Diverging and Converging Explanatory Models of Sleep Paralysis: Phenomenological, Cultural and Medical Perspectives ______

Home , Incubus, Kikimora, Night hag, Pillow, Susan Clancy, Sylvia Browne

DIVERGING AND CONVERGING EXPLANATORY MODELS OF SLEEP PARALYSIS: PHENOMENOLOGICAL, CULTURAL AND MEDICAL PERSPECTIVES ______

A Thesis

Presented to the

Faculty of

California State University, Fullerton ______

In Partial Fulfillment

of the Requirements for the Degree

Master of Arts

Anthropology ______

Bethany D. Ashford

Thesis Committee Approval:

Barbra E. Erickson, Department of Anthropology, Coordinator Sarah G. Grant, Department of Anthropology Linda Sun Crowder, Department of Anthropology

Summer, 2017

ABSTRACT

Sleep paralysis is a brief episode that occurs upon falling asleep or awakening, in which a person experiences full body paralysis and a sensation of pressure on the chest or throat, but is conscious and can see and hear. These experiential features are often accompanied by vivid hallucinations that an intruder is present, who may or may not physically attack the individual. These episodes typically result in intense fear and confusion. In this thesis, I use literature review to examine sleep paralysis from several perspectives in order to advance the holistic understanding of the human experience with the sleep paralysis phenomenon. Arthur Kleinman’s concept of explanatory models, which informs on the way individuals and cultures understand, cope with, and treat health related conditions and experiences, serves as a theoretical basis for cross-cultural analysis of sleep paralysis. The application of the concept of cultural salience reveals evidence that the level to which a culture endorses supernatural explanations of sleep paralysis has a positive correlation to the individual’s level of fear and belief in supernatural causation of the experience. This thesis presents ethnographic, psychological and neurological data showing that while the phenomenological features of the sleep paralysis experience are seemingly universal, the manifest thematic content of the accompanying hallucinations are experienced through diverse cultural lenses. This is supported by consistencies in historical and linguistic literature. Future ethnography and interdisciplinary research of sleep paralysis will benefit both academic and therapeutic pursuits.

TABLE OF CONTENTS

ABSTRACT ...... ii

LIST OF TABLES ...... v

ACKNOWLEDGMENTS ...... vi

Chapter 1. PERSPECTIVES ON SLEEP PARALYSIS: OVERVIEW ...... 1

The Sleep Paralysis Experience ...... 1 Objectives of this Thesis ...... 2 Methods ...... 3 Theoretical Framework ...... 3 Overview of Various Perspectives on Sleep Paralysis ...... 5 Chapter Contents...... 7

2. THE PHENOMENOLOGY OF SLEEP PARALYSIS ...... 9

Gross Motor Paralysis ...... 11 Chest Pressure ...... 11 Sense of Being Awake ...... 12 Hypnagogic and Hypnopompic Hallucinations ...... 12 Intruder and Incubus Hallucinations ...... 14 Vestibular-Motor Hallucinations ...... 15 Intense Emotion ...... 16

3. CROSS-CULTURAL EXAMINATION OF EXPLANATORY MODELS OF SLEEP PARALYSIS ...... 18

Pioneering the Ethnography of Sleep Paralysis: Robert C. Ness and the Old Hag ...... 19 Interpretations of Sleep Paralysis in Native Cultures of the Americas ...... 21 Cultural Explanations of Sleep Paralysis in Modern Latin America…...... 22 Sleep Paralysis Narratives in the Middle East and Morocco ...... 25 Variation in Explanatory Models of Sleep Paralysis in African Cultures ...... 27 Sleep Paralysis Narratives in European and Western Russian Cultures ...... 28 Explanatory Models of Sleep Paralysis among Intact and Displaced Asian Cultural Groups...... 30

iii Sleep Paralysis Explanations in Modern North American Cultural Groups ...... 37 Alien Abduction and Astral Travel ...... 39

4. SLEEP PARALYSIS IN LITERATUREAND ART THROUGH THE AGES .. 45

Sleep Paralysis in Ancient Texts ...... 45 Incubus, Witchcraft and Nocturnal Assault: Sleep Paralysis in Medieval and Early Modern Literature and Art ...... 47 Sleep Paralysis in Modern Media...... 51

5. SLEEP PARALYSIS IN THE ETYMOLOGICAL ROOTS OF NIGHTMARE 52

The Role of Language Change in the Etymological Roots of Sleep Paralysis and ‘Nightmare’ ...... 53 Table 1. The Etymology of Nightmare ...... 55 Sleep Paralysis Phenomenological Features in the Morphology of ‘Nightmare’ . 59

6. MEDICAL EXPLANATIONS OF SLEEP PARALYSIS ...... 66

Historical Medical Explanations of Sleep Paralysis ...... 66 Modern Neurological, Psychological and Physiological Explanations of Sleep Paralysis ...... 71 Prevalence of Sleep Paralysis ...... 72 Timing and Triggers of Sleep Paralysis ...... 75 Relationship between REM Sleep and Sleep Paralysis ...... 77 Neurological Explanations for the Phenomenology of Sleep Paralysis ...... 78 Correlation between Sleep Paralysis and Other Sleep Disorders ...... 88 Comorbidity of Sleep Paralysis with Psychological and Mood Disorders .... 92 Modern Treatments for Sleep Paralysis ...... 95

7. DISCUSSION ...... 97

Key Contributors to the Anthropology of Sleep Paralysis ...... 97 Future Anthropological Sleep Paralysis Research Opportunities ...... 98 Anthropological Patterns, Themes and Directions in Sleep Paralysis Research .. 102

8. CONCLUSION ...... 108

REFERENCES CITED ...... 110

LIST OF TABLES

Table Page

1. The Etymology of Nightmare ...... 55

ACKNOWLEDGMENTS

This thesis would not have been possible without the wisdom and support from my advisor, Dr. Barbra Erickson. Her guidance has been instrumental throughout my academic career at California State University, Fullerton, and her example is an inspiration to me as I embark on a new path in the academic world. I am grateful for my entire thesis committee, who, in addition to Dr. Erickson, include Dr. Sarah Grant and Dr.

Linda Crowder. Their commitment to this process and trusted advice are an invaluable support to me in this endeavor.

I am extremely grateful to my husband Aaron, whose constant love, support and encouragement throughout this process has been a true blessing, and an essential component of my success, and I am ever thankful for the encouragement from my loving family. This thesis is dedicated to the memory of my mother, Carolyn, who was the hardest working, most talented and most optimistic person I know. She always encouraged me to strive higher, and showed me, by example, that with dreams, faith and diligence, I can achieve any goals I set for myself.

vi 1

CHAPTER 1

PERSPECTIVES ON SLEEP PARALYSIS: OVERVIEW

The Sleep Paralysis Experience

Imagine you awake suddenly, uncertain of what woke you. Your bedroom is dark, and it seems as though it has been only minutes since you slid into bed. You had been reading; your tablet must have turned off and fallen to the side. It had been a stressful day, and you were exhausted. It is completely dark in your room except for a bit of soft moonlight coming in through the window—just enough to see shadows. You suddenly hear a rustling in the corner; like a reflex you attempt to jolt your head to look, but you cannot move your neck. You cannot move your arms either. You suddenly realize you cannot move at all! Fear grips you.

A few seconds have passed since you awoke, and you hear the rustling again.

Something or someone is in the corner. Who or what could it be? You remain frozen.

You try, but you cannot see past the edge of the closet. You can make out the shadows in the opposite corner from where the noise came. Is the bedroom door open? You know you closed it when you came to bed, but the door is definitely open. You are in full panic mode now. It is getting difficult to breathe. You hear the intruder moving toward you.

There is a tremendous pressure on your chest; you attempt in vain to gasp for air.

Someone or something is holding you down; you try to shake it off, but cannot move. It is crushing the breath out of you. Your heart is pumping so hard that you fear you may

2 have a stroke—that is, if you do not suffocate first. You try to yell, but only a muffled moan comes out.

Suddenly the intruder is gone and you can move; you can take a deep breath. In fact, you realize that now you are panting and sweating. Your tablet is right by your side where it fell out of your hand. Somewhat tentatively you turn on a lamp, lean up and turn to look in the corner where the creature—whatever it was—was hiding. The only thing in the corner is the laundry basket you left there. The bedroom door is closed. Confused and worried about what has just occurred, you turn onto your side and try to get back to sleep. The light is still on.

This experience is sleep paralysis (SP). It is a common phenomenon (Jalal,

Romanelli and Hinton 2015) that is typically benign, but is usually accompanied by panic provoking physical and mental phenomena (Cheyne and Girard 2007; Jalal, Romanelli and Hinton 2015; Ramsawh et al. 2008), and often instills an urgent sense of need to seek an explanation for the episode one has experienced (Jalal 2016; Otto et al. 2006).

Objectives of this Thesis

The objectives of this thesis are to provide a comprehensive overview of sleep paralysis (SP) in the literature, and to identify major themes, patterns and theoretical approaches, as well key contributors to the ever-expanding body of knowledge about SP.

It will show that SP is an apparently universal human experience, supported by the theoretical framework of phenomenology of SP, as well as neurological data (Jalal and

Hinton 2013; Jalal and Ramachandran 2014). This will be juxtaposed by evidence of great variability in cultural thematic content of associated hallucinations, as well as cultural narrative explanations of meaning and causality of the SP experience (Gordon

2015; Jalal, Romanelli and Hinton 2015). Phenomenological, neurological and cultural explanations align with one another, and when approached with respect and an attitude of cultural relativity, no explanation necessarily abrogates another, but may serve to complement one another to the extent of being therapeutic. Finally, the role of anthropologists in future ethnographic SP research, and collaborative, interdisciplinary research of SP will be examined.

Methods

Literature review is the methodology used in this investigation. The literature on sleep paralysis is broad and rich in variation. This comprehensive overview will serve to identify major patterns, themes, key contributors to the field and opportunities for future research. Academic literature has been sought in the fields of ethnography, psychology, neurology, physiology, linguistics and history; some popular literature has also been consulted, in order to understand the attitudes toward sleep paralysis (SP) in popular culture.

Theoretical Framework

A holistic approach was warranted by the subject of this investigation. In the field of medical anthropology, when researchers are concerned with a comprehensive understanding of the human experience with any health related phenomena, it is essential to take an integrated approach. Various perspectives will inexorably contribute to the overall knowledge of the various attitudes toward, beliefs surrounding and methods of dealing with and treating health related concerns, such as sleep paralysis (SP). With the especially mysterious and impactful quality of the experience, an interdisciplinary investigation is the only way to begin to embrace the complexity of the relationship

4 between SP, cultures and individuals. A literature review research methodology is also best served by a holistic approach to collection and presentation of data, of which the goal is to serve as a springboard of knowledge in future research pursuits, whether comprehensive or specific to one research perspective.

Arthur Kleiman’s (1980) concept of explanatory models is an ideal theoretical perspective from which to do a cross-cultural investigation of sleep paralysis (SP). His framework ideally suits inquiries into the widely varying cultural explanatory models and cultural specific narratives of SP. Explanatory models inform on the way individuals and cultures understand, cope with, and treat health related conditions and experiences, such as sleep paralysis (SP). It is essential to investigate experiences of individuals with SP, both as products of, and independent of culture, as well as to inquire into the influences that individuals have on cultural models and culture change as a response. Kleiman’s framework ideally suits this endeavor.

The concept of cultural salience applies ideally to the subject of sleep paralysis

(SP). Research shows that the level to which a culture endorses supernatural explanations of SP has a positive correlation to the individual’s level of fear and individual endorsement of supernatural causation, which then, in turn, tends to reinforce supernatural explanatory models. However, infusion of other philosophies and influences into a culture can impede this pattern, causing changes in individual and cultural models

(Gordon 2015; Hinton et al. 2005a). This theoretical approach to the SP investigation will assist in expanding anthropological understanding of the SP phenomenon, as well as impacting therapeutic efforts.

Overview of Various Perspectives on Sleep Paralysis

According to the American Sleep Disorders Association, sleep paralysis (SP) is classified as a ‘parasomnia’ (sleep disorder) associated with REM sleep (Ramsawh et al.

2008). Although it is a classic symptom of narcolepsy, and is correlated with certain psychological and mood disorders, in otherwise healthy individuals SP does not signify pathology (Jalal and Hinton 2015; Jalal, Romanelli and Hinton 2015; Sharpless et al.

2010). Reports of prevalence of lifetime occurrences of SP in the general population range widely from 2.2 percent to 62 percent (Cheyne, Newby-Clark and Rueffer 1999;

Girard and Cheyne 2006; Ness 1978; Otto et al. 2006; Sharpless et al. 2010), however more conservative estimates consistently show that prevalence ranges between 20 percent and 40 percent (Cheyne, Newby-Clark and Rueffer 1999; Davies 2003; Jalal, Romanelli and Hinton 2015).

Several key phenomenological experiential features of sleep paralysis (SP) episodes are agreed upon in the literature, both academic and nonacademic. They include a sense of being fully awake, full body paralysis, with the exception of ocular movement and involuntary respiration, pressure on the chest and/or throat, feelings of suffocation and intense emotion (typically fear). These features are very often accompanied by intensely vivid and realistic hallucinations, which can take the form of malicious intruders and violent attacks. When attempts are made by the individual to cry out, only moans are uttered (Cheyne 2005; Cheyne and Girard 2007; Davies 2003; Jalal, Romanelli and Hinton 2015; Ramsawh et al. 2008). After a SP experience it is not uncommon for an individual to experience postepisodic distress, and very often to seek an explanation for the event (Cheyne and Pennycook 2013; Jalal 2016; Otto et al. 2006).

