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BURDENS AND APPARENT AIDS TO SLEEP: SLEEP AND STRESS

The concept of stress is now often used in too broad a sense. As with other psychiatric terminology, care should be taken against using familiar terms too comprehensively, because their meaning gets lost and becomes diffuse, which is what has happened with many terms such as hysteria, psychopathia, neurosis, etc.

For this reason, I would like in particular to define psychic stress as follows: psychic stress should be understood as a mental burden that (1) goes beyond a general burden and (2) is specific to the individual person through whom it becomes pathogenic or becomes an illness.

Defined in a narrow sense, stress is a. relative and circumscribed excessive burden.

In this context, relative means that not every person is susceptible or vulnerable to the same stress. Circumscribed expresses the thought that in many areas the personality is not receptive to stress but is receptive to stress according to its individuality in narrowly limited areas. For example, persons with a tendency toward vacillations in mood—the cyclothymic personality structure already described —are especially vulnerable in situations involving change. What is involved may be a change in residence, a move to a new

location, or a change among people familiar to them. Schizoid personalities, on the other hand, are especially vulnerable to religious problems and to problems involving sexual drive, and these problems can become stressful for them. Persons with partial delayed development (in Krestchmer's terminology, partially retarded personalities) are vulnerable to demands made on them from the area of demands corresponding to their age but which, for these persons suffering from delayed development occur too early.

Persons with heightened, nervous irritability or, to express it differently, with a heightened psychovegetative liability, are more easily vulnerable and more receptive to stress from stimuli that increase this nervous irritability. Such stimuli include many originating in our technological society, noise, increased work tempo, irregularities in the rhythm of day and night that place too great demands on their sleep-wakefulness mechanism, and still many others.

Events, life situations, or activities accordingly can lead to such specific overstress which, although in and of itself not a burden, can become a burden in reference to the individual by exceeding the quantity of excessive demand, hence become stress. The origin of a whole chain of stresses often cannot easily be perceived, since the affected person only makes the last link in the chain responsible for his overstrain. In addition, factors not accepted as stress factors are suppressed and accumulate. The person then suffers from what appears to be excessive demand in one area with which he is in reality perfectly able to cope. The true origin of this situation, the discrepancy between burden and receptivity to burden, is either not recognized or is not accepted. If a sleep disturbance is the final result of such an individual chain of burdens, then in this instance understandably sleeping pills are senseless, since they only suppress a symptom without approaching the cause of the stress situation.

But it is possible in this instance—and this should be clearly recognized—that the sleep disturbance can have a decisively beneficial effect. It can be used for reflecting on one's own situation, the different factors that led to the stress situation, to think about one's attitude toward the situation, and peacefully and calmly to get a broad perspective on one's life, to sort out one's thoughts, and to work on clearing up and eliminating problems.

Recognizing the physiological necessity of a minimum amount of sleep, one or two sleepless nights can be consciously used nonetheless for writing down certain more far-reaching perceptions. Having something on paper can have a real unburdening effect. A burdensome thought can be placed in a neutral context, even if only a piece of paper. Even the positive attitude toward clearing up one's own problems and the activity involved in doing it can have a beneficial effect by blocking the feeling of being delivered up to a situation.

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