Page:The International Journal of Psycho-Analysis III 1922 1.djvu/47

 PLEASURE IN SLEEP AND DISTURBED CAPAQTY FOR SLEEP 39

nausea of the patieot now attached itself to this new symptom. She ceaselessly complained, 'If only the bleedings would stop I should be able to eat'. But the vomiting accompanied by violent physical tension and exhaustion did not allow the bleeding to stop. A profound mental change took place with the increase of her symptoms, and her mental attitude took on infantile traits. The sym- ptoms reacted with a temporary improvement according to the severity of the treatment. One symptom, however, resisted all efforts at alleviation — that of insomnia resulting from resistance to the relapse into the oral phase. It indicated the measure of the pathological force necessary for the suppression of the oral libido. This alarming condition was maintained for four whole weeks; for so long was the robust constitution of the patient able to stand the ravages of insomnia. At a moment when consciousness was already clouded she committed suicide in a way explicable by a knowledge of her predisposition (death from burning).

If we take into consideration the fundamental characteristics of this case, i. e. its structure, we come to the following con- clusion. The more active an individual has been in his oral phase, and the more energetically this stage of development has been later repressed, the greater is the chance that his ability to sleep will be aiTected by a pathological regression of the libido. The oral libido requires a high counter-charge which is in certain circum- stances apt to remove the general wish-to-sleep of the ego (draw- ing in of the libido). In support of this idea I will refer the reader to a case which Abraham * has published in an important work on the oral organisation. It needs only a very triiling trans- position of the facts quoted there to make clear the relationship. Abraham's patient showed in his childhood an utterly ungovernable oral impulse {gnawing the bed-post). Later, grati6cation of this zone became a condition of falling asleep, whereupon mastur- bation which almost always directiy follows oral libidinal activity appeared as an intermediate link. Every attempt to check the oral libido or masturbation 'had to be purchased by the patient with long periods of stubborn sleeplessness'. The insomnia of melancholies, who (according to Abraham) fall ill in consequence

' ' Untersuchungen tiber die friiheste pragenitale Entwicklungsstufe der Libido", Internationale Zeitsckrift fUr drzUicke Psychoanalyse, igie, Bd. IV, S. 86-7.