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Art and Images in Psychiatry
May 2004

The Nightmare

Author Affiliations


Arch Gen Psychiatry. 2004;61(5):439-440. doi:10.1001/archpsyc.61.5.439

When Max Eastman visited Sigmund Freud's apartment at Berggasse 19,Vienna, Austria, in 1926, he noticed a print of John Henry Fuseli's (1741-1825) The Nightmare hanging on the wall next to Rembrandt vanRijn's The Anatomy Lesson.1(p15) Freud did not refer to Fuseli's most famous painting in his writing,but his colleague Ernest Jones chose another version of it as the frontispieceof his book On the Nightmare,2 ascholarly study of the origins and significance of the nightmare theme. However,the nightmare did not fit easily into Freud's model of dreams as wish fulfillments.Initially he proposed that nightmares represent superego wishes for punishment;later he suggested that traumatic nightmares represent a repetition compulsion.3(p41) Fuseli's painting provides an opportunityto reexamine how the meaning of the word nightmare hasevolved.

John Henry Fuseli (1741-1825), Swiss-English. Cover: The Nightmare, 1781, oil on canvas; 101 × 124.5 cm. FoundersSociety purchase with funds from Mr and Mrs Bert L. Smokler and Mr and MrsLawrence A. Fleischman. Photograph copyright 1996, Detroit Institute of Arts,Detroit, Mich.

John Henry Fuseli (1741-1825), Swiss-English. Cover: The Nightmare, 1781, oil on canvas; 101 × 124.5 cm. FoundersSociety purchase with funds from Mr and Mrs Bert L. Smokler and Mr and MrsLawrence A. Fleischman. Photograph copyright 1996, Detroit Institute of Arts,Detroit, Mich.

In a career that lasted more than half a century, Fuseli created paintingsthat were recognized as among the most imaginative, dramatic, and sexual inBritish art. His "stylized images of ghosts and fairies, muscle-bound superheroes,fainting maidens and voracious viragos are obvious prototypes for the figuresin today's comic books, action movies and computer games."4(p6) Like these modern fantasy figures, Fuseli's paintings express anengaging dynamism, yet in his day he was best known for his illustrationsof the works of John Milton and William Shakespeare. William Blake was substantiallyinfluenced by his style.5 Fuseli was born inZurich, Switzerland, and died in Putney, London, England. His father, a courtpainter and art historian, insisted that his son become a clergyman. He wasordained as a Zwinglian minister in 1761 but soon abandoned the ministry forliterature and painting. Settling permanently in London in 1779, his reputationwas established in 1782 when The Nightmare was exhibitedat the Royal Academy,where he became professor in 1799 and its keeper in 1804.He is buried in St Paul's Cathedral next to John Opie and Joshua Reynolds.

The subject of the painting is a nighttime assault by a mare or incubus:the "night-mare." Thus, originally a night-mare was a night-demon causingdreams, and only later did the word denote the dreams themselves. Describingthis frightening event, in 1561 Hieronymus Brunschwig wrote, "The diseasecalled Incubus that is the Mare whych is a sycknesse or fantasye oppressingea man in his slepe, that to him semeth a great weyght lye upon hys body, whereforehe groneth and sigheth but cannot speak."6(p10)

The first neurology textbook in the English language, Robert Pemell's De Morbis Capitis; or Of the Chief Internal Diseases of the Head,7 refines this definition and includes incubus as a specific disorder. He notes that both Greek(ephialtes) and Latin terminology (incubus) refer to pressure on the body during sleep as if from a greatweight. Jarcho,8 in his review of obsoletediseases, traces the ancient origin of mare or incubus to Greek myths of giants, among them the Ephialtes.These giants attacked the gods and, at night, human beings, leaving them gaspingin terror from their weight; at times they would sexually attack women.

Pemell notes that in English, the incubus is called "the Hag or Night-mare,because it takes them in the night."7(p71) The English belief was that at night an old hag sat on the chestof the sleeper and caused suffocation. Pemell wrote, "Some will have Incubus[male] or Succubus [female], so-called from Devils of that name: but theseare the conceits of men."7(p71) Thus,the mare could be of either sex. He refers to nocturnal suffocation of thebody after the first sleep, in which the person oppressed is temporarily deprivedof speech and motion. He suggests that the brain is affected in its actionsinvolving imagination, sense, and motion and describes its differential diagnosisfrom nocturnal epilepsy: with the Mare there is no convulsion or motion. Pemellproposes that epilepsy obstructs "the fore-part of the head, but . . . theMare doth obstruct the hinder-part."7(p72) Among its causes are drunkenness and an abundance of food takeninto the stomach, resulting in crude vapors arising in the brain that stopthe motion of the nerves. Although the person strives to move and speak orcall for help, he cannot and is filled with fear and terror. He writes thatthose who have this disease are often in danger of subsequently developingstroke, vertigo, epilepsy, or madness and that children so affected may diein the night. He then describes treatments, noting that this disease occursonly at night and primarily in those who sleep on their back and that theperson should be aroused from sleep, but not too violently.

