Sleeplessness is often referred to as a cause of insanity, but it would be much nearer the truth to say that insanity causes sleeplessness. Dr. Rush says: “A dream is a transient paroxysm of delirium, and delirium a perpetual dream.” Not every dreamer becomes insane, in the common understanding of the term, nor every person who is distressed by wakefulness; nor do all those persons who dream dreams of a strange, droll, startling, heart-rending, exhausting character, become inmates of lunatic asylums, although all such are fit subjects for a rigid hygiene; and not a few out of this large number of bad dreamers—who are likewise afflicted with insomnia—but could with advantage place themselves under the charge of an expert in diseases of the brain, or even in an asylum, if either the former, or the physicians in charge of the latter, were in all regards thoroughly equipped for their work—a rare circumstance indeed. Normal sleep is dreamless; in default of this total oblivion, sleep is only partial—it is not perfect nervous repose. No person who suffers severely from indigestion but is also troubled with much dreaming, and, more or less, with wakefulness; and no person who has these last-named symptoms but can safely set them down; at least in great measure, to digestive disorder; and as, almost invariably, removable by improved habits.

Some very wise men have stated as their belief, that no man living is really of sound mind, any more than of sound body, in the strictest application of the term; all have their crazy aspects—their “weak spots,” as we say; and the anxious, brooding man, who fears the loss of his reason, may take courage from the thought that his symptoms are only a little worse than his neighbor’s, and only demand of him to diminish his dyspepsia if he would become normally insane! To attack insomnia as a disease instead of a symptom, is sure to result in discomfiture in the great majority of cases, and is in every instance unsound in principle. Once established, this condition of wakefulness tends to perpetuate itself; but this would be otherwise with an absolutely natural regimen. A man is wakeful at night because under his present physical condition he ought to be—just as in diarrhoea, the looseness is doing its work of cure. So with all symptoms. Pain has its office, and this is coming to be better understood; is already well known to thoughtful, well-informed people; and the wakefulness of which so many complain, and which, in some cases, is of the most distressing, painful character, is as truly normal, considering the present physical state of the sufferer’s brain, as is pain following a cut. As an aid in the removal of this symptom, next to a radical reform in one’s living habits, which is the only possible cure for the disease, the above reasoning is one of the most effectual.

When a man is wounded severely his anxiety is not increased by the pain; it causes no additional alarm, because he knows that it is entirely natural; let him know that sleeplessness is an analogue of pain, and he will, or may, bear it philosophically, and thus tend to its removal. He has a poverty-stricken mind, indeed, who can not, under such circumstances, pass an hour, or several of them, in comparative comfort, knowing that sleep will come in good time. But, thinking all the while that it is sleep only that he needs, his sleeplessness distresses him, causes him to be more and more alarmed, and, consequently, has the effect to postpone the oblivion so devoutly prayed for, but so little earned. To deserve sleep is to have it. Let the insomniac read the concluding article of this volume, and by the light of it review the hints on diet, air, exercise, etc., in the body of the article on consumption, so as to know what he has to do to become a good man, physiologically; and go to bed at about the same hour every night, if possible, or at any rate when he does lie down to sleep it should be after a quiet hour or half-hour devoted to peaceful and thought-steadying occupations, never exciting mental exercise, whether amusing or instructive; and when he draws the blankets about him, let it be with a sublime indifference as to whether he shall or shall not go to sleep promptly. “As to the subduing of the senses, the attempt to shut out external impressions by deafening the ears, closing the eyes, and lowering the sensibilities generally, is in itself a frequently recognizable and always possible cause of persistent wakefulness. The effort to compose the mind (after lying down) and subdue the activity of the senses is made by the higher mental faculty, a part or function of the organism which, of all others, needs to be itself restful in order that the physico-mental being may sleep. It is, therefore, obvious that an endeavor to go to sleep is a mistake.”[50]

