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Monday, April 01, 2002  Shock Waves:   A Scientist Studies His Stroke  By: J. Allan HobsonM.D. [continued]

ON FIRST-PERSON REPORTS 

What I give here is a subjective report— always suspect scientifically. Sleep science has learned to deal with such reports, however, in part by correlating specific aspects of a patient’s description with whatever anatomical and physiological data are available. This approach could be compelling and informative in connection with strokes, as well, if scientists could overcome their natural misgivings about subjective data. One key would be to record the subjective experiences of stroke victims more aggressively, thoroughly, and systematically.

How? Well, neurologists need to be sensitive to the significance for research of these subjective experiences and to develop techniques for obtaining information on them. As in my case, family members are almost always willing and able to help. Inexpensive handheld tape recorders can augment reports dictated to others. 

Without such proactive steps, a patient is reduced to a set of readily localizable signs of central nervous system damage; he becomes just another “classic case.” It surprises me that Adolf Wallenberg himself did not inquire about sleep and dreaming when he first described the syndrome in 1895; he was respected as a thorough clinician. Yet, in 50-odd papers describing cases like mine, I find not a single mention of the phenomena I describe: initial severe insomnia, suppression of dreaming, gradual and incomplete recovery of sleep, recovery of dreaming, and subsequent oversleeping. The sole first-person account that I did find of the effects of lateral medullary infarction, the kind of stroke I had, makes no mention of any change in sleep or dreaming.

BEGINNING TO DREAM AGAIN

Between my eighth and eleventh days, I had more dreamlike imagery during my fitful sleep, but none of the sort that commonly accompanies REM sleep: dreaming with elaborate and rapidly evolving plot, movement, bizarreness, dynamic emotion, and so forth. Here are two descriptions of my dream imagery on day :

I have the sensation of having paper all over my body which cannot be removed because there is a computer program that instantiates equal and opposite commands each time I try to remove one of them. This fruitless struggle goes on for hours and gradually replaces the alternating state of lucid thinking and lush visual hallucinations of the preceding 6 nights.

I see a female monkey whose head and paws are made out of silver foil containing brown flower petals. The monkey mama is floating in the air in front of me like a comical beatific protector. 

On the 10th day, my dreaming for the first time involved a human being and the beginnings of a dreamlike narrative structure:

Ed Schott, one of my coworkers in Boston, is filling in brain drawings for people who want to know how the brain works and he has made a huge quilt out of about thirty or forty drawings, all of which were in color and connected together in a scrupulous way. I said, “Look, Ed, you don’t need to do all this for the other people, why don’t you keep this one for us and just send them a copy.” 

Fragments like these were similar in form to my REM dreams before the stroke, but were not sustained. My typical REM-sleep dreaming did not return for exactly a month. By that time, I had been flown back to Boston by air ambulance and was in Brigham and Women’s Hospital. On the 31st day following my stroke, I had this experience:

Before I woke up I had a prolonged and interesting dream experience, in which I imagined that I was being treated by a woman or two women (possibly nurses) who were giving me magical fabric to put on my skin. This fabric released a kind of coolness and pleasurable sensation over my skin which I relished and I kept enjoying it as the fabric was moved from place to place on my hands, my chest, my belly, and my face. It was a little bit like the coolness that emanates from the ice packs that I used in waking to counter facial paresthesias, but very gentle and not like any other sensation that I have ever experienced. Nor was this dream like any other I ever had, because it just continued on and on and on in this wonderful analgesic, almost narcotically pleasant mode. 

I remember wondering what the mechanism of the cool pleasure was and being unable to come up with any reasonable explanation. I knew that I couldn’t reason well, but even this recognition still didn’t lead me to think that I was dreaming. Instead, I attributed it to warmth of women who had obviously made an important discovery on how to comfort people. I would guess this went on for about 30 or 40 minutes until I gradually woke up, and then I could go back and forth for about five minutes in and out of this dreamy state. But by five o’clock in the morning I was too wide awake to do anything else but remember it well, contemplate it, and vow to tape record its contents. 

To me, this dream was evidence that something in my brain was changing.

Although it was nothing like any REM-sleep dream I had ever had, I hoped the dream meant my spontaneous sleep mechanisms were recovering. My first elaborate, sustained dream did not occur until Day 38, after I transferred to Spaulding Rehabilitation Hospital and began to walk and exercise. Here is what I wrote about the dream:

It took place in a foreign country, which I thought might be Yugoslavia or Hungary. Lia and I were on a trip, and we were crossing a bridge with a lot of other people. It was a high arched bridge of a medieval sort. The bridge suddenly separated from the land and became a boat skimming across a very small river to get to a village on the other side. We had plans to stay in an old-fashioned inn. 

There was already some discomfort and difficulty finding each other as we got the boat near to the shore. I caught glimpses of her. She was talking to someone else, a man. At one point, either before or just after we got off the boat, I noticed that she had given or sold to him a half-inch bit used with my large brace to drill holes in wood in Vermont. I was very surprised and somewhat hurt by this. I noticed also that the bit had been used to make a very perfect hole in the shoulder bag, which the man wore. It was a shoulder bag very much like mine. 

In the dream, Lia explained to me that she had sold the drill but would give me the money. It still seemed to me odd that she would give a stranger one of my most precious tools without asking me. I was feeling very vexed and apprehensive. We got on the land, we walked around looking for the inn, and we were separated from each other on several occasions. During one of the times that we were together, she made it clear to me that she needed to have a secret life. 

When I was asking her about this man, it was clear that she meant that she needed to be free to have an affair with him if she wanted to. I found that very odd and very disquieting and tried to express my concerns. When we finally got to what appeared to be the inn, there was a strange scene in which she was again difficult to find. But I found her in what looked like a kitchen, and she was preparing to cook some food, which struck me as odd, since this was such a flimsy excuse. I asked her when she would be finished, and she looked at her watch and she said 45 minutes, to which I agreed, knowing that this was all the time she would need to make love with whichever stranger she had selected. 

I then walked around the inn, which had a very peculiar structure. On one side, there was a row of seats roofed over as in a theater and beside each of the seats were exotic bouquets of flowers. I walked down from one level of this improbable architecture to the next, finally getting to the bottom, and wondering in which room Lia and her lover were situated and how I could get to the window to see it. But by going down, I was of course going down from the bedroom level, as if to avoid my curiosity. I wandered all the way around the other side of the building, admiring the ancient medieval architecture, all of which was quite exotic and entirely impossible. When I came back to the place where I thought I might find Lia, there indeed was her coat, the brown coat with the fur trim and hood that she wears so often and that I like so much, but no sign of her and no sign of whatever man she might be with. 

Here was a REM-sleep dream if I ever had one. What makes that so likely is the 603 words in the description; researchers have found that reports on dreams occurring during non-REM sleep are typically less than 100 words. Nor must you be a psychoanalyst to discern the dream’s meaning. Cognizant of the damage inflicted on me by the stroke, I was feeling vulnerable to rejection by the woman I loved, the most important person in my life. I have often argued that the meaning of dreams is commonly transparent; this was a good example.