In terms of medical science and legal responsibility, the sleep disorder category of parasomnias, chiefly REM sleep behavior disorder and somnambulism, pose an enigmatic dilemma. During an episode of parasomnia, individuals are neither awake nor aware, but their actions appear conscious. As these actions move beyond the innocuous, such as eating and blurting out embarrassing information, and enter the realm of rape and homicide, their degree of importance and relevance increases exponentially. Parasomnias that result in illegal activity, particularly (...) violence, are puzzling phenomena for medicine and the law. Via a review of the pertinent medical literature, a general overview of the current scientific knowledge of parasomnias will be provided. Though this knowledge is far from complete, it can provide some neurobiological information about the nature of parasomnia, including conclusions about a sleepwalker’s level of intention as well as factors that predispose one to such episodes. Although a parasomniac’s complete lack of consciousness warrants acquittal from criminal liability, it does not exclude responsibility for subjecting oneself to exacerbating factors that result in these violent parasomnias. Individuals should be held accountable if they could be expected to control these factors. In addition, they should undergo appropriate treatment and management in order to prevent future parasomnia behaviors. Establishing a legal defense for parasomnia will prove difficult due to the strong potential for malingering, so specific criteria will be outlined in order to distinguish between true and fraudulent claims of crimes committed during parasomniac states. (shrink)

Isolated sleep paralysis is a common parasomnia characterized by an inability to move or speak and often accompanied by hallucinations of a sensed presence nearby. Recent research has linked ISP, and sensed presence more particularly, with social anxiety and other psychopathologies. The present study used a large sample of respondents to an internet questionnaire to test whether these associations are due to a general personality factor, affect distress, which is implicated in nightmare suffering and hypothesized to involve dysfunctional social imagery (...) processes. A new measure, ISP distress, was examined in relation to features of ISP experiences, to self-reported psychopathological diagnosis, to scores on the Leibowitz Social Anxiety Scale and to scores on a new questionnaire subscale assessing social imagery in a variety of waking states. Three main results were found: ISP experiences are only weakly associated with a prior diagnosis of mental disorder, sensed presence during ISP is associated preferentially with ISP distress, and ISP distress is associated with dysfunctional social imagery. A general predisposition to affective distress may influence the distress associated with ISP experiences; overly passive social imagery may, in turn, be implicated in this affect distress influence. (shrink)

Sleep is soothing, silent, and serene, until it is not. Sleep is often troubled, disturbed, or even “disordered” as the medical literature describes it. This paper begins from an extreme form of such disturbance—terrified sleep. Night terrors (pavor nocturnus), in which sleep is violently interrupted, offer important insights into sleep and the methods by which it is studied. The sanitising nature of the medical classification of night terrors as part of a continuum with sleepwalking and yet strikingly distinct from nightmares, (...) leads us into the arms of a more traditional, first-person, phenomenological investigation of night terrors. Without denying the power of both approaches, this paper offers a deconstructive alternative reading of this troubling of sleep through Jean-Luc Nancy’s rethinking of the body, its suffering and materiality. Nancy, and Derrida, help us tarry with the body terrified and trembling in night terrors. First the paper explores the medical incisions within sleep that carve out night terrors, as a delimited phenomenon. This is followed by a consideration of what phenomenology can, and crucially cannot, add to our understanding of night terrors. Next a deconstructive critique of the phenomenological concepts of Leib and Körper is utilised to return to the material body gripped by the night terror. This in turn leads to an alternative account of this parasomnia through a post-Nancean phenomenology of terror as distinct from fear and Angst. The paper closes by drawing out several conclusions about the body, sleep, and phenomenology’s limits when approaching the somnolent. (shrink)

The premise of this study is to look at the intergenerational transferal of language and racial trauma of Asian immigrants in general and Korean–American immigrants in particular to a western country, the United States of America. This study investigates trauma from a psychological standpoint, based on Chang-Rae Lee’s novel Native Speaker. In describing a marker of citizenship, the novel’s title also points to who is the native language speaker and who is a native of a country, and why one who (...) is not may be excluded. The Korean immigrants’ vulnerability to the English language and racial differences highlights their status as minority “others,” and they suffer from transgenerational trauma. As a result of transgenerational traumatic effects, Henry has various traumatic side effects such as dysphasia, aphasia, and parasomnia and finally leaves no stone unturned to recuperate from trauma. The Trauma of the Unspeakable theory by Michelle Balaev is used in this article to show how trauma affects people’s minds. (shrink)

REM sleep behaviour disorder is a REM sleep-related parasomnia which may be considered a “dissociated state of wakefulness and sleep”, given that conflicting elements of REM sleep and of wakefulness coexist during the episodes, leading to motor and behavioural manifestations reminiscent of an enacted dream. RBD has been reported in association with α-synucleinopathies: around a third of patients with Parkinson’s disease have full-blown RBD.Recent data indicate that PD patients with RBD are more prone to hallucinations than PD patients without this (...) parasomnia. However it is still not clear why RBD in PD is associated with an increased prevalence of VHs.Data exist which suggest that visual hallucinations in PD may be the result of untimely intrusions of REM visual imagery into wakefulness. RBD, which is characterised by a REM sleep dissociation pattern, might be a condition that particularly favours such intrusions. However, other hypotheses may be advanced. In fact, deficits in attentional, executive, visuoperceptual and visuospatial abilities have been documented in RBD and found to occur far more frequently in PD with RBD than in PD without RBD. Neuropsychological deficits involving visual perception and attentional processes are thought to play an important role in the pathophysiology of VHs. On this basis, RBD in PD could be viewed as a contributory risk factor for VHs. (shrink)

In 2008, the American Medical Association Journal of Ethics dedicated an entire volume to ethical issues in sleep medicine. Texts published in the “Educating for Professionalism” and “Law, Policy, and Society” sections of this volume serve as theorical starting points to establish a correlation between lack of medical training in sleep disorders and ethical dilemmas encountered by expert witnesses during trials related to problematic automatic behaviours that occurred during REM sleep.