Sleep paralysis (SP) has baffled doctors, scholars and laypersons for centuries, and has been studied from a physiological perspective nearly as long (Cheyne 2005;

Cheyne and Girard 2007; Cox 2015; Davies 2003; Golzari et al. 2012). The term ‘Sleep

Paralysis’ was coined by neurologist S. A. Kinnier Wilson in 1928 (De Jong 2005;

Miranda and Högl 2013). During the Middle Ages and later periods, referential terms and explanations for SP were related to humoral theory (Miranda and Högl 2013). The most prevailing explanatory models for SP throughout history center on supernatural causality of the phenomenon. The literature is full of evidence showing that for most of written history, SP has been attributed to culture-specific characters such as Incubus, witches, demons, and even extraterrestrial aliens, who commit nocturnal attacks on helpless victims. Ethnographic, historical, linguistic and psychological evidence supports this (Cox 2015; Davies 2003; Fukuda 2005; Gordon 2015; Jalal 2016; Miranda and Högl

2013; Otto et al. 2006).

Because of the consistencies in the emotional and phenomenological features of the SP experience cross-culturally, which are evident in ethnographic, linguistic and psychological data, combined with the neurological evidence published in the past decade corroborating them, research may benefit from hypothesizing that SP is a universal human phenomenon (Brooks and Peever 2012; Cheyne and Girard 2007; Hinton, Hufford and Kirmayer 2005; Jalal and Ramachandran 2014; Mason 2012). According to the theoretical framework put forth by researchers such as Cheyne, Hinton, Jalal and their colleagues, the general features of the SP experience always fall within certain categories, while the specific thematic content is seen through the lens of each individual’s culture

(Gordon 2015; Jalal, Romanelli and Hinton 2015).

Neurological research demonstrates a strong association between sleep paralysis

(SP) and REM sleep, and researchers believe that SP is a product of a desynchrony in sleeping and waking cycles; in other words, certain systems of the brain and body enter into sleep or drift out of sleep at different rates, resulting in complex brain functions that lead to the manifestation of the SP experience (Brooks and Peever 2012; Cheyne and

Girard 2007; Davies 2003; Jalal and Ramachandran 2014; Ramsawh et al. 2008).

Psychological evidence shows that SP can be triggered by certain conditions, including disturbed sleep, stress, and comorbidity with certain other physiological disturbances. Other conditions, such as having experienced trauma, or being a member of a culture that highly endorses fearful or harmful explanations for SP, may not only increase the likelihood of SP episodes, but may enhance the fearful quality of the associated hallucinations (Cheyne and Pennycook 2013; Hinton et al. 2005a; Jalal 2016).

Chapter Contents

Chapter 2 of this thesis explores the universal phenomenological experiential features of the sleep paralysis (SP) experience. Chapter 3 delves into ethnographic and psychological evidence to examine SP narratives and explanatory models cross- culturally. Chapter 4 looks at literature and art through the ages, to paint a picture of the philosophies surrounding SP in the past. Chapter 5 examines the etymological evidence of SP—the linguistic evolution of nightmare and its roots in the SP experience. Chapter

6 investigates past and present medical explanations of SP. Chapter 7, the discussion, unites the chapters by recognizing major themes and patterns in the literature, acknowledging key contributors to the various fields of SP research, and observing the

8 responsibilities and opportunities of anthropologists for collaboration in future research on sleep paralysis (SP).

CHAPTER 2

THE PHENOMENOLOGY OF SLEEP PARALYSIS

Historical and literary accounts (Davies 2003; Golzari et al. 2012; Gordon 2015;

Kompanje 2008; Oates 2003) and ethnographic studies (De Jong 2005; Hinton et al.

2005; Hinton, Hufford and Kirmayer 2005; Jalal and Hinton 2013; Ness 1978;

Yoshimura 2015) have given much insight into the rich variety in the cultural descriptions of and explanations for the ‘manifest content’ (Freud 2010) associated with sleep paralysis and the associated hallucinations. Along with the rich variety of characters held accountable for SP, and the narratives, imagery and beliefs involved, however, comes remarkable similarity among all cultural groups studied thus far in the underlying phenomenological features, experiential structure and physiology of the experience (Cheyne and Pennycook 2013; Jalal 2016; Paradis et al. 2009). Psychological and neurological clinical research has presented a wide body of research regarding not only the phenomenology of SP, but on the overall understanding of the SP experience

(Cheyne 2005; Cheyne, Rueffer and Newby-Clark 1998; Jalal 2016). Although the hypnogogic and hypnopompic hallucinations (HH) are a primary reason why the cultural explanations of SP exist, there are a few other key features of the phenomenology of the universal sleep paralysis experience that must be discussed. They are difficult to describe separately, but for the clarity of key points, they are highlighted individually below.

Additionally, while this section is intended to be descriptive in nature, and the physiological reasons for the key features of sleep paralysis will be elaborated on later in this thesis, it is impossible at this juncture to discuss the phenomenon of sleep paralysis in an academic or scientific forum without discussing its link to rapid eye movement (REM) sleep. By all current scientific accounts, sleep paralysis is related to the disturbance of

REM sleep (Brooks and Peever 2012; Davies 2003; Jalal 2016), and may be the dream functions of REM sleep intruding into conscious wakefulness (Jalal, Romanelli and

Hinton 2015). Skeletal muscle paralysis and vivid dreams are characteristic of REM sleep, and they typically do not carry over into consciousness; however, during a SP episode, they do. This combination, during SP, sets the scene for an individual to experience confusion, intense emotions, panic, vivid hallucinations and memory for the event (Cheyne and Girard 2007; Cheyne and Pennycook 2013; Jalal 2016).

It is also important to note that not all sleep paralysis episodes are the same. The array of common features rarely manifest in a single episode, and episodes vary in intensity (Cheyne and Girard 2007; Jalal 2016). However, across all of the accounts, independently of cultural, biomedical, or psychological explanations, the phenomenology comprises these key features (Cheyne and Girard 2007; Cheyne, Newby-Clark and

Rueffer 1999; Cheyne, Rueffer and Newby-Clark 1998; Jalal and Ramachandran 2014;

Jalal, Romanelli and Hinton 2015; Jalal 2016; Paradis et al. 2009):

By most accounts, in otherwise healthy individuals, sleep paralysis episodes occur while a person is waking or falling asleep (Cheyne 2002; Davies 2003; De Jong 2005;

Jalal 2016). Some evidence states that episodes usually happen in the early or waking hours, which would imply that statistically SP tends to occur more upon waking than

11 upon falling asleep (Davies 2003). Less important than the time at which SP occurs, is the timing; SP episodes occur between normal sleep cycles—typically immediately preceding or following an REM sleep phase (Cheyne 2002; Davies 2003; Girard and

Cheyne 2006; Jalal 2016; Jalal and Ramachandran 2014). This thesis will go into more detail in a later chapter as to the physiological implications of this correlation between SP and REM sleep.

Gross Motor Paralysis

Possibly the most common feature of sleep paralysis (SP) is the one from which its name is derived: paralysis. During SP, an individual is incapable of any voluntary muscle movements, although they are able to open the eyes, can see, hear and feel completely awake (Cheyne 2005; Ramsawh et al. 2008; Sharpless et al. 2010).

Pharyngeal muscle control also remains somewhat intact; however, only moans and grunts are possible (Davies 2003; De Jong 2005). The paralysis specifically pertains to skeletal muscle systems—the systems that are switched off during REM sleep (Brooks and Peever 2012; Jalal and Hinton 2013; Jalal and Hinton 2015; Jalal, Romanelli and

Hinton 2015; Miranda and Högl 2013).

Chest Pressure

During sleep paralysis episodes, involuntary respiratory movements remain intact, while voluntary breathing is typically impossible (Jalal 2016). This leads to sensations of chest pressure and throat constriction, which can intensify feelings of panic (De Jong

2005; Jalal 2016); hallucinations that one is being sat on, or crushed, may ensue (Cheyne and Girard 2007; Jalal 2016).

Sense of Being Awake

During sleep paralysis (SP), parts of the body and brain essentially fall asleep or wake at differing rates; full body paralysis sets in before a person fades into the unconsciousness of REM sleep, or fails to wane before the individual retains conscious upon waking (Jalal, Romanelli and Hinton 2015). The person remains paralyzed and cannot speak or cry out, but is able to see and hear, and is cognizant and fully conscious

(De Jong 2005; Jalal, Romanelli and Hinton 2015; Ramsawh et al. 2008; Sharpless et al.

2010). This is because during REM sleep and during consciousness the central nervous system is intensely active (Davies 2003; Jalal and Ramachandran 2014).

Hypnagogic and Hypnopompic Hallucinations

During sleep paralysis (SP), the normal REM sleep activity of dreaming may be activated (Jalal, Romanelli and Hinton 2015). The resulting vivid multisensory hallucinations are known as hypnagogic (upon falling asleep) or hypnopompic (upon awakening) hallucinations (De Jong 2005; Jalal, Romanelli and Hinton 2015; Ramsawh et al. 2008); both will from here on be referred to as ‘HH’ in this text.

It is quite common to sense the presence of a threatening intruder or to see shadows during SP (Cheyne and Girard 2004; De Jong 2005; Hinton et al. 2005; Jalal,

Romanelli and Hinton 2015; Solomonova et al. 2008). Common features of HH include hearing footsteps, voices and odd sounds such as rustling, humming, buzzing, or even extremely loud bursts of noise (Cheyne and Girard 2004; Evans 2006; Otto et al. 2006;

Parker and Blackmore 2002). Many people report feeling pressure on or tightness in the chest, shortness of breath or difficulty taking a breath, and pulling, touching or tingling sensations on the skin (Hinton, Hufford and Kirmayer 2005; Jalal, Romanelli and Hinton

2015; Otto et al. 2006; Parker and Blackmore 2002). Experiencing sensations of floating, other strange motion, out-of-body experiences and autoscopy can also occur (Cheyne and

Girard 2004; Jalal, Romanelli and Hinton 2015). It is not unusual to imagine that one is having a sexual encounter or being raped during SP (Jalal, Romanelli and Hinton 2015).

It is important to note that any one of the three categories of HH can occur alone, in any combination of the three categories, and on various levels of elaboration (Cheyne and Girard 2004). Even when complex hallucinations are rudimentary, disoriented or isolated, the person who has experienced them may come away from the episode with the impression that a coherent and meaningful sequence of events has occurred (Cheyne and

Girard 2004).

Baland Jalal and his colleagues, who have conducted extensive research on neurological and cultural explanations of SP and the accompanying HH, convey that the

“intrusion of such REM mentation into emerging wakefulness is tantamount to dreaming with one’s eyes open” (Jalal, Romanelli and Hinton 2015:652). Although these complex visual, auditory and tactile hallucinations involve the same REM brain function as dreaming, the experience is categorically different than normal dreams, or even nightmares (De Jong 2005; Jalal 2016; Jalal and Ramachandran 2014; Jalal, Romanelli and Hinton 2015). Because HH are vividly experienced by a spectrum of senses while a person is conscious, they invoke a sense of authenticity, typically causing feelings of intense fear and confusion (Cheyne and Girard 2004; Jalal, Romanelli and Hinton 2015;

Sharpless et al. 2010), and inspiring people to seek explanations or assign culturally distinct supernatural interpretations to them (Cheyne and Girard 2004; Cheyne and

Girard 2007; De Jong 2005; Hinton et al. 2005b; Jalal 2016; Otto et al. 2006).

James Allan Cheyne and his colleagues can be credited with the three category theoretical framework for the hypnagogic and hypnopompic hallucinations (HH) associated with SP—Intruder, Incubus and Vestibular-Motor (V-M) (Cheyne 2005;

Cheyne and Girard 2004; Cheyne and Girard 2007; Cheyne, Newby-Clark and Rueffer

1999; Cheyne, Rueffer and Newby-Clark 1998). Tested in several large samples, their framework has been proven to be consistently and universally applicable and complementary to the integrity of all SP research, in both medical and social science genres (Cheyne and Girard 2007). Previous research has lumped all hallucinations into a single category, making data ambiguous, but the three-category system allows for a more precise, and universal, understanding of HH (Cheyne 2005).

Intruder and Incubus Hallucinations

Although Intruder and Incubus sensations are distinct from one another, according to Cheyne’s three-category classification system of hypnagogic and hypnopompic hallucinations (HH), they are often described together because they often appear to occur sequentially in the same sleep paralysis (SP) episode (Cheyne 2005; Cheyne and Girard

2007). Either may appear in HH as an isolated sensation, but when both occur in the same episode, they are likely to become integrated in the person’s memory as parts of a more complex story, whether they actually occur sequentially or not (Cheyne and Girard

2004; Cheyne and Girard 2007). Both Intruder and Incubus often are interpreted as threatening, and are sources of intense fear, especially when the HH are elaborate or vivid

(Cheyne 2005; Cheyne and Girard 2007).

Depending on the person who is experiencing HH associated with SP, the identity of the intruder or incubus will be assigned from within the context of the individual’s

15 culture (Hinton et al. 2005). Interpretations may vary from demons, to ghosts, to witches, or space aliens (Davies 2003; Hinton et al. 2005; Jalal and Hinton 2013; McNally et al.

2004). A belief in the supernatural causation or certain cultural explanations of Intruder and Incubus experiences may also actually increase the likelihood of episodes to occur, or cause them to be more vivid or intense when they do occur (Jalal 2016; Jalal, Romanelli and Hinton 2015;).

Cheyne describes Intruder hallucinations as usually involving “a vague sense of a threatening presence accompanied by assorted noises, footsteps, gibbering voices, humanoid apparitions, and sensations of being touched or grabbed” (Cheyne 2005:320).

