Oneiroid State

ONEIROID STATE (from Greek oneiroides - dreamlike) as a special picture of mental diseases was identified by Mayer-Gross. The O. s. is characterized by the presence of rich internal experiences in the form of fragmented, fantastic complex scenes against a background of clouded consciousness. It thus shows affinity with pathologically altered consciousness; pictures of the disease were identified by Mayer-Gross from cases of "amentia". The difference from amentive states lies in the absence characteristic of amentia of a complete breakdown of consciousness. In O. s. the breakdown exists only between separate complex complexes of experiences, within which a certain coherence and wholeness is preserved. In this respect O. s. must be placed between states of breakdown and alteration of consciousness (under altered consciousness Mayer-Gross, in agreement with Jaspers, understands a state of consciousness in which separate fragments of experiences are clearly grasped and there occurs a certain concentration around a small closed circle of experiences - narrowed consciousness according to Bumke; an example may be the twilights states in epilepsy). Connected with this is another difference from amentia: in the latter there is consciousness by the patient of their pathological state and the associated confusion as a reaction to this consciousness, in O. s. this is not present, and in relation to the patient's attitude toward their state there is observed a peculiar mixture of complete passivity and intense activity. All this creates a special structure of O. s. On one hand, in it are noted features of "dynamics of breakdown of consciousness": experience as something whole and moving breaks down into separate pieces, but not small ones, but large, whole scenes, which are not only not random, but are definitely connected with previous experiences and with the current "I" of the patient. On the other hand, here is present the characteristic of altered consciousness "free (spontaneous) isolation of separate situations from reality" and concentration of experiences around them. The connection of these separate contents with the current "I" leads to the fact that in O. s. subsequently there is preserved memory of what was experienced during the pathological state. Psychologically O. s. gives features similar to dreams: presence of incompleteness, lack of direction of the general connection of experiences, tendency to formation of complex fantastic scenes and a peculiar experience of "not reached turning point" (as in dreams - something decisive must happen, but at the same time cannot happen). The entire described picture of O. s. reveals similarity and difference between it and the similarly named "oneiric delusion" (delire onirique), identified in 1894 by the French psychiatrist Regis; under this name was understood a state of confusion and hallucinosis on the basis of infections and intoxications, connected with sleep and dreams and usually directly preceding sleep and passing into it. The name emphasized this connection by adjacency, not isolating such states by their structure from the general cycle of toxic amentias. The physiol. substrate of O. s., in contrast to general brain intoxication in amentia, Mayer-Gross wants to see in localized brain damage in the area of the sleep center. The basis for this serves as clinical facts - dreamlike quality of the general picture, precursors of O. s. in the form of insomnia, increased fatigue, etc. Thus O. s. represents at its basis a reaction to toxic processes, but with a certain localization. In the content of the experiences are reflected many moments of a psychological order, which however can be considered only pathoplastic and which cannot explain O. s. completely. O. s. develops as an atypical form of endogenous psychoses (both large groups - manic-depressive psychosis and schizophrenia), as well as in other diseases. It is a superimposition on the basic psychosis and cannot be explained as an intensification of this psychosis or manifestation of constitutional personality traits. However, in the origin of such states apparently have significance characterological features of patients, in particular increased tendency to fantasizing, as well as sometimes hysterical traits (tendency to overestimation of self, seeking sensations, etc.). On the course of the basic psychosis O. s. has no effect. At separate phases of the psychosis O. s. may repeat several times, periodically; sometimes at repeated flare-up of the disease instead of O. s. develops only the picture of "daydreams". The O. s. identified in this way represent rather heterogeneous external pictures. Their unifying structural affinity is revealed by Mayer-Gross in a somewhat complex and one-sided form by its abstract psychologism, typical for phenomenological analysis. However, due to the thoroughness and detail of the analysis, the identification of these states as closed symptom complexes has entered into psychiatric usage and is beginning to penetrate even into manuals oriented to practical physicians.