind of the questioner. For all other
interrogations the replies are delivered purely under the influence of
random suggestion. In certain of these cases the pathway of
communication lies through actual physical contact, as in ordinary
mind-reading, where the insensible molecular oscillations of the
muscular elements of one individual serve to guide the movements
of another. But more frequently the transmission of ideas is effected
through the eyes. With these organs the table-rapper or the
planchette-writer reads the unspoken words of the questioner in a
manner very like, yet vastly more deliberate than, that by which deaf-
mutes now learn to interpret the movements of the lips of persons
with whom they converse. This fact is well illustrated by the
experience of Maury24 in an interview with a celebrated table-rapper,
who without the slightest hesitation made known to him the age,
name, and date of death of a brother whom he had lost. She also
gave the same information regarding his father, and related the
names of other persons upon whom he had fixed his attention. But if
he turned away his face or concealed his eyes, so that the woman
could no longer watch their expression, her responses ceased to be
of any value.
23 Luther V. Bell, Two Dissertations on what are termed the Spiritual Phenomena,
read at the meetings of the Association of Medical Superintendents of American
Insane Hospitals at Washington and Boston in 1854 and 1855.

24 Le Sommeil et les Rêves, 4th ed., p. 361.

In these partial developments of the hypnotic state it is worthy of
note that the phenomena of sleep are so few and so comparatively
insignificant that they are usually overlooked. Hence the veil of
mystery which has so often obscured the interpretation of such
cases. Careful observation, however, will always detect some
characteristic departure from the normal standard—some loss of
balance between the different parts of the nervous system—by
means of which the true relations of each example may be
determined.

TREATMENT.—A large proportion of the phenomena of somnambulism

and hypnotism depend rather upon an originally irritable organization
than upon a specially diseased condition of the nervous system.
Their treatment, therefore, frequently resolves itself into the
management of hysteria or of cerebrasthenia. But if the
manifestations of somnambulism develop for the first time in a
person advanced in years, who has previously enjoyed good health
and a sound mind, it should be regarded as an omen of grave
import, signifying the imminence of organic cerebral disease. Though
the meaning of such incidents is less sinister in early life, they reveal
an ill-balanced state of the nervous system and an imperfect process
of nutrition in the growing body. Such children are the frequent
victims of night-terrors, the form of disorder most commonly evolved
by their somnambulistic proclivities. The treatment of night-terrors
should therefore be chiefly directed to the invigoration of the general
health of the patient. Indigestion and malnutrition are among the
most prominent antecedents, and they should constitute the principal
objects of therapeutical attention. Constipation is usually present.
This may be relieved by the use of compound rhubarb powder or any
other gently stimulating laxative. Digestion should be aided with
pepsin as soon as the catarrhal condition of the alimentary canal, so
uniformly present, has been measurably improved. Cod-liver oil or its
substitutes should be administered for a long period of time. If the
nocturnal paroxysms be frequently renewed, it may be well to
employ the bromides, either with or without chloral hydrate; but as a
general rule it is better to rely upon hygienic and restorative
treatment, rather than upon any form of merely hypnotic medication.
 INSOMNIA.

The departures from the course of natural sleep which have been
thus considered are not so much the direct consequence of acute
disease as the result of structural deviation from the normal type of
the nervous system. We must now briefly review the strictly
pathological modifications to which sleep is liable.

Lithæmic Insomnia.

Among those who indulge freely in the pleasures of the table a form
of insomnia is not uncommon. Originating at first in mere overloading
of the stomach, and consisting in a direct irritation of the brain
through the medium of the intervening nervous apparatus,
sleeplessness finally becomes a symptom of more serious mischief.
The tissues become charged with nitrogenous waste, and a
lithæmic25 or gouty condition is established. Such patients are
wakeful, or if they sleep their slumbers are imperfect and
unrefreshing.26 Grinding of the teeth,27 noticed by Graves during the
sleep of the gouty, is a symptom indicative of a highly irritable
condition of important ganglia at the base of the brain. These
symptoms are sometimes associated with turgidity of the superficial
vessels of the head, indicating imperfect function of the circulatory
organs, with a tendency to accumulation of the blood in the venous
channels of the body. The sleep of such partially-asphyxiated
patients is fitful, irregular, and akin to stupor. Occurring in the
subjects of periodical gout, these disturbances of sleep become
increasingly serious as the paroxysm is approached, until loss of
sleep and the unrefreshing character of such slumber as may be
obtained become important factors among the causes of failing
health.
25 DaCosta, “Nervous Symptoms of Lithæmia,” Am. Journ. Med. Sci., Oct., 1881.

26 Dyce Duckworth, “Insomnia in Persons of Gouty Disposition,” Brain, July, 1881.

27 Trousseau, Clinical Medicine, Am. ed., vol. iv. p. 362.

For all such patients a proper recognition of the cause of their

disorder is essential. This must be corrected by measures
appropriate to the treatment of the gouty diathesis. Since the
condition of the cerebral tissues is a state of irritation caused by the
presence of excrementitious substances, such hypnotic remedies
must be selected as will not interfere with the defecation of those
tissues. Bromide of potassium, valerian, scutellaria, hyoscyamus,
hops, and cannabis indica are useful, together with all that class of
drugs which quiet the brain without hindering the process of
excretion. Chloral hydrate often produces an excellent result, but
care should be taken to prevent its habitual use.

Febrile Insomnia.