In a later publication he further specifies that at times the intruder’s presence is only sensed, while at others it is seen, heard, can be felt brushing by, grabbing or tugging at the bed covers (Cheyne and Girard 2007). Incubus experiences include pressure on the chest, tightness in the chest, difficulty breathing, feelings of suffocation, smothering, or choking, pain, and fear of imminent death (Cheyne 2005; Cheyne and Girard 2007); they can even be “violent physical and sexual assault experiences” (Cheyne and Girard

2007:960).

Vestibular-Motor Hallucinations

Vestibular-Motor Hallucinations, or V-M Hallucinations, as abbreviated by

Cheyne, differ greatly from Intruder or Incubus hallucinations in both content and emotion. They include sensations of floating, flying, falling and spinning, out-of-body experiences (OBEs), autoscopy (seeing oneself from an outside viewpoint), and hallucinated body movements such limb movements, sitting up, walking, crawling or hovering around the immediate and local environment (Cheyne 2005; Cheyne and Girard

2007; Cheyne and Girard 2009). Instead of fear and panic, V-M Hallucinations tend to provoke feelings of happiness and bliss (Cheyne and Girard 2007).

Intense Emotion

The intensity and threatening nature of sleep paralysis (SP) episodes can vary greatly from person to person, and between episodes. Some SP episodes can be mild or even pleasant experiences, as mentioned in relation to the flying and floating sensations associated with V-M HH, but more often than not, are associated with fear (Davies 2003;

Jalal and Hinton 2015; Jalal, Romanelli and Hinton 2015; Ramsawh et al. 2008). No matter the cultural context by which SP is explained, it is typically described with similar emotional themes such as intense anxiety, fear, helplessness and terror (Fukuda 2005;

Jalal and Hinton 2015).

Brian Sharpless, who has done extensive research on the fear associated with SP, reports that from the earliest documentations of SP, “fear has often played a prominent role, and this is consistent with empirical data” (Sharpless et al. 2010:1294). He goes on to highlight the 1999 publication in which Cheyne, Rueffer, and Newby-Clark study reports indicating that 90 percent of their student sample and 98 percent of their Web- based sample reported fear associated with SP (Cheyne, Newby-Clark and Rueffer 1999;

Sharpless et al. 2010). “This rate of fear far exceeds what occurs in dreaming, as dreams are only frightening 30% of the time” (Jalal, Romanelli and Hinton 2015:652).

Data show that the fear experienced in SP stems not only from the hallucinations, but also from the feelings of paralysis (Cheyne, Newby-Clark and Rueffer 1999;

Sharpless et al. 2010). One can imagine the sense of panic and helplessness that may result simply from desiring to take a breath of one’s own volition, and finding instead that

17 the chest and lungs do not respond. To add threatening bedroom intruders to this already frightful scenario would compound the feelings of fear.

Owen Davies illustrates with a true account:

One of the respondents to the sleep paralysis forum of the Massachusetts General Hospital Department of Neurology website gives an inkling of how frightening the nightmare can be. The man had fought for thirteen consecutive months in frontline combat in Korea, but said of his one nightmare attack in 1964: “Never, before or since, have I ever experienced the fear of that night.” [Davies 2003:182]

CHAPTER 3

CROSS-CULTURAL EXAMINATION OF EXPLANATORY MODELS OF SLEEP PARALYSIS

Although the physiologically driven phenomenological features of sleep paralysis

(SP) have been found to be cross-culturally universal (Jalal and Hinton 2013), cultural explanatory models of SP vary greatly. Because of feelings such as panic and confusion associated with the paralysis, and the fear associated with intruder and incubus hallucinations, explanations are typically sought (Davies 2003; Jalal 2016). The explanations available to people generally come from immediately adjacent sources— their community and culture. Because SP is not rare, there will likely be interpretations available to any person, in any part of the world, as to the cause and meaning of the experience. The hallucinations experienced, while suffering near-complete bodily paralysis, connote a seemingly real experience that in most cases leaves an indelible mark on the individual, and “will be interpreted in a number of culturally specific frameworks”

(Jalal and Hinton 2013:536). Supernatural accounts are quite common among cultural explanations for SP phenomenology, and range from visits by demons and ghosts, to visits or abductions by extraterrestrial aliens (Hinton et al. 2005a; Hinton et al. 2005b;

Jalal, et al. 2014; Jalal and Hinton 2013; Jalal and Hinton 2015; McNally et al. 2004;

Ness 1978).

The previous chapter, the Phenomenology of Sleep Paralysis, highlighted several of the contributions made by psychology to the study of SP. The following sections will

19 expound on the overall understanding of SP by illustrating, through ethnographic accounts, the diversity in culturally specific explanations of the causality and meaning of

SP.

Pioneering the Ethnography of Sleep Paralysis: Robert C. Ness and the Old Hag

Robert C. Ness is one of the pioneers in the ethnography of sleep paralysis (SP).

He is currently professor of sociology at Augusta University in Augusta, Georgia. He has expertise in the areas of qualitative social research, cultural anthropology and ethnography, and has publications on ceremonial behavior, folk healing and sleep paralysis (SP) (Augusta University 2017; ResearchGate 2008b). In 1978, Ness published his ethnographic work entitled “The Old Hag Phenomenon as Sleep Paralysis: a

Biocultural Interpretation,” and it has been cited by many other researchers (Jalal and

Hinton 2015; Jalal, Romanelli and Hinton 2015; Ness 1978; Yeung, Xu and Chang

2005).

Ness conducted his ethnographic SP research in 1973-74, in Northeast Harbour, a fishing village in northern Newfoundland with a population of about 400 people (Ness

1978). His qualitative research not only addresses the connection between SP and cultural narratives surrounding nocturnal attacks by supernatural entities, but also examines a specific example of a culture bound explanation of the common phenomenon.

His research helps to broaden the understanding of SP, and sheds light on this particular culture’s philosophies about illness and healing. By way of his interviews with members of the community, he reports the features and belief models of Old Hag attacks.

Victims of the Old Hag typically reported suddenly awakening, paralyzed and unable to speak, typically very soon after falling asleep. Other features include a sense of

20 being awake and completely aware of their surroundings, and a heavy weight on their chest, including sometimes seeing a creature, an indistinct human figure, or a witch sitting on their chest (Ness 1978). The experience is reportedly very different from a dream because it happens when they are awake but unable to move. Witnesses report that “some victims emit high-pitched groans or low moans,” that their “eyes may be opened or closed, and breathing appears normal” (Ness 1978:17). Victims report being unable to overcome paralysis “until someone touches them or calls their name,” and coming out of the episode sweating and exhausted (Ness 1978:16).

The preceding characteristics of Old Hag attacks are identical to SP episodes.

Another, which has not yet been discussed in this thesis, is also present: falling asleep in the supine position (on the back), is considered by members of the Northeast Harbour culture to increase the likelihood of “being hagged” (Ness 1978:17).

Ness divides the cultural viewpoints of causality of Old Hag attacks into three etiological classes: first, ‘stagnation’ of the blood. This is especially likely if a person falls asleep in the supine position, and is “potentially fatal if the victim is not shaken out of the paralysis” (Ness 1978:17). Second, a person is overworked, overtired and his or her blood thins; and third, it represents victimization akin to witchcraft, which is a belief held mostly among the older members of the community (Ness 1978).

Although Ness admits that the matter warrants more research, there is a link between witchcraft and the Old Hag for the older members of the community, and it may also represent a link to the etymology of the phenomenon. They use terminology referring to Old Hag attacks such as “charm,” and ask questions following someone’s attack such as, “do ya know who it was ‘agged ya” (Ness 1978:18)?

It should be noted that an attack of the Old Hag is not considered a sign of illness to the people of Northeast Harbour, nor does it impair its victims afterward. The only treatment mentioned is the preference of waking the victims during the attack to prevent death (Ness 1978).

Ness’s research speaks volumes about the merit of approaching ethnography with an attitude of cultural relativism. Had he been culturally biased or discounted the validity of descriptive methods, the disciplines of anthropology and psychology would have suffered a tremendous loss of knowledge. In this article, he does something that had only begun to be done in a handful of other areas in the world, including France, Germany,

Japan and China, which was to establish a correlation between culture-bound syndromes and their western psychological diagnostic categorical counterparts (Ness 1978).

Interpretations of Sleep Paralysis in Native Cultures of the Americas

In 2005, Law and Kirmayer published “Inuit Interpretations of Sleep Paralysis,” in which they report the findings of their investigations into modern and traditional Inuit explanatory models of sleep paralysis (SP). Their research was qualitative in nature, and data were gathered through interviews with both elders and young people in Iqaluit, on

Baffin Island. Most respondents were familiar with the concept of SP (Law and

Kirmayer 2005).

Accoring to Inuit tradition, the SP phenomenon is known as uqumangirniq in the

Baffin region, and aqtuqsinniq in Kivalliq region (Law and Kirmayer 2005). Cultural interpretations of uqumangirniq are associated with shamanistic cosmology. According to this world view, a person’s soul becomes vulnerable while the individual is asleep and

22 dreaming, and SP could be caused by malevolent spirits or shamans (Law and Kirmayer

2005).

The Zuni Pueblo of New Mexico have a subcategory of bad dreams that includes sleep paralysis and accompanying HH called ‘violent dreams.’ In SP episodes, they account a threatening presence nearby, often a deceased person, who, while they are conscious, renders the individual unable to move or cry out. These experiences are treated as sickness (Tedlock 1992).

The Quiché Maya also have a subcategory of bad dreams referred to in the context of ‘something suddenly appearing.’ During these experiences, a ghost springs upon a sleeping individual who is unable to move or call out for help (Tedlock 1992).

Cultural Explanations of Sleep Paralysis in Modern Latin America

Alejandro Jiménez-Genchi, MD et al. performed a study to evaluate Mexican adolescents and discover whether the phenomenon se me subió el muerto (a dead body climbed on top of me), with which they are familiar and had experienced, is the same phenomenon as sleep paralysis (SP) (Jiménez-Genchi et al. 2009). Their research was largely quantitative, using a questionnaire based on the design of the SP questionnaires used by Fukuda et al. (2000) and Wing et al. (1994) (Jiménez-Genchi et al. 2009). With it, they successfully matched up the features of se me subió el muerto to SP. Inability to move or speak occurred most frequently across the sample, and was usually (78 percent of the time) accompanied by hallucinations including chest oppression, sensed presence, visual hallucinations, auditory hallucinations and tactile hallucinations. The findings of this study have made a positive correlation between the se me subio el muerto phenomenon and sleep paralysis (Jiménez-Genchi et al. 2009).

In Puerto Rico SP and regular REM sleep nightmares are grouped together, but described differently. Normal REM sleep dreams (suenos) and nightmares (pesadillas) are described with much more visual content and varying subject and setting, and may be frightening, albeit inconsistently. SP, however, is described very differently; pesadilla is not an adequate term to describe “such realistic and horrifying experiences” (Jacobson

2009:274). Puerto Ricans have applied instead the “language of waking visions or apparitions associated with folk spiritualism,” such as sombras (shadows), celajes

(silouhettes), and espiritus (spirits), as well as terms associated with Christianity, such as demonios (demons) to describe SP experiences (Jacobson 2009:274). When asked about

SP experiences, study subjects use language regarding being visited by a person with or without identity, oppressive bodily sensations, feelings of suffocation and sexual encounter, both pleasant and sexual assault scenarios. They seem to consider the SP experience a genuine trauma that has occurred, which must be dealt with as they would any other trauma. They consider their spiritual and religious traditions better suited to cope with such challenges (Jacobson 2009).

On the Caribbean Island of St. Lucia, the cultural explanation of SP is called kokma (Cox 2015; Ness 1978). It can be considered a culturally bound incubus narrative

(sometimes referred to as the female counterpart: succubus) as it is described as the spirit of a dead, unbaptized baby which goes around attacking people in their beds, jumping onto their chests, grasping and squeezing their throats, and cutting off breathing (Cheyne,

Newby-Clark and Rueffer 1999; Cox 2015; Ness 1978).

Ness lends us a passage from anthropologist William Dressler (1977), who, while

Ness was writing his article based on data he collected in northern Newfoundland, had published his article based on his ethnographic research on St. Lucia:

The attack comes at the time an individual is just falling asleep or just waking up, and the individual’s sensations include a pressure on the chest, inability to move, and anxiety . . . (the experience) is referred to as kokma. A kokma is the spirit of a dead baby that haunts an area, and will attack people in bed. They jump on your chest and clutch at your throat. To get rid of them the attacked person struggles to cry out, or in some way gets another person’s attention who will scare off the kokma. . .The informants who have given me a description of kokma have always talked about the babies actually clutching at their throats…the attacks are always by dead, unbaptized babies. The kokma cannot be controlled, they ‘grab’ people just for the hell of it (Dressler 1977). [Ness 1978:34-35]

Like the Zuni Pueblo and Quiché Maya, the Kagwahiv of Brazil view sleep paralysis (SP) and the accompanying hallucinations as a type of frightening dream, which are the result of visits by spirits of the dead, who touch or strangle the sleeping person

(Tedlock 1992).

Joop de Jong, professor at the University of Amsterdam, whose expertise includes medical anthropology and psychiatry (ResearchGate 2008a), conducted qualitative psychological case study research on the cultural variation in SP experience and explanation in several countries, which he highlights in his 2005 publication, “Cultural

Variation in the Clinical Presentation of Sleep Paralysis” (De Jong 2005).

One of his subjects, a woman named Elisa from Suriname, who also suffered from depression, reported nocturnal attacks by an apuku or gnome. The apuku would sit heavily on her chest, pressing her throat and strangling her. She goes on to explain that the apuku attack “took place when she fell asleep and her soul was ready to leave her body” (De Jong 2005:82) Her soul would ‘stray’ around the room, and she would see her sleeping body as if from an outside perspective. This experience caused her intense fear.

