Chapter 9
The purpose of psychology is to give us a completely different idea of the things we know best. …That which has always been accepted by everyone, everywhere, is almost certain to be false.
—Paul Valéry, French poet,
in Tel Quel (١٩٤٣)
In another of his famously insightful statements, Sigmund Freud said that dreams are the guardians of sleep. The mysterious process of visually vivid, dramatic, nocturnal mentation has evolved via natural selection, partly in order to increase our chances of obtaining the restorative rest we need. Dreams attempt to manage stimulation that would otherwise awaken us. For example, Freud described someone’s alarm clock ringing on a workday morning. Since they had had less sleep than they needed, they longed to stay in bed, rather than being ejected from it by that obnoxious alarm. Consequently, instead of realizing the clock had sounded, they dreamt that church bells were making beautiful sounds. These musical instruments were letting everyone know it was Sunday morning, time to rise for prayer. Since the sleeping individual was not planning on attending the church service, s/he did not have get up. The dream wrapped that annoying alarm in a much more harmonious, appealing narrative. The desire to continue sleeping was gratified. Such dreams also illustrate Freud’s well-known assertion that wish fulfillment (in this case, the desire to sleep) is a central purpose of dreaming.
Much of the challenging stimulation with which dreams struggle to cope is not external, unlike the preceding alarm clock example, but arises from internal, psychological sources. After falling asleep, our minds continue grappling with challenging situations from our current lives. These stressful dilemmas are amplified by meanings those events have that derive from our complex personal histories (e.g., psychological conflicts and developmental microtraumata). Dreams, therefore, do battle on four fronts. They attempt to manage: ordinary external stimulation (like the alarm clock); common internal stimulation (such as urges to urinate); unfinished business from our current lives; and the resonances these contemporary stresses have with foundational issues with which we have struggled since our earliest years. Working on these four fronts, nocturnal mentation has the complex task of trying to shield us from disturbing stimuli and “knit up the raveled sleeve of care,” as Shakespeare so elegantly phrased it, in order to facilitate restorative sleep. Dreams have other important functions as well but, fascinating though they are, it would be tangential to our current goals to venture into those purposes at this point.
Sometimes dreams are unable to put to rest or otherwise resolve our intense stresses, intrapsychic dilemmas, and the residua emanating from developmental trauma. When these challenges exceed the dream’s capabilities, nightmares may ensue. In such instances, a psychic function that Freud charmingly called the night watchman may wake us up. This security officer’s role is to free us from the hallucinatory realm of the nightmare. “Thank God that was just a dream!” we sigh with profound relief. Fervently we hope we will not re-enter that terrifying domain when we go back to sleep. “Now I lay me down to sleep. I pray the Lord my soul to keep. If I should die before I wake … ” Hopefully before we meet any such terminal fate in a nightmare, the watchman will sound the alarm, rousing us back to the land of the living.
When dreaming works well, we can act out even our most dangerous impulses because the mind has been disconnected from motility. Paul, a very likeable adolescent patient, provides an excellent illustration of this fortunate phenomenon. He was extremely reluctant to share with me a profoundly upsetting dream he had experienced the night before. The fact that he mentioned having had such a dream was, no doubt, a good sign that at least a small part of him wanted to share that he had an inner life, one that could be discombobulating. Eventually, with great hesitation, horror, and self-loathing, this fine young man, his eyes averted in alarm and shame, gasped that in his dream: “I slit my younger sister’s throat with a kitchen carving knife!” This grotesque image shook Paul to the core. His face contorted in shock as if he had actually committed this crime in reality. Of course, with his access to motility securely disabled, he caused no actual harm to anyone.
Paul quickly wrote this deeply unsettling dream off as being the meaningless result of having deviated from his rigorous, health-conscious diet. He had gone out and consumed some beer with a friend several hours before going to bed that night. The alcohol, he was sure, had caused this dreadful dream. I suggested this nocturnal horror ‘movie’ in which he starred might not be meaningless. It could be letting us know just how angry he can sometimes feel toward Paula, the ‘golden child’ of his nuclear family to whom everything, such as health, popularity, and academic success, always seemed to come so easily. Only in this dream state, with access to motility firmly blocked, could Paul allow himself to be aware of the extent of his envy and hostility toward his also beloved sibling, and begin to understand why he felt that way. From this perspective his dream, while profoundly upsetting, was also potentially enlightening, and useful for expanding his self-awareness and increasing his ability to tolerate and manage complicated thoughts, intense feelings, and extreme fantasies. Paul agreed that this perspective on his nightmare made sense. Nonetheless, he clearly still felt absolutely awful that he could have generated such a repugnant script, even in a harmless dream.
