REFERENCE has already been made more than once, though only in an incidental way, to the childhood malady of pavor nocturnus, or "night terrors." In any book like the present one the subject of night terrors is deserving of detailed discussion. Not only do night terrors constitute a real handicap of childhood, but also they constitute a handicap, the seriousness of which is not yet appreciated by many people, and the true nature of which is as yet known to exceedingly few. In some quarters, indeed, there has been a disposition to minimise this malady, because it usually is "outgrown" by the eighth or ninth year. But, in reality, its effects—or, rather, the effects of the condition[272] of which it is a sign—may, and often do, continue through life. Fortunately, the new knowledge that psychology has gained concerning it enables parents to frustrate its evil consequences and, in most cases, to prevent its occurrence. At bottom, night terrors are almost identical with the nightmares of adult years. They are, to put it precisely, juvenile nightmares, with the added feature of profound disturbance in the waking state. The one real point of difference between night terrors and nightmares is that the former indicate a greater degree of nervous strain. The child who is a victim of night terrors generally has an hour or so of quiet sleep after going to bed. Then he wakes, shrieking for his mother. When the parents, alarmed, rush to his room, they are likely to find him out of bed, crouching behind a chair, or in the corner. His eyes are staring and full of horror. He seems not to recognise his parents, though he will eagerly clutch at them for protection. After a few minutes the attack passes off, he quiets down, returns to bed, and sleeps[273] soundly until morning, when, as a rule, he has no conscious remembrance of his fears of the night before.
While the night terror is at its height the child may have ghastly hallucinations, representing a continuance in the waking state of the dream-images that have distressed him. Also, instead of leaping out of bed, he may merely sit up, or may find it impossible to move at all, as is the case with many adults when coming out of a nightmare. A Chicago physician, describing his experiences as a child, relates:
"When I was five years of age, and during the sixth year, I suffered from nightmare. I sat up in bed and fancied I saw a monkey come down the chimney and fasten itself to my shoulder and bite me, and terrify me so that I would scream out. My older sister would then come, wake me up thoroughly, and satisfy me that it was but a vision.
"Other nights I would feel a sense of oppression, ringing in ears, a sensation of perceiving something[274] very small, which, gradually at first, and then rapidly, assumed enormous proportions and vast whirling speed, and which, I imagined, whirled me off with it—a buzzing in my ears, probably. Then would I feel that animals—rats—would creep over me and press heavily upon me, and I could neither move hand nor foot, nor speak."
The reference to the buzzing in the ears is typical of the attitude that until lately has been taken by almost all physicians in respect both to adult and to juvenile nightmares. For that matter, it still is the attitude of those physicians who are not familiar with the findings of medical psychology. Nightmare to them, whether in the old or in the young, is altogether a question of physical causation. As they see it, one need not look beyond bodily conditions of some sort to understand the nightmares of adults and the night terrors of children. Accordingly, treatment by sedatives, dieting, and hygienic measures has been the rule. Unfortunately, this by no means always succeeds in bringing about the desired result,[275] although such measures undoubtedly do benefit the general health.
Seemingly, to be sure, they are especially successful in the case of night terrors. But it is significant that, even if left untreated, night terrors seldom persist beyond the period of childhood. Then, however, those who have had them show a tendency, in many cases, to be troubled by unpleasant dreams, often taking on the character of most distressing nightmares. The frequency of these may, or may not, be diminished by the usual treatment of a dietetic sort. On the other hand, observation has shown that many persons afflicted with the indigestion and other physical conditions commonly held responsible for nightmares are not troubled by nightmare at all. As one observer puts it, even a person whose stomach is half destroyed by cancer may commit all sorts of dietary indiscretions and not suffer from nightmare in the slightest.
Evidently, then, physical conditions do not of themselves account for nightmares and night terrors.[276] One must look elsewhere for their ultimate cause. This is what the medical psychologists have done, and, doing this, they have discovered that the children who are troubled by night terrors are always children of a sensitive nervous organisation who have been subjected to emotional stress. A child may be nervously highstrung, yet entirely escape night terrors, provided his mind be kept free from emotional upheavals. But let anything occur to disturb him emotionally in an excessive degree and he at once becomes likely to suffer, not only from night terrors, but also—as it has been a prime purpose of this book to impress convincingly on every reader—from nervous affections of a more serious kind. He may even have "day terrors," seeing imaginary and terrifying objects as vividly as the child who wakes in panic from a distressing dream.
For example, a boy of eight was sent to the Washington neurologist, Doctor T. A. Williams, to be treated for general nervousness, and, in particular, for a tendency "to see things where there is really[277] nothing to be seen." Doctor Williams found the boy to be so nervous that it was hard for him to sit still and to keep from wriggling excitedly about in his chair. Questioned as to his hallucinations, he said that these were mostly of a snake. He could not describe the imaginary snake, except to say that its head was like an eel's. It seemed to come from nowhere, and presented itself to his astonished gaze with a suddenness that caused him to scream and run. His father gave Doctor Williams the additional information that these hallucinations were experienced only when the boy was alone, and that, though his day terrors were not followed by night terrors, he would not go to bed unless some one were in the room with him.
Questioning his little patient more closely, Doctor Williams next learned that he had a veritable horror of being alone at any time. As long as somebody was in sight, he could enjoy his games, and would readily run errands. Left alone, the imaginary snake, or some hallucinatory wild beast, was almost[278] at once seen by him. Further inquiry brought out the significant fact that this fear of solitude had actually been implanted in the boy by over-anxiety on his mother's part.
