Sleepwalking through history: medicine, arts, and courts of law

Awake or Sleeping? Maybe Both… A Review of Sleep-Related Dissociative States

Recent studies have begun to understand sleep not only as a whole-brain process but also as a complex local phenomenon controlled by specific neurotransmitters that act in different neural networks, which is called "local sleep". Moreover, the basic states of human consciousness-wakefulness, sleep onset (N1), light sleep (N2), deep sleep (N3), and rapid eye movement (REM) sleep-can concurrently appear, which may result in different sleep-related dissociative states. In this article, we classify these sleep-related dissociative states into physiological, pathological, and altered states of consciousness. Physiological states are daydreaming, lucid dreaming, and false awakenings. Pathological states include sleep paralysis, sleepwalking, and REM sleep behavior disorder. Altered states are hypnosis, anesthesia, and psychedelics. We review the neurophysiology and phenomenology of these sleep-related dissociative states of consciousness and update them with recent studies. We conclude that these sleep-related dissociative states have a significant basic and clinical impact since their study contributes to the understanding of consciousness and the proper treatment of neuropsychiatric diseases.

Stephanus Bisius (1724-1790) on mania and melancholy, and the disorder called plica polonica

Stephanus Bisius (1724-1790) was a physician of Italian descent and a graduate of the University of Pavia. He was invited to the Polish-Lithuanian Commonwealth in the early 1760s and became head of the Faculty of Medicine at Vilnius University in 1781. In 1772, Bisius had authored the first original study on nervous and mental diseases in the Grand Duchy of Lithuania. In his 35-page booklet, written in Latin and Polish, Bisius characterized mania and melancholy as diseases of the brain, explaining that the organs that feed the human soul are affected, not the soul itself. He introduced the principles of humoralism and solidism to readers, and recognized that autopsies had failed to reveal reliable findings concerning mania or melancholy. Bisius also described the origins of the challenging disorder called plica polonica, a strange condition associated with tufts of matted hair. As a physician during the medical Enlightenment, Bisius criticized metaphysical speculations in medicine and stated that plica was only a result of superstitions. Even though he proposed antiphlogistic treatments for patients with mania and melancholy, he maintained that time and faith in God might help some patients overcome their infirmities.

William Shakespeare's neurology

Many of Shakespeare's plays contain characters who appear to be afflicted by neurological or psychiatric disorders. Shakespeare, in his descriptive analysis of his protagonists, was contributing to the understanding of these disorders. In fact, Charcot frequently used Shakespearean references in his neurological teaching sessions, stressing how acute objective insight is essential to achieving expert clinical diagnosis. Charcot found in Shakespeare the same rigorous observational techniques for which he himself became famous. This chapter describes many of Shakespearean characters suffering from varied neurological disorders, including Parkinsonism, epilepsy, sleeping disturbances, dementia, headache, prion disease, and paralyses.

Lord Byron's physician: John William Polidori on somnambulism

John William Polidori (1795-1821) was the Edinburgh-trained physician hired by Lord Byron to accompany him to Switzerland, where he participated in the story-telling event proposed by Byron that led, with Polidori's help, to Mary Shelley's Frankenstein. Although those interested in English literature might also remember Polidori as the author of The Vampyre, one of the first extended works of fiction about vampires, his earlier interest in somnambulism and trance states is only beginning to be appreciated. Even more than students of Romantic literature, historians of science and medicine seem little aware of what Polidori had written about oneirodynia, a synonym for somnambulism, and how his thoughts from 1815 about such activities reflected the changing medical zeitgeist at this time. This chapter examines Polidori's medical thesis in a neuroscience context and compares what he wrote to the writings of several other physicians who were fascinated by nocturnal wanderings, their causes, their manifestations, and their possible treatments.