SLEEP
Historically, it was difficult to study sleep. Not much can be gleaned from observing recumbent persons and questionnaires are no use, because people remember little of their experience during sleep. The breakthrough came in the 1950's with electroencephalogram (EEG) recordings of brain electrical activity, when it was confirmed that sleep is anything but dormant.
We need sleep for biological restoration. It promotes cell growth, regeneration and memory consolidation. By shutting down most of the body's machinery, resources can be focused on repairing damage and development. When people are deprived of sleep for any reason, there is deterioration in performance, particularly on tasks requiring concentration, and eventually, behaviour becomes shambolic. The individual becomes progressively incoherent and irritable and, after a few days, may experience delusions and hallucinations. The disruptive effects of sleep deprivation have even been successfully used as a basis of persuasion in interrogation.
A vital part of sleep is dreaming, which happens most intensively during rapid eye movement (REM) sleep. We typically spend more than two hours each night dreaming, though this is often spread over four or five separate periods. Infants spend up to 50 per cent of their sleep time in REM sleep, which is understandable when one realises that REM sleep is the time used for brain development, as well as learning, thinking, and organising information. If people are woken when REM sleep commences, depriving them specifically of dream-sleep, the proportion of REM sleep increases once they fall asleep again to make up what was lost. This suggests that REM sleep is an essential aspect of sleep.
Sleep and sleep-related problems play a role in a large number of human disorders and affect almost every field of medicine. For example, problems like a stroke tend to occur more frequently during the night and early morning, due to changes in hormones, heart rate, and other characteristics associated with sleep. Sleep also affects some kinds of epilepsy in complex ways. REM sleep seems to help prevent seizures that begin in one part of the brain from spreading to other brain regions, while deep sleep may promote the spread of these seizures. Sleep deprivation can also trigger seizures in people with some types of epilepsy.
The neurons that control sleep interact strongly with the immune system. As anyone who has had the flu knows, infectious diseases tend to make people feel sleepy. This probably happens because cytokines, chemicals produced while fighting an infection, are powerful sleep-inducing substances. Sleep helps the body conserve energy that the body's immune system needs to mount an attack.
Sleeping problems occur in almost all people with mental disorders, including those with depression and schizophrenia. People with depression, for example, often awaken in the early hours of the morning and find themselves unable to get back to sleep. The amount of sleep a person gets also strongly influences the symptoms of mental disorders. Sleep deprivation is an effective therapy for people with certain types of depression, while it can actually cause depression in other people. Extreme sleep deprivation can lead to a seemingly psychotic state of paranoia and hallucinations in otherwise healthy people, and disrupted sleep can trigger episodes of mania in people with manic depression.
Sleeping problems are common in many other disorders as well, including Alzheimer's disease, stroke, cancer, and head injury. These sleeping problems may arise from changes in the brain regions and neurotransmitters that control sleep, or from the drugs used to control symptoms of other disorders. In patients who are hospitalised or who receive round-the-clock care, treatment schedules or hospital routines also may disrupt sleep. The old joke about a patient being awakened by a nurse so he could take a sleeping pill contains a grain of truth. Once sleeping problems develop, they can add to a person's impairment and cause confusion, frustration, or depression. Patients who are unable to sleep also notice pain more and may increase their requests for pain medication. Better management of sleeping problems in people who have a variety of disorders could improve the health of these patients and their quality of life.
Insomnia is a widespread affliction. It is linked with conditions such as depression and chronic pain, but occurs also in otherwise healthy people. It is often due to temporary life circumstances, like trouble at work or anticipation of an exciting event, however, some people just have difficulty sleeping regardless of circumstances. What is interesting is that complaints of sleeplessness are often exaggerated, because people remember more easily the times they are awake during the night than the times they are asleep. When insomniacs are observed in a sleep lab, their EEG records often suggest that their sleep pattern is fairly normal, even though in the morning they maintain they hardly slept a wink. Various devices for monitoring one's own sleep patterns are now marketed, for example mobile phone apps connected with forehead electrodes.
