This nervous tension of anxiety is often accompanied by physical muscle tension. When we are anxious, our muscles are tensed, ready for the call to action which in fact never comes. The tensed muscles may become sore and tender. If this is generalized we are said to suffer from nervous rheumatism, but more often the stiffness is confined to certain muscle groups, particularly those around the neck and shoulders.

Minor degrees of nervous tension show themselves in the way we function in our everyday life. There is a lack of ease about our reactions. Even in such a simple thing as walking, the natural ease of movement is lost, our arms do not swing in the accustomed fashion and our gait has the appearance of being strained and awkward. Sometimes these symptoms of anxiety very closely resemble those of organic illness.

A woman in her early fifties had been thoroughly investigated by a competent physician, and had had psychiatric treatment with drugs and discussion of various domestic problems. She complained to me that she was tired and lethargic. She was dizzy when she stood up and would become breathless when walking up a slight hill. She said that she was wobbly on her legs so that she had difficulty in standing to do the cooking.

I thought that an organic cause for her symptoms may have been overlooked, and I referred her back for further investigation, but nothing could be found. So I started her with relaxing mental exercises, and she has made a dramatic improvement, which shows that her symptoms were in fact due to anxiety. I later discovered that her unsteadiness on standing was due to the increased nervous tension in the muscles of her legs.

Nervous tension may be seen in our manner of speech. There is a tendency to talk abruptly and too quickly. The flow of words is interrupted and the observer is aware of a loss of natural ease of communication. In simple things such as writing, our tension makes us hold the pen too tightly. Our hand starts to shake, our writing becomes jerky, and the letters lose their normal rounded outline.

There is another aspect of nervous tension which further disturbs us. We do not like other people to know that we suffer in this way. It is considered socially desirable to be relaxed and at ease. To be tense and uncomfortable is to be socially inept, and as a result we do all we can to disguise our inner tension from those around us. We try to behave in a relaxed manner, and when we are seated we assume a posture of ease in the hope that others will not guess what is going on in our mind. In this attempt to keep from the others the truth as to how we feel, we concentrate on what we are saying and on the tone of voice as we say it. We try to present a facade to them so that they will not guess our true state of mind. To keep up this facade requires more and more effort. We have to concentrate on it so much that we can only give half our attention to the matter in hand. We become aware that we are not functioning to our full ability; we become more apprehensive, and our anxiety is still further increased.

*7\57\2*

Nowadays hypnosis is used more and more by doctors and psychologists. In 1958, hypnosis was formally accepted as a form of medical treatment by the American Medical Association, and three years later by the British Medical Association. Hypnosis is now no longer a magical act, but a well-respected science. Much research is conducted on hypnosis, and some medical journals are devoted entirely to hypnosis. The International Society of Hypnosis has thousands of members from all over the world, all of whom are doctors, dentists, and psychologists. Its headquarters is situated in the Austin Hospital, Melbourne.

Hypnosis is not a magical act, but a special state of awareness, and everyone has the ability to go into this state. We are familiar with the other states of awareness, the conscious state and the unconscious state; how the hypnotic state ties in with these is described below.

Unconscious state

In this state the person is not aware of anything and cannot be aroused easily. We enter the unconscious state during general anaesthesia and perhaps as a result of head injury. The person who has been unconscious cannot remember anything that happened to him or his immediate surroundings during the period of unconsciousness.

Conscious state

This includes the fully awake state, the sleeping state, and the hypnotic state. When we are fully awake our awareness of our surroundings is at a maximum. When we are asleep, our awareness is minimal and sometimes non-existent. In the hypnotic state, our awareness of what goes on around us is limited and is in between the fully awake and sleeping states. Psychologists call this a state of dissociation, as we are dissociated away from our normal awareness of our surroundings. This limited awareness is usually directed towards the contents of the suggestion given by the hypnotist.

It is thought that all of us have the ability to go into a hypnotic state when the circumstances are suitable. A hypnotist provides these suitable circumstances. To go into hypnosis, it is important for the person to focus on some idea and concentrate on it. We all go into a form of mild hypnosis when we watch a good movie. We become totally involved with the personalities of the characters and sometimes we feel as if we are part of the movie. Some of us may have tears in our eyes when there is sadness in the story, and we may become tense when there are dangerous or horrifying scenes. We can be so involved with the movie that sometimes we may not be aware of our surroundings. We are dissociating ourselves from our normal lives and we momentarily identify ourselves with the characters in the movie.

The swinging of a pocket watch by the magician allows the lady to focus all her attention on the watch. Nowadays it is possible for a person to go into hypnosis by just fixing his eyes on an imaginary point in front of him. With the appropriate suggestions from the hypnotist, the person’s scope of awareness will gradually become narrower and narrower. The appropriate suggestion is important to constrict the scope of awareness away from the surroundings. The result is that the person dissociates and detaches from his thoughts, so that his thinking then follows the suggestion of the hypnotist.

