254 HAMBURG
movement, attention, and sleep loss have illuminated a variety of sleep
disorders and symptoms of mental illness. During that period, the very
important discoveries about the differences between REM sleep and
non-REM sleep became clear. That was a really stunning discovery–that
for about a quarter of a night’s sleep the brain is in some ways very active.
And when you awaken people during that time, they are usually dream
ing, far more dreaming than anybody had anticipated.
I had high hopes that the biological and psychological significance
of dreaming would be clarified by these discoveries of REM and non-
REM sleep, and to some extent that has happened, but much remains
to be done. In recent years, one hope of mine has been fulfilled–the
entry of geneticists into this field, for instance in Dement’s laboratory.
Dreams were one of the principal building blocks of psychoanalysis,
which was dominant in the late 1940s and the 1950s in academic psy
chiatry as well as in the practice of psychiatry. Yet the meaning of dreams
remains much more of a mystery than I would wish.
One of the interesting findings about REM sleep is the compensa
tory rebound. If you deprive people of REM sleep by waking them
consistently, when they go into REM, they make it up at the first chance
they get, as if there were some quota of REM sleep that the brain re
quires. When total sleep time is sharply restricted for days on end, severe
disturbances are likely to occur: sensory disorders, lapses of attention,
micro-sleep intervals, and a tendency to withdraw. So sleep deprivation
has a widespread importance as a clinical and social problem, especially
for, but not limited to, adolescents. Adolescents, as a group in our society,
are sleep deprived, and it affects their academic performance, as well as
their involvement in serious accidents.
In recent decades, narcolepsy, a disorder characterized by frequent
lapses into sleep during the day, began to be clarified, particularly its genetic
basis. Psychiatric research concentrated especially on sleep disorders in
depression and schizophrenia. The work at the NIH Clinical Center in
the 1950s and ever since has been very important–particularly in depress
ed patients who show striking sleep abnormalities, most prominently in
psychotic depression. In general, the more severe the depression, the
greater is the tendency toward sleep abnormalities, and the NIMH
laboratory has had a very stimulating effect in this field, in its own