Rather let me, when staring out into the darkness,—for to attempt to shut out the sense of sight by closing the eyes is always to render the inner-mental sense increasingly acute: “the field of sight is soon crowded with grotesque and rapidly changing images—a phantasmagoria, the worrying effect of which is only a too familiar experience of the sleep waiter,” and all the mental senses are in like manner stimulated, and their acuteness intensified, by the endeavor to lower the sensibility of the sense organs; and, worst of all, to narcotize them with drugs or sleeping-draughts is irrational and its effects injurious, and if long continued, fatal;—rather, I repeat, having ears to hear, let me hear, and eyes to see, see; and a brain, let me think. Let the brain, the ears, and the eyes “forget their cunning,” only when the eyelids droop in sleep because I am sleepy. Meantime, not self-abasingly, but calmly and dispassionately, would I philosophize thus: Well, I am in for it again! I would like to sleep promptly, soundly, and long; why do I not? I suspect that I am not running this physico-mental machine even in a fairly physiological manner; I cause it to run at an abnormal rate during the day, and keep up intense mental excitement through stimulation of one sort or another, prolonging excessive mental activity too far on toward the night; and because of this, and the lack of a fair degree of muscular exercise, I only half breathe; of my fifteen or sixteen inspirations per minute, not one distends the air cells of my lungs to half their capacity. [Thus it transpires that the organism suffers in two ways, viz.: (1) the circulation is not sufficiently oxygenated for its general purposes; and (2) the waste matters are not “pumped out” of the substance of the brain,[51] as effectually as need be]. My coffee was strong and nice this morning; it stimulated me very satisfactorily throughout the day; and, what I had not bargained for, I am still feeling the spur (see article on Coffee). That new brand of cigars is exquisitely flavored; but, upon the whole, a perfect night’s sleep would be far more exquisite; at least, just now I am in the mood to think so. I sneered at that food-reformer who told me he was never a good sleeper until his present simple, natural habits made him so; but now, just at this moment, it seems as if it would be a good trade to exchange some of my favorite dishes for coarse food and balmy sleep! Oh, if I only could get “balmy” that way every night! I “got the best” of —— yesterday morning on those —— stocks, and spent an hour, bent over my desk, figuring to see how I could get hold of some more at that price, before its holders had time to ascertain its real value. I will tell the widow —— in the morning, what it is worth, instead of trying to buy hers under-price as I contemplated doing. And so I would con over and look through myself and my habits, feeling sure that my eyelids would droop, and sleep would come before I should have completed the work of reform; and I am sure that every sufferer will find that a real reform—a permanent reform—will unfailingly lead on to health, and so to sweet and satisfactory sleep.

“Let no sleepless person be discouraged. Maintain hope under all circumstances. Remember that there are many worse cases of suffering than your own in the world, although to you it seems impossible. Keep up your general health by all sanitary means possible; walk much in the open air, if you can walk; ride, if you can not walk. Above all measures, keep the functions of the skin in prime condition; cleanliness is antagonistic to sleeplessness. Dry friction over the body by the use of the hand, or better by the use of the French hair mitten, twice a day, we have found of great service. The air-bath should not be neglected. A few minutes after the employment of friction over the body, walk about without clothing in a cool room, and if possible let the sun strike upon the body. Do not remain uncovered too long, so as to become chilled. Keep the digestion good; eat only such forms of food as suit the digestive organs. Surround yourself with cheerful company if possible, read such books as do not tax or weary the mind, and life will cease to be a burden, even if you do not sleep as others do. Avoid above all things constant dosing; throw into the ditch, or into the sea, all nostrums that may fall into your hand.”

Comparatively few, even of the so-called hopelessly insane, but might in the early stages of their disease be completely restored; and at any period, so long as there is great vital force, or what would commonly pass for robust physical health, no case need be set down as hopeless. But while the present system of treatment prevails (it is not worthy the appellation of “system,”) the present small proportion of “cures” will continue to be the rule. The inmates are confined more or less closely, often in imperfectly ventilated apartments, deprived of the exercise in the open air they so much need, to the lack of which in their own homes is, in part, attributable their present condition; they are fed generously, even to plethora; and this, through the fault of the ignorance of their attending physicians, although, if these were wise enough to know when and how their patients needed “dieting,” the friends of these sufferers would never submit to anything bordering upon a strictly abstemious diet in their treatment. In visiting lunatic asylums in this and other countries, I have been struck with the appearance of groups of patients—the similarity of their physique, as compared with the men and women seen on our streets every day—fat or lean, seldom medium—all exhibiting clearly the physical characteristics of disease, as emaciation, obesity, lack of, or ravenous, appetite, usually the latter. Meal-time comes every five or six hours, and if the appetite is good, all are permitted to eat very much in excess of their needs; they are urged to eat when they desire to fast; and food is forced into their stomachs if they are inclined to abstain for any length of time. It is not uncommon to find patients who upon entering an asylum begin to fatten, though already in an abnormal condition in this regard, their symptoms becoming more and more discouraging as their weight increases, although neither physician nor friends connect the two facts in any way. The latter feel thankful that “poor dear J—— gets enough to eat!” In this connection I introduce an incident of recent occurrence, not as indicating that a compulsory fast for an extended period should be resorted to generally, nor my own belief that it is a specific for all mind-troubles, by any means, but as a fact of great significance which all interested in this question may well pause a moment to contemplate.