Although Pemell ridiculed the belief that the night-mare was causedby devils, the incubus as an evil spirit that descended on women to have sexualintercourse with them as they slept was recognized in ecclesiastical and civillaw in the Middle Ages. The Malleus Maleficarum,9 the Hammer of Witches, was an important text sourcefor witch trials that condemned women for having sexual intercourse with thedevil.

By the time the painting was begun, the term nightmare had been codified in Samuel Johnson's Dictionary, the first comprehensive dictionary in the English language, as follows:"mara, a spirit that, in heathen mythology, was related to torment or to suffocatesleepers. A morbid oppression in the night resembling the pressure of weightupon the breast."10(p353) Fuselidid not emphasize suffocation; instead he focused on the incubus, providinga visual representation consistent with the themes of contemporary gothicnovels. The painting may have influenced the creation of Mary Shelley's Frankenstein. His drawing The NightmareLeaving Two Sleeping Women emphasizes the sexual theme and shows theNight-Mare as he rides away (Figure 1),leaving 2 nude women distraught in bed. The 3 elements in the compositionof the painting—a sleeping woman; a night-mare or incubus squattingon her lower chest, frowning, defiant, and seemingly indifferent to her plight;and the head of a horse that peers through the curtain with wild staring eyes—areall consistent with the Malleus Maleficarum.11 A table at the foot of the bed holds a tray, somejars, and a dressing mirror; the shadow of the incubus is reflected on thecurtain. Dressed in virginal white, a woman lies on a salmon-pink coverlet,her head falling off the edge of the bed with her left arm dangling on thefloor. A poem by Fuseli's friend Erasmus Darwin describes the painting: "[T]hroughthe evening fog flits the squab fiend o'er fen, and lake and bog [and] seekssome love-wildered maid, by sleep oppressed, alights and grinning, sits onher breast."1(p58) Although thetheme is archetypal, there may have been a personal motive for this painting.On the reverse side of the canvas is the unfinished Portraitof a Lady (Figure 2). Thismay be Anna Landolt, a Swiss woman who rejected Fuseli's romantic advances.Deeply hurt, Fuseli wrote to her uncle of his unrequited love and of his dreamthat he had her in his bed: "[M]y hot and tight-clapsed hands about her—fusedher body and soul together with my own—poured into her [a la mode d'incubus]my spirit. . . . Anyone who touches her now commits adultery and incest. Sheis mine, and I am hers, And each earthly night since I left her I have lain[in my imagination] in her bed."11(p195) Was Fuseli's Nightmare in some sense a self-portrait?

Figure 1. 
Fuseli, TheNightmare Leaving Two Sleeping Women, 1810.

Fuseli, TheNightmare Leaving Two Sleeping Women, 1810.

Figure 2. 
Fuseli, Portraitof a Lady (reverse side of The Nightmare),late 18th century.

Fuseli, Portraitof a Lady (reverse side of The Nightmare),late 18th century.

Nightmare disorder is currently defined as "disturbing mental experiencesthat generally occur during REM [rapid eye movement] sleep and that oftenresult in awakening."12 They are marked bya dominant emotion, usually anxiety, fear or terror but also anger, rage,embarrassment, disgust, and other dysphoric emotions; these emotions are associatedwith disturbing dream content. Nightmares immediately following or appearinga month or more after a trauma (posttraumatic stress disorder) can also occurduring non-REM sleep. Recent studies of posttraumatic nightmares emphasizethat sleep-related breathing problems may accompany them. However, the mostlikely contemporary diagnosis for night-mare is not nightmare disorder butisolated sleep paralysis with terrifying hypnagogic or hypnopompic hallucinations.

Cheyne et al13 found that almost 30%of 870 university students reported at least 1 experience of sleep paralysisand that three quarters of these also reported at least 1 hallucinoid experience;slightly more than 10% experienced 3 or more. Fear was positively associatedwith hallucinoid experiences, most clearly with a sense of the presence ofan intruder. They propose a 3-factor model of hypnagogic and hypnopompic experiences.One factor, "intruder," consisting of sensed presence, fear, and auditoryand visual hallucinations, is conjectured to originate in a hypervigilantstate initiated in the midbrain and involving the amygdaloid complex. Anothercorrelated factor, "incubus," comprising pressure on the chest, breathingdifficulties, and pain, is attributed to effects of hyperpolarization of motoneuronson perceptions of respiration. These authors suggest that such experiences(more common in those who sleep supine) may be the sources of accounts ofsupernatural nocturnal assaults and breathing difficulties traditionally ascribedto the night-mare. Sleep paralysis with hypnagogic and hypnopompic hallucinationsis reported in posttraumatic stress disorder. Comparing Pemell's account in1650 with this recent proposal, he seems prescient in his description of adisorder of the hindbrain; REM sleep is initiated in the pons.

What can we learn from studying nightmares? Hartmann14 proposesthat posttraumatic nightmares may serve as a paradigm to teach us about themechanism of affective incorporation of experiences into dreams and that nightmaresrepresent the failure to master a dominant and powerful emotion. The questionremains whether the content of nightmares or of hypnopompic hallucinations,which do not necessarily arise following traumatic circumstances, can be meaningfuland have developmental significance in Carl Jung's pathway to individuation.15

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