Individualising the social? The history of insomnia around 1900.

Using the example of the fin-de-siècle German Reich, this article outlines how insomnia emerged as a "disease of civilisation" in an industrialising society, defined by time-specific notions, reflecting and strengthening the social norms of the time. Furthermore, it analyses the process of individualisation and flexibilisation that transferred the social struggles and economic demands of modernity onto the subject's body or soul. The history of insomnia around 1900 thus reveals a pattern of thought that shaped the understanding of the insomniac throughout the 20th century.

Awaking insomnia: sleeplessness in the 19th century through medical literature.

Sleep disorders have received growing public and scientific attention in the last decades. Scientific research and publications on sleeplessness are ongoing and considerable progress has been made on the medical understanding of sleep. And yet, insomnia affects an ever-growing number of people around the globe and remains both a difficult and common complaint general practitioners have to deal with on a daily basis. Sleeplessness is not new, although its transformation from a state of accepted wake to that of exasperating insomnia is a relatively recent transition in which, this article argues, Western medicine took an active part. In the 19th century, the theorisation of different nervous disorders and later of neurasthenia shaped the transformation of insomnia from a constituent of everyday life into a pathology. Based on research in French medical journals published in the second half of the 19th century, this article retraces a succession of medical paradigms for sleeplessness, including 'symptomatic insomnia', 'nervous insomnia' and interestingly, 'insomnia' as a key element in neurasthenia theories. The analysis of medical discourse in all successive theories reveals the decisive influence of physicians in the medicalisation of insomnia, their sociocultural representations echoing patient's complaints as well as professional imperatives.

Insomnia in Traditional Persian Medicine

Insomnia is a common complaint in outpatient clinics. It usually affects quality of life neg-atively, especially in severe cases. Nowadays, routine medical interventions comprise pharmacological approaches and cognitive behavioral therapy. Common medications used by afflicted patients are not competent enough in addition to their annoying side effects. It would naturally denote the need for considering novel strategies for treating insomniac patients. Approach to insomnia in traditional Persian medicine (TPM) has been cited in a scrutinized manner focusing on its main causes. Accordingly, its treatment is tailored based on the constitution of the patient, intensity of the disease, and type of the cause. In this paper we have discussed the causes of insomnia, diagnostic approach, and various medical interventions proposed in valid sources of TPM.

What sleep research can learn from history.

This article, in noting the recent interest of historians in sleep, assesses both the difficulties and the advantages of studying human sleep in the past. The history of sleep affords important new perspectives not only on everyday life in earlier centuries but also on the underlying origins of contemporary sleep disorders, including middle-of-the-night insomnia.

Marcel Proust: genius and insomnia.

Marcel Proust is considered one the greatest novelists of all times. His life was characterised by a long list of diseases. We analyse an important illness suffered by Proust: insomnia. It began in childhood and continued throughout his life, worsening progressively, and leading to a complete reversal of the sleep-wake cycle in the last years of the novelist's life. Several factors may be involved in the pathogenesis of Proust's insomnia. The beginning of insomnia since childhood, its characteristics, and the lack of precipitating factors suggest a form of idiopathic insomnia. Psychological traits of his personality (severe anxiety and depression) may have played a central role in the onset of insomnia. Further factors such as asthma and intake of stimulating substances may have had an important role in the maintenance and worsening of his insomnia. This sleep disorder affected both the lifestyle and literary genius of Marcel Proust. Insomnia is the prominent figure in the first novel ("Swann's way") of Proust's masterpieces entitled "In search of lost time," in which the novelist begins his journey through involuntary memory starting from his insomnia.

Management of insomnia in traditional Persian medicine.