Closely related with the sleeplessness of lithæmia are the

disturbances of repose which attend the evolution of the various
specific fevers. In many cases the condition varies all the way from
stupor to delirium. Excessive somnolence, such as often ushers in
the fever, is an indication for evacuant treatment. Cerebral
excitement calls for remedies like the bromides and chloral hydrate,
which do not interfere with elimination. If pain, like headache or
backache, be a symptom demanding attention, the addition of
morphia in small doses forms a valuable reinforcement for the
hypnotic mixture; but, as a general rule, opiates should be used with
a sparing hand. The various resources of hydrotherapy are often
invaluable when wakefulness results from the cutaneous irritability of
the eruptive fevers. During the later stages of a protracted illness the
occurrence of insomnia should direct attention to the nutrition of the
patient. Wakefulness is then the symptom of an irritable weakness of
the brain, demanding remedies which delay the process of
disassimilation. The failing power of the heart requires attention, and
diffusible nutriment must be given to convey the elements needful for
restoration of the exhausted brain. These indications are most
perfectly answered by the associated administration of opiates with
alcohol, milk, and beef-juice in small and frequent doses.

Insomnia from Exhaustion.

Cerebral exhaustion is a not uncommon cause of wakefulness in

cases uncomplicated with fever. It is usually the result of chronic
conditions of ill-health and depression, such as are often
encountered as the result of various cachexias or of dyspepsia, with
or without the abuse of alcohol, tea, coffee, or tobacco. Overwork,
debilitating discharges, pregnancy, parturition, mental anxiety,
depressing emotions, chronic heart disease, and incipient insanity
are fruitful causes of the exhaustion which produces this most
distressing form of insomnia. In such cases the cessation of healthy
nutrition leads to a condition of excessive instability in the cerebral
tissues. The oxygen which they receive from the blood is not stored
with any degree of permanence, but tends to pass directly into stable
combinations with the oxidizable elements of the brain.
Consciousness is thus continually aroused. The state of such a
patient presents a very close analogy to the condition of the victim of
diabetes whose liver refuses to retain its glycogen. The inordinate
discharge of sugar into the blood not only exhausts the tissues of the
liver, but also excites other organs—notably the kidneys—to
excessive and unwholesome activity. In somewhat similar fashion,
the failure of the brain to assimilate and to retain oxygen leads to an
abnormal intramolecular oxidation, which excites an excessive and
unwholesome activity on the part of the Ego in another region—
namely, in the field of consciousness. Such wakefulness might justly
be termed a psychical diabetes.

This variety of insomnia has frequently been ascribed to cerebral

anæmia occurring as a part of a general spanæmia. But this
universal impoverishment of the blood, though a sufficient cause of
the morbid instability, the irritable weakness, of the cortical tissues,
does not necessarily imply a comparatively bloodless condition of
the brain. Unequal circulation and local hyperæmia in different
organs of the body are no unusual consequences of the anæmic
state. Slight disturbances suffice to arouse the brain of such a
patient. The vaso-motor apparatus shares in the general irritability,
permitting blood to inundate the cortical substance almost without
provocation. The unstable protoplasm is only imperfectly renovated,
usually at the expense of the other tissues of the body. The weary
patient, busying himself with an unwilling review of the events of the
day, tosses long upon his couch before he can secure the approach
of “tired Nature's sweet restorer, balmy sleep.” When at length he
yields, his slumbers are brief, and the latter part of the night is but a
repetition of the earlier vigil.

Such patients need a very radical course of general treatment. A

complete change of habits should be effected. A long vacation in the
country, or, best of all, a protracted voyage in a sailing vessel, is
desirable. Hot foot-baths, with cold affusion upon the head, and
warm sponge-baths, or even the full bath in tepid water, at bedtime,
are of great service as means of tranquillizing the nervous system.
The indications for medicinal treatment, besides attention to the
predisposing cachexia, are twofold—to calm and to nourish the
enfeebled nervous substance. Opiates calm, but do not nourish—
they hinder the process of nutrition; hence the sufferer wakes
unrefreshed by the sleep which they procure, and is soon in a
condition worse than ever. The same objection lies against the
continuous use of the bromides. But alcohol and its hypnotic
derivatives (chloral, paraldehyde, etc.) not only calm the excitable
brain, but they also furnish to the tissues a certain amount of
diffusible nutriment which suffices to steady the brain until a change
of occupation, with rest and wholesome food, can produce a
complete restoration of its normal stability. To this effect of alcohol
must be ascribed its value as an hypnotic in the wakefulness of old
people who cannot sleep without a preliminary nightcap. A moderate
draught of hot toddy in such cases serves to arouse the feeble heart
and to equalize the circulation by the production of a moderate
degree of general vascular dilatation. The sugar and water afford an
easily assimilated food, while the alcohol benumbs the cortical
protoplasm to a degree which favors the cessation of conscious
perception. If administered in excessive doses, it is not sleep but
anæsthetic intoxication which follows. If this condition be unduly
repeated, the phenomena of chronic alcoholism supervene, with all
the horrible forms of insomnia that accompany cerebral starvation
and delirium tremens. Non-alcoholic nerve-stimulants and tonics,
with careful administration of easily-digested food, are then more
than ever needed to overcome the neurasthenic wakefulness.

Insomnia from Active Cerebral Congestion.

Still another form of sleeplessness is often experienced as a result of

actual inflammation in some portion of the body, either involving the
intracranial contents directly or reacting upon the brain through the
medium of its circulation. In such cases many of the symptoms of
acute inflammation are present. The head aches, the temples throb,
the face and eyes are suffused with blood, the temperature is
considerably increased. The senses become exalted, ideas pursue a
tumultuous course, there may be actual delirium. These
disturbances are due to an active hyperæmia of the brain. The
substance of the cortex becomes hyperexcitable, and the ordinary
incitements of sense produce an exaggerated effect in
consciousness. The patient does not sleep, and he feels no need of
sleep, because the nutrition of the brain is sustained at the expense
of the remainder of the wasting body. The most speedy and effectual
relief in such cases is obtained through a diminution of the current of
blood in the brain. Moderate compression of the carotid arteries has