Whilst in the hypnotic state, the person’s awareness is narrowed but is heightened and sharpened. So the suggestions of the hypnotist are totally received with minimal rejection. There are some very good hypnotic subjects who can go into a very deep hypnotic state. They can see imagined objects suggested to them or they can abolish the perception of pain if the appropriate suggestion is given. Hence hypnosis has been used in the management of chronic pain. The suggestion can also be made to change certain behaviours, and this has been used successfully to treat people who wish to give up smoking. The suggestion that the person can relax easily at night re-establishes confidence in sleeping and is very useful in some cases of insomnia.

Another most interesting feature of hypnosis is its influence on memory. People under hypnosis can remember things that they cannot remember whilst in the fully awake state. They can be taken back in time, to relive a period when they were much younger; this is called age regression.

This is another unique phenomenon in hypnosis. Whilst under hypnosis, it is possible to suggest to the person that after he wakes up from the present trance he will perform a task such as blowing his nose when the hypnotist gives a pre-arranged signal. The person is then awakened from hypnosis, and may have apparently forgotten what went on whilst under hypnosis. After a while, conversations unrelated to hypnosis take place; then the hypnotist, without warning, claps his hands, which is the pre-arranged signal in this case. The person, seeing the signal, starts to have an irresistable urge to blow his nose. He may make some excuse that his nose is itchy and then blow his nose. Most people feel uncomfortable until the posthypnotic suggestion is carried out.

*43/23/5*

When we are under stress, a normal reacting mechanism in our body works to counteract the stress applied to us. Our body feels threatened, and we put ourselves on battle alert. We respond in two ways: with a biological reaction and with a psychological reaction. These two ways go hand in hand with each other, and both are protective mechanisms against the threat of imminent danger.

Biological reaction

Our body is immediately geared up for the stress, ready for ‘fight or flight’. Plenty of adrenaline is circulating, and our muscles are all tensed, our heart pumping hard, our blood pressure high so that our body is ready for the flight, our blood thickened and able to clot easily just in case we are injured or bleed in the fight, and our eyes wide open with the pupils dilated and staring at every move of the enemy. There is little chance of falling asleep when there is imminent danger as we are on guard all the time.

The biological reaction to stress developed way back in the course of evolution, but is still very important in present day life; for example, in a boxing competition or when soldiers are fighting in combat. Or when attacked by a burglar, we have to either ‘fight’ or ‘flight’, although I personally prefer flight.

However, in most modern stress situations the biological reaction becomes a burden. Physical action is normally not required. If your boss misunderstands you, you become very uptight and are ready to explode. But in most cases, even if you want to, you are not going to give him a black eye, as this is a civilized world. This biological reaction generates a lot of energy, which we are unable to release. We feel distressed. Continual, chronic, modern stress can be harmful to the body. We are flooded with excess adrenaline, and we have a greater chance of falling victim to a heart attack or stroke. This is because, during the biological reaction to stress, the blood pressure is high to increase the energy supply through circulation, and the blood will clot easily to stop bleeding if this is necessary. Some authorities recommend an aspirin a day to thin the blood, so as to prevent heart attack or stroke, as both can result from a clot in a vital blood vessel; in the case of a heart attack, it is a clot in the coronary artery supplying the heart muscle, and, in the case of a stroke, it is a clot in an important artery supplying the brain.

Psychological reaction

One of the things that makes us human is that we possess a unique psychological reaction to stress. We automatically protect our psyche; we deny what is going to happen. Denial of the existence of the stress is a normal common defence mechanism. A sense of disbelief is not uncommon. We feel anxious and sad at the same time. We are no longer sleepy, our brain is on full alert, unable to switch off, and is ready for the challenge. In fact we are wide awake. We magnify and exaggerate the stress, so that the stress in question occupies every part of our mind. It is as if we are carrying a magnifying glass and examining the issue in detail all the time. So it is psychologically normal to exaggerate and to blow things out of all proportion when we are under stress. We will not let go until the issue is resolved.

The psychological reaction is useful as long as we do not suffer from it, but repeated exposure to stress can result in psychological illness, such as chronic insomnia, anxiety, panic attacks, agoraphobia, and even alcoholism. Were we all like coconuts, ordinary stress would have no effect on us. However, there are very few coconuts around. Psychologists have noticed that there are certain kinds of personalities that react excessively to stress. These are the perfectionists, who expect the real world to be perfect and strive for 100 per cent all of the time. If they feel that anything is not up to their expectation, they feel very stressed.

Albert Ellis, a famous psychologist in New York, has developed a new concept in psychology called the rational emotive therapy, in which all psychological problems are a result of our irrational thinking. He states that some of us believe: ‘I must be loved and approved by every person in my life, I must achieve at all times, and it is the end of the world if things are not how I expect them to be’. In other words, some of us have a very low threshold of tolerance, and our thinking is irrational and childish. If the boss misunderstands such a person, he will say: ‘This is horrible, as I must be loved and approved by every person in my life’. He will turn the incident into a catastrophe and feel stressed.

Hence, even with everyday ordinary stress which is normal and natural in our real world, some people feel very stressed. In other words, they are like tomatoes in the bag. A patient once came to see me with a fractured knuckle of his right hand. He told me he was driving from Canberra to Melbourne, and his car broke down. He felt so mad at the car that he punched the bonnet violently. The rest you know. He regretted what he did, as the bonnet now had an additional dent in it.