De Jong explains that a diviner, a trusted spiritual advisor, explained the attack as a form of witchcraft—someone had sent the gnome to perform the nocturnal attack (De Jong

2005).

Sleep Paralysis Narratives in the Middle East and Morocco

Ethnographic research shows that more than two thirds of Egyptians attribute sleep paralysis (SP) episodes to supernatural causes (Jalal, Romanelli and Hinton 2015).

Of this majority, most believe that SP represents attacks by the Jinn (Jalal and Hinton

2015; Jalal, Romanelli and Hinton 2015). In Arabic and Islamic mythology, the Jinn are a class of spirit creatures lower than the angels who are able to influence people and take on human or animal form (Dictionary.com 2016). Some Egyptians blame the attacks on the Shaitan demons, sometimes known as the Shaitan Jinn, a more specific class of Jinn who are reportedly, not necessarily evil, but are controlled by and do the bidding of the devil, Iblis (Encyclopdia Britannica 2017; Jalal, Romanelli and Hinton 2015).

Jalal and his colleagues report that nearly half of Egyptians who experience SP seek a traditional Islamic healing practice, called Ruqyah), as prevention against future

Jinn attacks. These include ritual prayer, called Salah, recitation of verses of the Quran, sometimes over water, which is then poured on the body as a blessing (Jalal, Romanelli and Hinton 2015). It is also common for Egyptians to seek religious advice about SP from priests called imams and sheikhs (Jalal, Romanelli and Hinton 2015).

Besides in the general population, Jalal and his colleagues have also studied SP among college students in Cairo, and have conducted comparative research between

Egyptians and the Danish. They found higher rates of SP in Egypt. Because a high correlation between stress, PTSD, and trait anxiety have been found among the Egyptian

26 population, the researchers assume that the Egyptians may suffer more from stress than their Danish counterparts (Jalal and Hinton 2015). Jalal et al. (2014) cite socioeconomic pressure as a probable cause. However, interestingly, among the Egyptian college student participants more than six times the number of women had experienced SP than the men (Jalal and Hinton 2015). This would lead to the assumption that it may not be solely socioeconomic causality, as typically this would affect the men as well, but perhaps it is an additional form of culture specific stress (Young et al. 2013). Further analysis of traditional and modern roles of women in Egyptian society may increase understanding in this area.

Other primarily Islamic countries in regions near Egypt also attribute sleep paralysis to Jinn-like demons. In Turkey the Jinn, held responsible for SP is named

Karabasan (Tureng Dictionary 2006; Wikipedia 2017). In Moroccan Arabic, the word for SP is boratat, which translates to “someone who presses on you” (De Jong 2005:84).

Boratat is often attributed to attacks by jnun (spirits), or zhor, sorcery by a woman who is angry with or wants to cause harm to an individual. The hallucinations (HH) that often accompany SP episodes among Moroccans are often composed of cultural witch imagery.

De Jong gives a description by a case study participant from Morocco: “Sometimes I see a scary old witch with a skinny head, long dirty hair, dirty teeth and old black clothes coming towards me” (De Jong 2005:83). A traditional Moroccan remedy for boratat is to put salt and a knife under the pillow while sleeping to chase the jnun away (De Jong

2005).

Variation in Explanatory Models of Sleep Paralysis in African Cultures

De Jong, the anthropologist who gave the account of the Surinamese woman

Elisa, also gives us the account of Fadi, a 43-year-old man from Guinea Bissau in

Western Africa. Fadi recounts his experiences during sleep paralysis (SP) episodes. He says that they only happen when he falls asleep on his back. He sees a faceless, sexually ambiguous, human-shaped shadow. He feels awake, cannot move, and feels chest pressure, as if someone is trying to “strangle” him. He exclaims, “My heart beats strongly and I think I am going to be killed.” He says the episodes do not last long, but they fill him with panic and leave him feeling fearful that someone is following him (De

Jong 2005:85). Fadi adds, “A few times, I tried to do something about it by putting a knife with some salt, lemon and kauri shells under my pillow” (De Jong 2005:85).

In Fadi’s native language, Fulani, this type of experience is called kibo kibongal, an explanatory model that refers to the soul of a deceased child, parent, friend or other person visiting his living loved ones. The living person feels the weight of the deceased visitor, but is unable to move or scream. Folk remedies include burning incense or a white candle, avoiding sleeping on one’s back or hanging a red piece of cloth over the door (De Jong 2005).

The Yoruba of southwest Nigeria have a particularly unique way of explaining

SP. In their traditional folk healing belief system the Yoruba have fifteen classes of psychiatric illness. One of these is ogun oru, which literally translates to “nocturnal warfare” (Aina and Famuyiwa 2007:50). This ogun oru category includes western biomedical phenomena known as parasomnias, including sleep paralysis (SP), sleepwalking, night terrors and nocturnal epilepsy (Aina and Famuyiwa 2007). Ogun

28 oru is attributed to witchcraft—spiritual attacks by a person’s enemies. Attacks come in the form of the victim being poisoned by eating or being fed demonic food in a dream; the outward manifestation of the attack is SP, or another parasomnia. Victims often do not remember the dream because it is kept hidden by spiritual forces (Aina and

Famuyiwa 2007). According to the local cultural belief model, ogun oru is “treatable through Christian prayers or elaborate traditional rituals designed to exorcise the imbibed demonic elements” (Aina and Famuyiwa 2007:44).

In the Zulu culture of South Africa, sleep paralysis (SP) is believed to be a type of nightmare that suffocates. People, usually men, are often hospitalized for severe anxiety after SP episodes (Tedlock 1992). The Swahili people in Kenya, Tanzania, Uganda and other proximal areas of Africa use the term jinamizi for SP, which translates to ‘bend toward or on’ (The Linguist List). The first part of the word also sounds like Jinn, which is believed by some researchers to represent the same. Further research may reveal strong connections between the Swahili SP narratives, and those of other Islamic cultures of the world (De Jong 2005; Jalal and Hinton 2013; Jalal et al. 2014; The Linguist List

1990; Wikipedia 2017).

Sleep Paralysis Narratives in European and Western Russian Cultures

In Slavic folklore, Kikimora is a domestic spirit who appears in homes and can cause the nightmare, or sleep paralysis (SP). She is said to be the wife of Domovoi, another domestic spirit. They may act independently of one another, or together, often sharing similar activities, namely mischief, such as tangling the needlework of women, or plucking the feathers from chickens. Kikimora enjoys causing inconvenience and mild harm to people and domestic animals. If a dish falls off of the table and breaks at night,

Kikimora is likely to blame. She also serves as an omen of impending disaster or death.

Kikimora typically appears in the semi-transparent anthropomorphic manifestation of a peasant woman; however, because she possesses no permanent physical body, she can take the shape of domestic animals as well. In her human-like form, she is often considered ugly and old, and she prefers to reside in dusty corners. Kikimora especially delights in frightening children and weaker individuals in the night, and causing nightmares and SP (Ivanits 1989; Klimczak 2016; Kushnir 2014; The Linguist List

1990). Folk methods for keeping Kikimora at bay include burying a silver item or sprinkling a trail of salt in front of the entrance to the house. Sagebrush and garlic may also ward off Kikimora (Kushnir 2014).

Another spirit in the folklore of Slavic regions throughout Eastern Europe and parts of Russia said to be responsible for sleep paralysis (SP) is the Vjek demon, who lies on victims’ chests attempting to crush them (Holden and French 2002). In Hungary, SP is called boszorkany-nyomas, which literally translates to ‘witch pressure’; the common term for ‘nightmare’ is lidércnyomás, which translates to ‘incubus pressure’ (Davies

2003; Google Translate 2006). In Greece and Cypress, SP is caused by the demon called

Mora. Mora visits individuals in the night, sitting on victims’ chests, causing asphyxiation and stealing their voices (The Linguist List 1990; Wikipedia 2017). This name is similar to Mara, who is held responsible for SP in many Western European and

Scandinavian cultures (Davies 2003).

In 2015, Jalal, Romanelli and Hinton published an article on their investigation into the cultural explanations regarding causality and meaning of sleep paralysis (SP) in the Abruzzo region of Italy. Their research methodology was both qualitative and

30 quantitative; they collected their data via questionnaire, and presented it as case studies.

They found what they termed, “a multilayered cultural interpretation of SP” called “the

Pandafeche attack,” which is “associated with various supernatural beliefs” (Jalal,

Romanelli and Hinton 2015:651). The Pandafeche is a supernatural being that is described as a ghost, an evil witch and sometimes, a frightening humanoid cat (Jalal,

Romanelli and Hinton 2015).

Folk methods for the prevention of a Pandafeche attack include placing a small pile of sand by the bed, putting a broom by the bedroom door, and, interestingly, sleeping in the supine position (Jalal, Romanelli and Hinton 2015). Seldom in the literature is sleeping in the supine position recommended for preventing SP; typically sleeping on the back is reported to trigger SP episodes (Dahmen and Kasten 2001; De Jong 2005; Ness

1978).

Explanatory Models of Sleep Paralysis among Intact and Displaced Asian Cultural Groups

Kanashibari is the common term for sleep paralysis (SP) in Japan (Fukuda,

Ogilvie and Takeuchi 2000; Takeshi et al. 2011; Yeung, Xu and Chang 2005; Yoshimura

2015). As a native of Japan and a student of culture, Ayako Yoshimura’s ethnographic, historical and experiential account of kanashibari is both descriptive and thorough. She explains that the Japanese cultural explanation for SP is a dichotomy of scientific and supernatural causality that leaves most individuals “[struggling] to make sense of the experience” (Yoshimura 2015:147). The scientific explanation dictates that suimin-mahi

(the clinical term for kanashibari—literally translated ‘sleep paralysis’) may be caused by fatigue, stress or sleep disorder, while the supernatural explanation attributes the SP phenomenon to visits by curious or malicious spirits (Yoshimura 2015).

The meaning of kanashibari runs deeply in Japanese vernacular. In Japanese kanashibari is literally translated “metal-binding” (Yoshimura 2015:151). The Kōjien dictionary defines the word as: the act of binding tightly, or the state of being bound tightly, restricting movement; it also refers to one being frozen in fear. In every-day

Japanese vernacular, the word kanashibari is used in reference to any stalemate or state of immobility. For example, it would be used in reference to a political campaign standstill, a sports team’s losing streak or being trapped in a mountain of debt. According to Yoshimura, kanashibari is, therefore, perfectly suited to be used in reference to SP

(Yoshimura 2015).

The term kanashibari has its roots in medieval Japanese religious literature, where it is used as part of the name for magic spells cast by priests of certain Buddhist sects.

The type of kanashibari spell that is the most well-known was created to exorcise malevolent spirits or to defeat an opponent. These magic spells worked by summoning the power of the patron deity of Shugendō (Yoshimura 2015). In Japanese literature of the late 1800’s, kanashibari spells are used to deliver revenge to characters meriting it, and in today’s popular culture, kanashibari magic can be found in ‘Pokemon’ and

Japanese translations of J. K. Rowling’s Harry Potter series (Yoshimura 2015).

According to the supernatural cultural narrative of kanashibari, there is no single supernatural entity or character identified with the phenomenon. The term actually refers to the specific type of paralysis that a person enters into when spirits visit or try to communicate with a sleeping individual (Yoshimura 2015).

The zashikiwarashi, a beneficent but mischievous household spirit that promotes family prosperity, has been implicated as the cause of kanashibari in some literature.

However, according to Yoshimura, despite its curiosity about house guests, and its tendency to sit on their chests to inspect them in the night, is not usually associated with any malevolent activity. The zashikiwarashi is merely one of the many supernatural entities with the ability to cause SP (Yoshimura 2015).

Yoshimura further expounds on the concept of kanashibari by noting that the term has come to be used outside of Japan; however, the term has come to take on slightly different cultural interpretations from those within Japanese culture. For instance, in Hawai’i, kanashibari is known as a ‘choking ghost’ (Yoshimura 2015).

In China, the widely familiar supernatural cultural interpretation of sleep paralysis

(SP) is ghost oppression (Hsieh et al. 2010; Jalal, Romanelli and Hinton 2015; Wing, Lee and Chen 1994; Yeung, Xu and Chang 2005). In an article published in 1994, Wing, Lee and Chen report that of their 603 undergraduate student informants, most were familiar with ghost oppression, and many of them had experienced it. Participants were asked to describe features of their experiences, and it was concluded that ghost oppression and SP are phenomenologically identical.

Going back to ancient times in China there exists a cultural belief that sleep and the spiritual realm share a close relationship. During sleep, a person’s soul is especially vulnerable to the spiritual influence (Wing, Lee and Chen 1994). In religious traditions of Taoism and Buddhism, especially in Taiwan, “ghosts-related” experiences, such as sleep paralysis (SP) and the related hallucinations (HH), are considered to be ominous

(Hsieh et al. 2010:1270). Many people may seek assistance in temples to help remedy the negative feelings that a SP episode may provoke (Hsieh et al. 2010).

In their 2005 article, Yeung, Xu and Chang report a “waning belief in supernatural forces” among Chinese and Chinese American study subjects (Yeung, Xu and Chang 2005:141). Participants in their study were very skeptical about supernatural explanations of SP, which, considering the wide diversity of age and education levels represented among their study subjects, as well as the fact that they also continue to embrace many traditional Chinese ways, surprised the researchers (Yeung, Xu and Chang

2005). The authors speculate that these findings may be a sign of westernization among the Chinese, with more people leaning toward science and away from traditional folk explanations of illness and physiological experiences such as SP. However, their sample sizes were admittedly small, the study was done in clinical psychiatric settings where the participants were potentially well-versed in the scientific language and explanations of

SP, and the participants were from metropolitan areas (Boston and Shanghai); the findings, therefore, are highly unlikely to be a valid representation of the diverse population of China (Yeung, Xu and Chang 2005).