The fact that a third of our life is spent in sleep would, in itself, be sufficient justification for studying it scientifically. The discovery that it is not just a passive state, but a highly active process of profound biological and psychological importance, has led to great efforts in recent decades to further our understanding of it. Despite that, we are far from unravelling all of sleep's mysteries.
The Efficacy of Hypnotherapy
In the 1840s Scottish neurosurgeon, James Braid coined 'Hypnotherapy'. At that time, in India, British surgeon, James Esdaile, practiced hundreds of scrotal and abdominal operations, adopting hypnosis as the only anaesthetic. It was unfortunate timing that he reported his research dissertation on hypnosis to London Royal Society just as chemical anaesthetics were discovered. The technique was not agreed on by the medical establishment.
These days, whilst an increasing number of people are asking about private practitioners, the level of studies within the hypnotherapy field is meaningful enough that it remains on the fringes of medicine. In a report on alternative and complementary medicine in 2000, the Science and Technology Committee of the UK's House of Lords has given hypnosis a bad reputation by putting it in the "poor research/regulation" category. In other words, the therapies were unlikely to enter mainstream medicine without substantial changes.
If you research the PubMed database using the term "hypnotherapy," you find 11,518 hit-words, so there are plenty of studies out there. However, most of the researchers are not satisfied with the gold standard of a Randomised Controlled Trial (RCT) instead of taking the frame of reviews or case studies. Only 91 relevant RCTs conducted in the world have worked in the past four years. The researchers propose that hypnotherapy can be an effective treatment for pain control, irritable bowel syndrome, anxiety disorders and smoking cessation.
There is clear evidence that hypnosis has psychological and physiological effects. That's why Peter Whorwell at the University of Manchester has researched the efficacy of IBS (irritable bowel syndrome) surgery for gastrointestinal modulation with hypnotherapy and possible immune function support. But even though IBS is one of the best-covered areas, the action with mechanism is not clear and the Cochrane Collaboration from assessing clinical trials has criticised the size and quality of the studies.
In spite of the evidence that hypnotherapy reduces pain, anxiety and stress, there are a couple of reasons why few trials have been done. From these stages, hypnosis's usage doesn't aid its image. Also, it has the same problems as other "talking" therapies. Alternative funding should be built up, as the drug companies do not benefit from funding expensive studies.
But, one of the biggest obstacles to hypnosis being considered on a more scientific basis is the therapists themselves. Its effects are a result of a unique interaction between the practitioner and the patient. The expectation is similar to that of a drug and therefore should follow the same trial testing criteria. However, this argument is not helpful.
I strongly believe that whilst meeting with a living, breathing person, it is hard to decrease the process of clinical hypnosis and to receive YES or NO responses that are able to be reliably repeated in other conditions. However, for hypnosis to be considered medical, it should be measurable, replicable and vigorous. Actually, we need to model a body of clinical evidence in order to adapt to the medical profession.
With standardising protocol used, we demand quantitative measures of the effects on the patient, so studies can be compared. Ideally, researchers would have access to state-of-the-art brain scanning equipment. In reality, we are able to get simple biochemical markets of hypnosis and after-effects under suitable usage.
Coming out of such studies in England, Ursula James founded the Medical School Hypnosis Association with her colleagues. According to Complementary Therapies in Clinical Practice, she explains schemes to bring medical professors and students together with hypnotherapists to operate coordinated national trials and build up a large body of evidence from research replicated at multiple locations. Most of all, one of the first questions is whether clinical hypnosis is able to decrease stress. That is an important component potentially in an illness. We work towards using standardised questionnaires to calculate lifestyle, stress and depression and to measure various stress hormone levels in saliva samples taken from case applicants.
If we are able to present that there is a decrease in stress, we hope that hypnosis will be supplied to patients to treat their condition. With a wide range of usages, it could open up study into other areas including decreasing the thoughts of pain and improving recovery times.
