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Dickes, R. Papernik, D.S. (1977). Defensive Alterations of Consciousness: Hypnoid States, Sleep, and the Dream. J. Amer. Psychoanal. Assn., 25:635-654.

(1977). Journal of the American Psychoanalytic Association, 25:635-654

Defensive Alterations of Consciousness: Hypnoid States, Sleep, and the Dream

Robert Dickes, M.D. and Daniel S. Papernik, M.D.


The alteration in the state of consciousness, called the hypnoid state, is described. The reasons for selecting this term are given. Although this phenomenon occurs under the most ordinary circumstances and is ignored frequently, it functions as a significant ego defense, protecting the ego from unacceptable instinctual demands, and results in a pathological route to sleep. Hypnoid states are differentiated from "physiological sleepiness," from hypnosis, and from other alterations in the state of consciousness. Analytic material from the authors' cases as well as from a review of the literature demonstrates the ubiquitous nature of this phenomenon.

The authors postulate that the defensive function of altering one's state of consciousness occurs in sleeping as well as in waking life, that the superego initiates the development of the hypnoid state, and changes in consciousness occur in the ego to counter unacceptable sexual and aggressive impulses. For the defense to be successful, the hypnoid state must be of sufficient depth so that neither sexual nor aggressive responses are noted and access to the motor apparatus for direct expression is denied.

Attention is also directed to the management of the hypnoid state, which always functions as a resistance in treatment. Since even minor alterations can impede the progress of treatment, it is important to recognize its presence and to intervene at the appropriate time.

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