Cambodians have a dualistic cultural explanatory model of sleep paralysis (SP) consisting of both spiritual and physiological components. In either causal explanation the phenomenon is called ‘the ghost pushes you down’ (Hinton et al. 2005a; Jalal,

Romanelli and Hinton 2015). In the Cambodian supernatural explanation of SP, the hypnagogic and hypnopompic hallucinations (HH) are attributed to “attacks by dangerous demons and the ghosts of the deceased (sometimes the ghosts of those who died horrible deaths during the Pol Pot genocide)” (Jalal, Romanelli and Hinton 2015:653). These ghosts cause the chest pressure and difficulty breathing that is characteristic of SP by pushing down on victims’ chests (Hinton et al. 2005a).

In their physiological explanation, Cambodians believe that SP is the result of dysfunction of the body. One cause of SP is a “weak heart” that may suddenly stop working properly, and may trigger “bodily freezing” (Hinton et al. 2005a:50). The disturbance of blood flow throughout the body is another leading cause of SP, according the Cambodian physiological model. A “wind-like substance,” which “runs alongside blood in vascular conduits” is responsible for a temporary loss of the use of the limbs and

“a dangerous surge of blood. . .upward in the body” (Hinton et al. 2005a:50). These elaborate and severe cultural explanations for SP heighten the level of panic people have in response to having SP episodes, viewing SP as an ominous communicator of bad health, bad luck, spiritual assault and a traumatic event from which one must recover

(Hinton et al. 2005b).

Devon Hinton and his colleagues have extensively studied the significance of SP among Cambodian refugee survivors (living in Massachusetts) of the Khmer Rouge regime era (1975–1979), during which “between between 1 and 3 million of Cambodia’s

7 million people died from illness, starvation, and murder” (Hinton et al. 2005a:47).

Hinton and colleagues found that posttraumatic stress disorder (PTSD), panic disorder, and SP are very common in this population, and SP is frequently associated with extremely terrifying HH (Hinton et al. 2005a). Hinton et al. (2005b) elaborate that the comorbidity of SP and PTSD or panic disorder can essentially magnify one another, further impacting both the intensity of SP episodes and the traumatic implications it has to waking life.

In 2009, Grayman, Good and Good published an article entitled, “Conflict

Nightmares and Trauma in Aceh.” In it, they report on a large study conducted to

35 examine the widespread trauma, among the Aceh people from the Aceh Province in

Indonesia, resulting from the near thirty-year rebellion by the province of Nauggroe Aceh

Darussalem (commonly known as Aceh) against Indonesia. The investigators revealed elaborate cultural narratives involving the role of nightmares and the spirits who cause them, in construction of explanations for, and methods for dealing with, trauma and

PTSD (Grayman, Good and Good 2009).

The Acehnese and Indonesian languages have no lexical term for nightmare, nor do they believe that nightmares are dreams. Nightmares are the “work of mischievous spirits called ‘jin’” (Grayman, Good and Good 2009:290). Jin are responsible for nightmares that cause temptation, tell lies, or are frightening to the sleeping person. They are especially responsible for two of the most frightening nightmare experiences: traumatic and vividly graphic nightmares of experienced or witnessed acts of warfare, violence or torture by the TNI (Indonesian military) and SP (Grayman, Good and Good

2009).

Acehnese informants use the terms digeunton, which means pressed on, or dicekek, meaning choked or strangled, when speaking of the SP phenomenon. The cultural narrative of SP includes an incubus character, similarly described by all informants as a jin who takes the form of a tall, dark and obscure humanoid figure that puts strong pressure on a sleeper’s chest or holds the victim in a “tight and choking embrace,” so that the individual cannot move, breathe nor call for help (Grayman, Good and Good 2009:305).

Another Southeast Asian culture, the Hmong, are historically a primarily agricultural people who lived in the mountainous areas of China and Laos. Being

36 displaced by the Vietnam War, many Hmong came to be abruptly relocated to other countries, including the United States, often splitting large extended families. The Hmong immigrants were often met with a great culture shock in their new countries as they were not accustomed to an urban way of life. Additionally, since Hmong is an oral language, they not only had to adjust to new languages, but also to the concept of written language

(Lor et al. 2017).

Although Christianity and western medicine have been somewhat integrated in the Hmong community in North America, many Hmong continue to rely on traditional folk medicine, “including animistic folk healing and the healing power of shamans” (Lor et al. 2017:402). Some Hmong people prefer shamans over western biomedical doctors even in the face of certain serious conditions—especially members of the older generation of Hmong immigrants, who are not always familiar with, nor understand, the western biomedical terminology and illness concepts. In traditional Hmong belief there are two categories of illness: spiritual illness, which must be healed by a shaman, and physical illness, which may acceptably be treated by biomedicine. Soul separation from a host individual is an especially serious problem in Hmong folk medical belief. In cases of spiritual illness and soul separation, categories in which the majority of illnesses fall,

“a shaman is the only healer who can communicate directly with the supernatural spirits responsible for the illness and correct the soul loss” (Lor et al. 2017:402).

The Hmong refer to sleep paralysis (SP) as dab tsog, a “terrifying nighttime occurrence of the crushing spirit on their chest” (Young et al. 2013:58). This spiritually caused illness is extremely feared among the Hmong. Links have been made between belief in the dab tsog and SUNDS (Sudden Unexplained Nocturnal Death Syndrome) in

37 this community. Both SP and SUNDS happen at much higher rates among the Hmong than in other communities (Cox 2015), and although there is a correlation between dab tsog and SUNDS, they are distinct disorders (Young et al. 2013). Many Hmong people experience SP repeatedly (Young et al. 2013). Ethnographers believe that the fear that

SP provokes in the case of the Hmong may have a greater impact because of the belief in dab tsog (Young et al. 2013). Perhaps this culture-specific fear regarding SP may cause sleep disturbances, leading to a higher frequency of episodes.

Sleep Paralysis Explanations in Modern North American Groups

Fukuda and colleagues report that “since Canadians have no definitive cultural framework for the [sleep paralysis] phenomenon, their interpretations might be easily affected by their own cognitive attitudes” (Fukuda, Ogilvie and Takeuchi 2000:293). The article was designed to compare Canadian and Japanese participants’ recognition of SP in relation to the features of the experience, to judge these findings in relation to how religious, spiritual or superstitious the participants considered themselves to be, as well as to determine whether or not they consider SP to be a type of dream (Fukuda, Ogilvie and

Takeuchi 2000). Results varied in all areas and data classes did not relate well with one another.

Given this information, this author speculates that more definitive meanings of

‘dream’ or ‘non-dream’ categories, in relation to various cultural and physiological dream categories, may have yielded more beneficial data. It is true, however, that the absence of definitive cultural explanation for a concept (namely SP) among the Canadian participants does, indeed, shed light on cultural views of the concept, and cultural world views in general—it is a variation of explanatory model (Kleinman 1980). This is

38 comparable to the concept that a culture’s lack of belief in supernatural forces or religion gives information regarding a culture’s view of the world, and may inform on how that culture deals with other impactful life events, such as birth, death and illness (Bailey and

Peoples 2002; Fukuda, Ogilvie and Takeuchi 2000). Scientific views, physiological knowledge and previous experience with SP may also affect how people view or react to

SP (Jalal 2016).

The seeming lack of a cultural framework for SP among Canadians, in contrast to many other cultures that have a cultural explanation for it, may lead to future research on the concepts of individual vs. cultural identity and science as a world view. Future research in this area may provide data that will enable further comparison between those who rely on scientific explanations, to those who endorse supernatural explanations of

SP, and the extent to which these beliefs affect prevalence and severity of episodes.

In other areas of North America sleep paralysis (SP) has more distinct cultural explanations. For instance, in some African American communities in the Southern

United States, sleep paralysis (SP) is referred to as the “witch (or devil) riding your back”

(Ramsawh et al. 2008:388). People of West Indian descent may hold the kokma accountable for SP, as mentioned earlier in this text, or of being frozen in a ‘trance’ while a ghost passes through one’s body (Ramsawh et al. 2008). Two studies published in

2008 on the risk factors involved in SP among the African American population, each concluded that although SP is prevalent among African Americans, it does not represent a phenotypic expression. The high rates of SP in this population are, therefore, due to other factors (Mellman et al. 2008; Ramsawh et al. 2008). Positive correlations between panic disorder and stress were found; sleep deprivation, poverty and other social pressures may

39 also be to blame (Mellman et al. 2008). Future research may shed light on these uncertainties.

Alien Abduction and Astral Travel

Perhaps one of the most distinctive connections made between sleep paralysis

(SP) and a cultural narrative is that of the Alien Abduction narrative that has sprung up in the United States since the mid-twentieth century. For many Americans, abduction by extraterrestrial aliens seems a fitting interpretation for their strange, half-waking experience. Within the past couple of decades, accounts of alien abductions have begun to be studied by psychologists and anthropologists. Two major contributors to these efforts are Susan Clancy and Richard McNally. Along with their colleagues, they have greatly increased our understanding of SP in the guise of alien abduction (Clancy et al.

2002; Hinton, Hufford and Kirmayer 2005; Spanos et al. 1993; Vyse 2005; Yeung, Xu and Chang 2005). Their contributions include providing improved understanding of the cultural explanations of the physiological phenomenon SP through modern, close-to- home experiential and psychological lenses, as well as presenting evidence for a link between seemingly scripted recall of alien abduction and false memory of sexual abuse, which has sparked much controversy (Clancy et al. 2000; Clancy et al. 2002; McNally and Clancy 2005a; McNally and Clancy 2005b; McNally and Clancy 2006; Pendergrast

2006).

Part of the controversy seems to lie in hypnotherapy techniques and other forms of psychological therapy in which therapists allegedly feed (guide patients to recall) culturally scripted elaborations of the SP experiences. Although some recalled accounts of alleged sexual abuse are undoubtedly valid, there is sensitivity and contention

40 surrounding potentially coerced accounts; with the same therapy techniques being used to elicit alien abduction accounts, although the actuality of alien abductions is highly unlikely, a similar controversy exists (Bullard 1989; Clancy et al. 2000; Clancy et al.

2002; McNally and Clancy 2005a; McNally and Clancy 2005b; McNally and Clancy

2006; McNally et al. 2004; Pendergrast 2006). This psychotherapy perplexity seems to be what sets the alien abduction narrative apart from other forms of supernatural cultural narrative for SP, such as the Old Hag, or Jinn (Ness 1978; Jalal, Romanelli and Hinton

2015). In every other sense, with the exception of the thematic material, the alien abduction explanation for SP is exactly in line with others—it is a culture specific narrative (Hinton et al. 2005a).

Research has found that individuals who report being visited or abducted by aliens “describe their first encounter with extraterrestrials in terms indistinguishable from classic SP accompanied by [HH]” (Hinton et al. 2005a:50). Another commonality between alien abduction stories and SP is the timing; alien abductions tend to occur when a person is falling asleep or awakening (Spanos et al. 1993). During alien abductions paralysis, chest pressure, feelings of being pinned down, lifted or moved are reported, along with the inability to cry for help, and people hear strange noises such as buzzing, footsteps, rustling, and see strange pulsing or flashing lights. Feelings of electrical pulses and vibrations through the body often accompany abduction stories along with the sense of threatening intruders lurking nearby. Sexual molestation and other strange sensations in the groin and pelvic area are often reported to accompany abduction experiences. All of these classic features of the SP phenomenon are explained by some as visits by extraterrestrial beings who desire to examine individuals, often taking them to another

41 location, such as their ship, to do so. Victims may be anesthetized in order to undergo examinations— which, to them, explains the paralysis. Probing and procedures designed to conduct experiments, or harvesting of samples, including eggs and sperm, have been reported as well (Cheyne and Girard 2007; Clancy et al. 2002; Davies 2003; Holden and

French 2002; McNally and Clancy 2005b; McNally et al. 2004; Spanos et al. 1993; Vyse

2005).

It may seem natural to separate classic folklore and mythology of ghosts, witches and demons from futuristic alien stories, but there may be more commonalities than differences in these ancient and modern narratives. Thomas Bullard suggests that extraterrestrial alien abduction stories are nothing short of modern folklore, which provides meaning for individuals seeking answers for the unexplainable. Alien abduction narratives hold the following “parallels in folk tradition” (Bullard 1989:158): The first of the parallels that Bullard gives is “visits to and from the otherworld” (Bullard 1989:159).

A common theme in many cultural traditions is an “otherworld where gods, demons, fairies, spirits of the dead, or other mysterious beings dwell” (Bullard 1989:159). These are typically humanoid beings, such as dwarves or fairies; they often possess powers and skills beyond those of humans; and they can be supernatural or mortal (Bullard 1989).

The second of Bullard’s parallels is “initiations, conversions, and final judgments”

(Bullard 1989:161). A person is often considered to be forever changed by an alien abduction experience. In some cases it is as though a subculture exists; the individual who has experienced the abduction is initiated into the group of those who have experience and understanding of something that only their group can (Bullard 1989).

This not only a classic theme in literature, but is also classic anthropological rite of

42 passage conceptualism as put forth by Durkheim and Turner (Erickson and Murphy

2008). Third on Bullard’s list of parallels is “a modern tradition” (Bullard 1989:163).

“Aliens have become a fixture in popular culture, described and depicted countless times in pulp literature, comic books, cartoons, television series, and movies,” and alien abduction reports only occasionally stray from these popular accounts (Bullard

1989:164). In alien abduction narratives, as in every other case of cultural narrative of

SP that has been explored thus far in this thesis, the thematic content of SP episodes is dependent on, and rarely strays from, the cultural norm (Bullard 1989; Davies 2003;

Jalal, Romanelli and Hinton 2015).