Movie of Metropolis
…being the science-fiction film that is steadily becoming a fact
A When German director Fritz Lang visited the United States in 1924, his first glimpse of the country was a night-time view of the New York skyline from the deck of an ocean liner. This, he later recalled, was the direct inspiration for what is still probably the most innovative and influential science-fiction film ever made – Metropolis.
B Metropolis is a bleak vision of the early twenty-first century that is at once both chilling and exhilarating. This spectacular city of the future is a technological marvel of high-rise buildings connected by elevated railways and airships. It's also a world of extreme inequality and social division. The workers live below ground and exist as machines working in an endless routine of mind-numbing 10-hour shifts while the city's elite lead lives of luxury high above. Presiding over them all is the Master of Metropolis, John Fredersen, whose sole satisfaction seems to lie in the exercise of power.
C Lang's graphic depiction of the future is conceived in almost totally abstract terms. The function of the individual machines is never defined. Instead, this mass of dials, levers and gauges symbolically stands for all machines and all industry, with the workers as slave-live extensions of the equipment they have to operate. Lang emphasizes this idea in the famous shift-change sequence at the start of the movie when the workers walk in zombie-like geometric ranks, all dressed in the same dark overalls and all exhibiting the same bowed head and dead-eyed stare. An extraordinary fantasy sequence sees one machine transformed into a huge open-jawed statue which then literally swallows them up.
D On one level the machines and the exploited workers simply provide the wealth and services which allow the elite to live their lives of leisure, but on a more profound level, the purpose of all this demented industry is to serve itself. Power, control and the continuance of the system from one 10-hour shift to the next is all that counts. The city consumes people and their labour and in the process becomes a perverse parody of a living being.
E It is enlightening, I think, to relate the film to the modern global economy in which multinational corporations now routinely close their factories in one continent so that they can take advantage of cheap labour in another. Like the industry in Metropolis, these corporations' goals of increased efficiency and profits have little to do with the welfare of the majority of their employees or that of the population at large. Instead, their aims are to sustain the momentum of their own growth and to increase the monetary rewards to a tiny elite – their executives and shareholders. Fredersen himself is the essence of the big company boss: Rupert Murdoch would probably feel perfectly at home in his huge skyscraper office with its panoramic view of the city below. And it is important that there is never any mention of government in Metropolis – the whole concept is by implication obsolete. The only people who have power are the supreme industrialist, Fredersen, and his magician/scientist cohort Rotwang.
F So far so good: when the images are allowed to speak for themselves the film is impeccable both in its symbolism and in its cynicism. The problem with Metropolis is its sentimental story-line, which sees Freder, Fredersen's son, instantly falling in love with the visionary Maria. Maria leads an underground pseudo-religious movement and preaches that the workers should not rebel but should await the arrival of a 'Mediator' between the 'Head' (capital) and the 'Hands' (labour). That mediator is the 'Heart' – love, as embodied, finally, by Freder's love of Maria and his father's love of him.
G Lang wrote the screenplay in collaboration with his then-wife Thea von Harbou. In 1933 he fled from the Nazis (and continued a very successful career in Hollywood). She stayed in Germany and continued to make films under the Hitler regime. There is a constant tension within the film between the too-tidy platitudes of von Harbou's script and the uncompromisingly caustic vigour of Lang's imagery.
H To my mind, both in Metropolis and in the real world, it's not so much that the 'Head' and 'Hands' require a 'Heart' to mediate between them but that the 'Hands' need to develop their own 'Head', their own political consciousness, and act accordingly – through the ballot box, through buying power and through a sceptical resistance to the materialistic fantasies of the Fredersens.
I All the same, Metropolis is probably more accurate now as a representation of industrial and social relations than it has been at any time since its original release. And Fredersen is certainly still the most potent movie symbol of the handful of elusive corporate figureheads who increasingly treat the world as a Metropolis-like global village.
