Elizabeth A.J. Scott, MD
Since time immemorial people have had difficulties in going to sleep. Their treatment, separated by distance and time, by differing climates and life styles, has differed widely in theory but has had an amazingly similar delivery across cultures and history.
Priests were the medical specialists and those seeking help went to their temples for diagnosis and treatment. They used their interpretation of their patients’ dreams to diagnose the problem and to suggest treatment. It appears from the gifts found at temple sites that some of them were skilled and successful.
One of the earliest, Imhotep, priest-physician and architect of the step pyramid of Sakkara from around 2980 BC, was worshipped as the God of Medicine at temples and shrines all over Nubia and Egypt. His forte was almost certainly incubation, namely sleeping in a Holy place to obtain dreams from the Gods. Dream interpretation by such priest-physicians was at the time the backbone of medical treatment. To quote a writing of the time:
If a woman dreams she has sex with a goat she is likely to die; with a dog – she will be delivered of a boy; with a cat – she will have many children.
But life was simpler then and dream dictionaries more universally applicable.
In the West, we can date a clear interest in and need for hypnotics from the medical treatises called the ”Hippocratic Collection” which appear to have been produced in the Alexandrian medical school about 300 B.C. Sourced to Hippocrates who was said to have been a member of the Society of Asclepius and of his family, it is generally thought to have had several authors. But its interest lies not in its name but in its teaching that superstition and religion play no part in disease causation.
One article on “The Sacred Disease” (epilepsy) says, and I quote the Encyclopedia Britannica translation:
It arises – like other diseases – from things that enter and quit the body such as cold, the sun and winds. Things which are ever-changing and never at rest.
Nonetheless, great thinkers throughout Greek history maintained a reverence for the power and meaning of dreams, reflected in the numerous temples and rituals of the times. It was an approach to medical treatment that was slow to wither. Artemidorus, a Greek geographer who lived in the first century before Christ was probably an initiate of the sect of Apollo. He insisted that, for correct interpretation of a dream, the interpreter must be aware of the life events leading up to the dream, the occupation and lifestyle of the dreamer and whether or not the dream was similar to previous ones. His maps of the world are lost, but his Oneirocritica, a book of dream interpretations, survives as what might be termed as the precursor to modern psychoanalysis.
Plato knew that anarchic thoughts and physical appetites, not under the mental control of a waking mind, lurk in sleep. Between 300 and 200 BC he prescribed a well-ordered day without excess to achieve a good night’s sleep. Aristotle likened dreams to the eddies in a river that divide, swirl, and disappear. He knew that dreams are easily forgotten.
Epidaurus was a great center for incubation founded by Asclepius, the physician whose sons, Homer says, were army doctors in the Greek camp at the siege of Troy. There, many stone tablets describing cures that derived from dream interpretations have been excavated. In thanks for such prescribed cures, it appears that the healed individual would offer a rooster.
In Palmyra, at the great temple of Zeus, a petitioner would sacrifice a goat and wrap himself in its skin to sleep. The priests then interpreted his dream that night and prescribed treatment as appropriate. Second only to Zeus, the father of the Gods, came Apollo, the great diviner of dreams. His shrine at Delphi was as famous for incubation as it was for the oracular utterances of its Pythia.
I have seen the great compound that houses the temple ruins at Palmyra. The pillared temple stands high and aloof dwarfing the fountains where petitioners cleansed themselves and made their sacrifices. In the wavering smoky scented light of flambeaux, as richly clad priests chanted and processed, the petitioners must have been awed into belief in their power to help. Little wonder either if their sleep was beset with dreams for the priests to interpret the next day.
Pliny the Elder (23 – 79 AD) was one of the few early writers in the Western medical tradition to address the matter of sleep. A naval and army officer, he published the Historia Naturalis, an encyclopedia containing prescriptions such as the use of the plant purslane (Portulaca oleracea) “to drive away the unclean dreams of venery.” It was one of the first books to be translated and printed as early as 1469. At the same time Dioskurides, another military surgeon, wrote De Materia Medica, which remained a medical textbook well into the seventeenth century. He agreed with Pliny that purslane “quenches the outrageous desire to lust.”
Galen, working between 130 and 200 AD, and the physicians who came after him built on the “Hippocratic Collection” to gradually evolve the humoral theory of disease causation and treatment that held sway through the Middle Ages. The body was said to be held in healthy balance by the four humors: blood, phlegm, black bile and yellow bile. When one or other of these became excessive, illness resulted and treatment was angled to restore the perfect harmony of the humors.
The Middle Ages
As the new Christian religion swept through Europe and the Middle East, its theologians opposed the use of dream interpretation for any purpose. Dreams were thought to be visitations from the devil, temptations to be resisted. Those afflicted with them might be suspected of being witches, and witches were burned. Dreams were taboo. Someone wanting to describe his dream did so in a joking manner.
“The flux,” “stoppage of the water,” “the gout,” “female courses”—all figure large in the 1551 herbal text written by William Turner, Dean of Wells, the Duke of Somerset’s physician. While the text devotes little time to the difficulties associated with getting to sleep, he does acknowledge: “Of times a man cannot sleep by reason of the heat of the brains moving…” or “when melancholy is risen into the head, sometimes cometh it by reason of exceeding heat”. His treatments included sweet almonds, lettuce leaves or seed, violet leaves, barley water and cream, or pottage of peas taken late in the evening. He was aware of the sedative action of poppy extract, but clearly kept it for those who had pain; and like his predecessors, he had many potions for the relief of “dreams of venery”.
