Broken Dreams

BOOKS & ARTS COMMENT H. KORVOLA/GETTY

Some people need more rest than the prescribed eight hours a night — or need it at different times.

SLEEP SCIENCE sleep’: a consolidated nocturnal experience programmed by biology, but potentially moulded by behaviour modification and, of course, drugs. The work of sleep-science Broken dreams pioneer Nathaniel Kleitman, who in 1938 descended into Mammoth Cave in Kentucky to try to realign his biology to a 28-hour day, Meredith Wadman lifts the blanket on the creeping thrust an awareness of sleep research into medicalization of sleep in the United States. the public eye. It also reinforced the idea that sleep can be controlled by willpower — a concept further cemented by Kleitman’s illions of people in the United Wolf-Meyer lays student, William Dement. States struggle to achieve that much responsibility Dement founded the first sleep laboratory, great American dream, a ‘good for the medicalization at Stanford University in California, in the Mnight’s sleep’. So says Matthew Wolf-Meyer of sleep at the feet of early 1970s. He understood healthy sleep “as in his ambitious The Slumbering Masses. He a US sleep-medicine resting upon a biological foundation of eight contends that capitalist necessity defines establishment that has quiet, motionless and consolidated hours of sleep in the country today, shoehorning grown up since the sleep … between sunset and sunrise”, writes sleepers into a societally convenient but 1950s. Its roots, how- Wolf-Meyer, arguing that Dement’s The physiologically arbitrary eight-hour night. ever, emerge in his Promise of Sleep (co-written by Christopher Those who can’t manage the prescribed fascinating history of The Slumbering Vaughan; Delacorte, 1999) “promotes a amount of slumber at the prescribed time the Protestant origins Masses: Sleep, model of nature and human biology from Medicine and are often labelled disordered sleepers. Wolf- of sleep in the United Modern American which all variations are disorders”. Work Meyer’s message is that society should bend States. The influential Life such as Dement’s has, in Wolf-Meyer’s view, to accommodate, even celebrate, diversity Puritan minister Cot- MATTHEW J. WOLF- been one factor in helping to pave the way in sleeping behaviour, rather than branding ton Mather argued in MEYER for the modern pharmaceutical industry to nonconformism pathological. the late seventeenth Univ. Minnesota Press: find a broad new market among disordered For now, night owls and others who fail century that those 2012. 312 pp. $24.95, US sleepers. Many of these sleepers are given £18.50 to adapt to the eight-hour, nocturnal norm with a proclivity for the catch-all diagnosis of ‘excessive daytime — whether owing to disease or a particular the luxuries of slumber were failing in their sleepiness’, the use of which in the medical hard-wired biology — are a boon to the phar- earthly and God-given duty to be productive. literature has exploded in the past ten years. maceutical industry. Wolf-Meyer, an anthro- The bed, Mather opined, is one of just a few Those looking for an exhaustive pharma- pologist, calls for a shift towards more flexible places where “the Devil has laid out most fatal copeia of the sleep-medicine industry will organization of workdays, school and social snares”. A generation later, Benjamin Frank- not find it here. Wolf-Meyer notes that US lives, and away from the assumption of mon- lin turned the same message positive with his olithic “slumbering masses”. Otherwise, he still-famous dictum, “Early to bed, early to STRESS AND RESILIENCE warns, “Americans may be doomed to a future rise, makes a man healthy, wealthy and wise.” The links between adversity and of proliferating sleep disorders, amphetamine This morality handily converged with mental illness. nature.com/stress breakfasts, and sedatives for dinner.” the twentieth-century idea of ‘normal