Insomnia is a sleep disorder which affects 10-48% of general population. Different measures, such as pharmacotherapy and behavioral management, are applied for insomnia and associated complaints. In traditional medical systems, herbal medicines are considered beneficial. Therefore, the present paper compiles pharmacological and medical insights into the management of insomnia according to Traditional Persian Medicine. Herein, preserved medical and pharmaceutical manuscripts of Persian medicine from 10th to 18th century A.D. were investigated for information about concepts of insomnia treatment and herbal remedies. Additionally, for all herbal remedies, an extensive search of scientific databases, such as MEDLINE and Scopus, has been performed to find related works concerning hypnotic, sedative, and anxiolytic as well as narcoleptic effects. Insomnia (generally called Sahar in Persian manuscripts) is a well-known disorder. Herbal medical intervention was the major treatment prescribed by Iranian physicians. Totally, 36 medicinal herbs related to 25 plant families are derived from the searched literature. These remedies were applied orally, topically, and nasally. Based on scientific data, 50% of reported herbs have relevant pharmacological effects. Besides historical elucidation, this paper presents medical and pharmacological approaches that had been applied by Persian practitioners in order to deal with sleep complications. Considering the fruitful results of these findings, this essay should encourage researchers to conduct more investigations in this field in order to understand the mechanisms and effects of traditionally applied herbs still unknown to modern medicine.

Insomnio y muerte de Marilyn Monroe. Parte II: muerte / No disponible

Objetivo: Evaluar las circunstancias de la muerte de Marilyn Monroe (MM) desde un punto de vista médico, e intentar reconstruir el tratamiento prescrito para su insomnio crónico. Material y métodos: Documentación original de la investigación policial y médico-forense sobre su muerte, recetas de medicamentos y otros documentos de interés, testimonios directos de los testigos principales y valoración de conflictos de intereses. Resultados: MM falleció la noche del sábado 4 de agosto de 1962 a causa de una sobredosis de fármacos hipnóticos. Existió una divergencia entre la investigación policial, que valoró la muerte como accidental, y la forense, que prevaleció, y que la clasificó de "probable suicidio". Este dictamen se apoyó en una "autopsia psicológica", externa a la investigación oficial, llevada a cabo por especialistas en salud mental relacionados profesionalmente con el Dr. Greenson, psiquiatra de MM y fuente principal de esta investigación, la cual ignoró los hallazgos policiales. Parece probable que sus médicos mintieran sobre la hora y circunstancias de la muerte y retrasaran el aviso a la policía, que el cuerpo fuera cambiado de posición durante ese tiempo y que se intentara justificar la presencia de una cantidad de pentobarbital que no figuraba en ninguna parte. El Dr. Engelberg prescribió al menos diez fármacos psicoactivos en los dos últimos meses de vida de MM, aunque después lo negaría. Las conclusiones de la investigación forense parecen contaminadas por un problema de corporativismo médico. El tratamiento prescrito para el insomnio fue inadecuado, incluso para los estándares de la época (AU)

Objective: To evaluate the circumstances of Marilyn Monroe’s death from a medical perspective, and to try to reconstruct the treatment prescribed to her for chronic insomnia. Material and methods. Original documents from the police and forensic investigations on her death, drug prescriptions and other valuable documents, direct accounts from the main witnesses and assessment of conflicts of interest. Results. MM died on the night of August 4, 1962 from an overdose of hypnotic drugs. There was a divergence between the police investigation, which labelled the death as accidental, and the forensic one, which prevailed and described it as a ‘probable suicide’. This opinion relied on a ‘psychological autopsy,’ external to the official investigation, carried out by mental health specialists professionally related to Dr. Greenson, MM’s psychiatrist and the major source for this investigation, which ignored police findings. It seems likely that her doctors lied about the hour and circumstances of her death, and delayed the call to the police, that the position of the body was changed during this time, and that they tried to justify the presence of an unaccounted for quantity of pentobarbital. Dr. Engelberg prescribed al least ten different psychoactive drugs during the last two months of MM’s life, although he would later deny it. The conclusions of the forensic investigation seem contaminated by a problem of medical corporatism. The treatment prescribed for insomnia was inadequate, even for the period standards (AU)