Let us examine what happened here. The car breaking down was a source of stress, as he did not expect it to. His psychological reaction was to exaggerate it out of all proportion, and say to himself: ‘It is the end of the world, as things are not how I expected them to be’. The biological reaction was switched on at the same time, and he was ready to fight. The enemy here was the car. The result was that it got punched, and he got the injured hand. An ordinary everyday incident can be turned into a catastrophic one if we do not direct the reactions to the stress in the appropriate direction in order to aid its resolution.

*39/23/5*

Tryptophan is another non-prescribed hypnotic drug. It is one of the amino acids, and is a basic component of protein. Since this is a naturally occurring substance in most of our food, it had considerable appeal to the non-drug enthusiasts.

Trytophan is a precursor of serotonin in the brain, and serotonin is involved in the modulation of mood and sleep. Many studies have been conducted on the effectiveness of tryptophan in helping sleep. In animals and human subjects, tryptophan speeds up sleep onset, increases total sleep time, and reduces the number of awakenings during the night. It also has the advantage of not suppressing REM sleep like other sleeping pills. However, it is a very mild hypnotic compared to benzodiazepine.

Tryptophan is present in many foods, such as milk, eggs, meat, vegetables, and so on. It has been documented that a glass of malted milk before bedtime can help induce sleep. Tryptophan is marketed in Australia as Bioglan, Sedatol, Trypto-Sleep, Vita Glow, and Neuroremed.

The recommended dose is 1 to 4 g as a single dose one hour before sleep. A normal diet contains only a minute amount of tryptophan compared to the other amino acids. If tryptophan is taken after a high protein meal, only a small amount of tryptophan goes into the brain. It is recommended that tryptophan be taken instead after a high carbohydrate meal. The rationale is this: the carbohydrate induces secretion of insulin from the pancreas, which promotes absorption of competing amino acids into the muscle and leaves the tryptophan to be transported into the brain for inducing sleep.

Narcolepsy is the most interesting cause of EDS. People suffering from narcolepsy have sleep attacks and are chronically sleepy. They cannot resist sleep and sleep comes abruptly, sometimes in the most embarrassing or hazardous circumstances. They can fall asleep while driving for short distances or even when they are operating dangerous machines. It has been reported that they can even fall asleep whilst having sex, when the body should be pumping hard with adrenaline.

This condition results from a developmental defect in the brain, present at birth, and is most prominent at around 20 years of age. It is not infectious. Narcolepsy is sometimes associated with other phenomena, namely cataplexy, hypnogogic hallucination, and sleep paralysis:

* Cataplexy is a sudden paralysis of some part of the body. This can be brought on by the sudden expression of emotions, such as laughter, excitement, anger, or extreme pleasure. This is the reason why a person suffering from narcolepsy can become paralysed with sleep when he is about to climax during sex.

* In hypnogogic hallucination, a person sees things before he is fully awake from sleep. The word hypnogogic comes from ‘Hypnos’, the name of the Greek god of sleep. It is a mixed feeling of dreaming and being awake at the same time. It can be an experience of seeing things that do not exist, but the person is convinced that he is awake.

* Sleep paralysis is much more common. Most of us experience it occasionally. For instance, you are still in bed, you think you are awake, and you can see the room you are in. You may be able to move your eyes, but the body is completely paralysed and immobile. Usually when this happens you are in a transitional state between dreaming and reality; that is, you are in the process of waking up from a dream. The experience can be frightening.

As we have already learnt, when we are in REM sleep our body is completely paralysed, as if there is a jamming mechanism that prevents our limbs from moving. When we are sleeping it does not worry us, because we are not aware of the paralysis. However, when we are semi-awake and aware of the inability to move our limbs, we are gripped by a terrible feeling of imminent catastrophe and panic follows. One patient told me about her husband who had frequent sleep paralysis. He made so much noise in his throat during an attack that she knew he was in trouble. But once she touched him he would wake up and immediately feel incredible relief. The husband told me that during an attack he always thought he was going to die, as he could not move at all. He believed a ghost was sitting on top of him, immobilizing him.

Cataplexy, hypnogogic hallucination, and sleep paralysis are all a disorder in REM sleep, namely that REM sleep occurs too quickly and too often. Sleep comes easily and quickly, and REM sleep may occur within ten minutes of falling asleep. During REM sleep the mind is actively dreaming, but the muscle tone of the body is flaccid. Cataplexy and sleep paralysis both result from this loss of muscle tone, whereas hypnogogic hallucination is associated with the actual experience of dreaming during REM sleep. It has been shown that narcoleptic patients do not have the ultradian rhythm or the 90 minute cycle and their sleep does not show the normal REM/NREM cycle.

People who suffer from narcolepsy should never drive long distances or engage in hazardous work. Accidents are common among the narcoleptics, and they find it difficult to hold onto a steady job as their bosses generally dismiss them for sleeping on the job. When a narcoleptic patient is tested in the sleep laboratory, an excess of REM sleep is recorded, especially immediately after falling asleep. Medical treatment with a stimulant called amphetamine, which has to be taken regularly, can be successful.

*24/23/5*