Research shows that people who believe they were abducted by aliens recount their experience with intense emotions as authentic as those of PTSD patients (Hinton et al. 2005a; Hinton, Hufford and Kirmayer 2005; McNally et al. 2004); they truly believe that they are recounting memories of actual experiences (McNally et al. 2004).

Researchers have compared the stories of alien abduction accounts, and conclude that the accounts have in common a culturally shared script (Clancy et al 2002; McNally et al.

2004). Mass media likely plays a role in this, but to what extent is unknown (Bullard

1989). Apart from the specific thematic content and controversial psychotherapy techniques involved with ‘remembering’ the content of ‘abduction’ events, the alien abduction explanation for SP is no different culturally from the supernatural nature of the

Old Hag or Jinn narratives (Bullard 1989; Jalal, Romanelli and Hinton 2015; Ness 1978).

The alien abduction narrative is simply a new version of an old classic—a cultural explanation for SP that happens to be endorsed by therapeutic professionals within the

43 culture, just as in ogun oru (Aina and Famuyiwa 2007; Bullard 1989; Hinton et al.

2005a).

In ‘psychic’ belief models and areas study—also referred to as ‘new age,’

‘spiritualistic,’ and ‘occult’—sleep paralysis (SP) is viewed as a less important aspect of, or simply a feature of, a larger phenomenon that includes out-of-body experience (OBE) and autoscopy (seeing one’s own physical body from an outside perspective). Sylvan

Muldoon and famous America investigator of the occult, Hereward Carrington, published a book in 1929 entitled The Projection of the Astral Body. In it, Muldoon describes how he discovered ‘astral projection’ at the age of twelve. He awakened to find himself in a state that startled him; he could see that his ‘astral’ body (soul) was separated from his physical body, and the two were connected by a cord. The authors went on to publish two more books on ‘astral projection,’ and the belief model that they helped to inspire has won many followers, and inspired many stories, over the past eighty-eight years (Raduga

2004).

Well-known psychic Sylvia Browne believes that sleep paralysis (SP), which she calls ‘astral catalepsy,’ happens to a person immediately preceding an out-of-body experience, which she calls ‘astral travel.’ During astral travel, Browne believes the soul can travel great distances away from the physical body (Yoshimura 2015). Robert Bruce calls OBEs ‘astral dynamics’ (Google Books). Michael Raduga, author of The Phase, promotes the idea that OBEs, combined with lucid dreaming, equate to the phenomenon called ‘the phase,’ and can enable the soul to speak with souls of the dead (Raduga 2004).

Researchers such as psychologist J. Allan Cheyne understand these experiences, including OBEs and autoscopy, to be vestibular-motor (V-M) hallucinations—key

44 phenomenological features that often accompany SP episodes (Cheyne and Girard 2007;

Cheyne and Girard 2009; Cheyne Newby-Clark and Rueffer 1999; Cheyne, Rueffer and

Newby-Clark 1998). Contrarily, the shared idea among believers in the psychic/new age framework is that SP is only a small part of out-of-body experiences (OBEs), and not accurate enough to characterize the potentially rewarding, spiritual experience that OBEs can be to both novice and expert practitioners (Raduga 2004; Yoshimura 2015).

CHAPTER 4

SLEEP PARALYSIS IN LITERATURE AND ART THROUGH THE AGES

Sleep paralysis (SP) has been a topic of literature and mythology for thousands of years (Davies 2003). The following chapter expounds upon the culture specific interpretations of SP in the previous chapter by elucidating ancient foundations of folklore and mythology upon which many of the modern cultural narratives have been elaborated. This chapter also serves to highlight how literature and art serve as catalysts, verbally, visually and contextually reinforcing and perpetuating the cultural SP narratives.

Sleep Paralysis in Ancient Texts

An early version of the nightmare or incubus character Lilitu, a she-demon, and later known as the succubus (female equivalent to incubus), is first referred to in the

Sumerian King list of 2400 BC. Lilitu is reputed to have born “children from her nocturnal unions with men” (Cox 2015:1). In certain variations of the legend, she is said to be Adam’s first wife, who was transformed into a demon for choosing not to obey.

She is reported to prey on women and babies during childbirth. Although the legend of

Lilitu is ancient, women in Middle Eastern maternity wards are still seen wearing amulets to ward off attacks by her (Cox 2015).

In Hebraic representations of Lilitu she becomes Lilith, and is held in similar regard. She is a she-demon who preys on newborn babies and women in labor. Lilith

46 acts as a classic succubus, hovering over people at night, causing disease, and taking advantage of sleeping men in order to be impregnated by them and cause them shame.

Being closely associated with the devil, Lilith is often depicted as a serpent, dragon, scorpion, night monster, or in the case of Isaiah 34:14, a screech owl. The rabbinic text, the Talmud, also portrays her as the first woman, and Adam’s first wife, who later went astray. The Talmud gives narratives of Adam’s relationship with Lilith (Cox 2015).

A few centuries later, the ancient Greeks had philosophies about sleep and sleep paralysis (SP) based on their own cultural understanding of the supernatural world. To them, sleep was not simply a state of unconscious dreamful rest, but an “inner world,” which they valued for its ability to help them “escape from the problems of the living world,” and provide the potential for prophecy and wisdom learned from dreams (Siegel and Kryger 2016:183). They believed that sleep represented another plane of existence— an altered state of consciousness. While the body is asleep and has “no perception,” the soul sees, hears, feels emotional and physical sensations, walks, and thinks; “all the functions of the body and of soul are performed by the soul during sleep” (Siegel and

Kryger 2016:183). The ancient Greeks had many gods related to sleep, and much of

Hippocrates’ writing explores the various states of consciousness associated with sleep

(Siegel and Kryger 2016).

Although Hippocrates’ philosophy on sleep paralysis (SP) is not mentioned, an early attempt to explain SP was made by Paulus Ӕgineta, a Greek physician who lived in the seventh century A.D. He dubbed SP pan ephialtes because he believed that Pan, the god of nature, was responsible for it, and would leap upon the chests of his victims with his deer-like legs and hooves (Tureng Dictionary 2006).

In the Eastern Han dynasty of China, between 30 and 124 A.D., the first Chinese dictionary, the Shuo Wen Chieh Tzu, was written. In it, the character for ghost oppression appears for the first time, comprising the characters for ‘oppression’ and

‘ghost.’ As discussed in the previous chapter, in modern-day China ghost oppression is still the term used in reference to the SP phenomenon (Wing, Lee and Chen 1994).

Another ancient document, a Chinese book about dreams, written as early as 400 B.C., contains a description of the SP experience (Davies 2003; Golzari et al. 2012).

Incubus, Witchcraft and Nocturnal Assault: Sleep Paralysis in Medieval and Early Modern Literature and Art

Medieval theologians believed that evil forces were responsible for the sleep paralysis (SP) phenomenon (Golzari et al. 2012). The idea of nocturnal attacks on sleeping people by witches preoccupied Anglo-Saxon England (Tureng Dictionary 2006).

Descriptions of SP as ‘the nightmare’ were written in the medieval period. “One fourteenth-century manuscript describes . . . how the ‘night-mare’ lay on top of people at night” (Davies 2003:183). The word ‘night-mare’ appears in the earliest English-Latin dictionary, the Promptorium parvulorum, published in 1499, where it is translated as epialtes. A twelfth-century account of a “nightmare experience” had by an English knight named Stephen of Hoyland describes Stephen's experience with the Latin terms intolerabili phantasia vexari and insomnis oppressus (Davies 2003:183).

Although most people in medieval Europe continued to blame demons and witches for SP, by about the fourteenth century postulations of medical causation were beginning to emerge. In his 2015 article entitled, “Medical Condition, Demon or Undead

Corpse? Sleep Paralysis and the Nightmare in Medieval Europe,” Stephen Gordon cites many examples of written accounts and correspondence of physicians, clergymen and

48 monks discussing possible medical and spiritual causes of ephialtes or incubus, both terms for sleep paralysis (SP) (Gordon 2015). These writings seem to represent a philosophical shift that was beginning to occur in Europe. Since the Catholic Church was the governing party in all things supernatural, changes in explanatory models of SP were slow to take place, but educated men were beginning to integrate inquiries about the role of physiology in SP discussions (Gordon 2015).

In his 2003 article, “The Nightmare Experience, Sleep Paralysis, and Witchcraft

Accusations,” Owen Davies reports on documents that he has researched regarding witch trials in Western Europe and the American Colonies throughout the sixteenth, seventeenth and eighteenth centuries. He cites verbal accusations of witchcraft, which were regarded by courts as evidence of guilt, and for which many accused were put to death. With growing knowledge of the sleep paralysis (SP) experience and its phenomenology, many of the accounts of witchcraft now fit the description of SP (Davies

2003). Even though SP was beginning to be accepted as an occurrence of natural causation, the courts continued to accept witchcraft accusations for it, and to make convictions into the eighteenth century, and even later in some European areas (Davies

2003).

Davies stresses the importance of SP in the shaping of witchcraft fantasies and accusations of past centuries. In the cultural environment of those times, SP “was not just a symptom, like other bodily conditions associated with witchcraft, but through its hallucinatory content was also a potent confirmation of a witch's power and, in some cases, a vivid proof of guilt” (Davies 2003:182).

Sex and the nightmare experience (SP) have been linked since the earliest written descriptions of night-time predators (Cox 2015; Davies 2003). Common themes of the experience and the myth include sexual arousal, sexual molestation, and sexual assault, sometimes violent in nature (Cheyne and Girard 2007; Davies 2003). In the seventh century A.D., Greek physician Paulus Ӕgineta authored a medical encyclopedia. In his description of the nightmare he includes the following: “some imagine often that they even hear the person who is going to press them down, that he offers lustful violence to them” (Davies 2003:190). A 1666 dissertation written by a student at the University of

Tübingen describes “how the victim of nightmare gets pressed, squeezed, twisted, excited or forced to sexual relation” (Davies 2003:190).

The terminology for the nightmare experience (SP) was an important topic of debate among medieval demonologists, theologians, philosophers and medical writers

(Davies 2003; Gordon 2015). While some preferred to use the innocuous Greek term ephialtes, others, preferred the term incubus (Gordon 2015). For some, the terms were synonymous, interchangeably used in reference to the nightmare experience. However, theologians pushed for the term incubus, which, because of religious influence, began to take on a more sinister meaning and carried more sexual innuendo. To them, the term incubus literally connoted a sexual assault by a demon (Davies 2003; Gordon 2015).

In 621 AD, Isidore of Seville published Etymologiae (Latin for Etymologies).

This encyclopedia of etymology is an important marker of the official change of the meaning of the word incubus. The encyclopedia defines the ‘hairy ones’ as Panitae in

Greek, and incubus in Latin. These are demon creatures who indiscriminately copulate with animals, and therefore, are shameless toward copulating with women when possible

(Gordon 2015). According to Isidore, nightmares are assaults on sleeping people by demons, who assert pressure on the victims’ chests, cause terrifying visions, and attempt to drag people into sin (Gordon 2015).

In 1887, Guy de Maupassant, “one of the most important French writers and storytellers” published his famous tale, The Horla (Miranda and Högl 2013:578). The story is one of the most acclaimed short stories ever written, and has been interpreted as a

SP experience had by the main character, who is “startled at night by an invisible and disturbing stranger, causing him to become insane” (Miranda and Högl 2013:578).

Author Owen Davies writes of the amusement that he encountered in his search on ‘the nightmare’ in literature. In addition to Guy de Maupassant's The Horla, he mentions that several nineteenth- and early twentieth-century novels feature accounts of

‘the nightmare’ (possibly as SP), including The Withered Arm by Thomas Hardy, Moby

Dick by Herman Melville and The Beautiful and Damned by Scott Fitzgerald (Davies

2003).

Swiss artist Henry Fuseli’s 1781 painting ‘the Nightmare’ is perhaps the “most famous representation of the [SP] phenomenon” (Cox 2015:2). ‘The Nightmare’ depicts a young woman lying across her bed, appearing to be helpless, with a frightening demon or goblin squatting on top of her chest and belly. The painting is an illustration of sleep paralysis (SP) accompanied by frightening hallucinations (HH) (Pearce 1993; Siegel and

Kryger 2016). Fuseli’s painting is often used in conjunction with SP in scholarly and popular literature.

Sleep Paralysis in Modern Media

Medieval cultural narratives for SP may be responsible for popular culture’s exponential increase in vampire, witch and zombie stories in the past century.

Steven Gordon writes:

Given the widespread belief in the walking dead in medieval Europe, the relationship between the restless corpse and the nightmare experience may have been a lot more common than we currently appreciate. With nocturnal, bedroom assaults being a standard feature of Early Modern witch and vampire narratives, it can be contended. [Gordon 2015:427]

Certainly the literature of the past 150 years could be reflecting a deeply engrained set of fantasy subjects that may have evolved from early religious and supernatural explanations for phenomena such as SP.

If one were to search “sleep paralysis” in your favorite internet search engine, one will invariably find many websites that are devoted to sleep paralysis (SP) from various approaches, including occult, new age, religious, self-help, how-to, blogs and chat rooms, academic publications, clinical publications, artistic narrative, horror narrative, non- fiction descriptive, and more. The Sleep Paralysis Project (MacKinnon 2017) is a contemporary website dedicated to making and presenting films and artwork on the subject of the SP experience. On Pinterest.com, eBaum’s World “Beware of the

Boogeyman,” (Pinterest 2017) describes the SP experience as the infamous Boogeyman, or scary monster hiding under beds, and threatening to come out and attack.