Insomnio y muerte de Marilyn Monroe. Parte I: Insomnio / No disponible

Objetivo: Conocer la historia clínica del insomnio de Marilyn Monroe (MM) y de quiénes, y con qué criterio, cuidaron del mismo. Material y métodos: Empleo de información gráfica (documentos y fotografías) de origen contrastado, testimonios directos de testigos verificables y valoración de conflictos de intereses. Resultados: MM daba importancia al sueño nocturno para presentar un buen aspecto en su trabajo. Desarrolló insomnio durante su ascenso a la fama en el contexto de un problema de pánico escénico y su adicción a barbitúricos pudo iniciarse por la facilidad para obtenerlos. Se interesó por el psicoanálisis como vía de autoconocimiento personal y mejora interpretativa. Sus psiquiatras basaron su tratamiento en el psicoanálisis freudiano y un uso intensivo de fármacos, sobre todo barbitúricos, pero esta estrategia fracasó. La relación médico-paciente con su último psiquiatra, el Dr. Greenson, fue particularmente anómala. En sus últimos meses de vida, MM fue tratada con cerca de una docena de psicofármacos, sobre todo barbitúricos, pero también otros hipnóticos y ocasionalmente anfetaminas. Discusión: Los fármacos complicaron la evolución del insomnio de MM y ejercieron un efecto negativo sobre su salud general y su comportamiento, situación que suelen ignorar los diversos diagnósticos psiquiátricos que se le otorgan. Dada la falta de control médico, la presencia de intereses espurios, y una paciente que creía tener bajo un control razonable su consumo de fármacos, la aparición de una complicación grave sólo era cuestión de tiempo(AU)

Objective: To understand Marilyn Monroe’s (MM) insomnia clinical history, and how and by whom it was managed. Materials and method: Use of graphic information (documents and photographs) from verified sources, direct accounts from reliable witnesses, and assessment of conflicts of interest. Results: MM valued nocturnal sleep as a way to keep her good looks at work. She developed insomnia during her raise to fame in the context of stage fright, and might have become addicted to barbiturates because she had an easy access to them. She became interested in psychoanalysis as a way of self-knowledge and acting improvement. Her psychiatrists based their treatment in Freudian psychoanalysis and an intensive use of drugs, mostly barbiturates, but this approach failed. The doctor-patient relationship with her last psychiatrist, Dr. Greenson, was particularly anomalous. During the last months of her life, MM was prescribed close to a dozen different psychoactive drugs, mostly barbiturates, but also other hypnotic drugs, and occasionally amphetamines. Discussion: Drugs complicated the course of MM’s insomnia and had a negative effect on her general health and behaviour, a situation that is usually ignored by the various psychiatric diagnoses given to her. Due to a lack of real medical control, the presence of spurious interests, and a patient who thought she had reasonable control on her drug intake, a severe problem was just a matter of time(AU)

Sleep and insomnia.

Recently, the Mental Health Foundation published the largest survey of the nation's sleep. It revealed that people with insomnia suffer from dramatically higher rates of relationship difficulties, energy deficiency, and depressed mood, as well as other health and wellbeing problems. From this report published on 27 January 2011, it appears that poor sleep is a seriously neglected public health concern, and there is an urgent need to do something about it. One hundred years ago, the BJN published an article by Dr Woods Hutchinson, about sleep and enclosed are some key points made at the time:

"Unborn selves"--literature as self-therapy in Virginia Woolf's work.

The connection between mental disorders and creativity in writers, poets, and other artists has been the subject of scientific interest for a long time. The aim of the present study is to examine the relationship between Virginia Woolf's bipolar disorder and her literary creativity. The authors summarize Virginia Woolf's life, family background, and the course of her illness and examine their influence on her work and creation. The authors try to present the complex process in the course of which the work of art is born with the help of the unconscious and conscious. In addition, the authors consider the effect of the development of her illness on her creativity and the way in which she integrated her experiences, anxieties, misconceptions, and hallucinations into art during decompensated depression. Based on these, the authors would like to give an insight into the writer's life and work, which can help us understand better Virginia Woolf's personality, both from artistic and psychiatric point of view.