Just as dreams cannot always contain and manage all our concerns so that we can comfortably continue sleeping, so, too, the night watchman may not always succeed in waking us up fully from a nightmare. On such occasions, it may seem as if this security officer were dozing on the job. In some such instances of suboptimal psychic functioning, our access to motility may not be fully disconnected, or it may be restored to some extent while we continue to be trapped in our nightmare. We may then thrash about in our sleep, yell, or even leap out of bed to engage in some form of flight or fight behavior aimed at saving ourselves and perhaps our loved ones from whatever was threatening us in our dream.
When Kenneth Parks headed out a sixth floor window in his sleep when he was a preteen, the switch on his access to motility was clearly not in the ‘off’ position. Fortunately his mother, who was still up and about and checking to make sure her son was sleeping safely and soundly, managed to grab him by his leg before he fell several storeys to the ground below. Had she not been on duty as an external night watchman, Ken would have seriously injured or killed himself. Unfortunately, years later, when he was a young adult, no one was there to seize him as he left his home to sleepdrive to his in-laws’. Nor was anybody there to restrain him twenty-five minutes later when he brutally assaulted his wife’s parents. It was equally tragic that there was nobody to securely hold Oscar Pistorius during what I will argue was his parasomniac episode.
Due to their immature nervous systems, children are prone to sleepwalking, sleeptalking, and sleep terrors (pavor nocturnus). In the latter condition, they appear to be having nightmares from which they cannot easily be woken. Typically they sit up abruptly during these episodes and scream, as if they are terrified of something. They may after awhile fall back to sleep, or run about with a high heart rate in a glassy-eyed frenzy of escape-like activity. If parents attempt to console and control their offspring during such events, these children will stay stiff and distraught. They may even beat with their fists on their parents’ bodies. Youngsters have full or partial amnesia for all these episodes that arise during deep non-REM sleep. On rare occasions, a single image may be recalled.
Pavor nocturnus may continue from childhood into maturity. Alternatively, it may begin in adulthood. More than two percent of adults have sleep terrors up to age sixty-five, after which the prevalence drops to one percent. (Approximately 4% of adults sleepwalk.) These nocturnal terrors are characterized by sudden, loud, terrified screaming, with wide dilation of the pupils, rapid heart rate and breathing, and profuse sweating. The person may sit up quickly while shouting or yelling. They may engage in frenzied activity and become injured. There is usually a fight or flight theme in relation to perceived attack.
What Is This Thing Called Parasomnia?
Professor Carlos Schenck defines parasomnia as referring to all the abnormal things that can happen to people while they sleep, apart from sleep apnea. Some examples he describes as belonging to this diagnostic category are: sleepwalking; sleep-related eating disorder; nightmares; sleep paralysis; rapid eye movement (REM) sleep behavior disorder (RBD); sleep aggression; and sexsomnia, sometimes called sleepsex or atypical sexual behaviors of sleep (sexual acts carried out by sleepers usually during confusional arousals but sometimes during somnambulism). The parasomniac category of sleepwalking also covers other peculiar behaviors such as sleepdriving and other instances where individuals carry out surprisingly complex and often self-endangering activities. One sleep researcher, Rosalind Cartwright, has noted the surprisingly high frequency of sleep emailing.
Parasomnias form a nebulous realm of disturbed sleep and dreaming, Professor Schenck (2005) notes. Individuals with these conditions suffer from “massive, radical transformations emanating from deep within. …Their brains are misfiring during sleep, resulting in aberrant behavior, distorted perception, and altered dreaming” (p. 12).
Since these parasomnias frequently run in families, there is probably often a genetic factor. Brain disorders may be responsible, as in many cases of REM sleep behavior disorder (discussed more fully later). Parasomnias may be triggered by other sleep disorders such as obstructive sleep apnea, and by various medications. These nocturnal oddities affect approximately ten percent of Americans. Occurring at all ages, they are most common in children.
Parasomnias can occur at any point in the sleep cycle. If they manifest while falling asleep, people may experience disturbing hallucinations or sleep paralysis where they are unable to move for seconds or minutes. Here access to motility has been shut off while waking consciousness continues. This paralysis can be frightening, especially when accompanied by disturbing hallucinations.
Parasomnias that occur during sleep include nightmares, sleep-related groaning that can prevent roommates from sleeping, and REM sleep behavior disorder (RBD) that often involves vigorous, harmful, dream-enacting behaviors. RBD dreams are not usually ordinary. Typically they are much more vivid, intense, physically active, confrontational, aggressive, and violent, with classic fight or flight scenarios. While these individuals dream of attacking and trying to kill intruders, or fighting off wild animals, usually their bedmates are the recipients of these assaults. Those with this disorder may yell and shout profanities. They are at high risk for injuring themselves or their partners, sometimes fatally. Most people with RBD remember the dreams they enacted, although at least ten percent do not.
These agitated parasomniacs may: punch through walls; crash through glass windows, plummeting to the ground below; forcefully drag someone out of bed, trying to save them from imaginary attack; hurt someone who is usually asleep but is mistaken for the attacker; pick up weapons; check under beds and in closets; create barricades; smash lamps and other nearby appliances; and throw things at invisible intruders. These terrified actors generally remember nothing about these events. If they do, it is typically a vague sense of fright, or a hazy image of something chasing them, or of some frightening entity being in the room.