One of the most extraordinary cases of an insane man attempting to restore his reason by voluntary starvation was discovered recently at the —— County Insane Asylum. The case presents an interesting study for medical men generally. ——, aged forty years, a well-known resident of ——, who has been confined in the institution for the last two years, has abstained absolutely from all food except water, for the space of forty-one days. From the forty-second day of his fast until the fifty-first day he drank one pint of milk daily, and from then began eating strawberries and milk. This diet was maintained for three weeks, and was then succeeded by oatmeal gruel and milk. The case is a matter of careful record at the institution and under circumstances that prevented deception. Therefore, there is not the slightest doubt as to the extraordinary performance having been genuine. Mr. ——, when he first came to the asylum, was very violent at times, but, like many insane persons, he was a ravenous eater. His insanity is supposed to be hereditary. Occasionally he has had lucid intervals, and during these brief periods he frequently expressed the belief that there existed some method by which the insane might have their affliction alleviated if not entirely done away with. To Mrs. ——, the matron of the asylum, he took a great fancy, and, while averse to having anything to do with any other of the officials, he confided in her thoroughly and often expressed the wish that his mind might be restored to him and that he could be released. “For forty-one days,” said Mrs. ——, “nothing passed his lips but water, and tepid water at that. Of this fact I am thoroughly positive, knowing as I do the continuous efforts made every day to induce him to eat. When he began the fast he had been living on the same diet as the rest of the patients. He came to me and said, seemingly in a perfectly rational manner, that he was anxious to be cured, and that he thought abstinence from food for a time might benefit him. Mr. —— said he did not intend to carry his experiment to extremes, but that the moment he felt it would be proper for him to break the fast he would do so. On the second day —— again refused to eat, and did not go out of his room. On the third day he drank a small cupful of water. At the end of the seventh day he had drank about six pints of water, and the natural functions of the body had then ceased. All of the attendants were instructed to use every possible means to induce the man to partake of nourishment, and a man was with him constantly through the day.”

“Could he not have obtained food at night?” was asked.

“It would have been impossible,” replied Mrs. ——. “All the rooms are locked, and none of the patients have access to other parts of the building after sundown. We would have been only too glad had he taken food. About the 20th day he began to get thin and haggard-looking about the face, and seemed to be feeble. He said that his head felt better, and that he did not intend to eat anything as long as he felt so well. On the 35th day he became so weak that he had to go to bed, and remained there until he broke the fast. I had told him that whenever he wanted to eat to send me word, no matter what hour of the night or day it happened to be, and I would see that he was provided with anything he might fancy. On the afternoon of the 41st day since Mr. —— had ceased eating,” continued Mrs. ——, “he sent up word by an attendant that he should like to have a cup of coffee.[52] I hastened to comply with the request at once, and had a cup of very strong Java prepared. Mr. —— drank it, and followed it up an hour later with a cup of nice, rich milk. He stuck to the milk for a week, I think, and then added strawberries. This low diet was kept up, oh, for a long time, probably a month, then he gradually began eating oatmeal mush and gruel, which has been maintained up to to-day.”

“And you are perfectly positive, Mrs. ——, that Mr. —— fasted absolutely, with the exception of water, for forty-one days?”

“Perfectly satisfied,” replied Mrs. ——; “in fact, I know it. There can be no possible doubt, inasmuch as the attendants were only too anxious to force the man to eat.”

“Do you think the fast has made any change in Mr. ——’s condition?”

“Well,” replied Mrs. ——, “he will probably be discharged as cured at the next meeting of the board of freeholders in August.”[53]

A certain class of wakeful patients are benefited by the practice of eating shortly before bedtime, when this right has been earned by sufficient restriction during the day. To make this the fourth, or even the third meal, however, is almost certain to increase the difficulty at last. The victim of sleepless nights often finds himself quite overcome with drowsiness after his midday meal. If then he could throw himself upon the bed he would have no time to “count,” or even think of such a device for putting himself to sleep. He was wide awake before lunch, and but for the habit of taking it, could have finished the day better without than with this out-of-season sleeping potion. Let him take the hint, eat his second and last meal, a sufficient one of plain food, in the evening after fully rested, and, thus equipped, go to bed directly, or after an hour or two of agreeable, but non-taxing, social converse. He must avoid every form of artificial stimulation—tea, coffee, wine, beer, tobacco. To breathe the atmosphere of an office, hotel, or smoking-car, for any considerable period, is no better, may be worse, than a moderate indulgence at first-hand in the open air.