His horror of being alone was paralleled by her dread of having him out of her sight. She was continually thinking, and talking, of risks he would incur if he were allowed to be by himself. In this way she had unconsciously infected him with a "fixed idea" that something dreadful was sure to happen to him unless older persons were at hand to protect him. This fixed idea preying on his unusually impressionable mind, and keeping him in a constant state of emotional strain, was the decisive factor in the production of his day terrors. In proof whereof it need only be added that his hallucinations and general nervousness ceased to trouble him soon after corrective training was begun, supplemented by treatment by "suggestion" to rid him of the abnormal fear of being alone.
Fortunately, though I might detail a number of[279] other cases of day terrors, this affliction is of rare occurrence, compared with night terrors. And, from the point of view of the medical psychologist, it is only to be expected that such should be the case. As explained by Doctor Williams, in a passage which gives a clear idea of the mechanism of night terrors:
"If I say to a small boy that a bear will eat him up, the effect upon his emotions entirely differs, whether I make the remark with portentous gravity and horror, or whether I say it with bubbling joviality as, evidently, a huge joke. In the first eventuality, the boy will rush to my side in terror and try to be saved from the bear, and a phobia is in course of construction; with the latter proceeding, the boy will laugh consumedly, and it would not take much to make him enter the cage and strike the bear. But, even when terrified, a child feels a refuge in the protection of his elders during the day, when they are rarely absent....
"At night, however, the child is alone, and his little consciousness cannot find the support of others.[280] Before the kaleidoscope of his dreams pass the various images and accompanying emotions of his waking life, so that if any of these images has become linked with fear it is certain to bring with it terror, as it surges into dream in the night, and the child jumps up, awakened, in panic, finding no one near, upon whom to lean."[17]
In many a case of night terrors, no great psychological skill is required to detect the influence of emotional stress as the prime factor in causing the alarming attacks. In one instance that has come to my knowledge, a seven-year-old girl was brought to a physician, with a history of both night and day terrors. She was subject, her mother said, to attacks of loud screaming, during which she seemed dazed and in an agony of fear. The attacks sometimes lasted ten minutes, and immediately afterwards the girl generally fell into a heavy sleep. Her night terrors were of the usual sort, except that on the occasion of the first attack she was in such a panic[281] that she opened her bedroom window and threw herself out of it. Luckily, it was early evening, and her mother, walking in the garden beneath her window, was able to catch her and save her from harm.
"She had gone to bed as usual," the mother said, in detailing this episode, "and seemed to be quite well, though I remember I thought she looked a little wild about the eyes. For an hour she slept quietly. Then, as I later learned, she woke up moaning, jumped out of bed, and made for the window."
"And," asked the physician to whom the child had been taken, "had anything out of the way occurred to her that day?"
"Nothing."
"Are you sure of that?"
"Well, nothing of real account, at all events. I have been told that somebody jokingly said to her that if she were not a good girl a black man would come to her room and carry her off. But this did not seem to disturb her much at the time."
Hereupon, the situation became clear to the physician.[282] It was evident that, subconsciously if not consciously, the thought of the supposed danger, acting on a mind none too well organised by inheritance—there was epilepsy in the family—had acquired sufficient force to bring on the attack of nocturnal panic and the subsequent attacks of day and night terrors. Probably, moreover, this was not the first time that statements of a fear-inspiring character had been made to the child, so that this last "joke" might well serve to agitate her excessively.
Compare with this the case of a four-year-old boy, whose night terrors were accompanied by a strange hallucination that he saw the devil, and that the devil was trying to catch him. Every night for several weeks he would wake after one or two hours of sleep, would leap from bed with a shriek, and run wildly around the room, calling on his mother to save him and to drive the devil out of the house.
Impressed by the recurrence of this hallucination, the physician in charge of the case questioned the boy's mother as to a possible explanation for his[283] believing the devil was chasing him. Reluctantly, the mother confessed that one day when her little son had been unruly she had warned him that if he did not behave the devil would come for him. It was the night after she had thus foolishly threatened him that he had his first attack of pavor nocturnus. Armed with this knowledge, the physician began a course of treatment which effected a cure in a week. It properly included tonics and dieting to overcome the indigestion and other physical ailments caused by the strain of nervous excitement. But its principal feature was treatment by suggestion, to dislodge from the boy's mind his morbid fear of the devil.
Anything which causes the instinct of fear to function abnormally may act with decisive force in bringing on night terrors. The telling of ghost stories and other gruesome tales of the supernatural has been productive of much harm in this respect. And, as brought out in the preceding chapter, cases of night terrors have similarly been traced to the hearing or[284] reading by children of fairy tales containing elements of the horrible. The child that is supersensitive may be so impressed by these elements as to brood over them and, in waking reverie, apply them to himself. Thus they get fixed in the mind, to disturb and alarm it, and, eventually, to find expression in dreams of so unpleasant a character that night terrors may be a result.
With the night terrors left untreated psychologically, subsequent nervous ailments, perhaps lifelong invalidism, may further penalise the hapless victim of parental thoughtlessness. I am reminded of a certain patient of Doctor Sidis's, a woman afflicted with neurotic ills up to the age of sixty, and, when she first consulted the New England specialist, displaying a most complicated set of disease symptoms. She had kidney trouble, stomach trouble, frequent headaches, insomnia, and general nervousness. In especial, she suffered from an obsessive fear of becoming insane. This fear, at times, was so extreme that she would walk up and down her room night[285] after night, "like an animal in a cage," to use Doctor Sidis's expressive phrase. Repeated examinations by different physicians had failed to bring to light any evidences of organic disease of stomach, kidneys, or brain, and a diagnosis of hysteria had finally been made. Consequently, it became Doctor Sidis's special task to endeavour to get at these latent memory-images that had acted with disintegrative power on the mental and bodily processes, recall them to conscious remembrance, and, by suggestive treatment, rob ............