The average age of onset of chronic RBD is in the early 50’s, predominantly (85%) in males. These conditions can, however, manifest in either sex, at virtually any age. It is possible that as many females as males may have RBD, but with less violence, in accord with general trends observed in male-female comparisons. These quieter forms of RBD would not cause as many problems and therefore would remain under-reported. They would be less likely to instigate medical or psychological interventions.
Professor Schenck’s first RBD patient, Donald Dorff, described one of his episodes as a “violent moving nightmare.” Another time he believed he was engaged in a vigorous football game. In the middle of that dream, he woke up, finding himself lying on the floor. He had smashed into his dresser, knocking everything off the top and shattering the mirror.
RBD can affect people taking certain medications, such as antidepressants. It can manifest in individuals who have, or are at risk for developing neurological disorders, such as Parkinson’s, narcolepsy, or stroke. With regard to medications, in Oscar Pistorius’ bedroom police found needles and boxes of what they believed to be testosterone. The prosecution wondered whether this substance could have fueled irritability and aggressiveness. The defense countered that the substance was merely an herbal remedy, Testis Compositum, which athletes use to help repair muscle tissue. Ben Greenfield, an expert in fitness, nutrition, and sports science, explained in Fox News Magazine on February 21, 2017 that Testis Compositum is a blend of purported testosterone-enhancing compounds like pig testicles, heart, embryo and adrenal gland. It can contain other ingredients like cortisone, ginseng, botanicals, and minerals.
What Steven Lamm, director of men’s health at New York University’s School of Medicine, found most interesting was that the name of this substance “implies it aids with testosterone production.” In homeopathic doses, as Testis Compositum is used, the likelihood of stimulating testosterone production is extremely low, Dr. Lamm asserted. Ben Greenfield agreed: “The stuff can help with sexual performance and also can help you feel a little better if you have very low testosterone, but you’d actually have to take enormous quantities of something like Testis Compositum to get a significant performance-enhancing effect.” It’s not a banned substance either, noted Dr. Lamm. “The fact that [the Olympic Committee] didn’t appear to have any problems with the substance tells me that it doesn’t do anything.”
The use of Testis Compositum may be indicative of something more serious, Ben Greenfield opined: “Most athletes use this as a ‘cover up’ for use of the stuff that really works: bioidentical testosterone and DHEA creams, lotions and injections.” As for the needles found in Oscar’s home, “At least in America—I don’t know how it is in other countries—you can’t, as a consumer, buy anything over the counter that is injectable,” says Dr. Lamm.
Greenfield and Lamm concurred that Testis Compusitum would have little, if any, effect on an athlete. With Olympic athletes, their testosterone, 99.9 percent of the time, is completely normal, Lamm states. Low testosterone is usually a symptom among men with poor health. “If I’m looking at a conditioned athlete, with 10 percent body fat, the likelihood they have low testosterone is zero.” He dismissed the notion that Testis Compositum had an effect on Oscar on the night of the murder. “No matter what medication, they’ll always try to connect it to something,” he states, referring to the media. He doubted there was much substance to such speculation.
Other parasomnias (confusional arousals, sleepwalk–ing, sleep terrors, sleep-related eating disorder) can occur when sleepers have abrupt, partial awakenings. When people are waking up, sleep-related hallucinations can happen, Professor Brogaard & Kristian Marlow note. As Kenneth Parks began to emerge from his somnambulism and saw his mother-in-law’s face as sad, he may have been in a hallucinatory state of mind. Reports from other somnambulists suggest that hallucinations or dream-like states of mind take place during their perambulations. Brogaard & Marlow cite one close call in which Alyson Bair, a 31-year-old woman from Idaho, had a nightmare that she was in a deep river, getting tired. In her dream she realized she actually was drowning. Suddenly she woke up—perhaps a manifestation of Freud’s night watchman being on the job. Alyson had been sleepwalking, ending up in the river outside her home. “I thought I was dreaming, but then I realized I wasn’t and I was scared,” she told ABC News. Making her way to the riverbank, she stayed put until she was found the next morning. These confusions between sleeping, waking, dreaming, hallucinating, and reality perception, I will argue, were likely also operative during Oscar Pistorius’ nocturnal episode that, tragically, went beyond Alyson’s near death experience.
In a more dangerous version of Alyson’s aqueous incident, the Associated Press reported on Nov. 27, 1998 that James Currens, a seventy-seven-year-old man in Palm Harbor, Florida with a habit of sleepwalking, awoke in several feet of water in a pond behind his home. His legs were stuck in the mud. James recalled several alligators coming around him. Attempting to keep them away, he poked at them with his cane. A neighbor heard him yelling and called the police. Officers used lights to scare off the alligators and rescued James.