CHAPTER 5

SLEEP PARALYSIS IN THE ETYMOLOGICAL ROOTS OF NIGHTMARE

Chapter three of this thesis was devoted to examining the similarities and differences between cultural explanations for the sleep paralysis (SP) experience. As long as cultural narratives are truly describing SP, all will share certain specific phenomenological experiential features, including gross muscular paralysis and chest pressure, often accompanied by hypnagogic or hypnopompic hallucinations (HH), which will either manifest as incubus, intruder, vestibular-motor hallucinations, or any combination of the three types (Cheyne 2005; Cheyne and Girard 2007; Cheyne, Newby-

Clark and Rueffer 1999; Cheyne, Rueffer and Newby-Clark 1998; Davies 2003; Jalal,

Romanelli and Hinton 2015). With cross-cultural universality in phenomenological features of SP, and similarities of some narratives content themes explaining the SP experience, it is not surprising that this is reflected in the etymology of SP and the word for nightmare in many languages (Davies 2003). This chapter explores SP and

‘nightmare’ from a linguistic perspective.

Because of the historical nature of the last chapter of this text, the terms ‘sleep paralysis (SP)’ and ‘the nightmare experience’ have been used somewhat interchangeably, a fact which merits being explanation. In nearly all early descriptions,

SP is referred to as ‘nightmare’ (Golzari et al. 2012). In 1664, in what was likely the first ever clinical description of SP, a Dutch physician diagnosed the SP victim with incubus

53 or ‘night-mare’ (Cox 2015). In his 1842 descriptive account of a frightening daytime nap, Dr. E. Binns termed his experience with SP accompanied by HH a ‘daymare’

(Pearce 1993). It is common in modern publications, as well, to observe SP referred to under umbrella terms, such as ‘the nightmare experience,’ or ‘modern variation of the nightmare’ (Cox 2015; Davies 2003; The Linguist List 1990).

Owen Davies brilliantly sums up the nightmare concept:

The nightmare encapsulates a unique aspect of human experience: a moment when reality, hallucination, and belief fuse to form powerful fantasies of supernatural violation. [Davies 2003:182]

The Role of Language Change in the Etymological Roots of Sleep Paralysis and ‘Nightmare’

Every language in the world is changing constantly. Language change is evident in different ways over short and long periods of time; it varies from near to far distances, and it appears differently depending on the socioeconomic status to which groups of people are assigned. Linguists have been able to identify near-universal, and universal, patterns in these changes, which have enabled the predictability of current and future language change, and have allowed for the reconstruction of past languages, identification of language borrowing, discovery of past migrations, trade patterns, cultural fissions and fusions, and countless other aspects of human history and prehistory

(Aitchison 2003; Romaine 2000).

While numerous types of language change are evident when investigating the linguistics of sleep paralysis (SP) and ‘nightmare,’ for the purposes of this text, only the long-term changes will be examined. The focus of investigation in this chapter is the etymology, or the word origins, of SP and ‘nightmare,’ which will include documentation

54 and some evaluation of morphology, phonology, semantics and evidence of borrowing

(Davies 2003).

Linguistic evidence shows that terminology for ‘nightmare’ in various languages specifically refers to common, key phenomenological features of the sleep paralysis (SP) experience, such as chest pressure, and intruder and incubus hallucinations (HH). This is evidence of one, or variations of both, of the following: that early terminology for

‘nightmare’ connoted SP, and experienced a semantic shift, or expanded its meaning, to include a broader, related set of experiences including any ‘bad dream’ (which is a common type of pattern in linguistics); that in some languages, the terms for ‘nightmare’ have always been umbrella terms, which include both the broader category of ‘bad dream,’ and the more specific element of SP (The Linguist List 1990; Romaine 2000;

Davies 2003; Wiktionary 2017). The second seems less likely to be true considering that the morphology of the words for ‘nightmare’ in many languages is astoundingly suggestive of having etymological roots in SP (Davies 2003). To decipher the exact validity of either argument will require more in-depth linguistic investigation; however, it can be averred with confidence that the semantics of modern words for ‘nightmare’ in many languages now connote any sort of bad dream (sometimes including SP), a difficult situation, or even a difficult person (Davies 2003; Google Translate 2006; Golzari et al.

2012; Hinton, Hufford and Kirmayer 2005; The Linguist List 1990).

As is mentioned in the previous paragraph, patterns in the linguistic evidence suggest that in many languages, terms for ‘nightmare,’ which have been composed of the morphology indicating SP phenomenology, have likely sustained shifts in meaning from

Table 1. The Etymology of Nightmare

The Etymology of Nightmare Morphology of Chest Pressure Morphology of Intruder/Incubus Other Morphology

Language Common Term for Nightmare Press/Pressure Tread On/Crush Leap Upon Heavy/Weight Ride/Straddle Toward/OnBend Mare/Hag/Witch Demon/Incubus Elf Night Experience/Thing Dream French Cauchemar 1 2 Bulgarian Koshmar 1B 2B Romanian Coşmar 1B 2B Lithuanian Košmaras 1B 2B Georgian Koshmari 1B 2B Polish Koszmar 1B 2B Russian Koshmar 1B 2B English Nightmare 2 1 Dutch Nachtmerrie 2B 1 Croatian Noćna Mora 2 1 Czech Noční Můra 2 1 Slovak Nočná Mora 2 1 Afrikaans Nagmerrie 2B 1 Norwegian Mareritt 2 1 Danish Mareridt 2 1 Icelandic Martröð 2 1 Swedish Mardröm 1 2 German Alptraum 1 2 German Alpdrücken 2 1 Irish Tromlui 1

The Etymology of Nightmare Morphology of Chest Pressure Morphology of Intruder/Incubus Other Morphology

Language Common Term for Nightmare Press/Pressure Tread On/Crush Leap Upon Heavy/Weight Ride/Straddle Toward/OnBend Mare/Hag/Witch Demon/Incubus Elf Night Experience/Thing Dream Hungarian Lidérc-nyomás 2 1 Italian Incubo W Turkish Kâbus W Arabic Kabuus W Spanish Pesadilla 1 2 Portuguese Pesadelo 1 2 Greek Ephialtes W Estonian Luupainaja 2 1/3 1/3 Finnish Painajainen 1 2/3 2/3 Saami Deddon W Swahili Jinamizi 2 1 Chinese É Méng 1 2

(Davies 2003; Harper 2001; Google Translate 2006; Linguist List 1990; Wikipedia 2017; Wiktionary 2017)

Key: Numbers = Morphological Word Parts (Fields with more than one number are unconfirmed, and require further investigation.) W = Involves Entire Word B = Likely Borrowed from another Language Note: Semantics may be implied even though morphology is concrete; morphology may, or may not, have differing denoted and connoted meanings (i.e., incubus morphology denotes pressure, while connoting demon character). This table features morphological meanings only.

57 specifically connoting SP, to indicating any sort of bad dream, and in some cases, also indicating a difficult situation or person (The Linguist List 1990; Google Translate 2006).

Linguistic evidence also shows that these terms have been shared between and borrowed by various languages (Davies 2003; The Linguist List 1990; Wiktionary 2017) (see Table

1).

In some cases, the borrowing of ‘nightmare’ terminology seems to be on the semantic level only, with the connotation ‘any sort of bad dream’ having already been attached. The evidence for this lies in the morphology. For many languages who have adopted certain terms for ‘nightmare’ (bad dream), the root word parts indicating SP phenomenology do not seem to belong to that particular language, either in present or past form. It would seem the words originally connoting SP have undergone a shift in meaning, expanding in connotation to include ‘nightmare’ as ‘any bad dream,’ and were subsequently adopted (Davies 2003; Hinton, Hufford and Kirmayer 2005; The Linguist

List 1990; Romaine 2000; Wiktionary 2017) (see Table 1).

For example: it is suggested that the first morpheme of the modern French word for nightmare, cauchemar, is derived from old French caucher, and previously from

Latin calcare, both meaning ‘to tread on’ (Davies 2003; Harper 2001; The Linguist List

1990). The second morpheme ‘mar,’ comes from Old High German and Norse Mara,

Mor in Old Irish, and Mora in Slavic languages and Greek mythology, a female, supernatural, typically evil-intentioned spirit or demon that comes to people at night, frightening victims and lying on their chests (Davies 2003; The Linguist List 1990).

Cauchemar appears to have been borrowed by several languages in Central and Eastern

Europe (Slavic, Germanic, et al.), in slightly adapted forms for spelling and

58 pronunciation, as a common term for ‘nightmare’ (i.e., Coşmar in Romanian, and

Koshmar in Russian) (Davies 2003; Harper 2001; The Linguist List 1990; Wiktionary

2017) (see Table 1). Evidence suggests that the unpaired morphemes in these languages do not stem from synonymous modern or previous root word forms in their respective languages, as they do in French, but rather, that the word cauchemar, as a whole, with the meaning ‘nightmare,’ for any sort of bad dream, already attached (Harper 2001; Hinton,

Hufford and Kirmayer 2005; Google Translate 2006; The Linguist List 1990; Wiktionary

2017) (see Table 1). Interestingly, certain terms that specifically connote names of demons responsible for SP are very similar to cauchemar as well, i.e., kikimora in

Russian, and kokma in the West Indies (Cox 2015; Davies 2003; De Jong 2005; Ivanits

1989; Kushnir 2014; Ness 1978).

Comparatively, in other languages, it would appear that particular morphological sets seem to have evolved side-by-side within many neighboring and related languages; having historically shared meanings for root word parts. These morphological components seem to have subsequently semantically evolved in very similar ways to each other to incorporate broader meaning for ‘nightmare,’ meaning ‘any bad dream.’ This may be due to the fact that neighboring languages share many similarities in form and function, likely stemming from a common ancestor language, and therefore coincidentally have manifested similar morphological pairs that have come to possess similar single meanings (i.e., ‘nightmare’ in English, and ‘nachtmerrie’ in Dutch) (Davies

2003; Hinton, Hufford and Kirmayer 2005; Romaine 2000; The Linguist List 1990;

Wiktionary 2017) (see Table 1).

However, borrowing has not been ruled out for some of these examples, and will take further linguistic research to determine if, and how far back in time the borrowing took place. It is also apparent that the languages that share similar terms and/or word parts for ‘nightmare’ do not all belong to the same language family, but rather, like terms appear to skip around. It requires further linguistic investigation to determine whether these terms for ‘nightmare’ stem from shared prototypical language families, or if the terms were more recently borrowed due to cultural contact or diffusion (Davies 2003;

Romaine 2000; The Linguist List 1990) (see Table 1).

Sleep Paralysis Phenomenological Features in the Morphology of ‘Nightmare’

It is important to note that SP as ‘nightmare,’ or ‘the nightmare experience,’ refers to sleep paralysis (SP) accompanied by hypnagogic or hypnopompic hallucinations (HH)

(Cheyne and Girard 2007; Davies 2003). As mentioned in chapter two, SP is not always accompanied by HH; in fact, these types of experiences may occur in a relatively small percentage of the population. However, due to the impact that these experiences have on people, throughout history they have come to be known as “prototypical nightmares”

(Cheyne and Girard 2007:960). As these features of SP, or nightmare, manifest to the half-waking person, it is the combination of the sensation of chest pressure, and intruder/incubus HH that are integral to ‘the nightmare experience,’ as is evident in the linguistic data (Davies 2003; Harper 2001; The Linguist List 1990).

Although the sensation of chest pressure, a usual feature of sleep paralysis (SP), may not necessarily be accompanied by hallucinations (HH), it causes panic, sets the fearful tone for the SP experience, and may invite HH to occur (Cheyne and Girard 2007;

Cheyne, Newby-Clark and Rueffer 1999; Cheyne, Rueffer and Newby-Clark 1998;

McCarty and Chesson 2008). HH provide frightful visual, cultural thematic information to the person experiencing ‘the nightmare’ (SP), but the chest pressure brought on by the awareness that one is paralyzed, and not in control of one’s own breathing, provides the crucial, tactile, physical evidence of the intruder/incubus character’s presence to the person experiencing SP (Cheyne and Girard 2007; Jalal 2016; Solomonove et al. 2008).

Analysis of the linguistic evidence shows that chest pressure is a key element in the morphology of words for ‘nightmare’ in various languages, a key reason that etymologists predicate the importance of SP to the evolution of nightmare terminology and conceptualization (Davies 2003; The Linguist List 1990).

Certain terms specific to sleep paralysis (SP) which have been discussed in chapter three, incorporate word parts connoting the ‘act exerting pressure,’ or the

‘sensation of pressure’ on the chest, throat or torso of the individual experiencing the

‘nightmare’ (SP). In many cases, the connotation of pressure is incorporated into the term for SP, often along with the name of the intruder/incubus character that performs the act of frightening and exerting the pressure. For example, digeunton, the Indonesian term for SP, translates to ‘pressed on’ (Grayman, Good and Good 2009); boratat, the

Moroccan Arabic term, means ‘someone who presses on you’ (De Jong 2005); jinamizi, the Swahili word for SP, translates to ‘bend toward or on,’ and is also reminiscent of the

Jinn, spirits who are blamed for SP in many predominately Islamic parts of the world (De

Jong 2005; Jalal and Hinton 2013; Jalal et al. 2014; The Linguist List 1990; Wikipedia

2017). Kikimora is the Slavic character responsible for SP, whose name is phonetically similar to the term for ‘nightmare’ in many Slavic and neighboring languages, and incorporates Mora, the female demon who causes SP. The name Karabasan, the Turkish

61 demon responsible for SP, is very similar to the Turkish kâbus and the Arabic kabuus, both terms for nightmare; the terms derive from the Arabic word kabasa, meaning ‘to press’ (Botterweck 2014;The Linguist List 1990; Tureng Dictionary 2006; Word

Reference 2010), and kabasa is, reportedly, a cognate of the ancient Semitic word, kabāsu, meaning ‘to press, conquer, or besiege’ (Botterweck 2014; Harper 2001; Word

Reference 2010).

