We see now how widely different starting points can lead to sleep and
can understand from it how widely different disturbances can prevent
sleep. Sleep must result when fatigue is coming, but sleep must also
result when the elements of the rest feeling are produced, and as we saw
that the components of the rest feeling were the sensations of decreased
sensitiveness and decreased activity, sleep must result when either the
sensations and associations are absent and actions are suppressed, or
when monotonous sensations and automatic actions raise the threshold.
Sleep must arise further if our will associates the mere idea of such
rest, and finally physical or chemical means may produce a sleep
bringing effect either on the lower center or on the blood-vessels and
cells of the cortex. Correspondingly sleep may be prevented by
disturbances in any one of these spheres. There may be no normal
fatigue, there may be no fatigue sensation, there may be no rest feeling
on account of perceptions, or on account of associations, or on account
of impulses to action; there may be no normal response in the
subcortical center, there may be no physical effect in the cortex on
account of an existing hyperaemia or on account of an abnormal condition
of the cells. The psychotherapeutic treatment must carefully analyze
which element would be fit to supply the last link in the circular
chain. Sometimes we need the suggestion of fatigue, sometimes the
inhibition of ideas, sometimes the suppression of impulses, sometimes
the suggestion of rest, and so on. A mere general suggestion of sleep is
on the whole effective only in the cases of those persons in whom this
idea in itself awakens those various components. Very often it is
entirely ineffective in this general form. Sometimes it is possible to
carry the hypnotic state itself directly over into sleep, but it seems
more in the interest of the patient to separate those two states
distinctly.
We are still confined to processes in the brain itself if we turn to
headache. If it were only a question of inhibiting the pain by mental
suggestion, the case would not be different from inhibiting the pain of
a peripheral organ without attempting to cure the diseased organ itself.
But in the case of headaches, it seems justified to claim that in
certain varieties of this multifold symptom, not only the pain is
suppressed but the disturbance itself is removed. Especially where the
headache seems to result from hyperaemia, the trouble seems to be
accessible to psychotherapeutics. On the other hand I have never seen
any lasting effect on the so-called sick headache or migraine. While
continuous headaches or headaches which occur daily yielded to my
influence, sometimes completely, I was unable to prevent even by
preparatory hypnotization any migraine which appears periodically, for
instance, simultaneously with menstruation.
Public-domain text, read in full here on John Shaqi.
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