drug-maker Sepracor spent “hundreds of millions of dollars” on the US launch of the sedative Lunesta (eszopiclone). But he offers only one example to support his contention that companies are widening their net: pharmaceutical firm Cephalon’s successful effort to expand the user base for the stimulant Provigil (modafinil) from people with narcolepsy to those with sleep apnoea and ‘shift-work sleep disorder’. Neither has Wolf-Meyer tracked down the associated and — he implies — growing revenue numbers for leading stimulants and sedatives. Such figures would buttress his claim that in “a few short years, excessive sleepiness may successfully become the new erectile dysfunction”. Wolf-Meyer might have delved deeper if his scope had been narrower. As it is, he covers everything from the socialization of children to sleep at the appropriate hour (think of Margaret Wise Brown’s bedtime In the early twentieth century, unpaid patient labour kept Kings Park hospital self-sufficient. classic Goodnight, Moon) to the use and abuse of caffeine and other stimulants, PSYCHIATRY and the plight of workers in Indian call centres, forced to synchronize their hours with US time. Yet in other ways, the broad treatment pays dividends. It is illuminat- The dispossessed ing, for instance, when Wolf-Meyer takes us inside a Minnesota sleep clinic where Amy Maxmen views a prizewinning film that shines medics are struggling to help a sleepless a light into the dark corners of US psychiatric care. young girl already prescribed five drugs. Implicit in Wolf-Meyer’s analysis is that the medicalization of sleep is a profit- ucy Winer checked into Kings Park institutions. Although Kings Park: driven pursuit. No doubt economics did psychiatric hospital on Long Island, the drugs adminis- Stories From an indeed have a big role in the rise of sleep New York, after overdosing on sleeping tered to people with American Mental Institution medicine, but the author finds little room Lpills and slitting her wrists. It was 1967; she serious mental ill- DIRECTED BY LUCY for the real benefits of some treatments. was 17. Stern nurses dressed her in a hospi- ness are arguably less WINER Can it be bad when medication prevents tal gown and escorted her into a room where dangerous now than Wildlight Productions: a narcoleptic from falling asleep at the identically dressed women slept on the floor they were in the 1960s 2012. wheel? And I, as a sleep apnoeic with or leaned lifelessly against walls. The women and therapy is widely kingsparkmovie.com daily work and family responsibilities, am were literally floored by antipsychotic medi- accepted, not every indebted to the machine that keeps my cations that, as Winer was to find in her six one who needs these advances receives airway open at night and prevents what months in the hospital, felt like an iron suit. them. In the United States, more than 10% would otherwise be literally hundreds of “We had been thrown away, stripped, of people with serious mental illness are now sub-conscious wakenings. locked up. We were disposable,” says Winer, homeless, or in prison (L. Davis et al. Curr. The Slumbering Masses suffers in in the documentary Kings Park. Winer Psychiatry Rep. 14, 259–269; 2012). many places from jargon. Sentences directed and co-produced the film 30 years Winer’s intent, too, is to shine a light on such as, “Normative desire facilitates the after her stay at the hospital, now long aban- the dehumanized patients — and over- functioning of everyday spatiotemporal doned. Kings Park tells a tale of mental health whelmed doctors — challenged by inade- hegemony and is in turn formed through care that must be told, she says. The psychia- quate resources for mental-health treatment. that very same hegemony” made me long trists who are now showing it at meetings and She spent 11 years creating the film to for a lay-friendly translation. workshops around the United States agree: explore her terrifying personal experience A. BLACKSBERG P. RESTORATION: MUSEUM/DIGITAL HERITAGE KINGS PARK PHOTO: But there are passages of telling clar- last month, the New York Association of with mental illness as a teenager. As she ity. Wolf-Meyer tells the story of Betsy, Psychiatric Rehabilitation Services presented turns her gaze outwards in interviews with a woman in her 50s who fought insom- Winer with the 2012 Public Education/ psychiatrists, attendants and other former nia for decades. She tried, she confesses, Media award. Kings Park touches a nerve. patients, Kings Park also becomes a history “lots and lots of drugs. Everything from The psychiatrists’ goal is to inspire pro- of US psychiatry told from multiple per- benzo[diazepines] to Xanax, antidepres- gress by conveying to mental health-care spectives. The journey ends in the present, sants, and all the tricyclics [as well as] providers how it felt to be on the receiv- at the assisted-living centres and prisons muscle relaxers mixed with other drugs. ing end of deficiencies in state mental where many former residents of psychiatric And they’re effective for a while, and then hospitals live. Most large state-run men- they all wear off.” ■ STRESS AND RESILIENCE tal hospitals in the United States shut their The links between adversity and doors over the course of four decades: Meredith Wadman is a correspondent mental illness. nature.com/stress between 1955 and 2003, the number of inpa- for Nature based in Washington DC. tients in them dropped by more than 90%.