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Isakower, O. (1938). A Contribution to the Patho-Psychology of Phenomena Associated with Falling Asleep. Int. J. Psycho-Anal., 19:331-345.

(1938). International Journal of Psycho-Analysis, 19:331-345

A Contribution to the Patho-Psychology of Phenomena Associated with Falling Asleep

Otto Isakower

The principal object of this paper is to give an account of a group of phenomena of a particular kind, which I have had the opportunity of observing in a number of patients suffering from widely different types of psychological disorders and also in some normal persons. To facilitate description and also to bring out the affinity between the numerous varieties of these phenomena, which occur under different conditions, I propose, as far as may be, to speak of them in what follows as if I were dealing with a single phenomenon.

The phenomenon in question is closely akin to certain well-known hypnagogic manifestations, and this mainly by reason of the fact that it very often occurs when the subject is on the point of falling asleep or is already half asleep. It may, however, also be noted, although more rarely, at the moment of waking and is specially frequent in illnesses accompanied by fever. One regular condition of its occurrence is that the individual concerned should be in a recumbent posture. All those persons who have observed this phenomenon in themselves state that they often experienced these sensations in childhood and fairly frequently again at puberty, but that in later years it rapidly diminished in frequency.

Let me now quote some first-hand accounts which will make plain what is the nature of the phenomenon in question. Here is a woman patient's own description of an experience of the type which I have in mind.

'When I'm feverish, I get a curious sensation in my palate—I can't describe it. Yesterday I noticed it when I was going to sleep, although I wasn't feverish. At the same time I have a feeling as if I were on a revolving disc. Giddiness and a kind of general discomfort. It's as if I were lying on something crumpled, but this crumpled feeling's in my mouth at the same time; the whole thing begins in the palate—I can almost feel it now when I think of it.

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