India and China
The Christian world was not alone in this theory and though treatments for other diseases vary hugely, I have been surprised how many of the same prescriptions for a sound night’s sleep are used by different medical systems and cultures.
In India, thousands of years before humoral medicine was postulated in the West, Ayurvedic medicine recognized good sleep as protective and supportive. Treatments to produce mental ease with a comfortable room and bed, pleasant sounds, smells and gentle massage were prescribed. Rice, curd, wine, milk and soup from aquatic animals were all suggested as hypnotics. The similarity to 16th century prescriptions in Great Britain is strong. Herbals at that time suggest wine and warm soup. In fact 20th century sleep hygiene leaflets talk about comfortable beds, quiet surroundings and relaxation techniques and sleep researchers like Professor Ian Oswald say that hot milk at night is an aid to sleep.
Tibetan medicine developed a similar humoral basis for the treatment of insomnia; however the literature on the topic is far more elaborate than in other cultures. Buddha described the “Four Sublime Truths,” which lead from the isolation of the cause of disease to its eradication. This was accompanied by the “Eightfold Path” with suggestions on how to achieve the desired effect. However when Buddhism came to Tibet from India, Tibetan monks, tucked away in their mountain fastness, built these teachings into a medical discipline. The Four Tantras and the Blue Beryl form the basis of Tibetan medicine, provided an ordered discipline to live by. They explain natural phenomena, organic pathology, psychology and the world around us within a systemized framework in a rational, respectable and impressive framework. For good sleep, say the Tantras, avoid negativity of mind, speech or action, refrain from envy or the temptation to humiliate, care for your elderly, and approach bed-time with a quiet mind and conscience. Warm milk, curd, wine or meat broth before bed help you to sleep, as does head massage. This is still very similar to Western thought even today.
Chinese medicine going back millennia is based on keeping our surroundings, body forces and fluids in balance so our yin (shady side) is in harmony with the yang (sunny side) of our nature. Traditionally treatment is by acupuncture, moxibustion (heat application at acupuncture points) or herbs or minerals. Although these are not really do-it-yourself remedies, acupressure or gentle massage over some of the acupuncture points such as on the back of the head behind the ears is common to many medical traditions and very similar to a relaxing massage. Chinese hypnotic medication is not generally available in the West but one common prescription, Chinese angelica, is an anti-anxiolytic and vasodilator which is not dissimilar to the effect some of our herbal hypnotics have.
All over Europe, as belief in the humors began to wane and modern medical theories flourished, the need for a sound sleep remained important. Sedative herbs became better known by everyone. By the 18th century many housewives had their own herbals, gathered their own herbs and doctored their families. Valerian, lime flowers, and passion flowers became well known sedatives. Lavender, rose and neroli were but a few of the pleasant relaxing oils used in massage. No one remembered that they had been used since the days of the Egyptians.
American settlers returning to Britain brought back the knowledge and seeds of tranquilizing herbs from the Indians. Samuel Thomson was one such and his book on herbs was imported to Britain and became popular. Albert Coffin followed him with his own text book which was adopted by the newly formed National Institute of Medical Herbalists (N.I.M.H.) in 1864. It was merely a consolidation of thousands of housewifely herbals over the years and were just local plants with actions similar to all hypnotic herbs used over hundreds of years. Interestingly, Jesse Boot of Nottingham was one of the original members of the N.I.M.H. and went on to develop his father’s herbalist shop into the national chain of pharmacies called “Boots the Chemist” which has dominated the British High Street since the early part of the 20th century.
In the 20th century herbal medicine was overshadowed by modern hypnotics, whose action is stronger, faster acting and whose dosage is very reliable. But looking back at the history of hypnotics I am amazed how from such separate roots and different climates the prescription for a sound sleep is so similar.
All traditions recommend a quiet mind from a balanced lifestyle, leaving some hours between the last meal and sleep, warm drinks such as wine and milk and vasodilating herbs such as Indian Snake Root from America, onions from Tibet and lime flowers from Europe as soporifics. Massage, especially of the back of the head, to relax the body is featured in Europe, China, Tibet and India.
With medication we can now override wakefulness and its causes to attain a solid sleep. However, to cure the root causes of insomnia we might do well to read those old texts. They are still valid and as is often the case, the medical theories we have scorned come back to confound us.
Across the stage of Europe and the West strode Freud, declaring that dreams mattered and that in their interpretation could lie the means of curing many illnesses. Father of modern psychoanalysis to be followed by so many experts in mental problems, Freud made dreams important once more.
The priest-doctors would have said, “We told you so!”
DR. ELIZABETH A. J. SCOTT is a retired general practitioner with a continuing interest in the problems of sleep and dreaming, who lives in Edinburgh, Scotland. She also lived in India for four years where she conducted research on sleep.
Her publications include:
- The Natural Way to Sound Sleep. Orion, 1996 (ISBN 0-75280-652-1)
- The Natural Way to Stop Snoring. Orion, 1995 (ISBN 0-75280-067-1)
- Your Dreams – What They Really Mean. Clarion, 2004 (ISBN 1-899606-30-0)
- The Right Way to Interpret Your Dreams. Elliot Right Way Books, 2001 (ISBN 0-7160-2140-4