Aside from highlighting the terms which are presently used to connote sleep paralysis (SP) in various languages, which are an important aspect of the etymology of

‘nightmare,’ the specific purpose of this section is to examine words that may have once been used specifically to refer to SP, and over time, have come to mean ‘nightmare,’ with the broader connotation of ‘any bad dream’ (Davies 2003; Hinton, Hufford and Kirmayer

2005; The Linguist List 1990). The following are examples of ‘chest pressure’ in the morphology of ‘nightmare.’

“Latin incubus derives from incubare” meaning “to lie down upon” (Davies

2003:184); it is also defined as “to lie over” (The Linguist List 1990), and “lying upon…incumbere,” which connotes sexual violation (Gordon 2015:430). Ephialties,

Greek for nightmare, and, in medieval times, the name of the demon that causes nightmares, comes from the ancient Greek verb ephallesthai, which means ‘to leap upon’

(Davies 2003; Google Translate 2006; Harper 2001).

As discussed previously, cauchemar is the French word for nightmare. The word’s first morpheme comes from the old French word caucher meaning ‘to press, or tread on’ (Davies 2003; Google Translate 2006; Harper 2001; The Linguist List 1990).

The second morpheme of the Icelandic term for nightmare, martröð, derives from troda,

62 meaning to press, squeeze, tread on, or crush’ (Davies 2003; Google Translate 2006).

The German term for nightmare, alpdrücken, means ‘elf pressing’ (Davies 2003). The

Hungarian word for sleep paralysis (SP), boszorkany-nyomas, is translated as ‘witch pressure,’ while their term for nightmare, lidérc-nyomás means ‘incubus pressure’

(Davies 2003; The Linguist List 1990).

Luupainaja, the Estonian word for nightmare, means ‘something that presses on your bones, or lies heavy on your bones,’ and the Finnish term painajainen is translated very similarly as ‘something that is heavy or weighs upon you’ (Davies 2003; The

Linguist List 1990). Nightmare in Old Irish, tromlui, also carries the meaning of ‘being pressed on or weighed down,’ as the first morpheme, trom means ‘heavy’ (Davies 2003;

Google Translate 2017). Deddon, nightmare in Sami (Lapp), is from the verb deaddit, meaning ‘to press or weigh down’ (The Linguist List 1990). The medieval French term for nightmare appesart, modern Spanish pesadilla, and modern Portuguese pesadela all come from the verb pesar, meaning ‘to weigh or to be heavy’ (Davies 2003; Google

Translate 2017).

Some terms for nightmare specifically connote being straddled, or “ridden like a horse” (Davies 2003:184), such as in the Norwegian term mareritt, meaning ‘ridden by the mare demon,’ the English hag-ridden, and witch-ridden, and hag-rod in

Newfoundland (Davies 2003; Ness 1978). In fact, the term haggard (the appearance of being poorly rested), is a derivative of hag-rod, or hag-ridden (Oates 2003; Tureng

Dictionary 2006).

Also abundant in the linguistic evidence of terms for ‘nightmare’ are the names of the cultural intruder/incubus characters that dominate various cultural interpretations of

‘the nightmare experience’ (SP). Several terms mentioned above in the ‘chest pressure’ section also merit being mentioned here. Incubus, one of the most used names in reference to ‘the nightmare experience,’ is not only a form of the Latin word meaning ‘to lie on,’ but the word is used as the name of the demon who causes nightmares; more specifically, the name is one that is most often used when referring to violent, nighttime sexual assaults, which are experienced as part of the HH of SP (Cheyne and Girard 2007;

Cox 2015; Gordon 2015). Jinamizi, the Swahili word for nightmare, also mentioned above, includes jin as the first morpheme. Some researchers believe this is representative of Jinn, the spirits held accountable for SP episodes in many Islamic cultures (Jalal and

Hinton 2013; Jalal et al. 2014; The Linguist List 1990; Wikipedia 2017).

Alpdrücken, a German term for nightmare meaning ‘elf pressure,’ was mentioned above; however, Alptraum, meaning ‘elf dream,’ is also a common German term for nightmare (Davies 2003; Google Translate 2006). In this case, the ‘elf’ character is not a cute, mischievous, fairy-like creature, but rather more like a goblin. The elf is described as “an insidious being . . . that exerts pressure on the sleeper’s chest and takes their breath away” (The Linguist List 1990). Similarly, nightmare in Mandarin Chinese, É Méng, is translated ‘demon dream’ (Google Translate 2006; The Linguist List 1990).

Perhaps the most notable name found in the morphology of nightmare is mare, which is found as the second morpheme in the English word ‘nightmare.’ Mare is a female spirit, typically evil-intentioned, who visits people at night and lays on, or straddles their chests in the attempt to terrorize and suffocate them (Davies 2003; Oates

2003; The Linguist List 1990). She is described in various folklores as a witch, a hag, a demon, or a house spirit; sometimes her visual appearance is a component of the

64 narrative, as well as various personality traits or methods of terror and destruction (Cox

2015; Davies 2003; Ivanits 1989; Klimczak 2016; Kushnir 2014; Ness 1978; Oates 2003;

The Linguist List 1990). Although she is typically considered ugly, occasionally she may be beautiful, which seems to be a disguise to trick children or lead men astray. In these cases, she is treated more as a classic succubus spirit (Cox 2015; Klimczak 2016).

Although she is “largely forgotten” in modern cultural narratives (Davies

2003:183), mare, or the mare, in her many forms, is still present in the terms for

‘nightmare’ (as any bad dream) in many Germanic, Romantic, Slavic and Uralic languages (Davies 2003; Hinton, Hufford and Kirmayer 2005; Klimczak 2016; The

Linguist List 1990). Because of her widespread existence within the various cultural backgrounds and languages, the slight variations in the spelling of her name (which is a pattern of long-term language change), and the subtle differences in the precise role she plays in cultural nightmare narratives, etymologists find it suggestible that she may hail from as far back as a Proto-Indo-European dialect (Davies 2003; Romaine 2000; The

Linguist List 1990).

Mare is known as Mara in Norse and Old High German folklore (Gordon 2015;

The Linguist List 1990). Her name, in the morphology of the English word nightmare, comes from Middle English (The Linguist List 1990). Until recently, the common

German term for nightmare was nachtmahr, while now alptraum has exceeded it in popularity (Davies 2003; The Linguist List 1990). Nightmare in Norwegian is mareritt, which means ‘to be mare-ridden’; in Danish it is mareridt; it is mardröm in Swedish; and it is nachtmerrie in Dutch (Davies 2003; Google Translate 2006; The Linguist List 1990).

In Russian, mare appears in the morphology as both mar and mor, which is suggestive of

65 borrowing (Romaine 2000); the modern Russian word for nightmare is koshmar, while the spirit kikimora is blamed for sleep paralysis (SP) (Davies 2003; Ivanits 1989; Kushnir

2014; The Linguist List 1990). In many other Slavic and Eastern European countries, mare is known by both mor and mar morphemes (see Table 1). In Greek folklore, mare is known by the name Mora, and in Old Irish she is Morrigain, ‘queen of elves’ (Harper

2001; Klimczak 2016; The Linguist List 1990).

It is suggested by some etymologists and other researchers that other Indo-

European morphemes may share roots with the mare concept. For example, moros

(death), mer (drive away), mara (greater), and mar (to pound, bruise, mark), share similarities with the word parts found in the morphology of nightmare. However, these examples are just a few of the many found in the various Indo-European languages; most true connections with the mare concept are highly debated (Davies 2003; Harper 2001;

The Linguist List 1990). Clearly the linguistic evidence shows that, in many parts of the world, the concepts and etymology of ‘the nightmare’ have their roots in the sleep paralysis (SP) experience (see Table 1).

CHAPTER 6

MEDICAL EXPLANATIONS OF SLEEP PARALYSIS

Medical scholars and practitioners have been involved in the cooperative attainment of knowledge and understanding of human physiology for millennia. Sleep paralysis (SP), although not identified with the same terminology then as now, has been found documented in the written studies of physicians, academics and practitioners of faith and the supernatural for many centuries. Like many other genres of human knowledge, it is likely that medical study and practices related to SP preceded their being recorded in writing. This chapter is devoted to exploring the literature on SP written from the medical perspective; the first section will examine the historical writings—prior to about 100 years ago; the second section will focus on more modern medical understanding of SP.

Historical Medical Explanations of Sleep Paralysis

As discussed in chapter four, sleep paralysis (SP) has been alluded to in writing since the Sumerian King List of 2400 BC (Cox 2015). In around 400 BC, a detailed description of sleep paralysis was written in a Chinese book about dreams (Davies 2003);

Greek scholars also wrote about the subject (Siegel and Kryger 2016). “Throughout history, sleep paralysis and the similar term ‘nightmare’ have been widely accompanied by mythological creatures with paranormal powers,” such as “Ephialtes of the Greeks, and Incubus of the Romans”; early schools of medicine shared this philosophy, such as

67 the Methodic School of Medicine in Laodicea (first Century BC) (Golzari et al.

2012:232).

A scant few centuries later, Greek physicians, including Galen in the second century AD, began to attribute sleep paralysis (SP) to natural rather than supernatural causes. They believed SP was caused by “a variety of gastric disturbances following eating of indigestible food, overeating, or abundant alcohol consumption” (Golzari et al.

2012:232).

Akhawayni Bokhari was a tenth century physician in Bukhara, a city located along the Silk Road in what is now Uzbekistan, that in the Islamic Golden Age had become an intellectual hub (Golzari et al. 2012). Bokhari was both a practicing and theoretical physician. During his twenty year career, much of his clinical work was focused on retesting the hypotheses of his predecessors. Sometime before his death in

983 A.D., he documented his experience in his book entitled, Hidayat al-muta`allemin fi al-Tibb, commonly known as the Hidayat, in which there is a chapter devoted to sleep paralysis (nightmare) (Golzari et al. 2012:230). In the Hidayat, Bokhari writes of his medical opinion on SP (as nightmare). Like the Greek physicians of a few centuries before, Bokhari explains SP as being “caused by rising of vapors from the stomach to the brain” (Golzari et al. 2012:231-233).

Bokhari rigorously makes a connection between epilepsy and sleep paralysis (SP); a connection his Greek and Islamic predecessors had also suggested. Although rudimentary in theory, the connection is valid. Modern medicine understands the relationship between these two disorders to be extremely complex (Golzari et al. 2012).

During the same time, in the Middle Ages of Europe, theologians remained the primary influence on policy and public opinion in Europe. They endorsed the theory that

SP (nightmare) is attributable to evil powers (Golzari et al. 2012). As if pushing at the floodgates of the Renaissance, the knowledge and philosophy that were being proffered elsewhere in the world were beginning to seep into European thought as well. Centuries of work and theoretical documentation by Greek and Islamic scholars, physicians, philosophers and politicians would soon, albeit slowly, begin to benefit Europe. Theories on sleep paralysis (SP) would, of course, also be affected (Davies 2003; Golzari et al.

2012; Gordon 2015).

In its progress toward the Renaissance, Medieval Europe began to see a change in views of many things, including sleep paralysis (SP). In 1159, John of Salisbury wrote his well-known book on the philosophy of ethics and politics entitled Policraticus. In agreement with his fifth-century predecessor, European writer Macrobius, Salisbury wrote that ephialtes (SP with its accompanying hallucinations and sensations of chest pressure) is a manifestation of delusions, and a “very real form of mental ill-health,” and he averred that the person who experiences it is “in need of a doctor” (Gordon 2015:429).

Similarly, Gervase of Tilbury, an English canon lawyer, writer and statesman, seemed to be in accordance with centuries-old views in his famous encyclopedic book,

Otia Imperialia (Recreation for an Emperor) written in 1215. In a time in which disagreement with church law could get a person executed, Gervase boldly posited the question as to the supernatural origin of SP; however, did so cautiously (Davies 2003;

Gordon 2015). Behind the shield of, and in agreement with, Augustinian teaching,

Gervase seemed reluctant to wager an opinion, nor to disagree with popular religious

69 belief at the time, about the cause of lamia and the Pan and Silvani, as were his terms for sleep paralysis (SP) and the accompanying hallucinations (HH). In agreement with the physicians of the time, Gervase wrote that lamia (SP episodes) are most likely caused by a “thickening of the humours” which “disturb people’s spirits in their sleep and cause heaviness” (Gordon 2015:433); although, because demons and angels are very real, and incubi are capable of tangibly affecting in their sleep, and causing or experiencing sexual arousal, supernatural causes for lamia cannot be overruled (Gordon 2015).

With the onset of the Renaissance in Western Europe, by the early fourteenth century, humoural theory began to be seen as an acceptable explanation for many disorders, including sleep paralysis (SP), previously believed to have supernatural origin.

In 1318, French physician, Bernard of Gordon, “[rejected] the theological and popular perception of the ‘incubus’ and ‘old women’ as nonsense and [supported] the idea of corrupted humours or digestion problems being the cause of a night-time attack” (Gordon

2015:429). In 1361, English physician John of Gaddesden also argued that sensations that something is pressing on one’s chest are simply dreams, and have no basis in reality

(Gordon 2015).

King James I of England [1567-1625], though known for being an avid witch hunter, agreed in writing with those calling for the validity of natural causal explanations for what, in his own words, the “mediciners hath given that name of incubus” (Davies

2003:187). The King protested the opinion that sleep paralysis (SP) is caused by

“witches and diabolic spirits,” and averred rather, that it is “a natural sickness” caused by

“a thick phlegm falling into our breast upon the heart while we are sleeping, [and] intercludes so our vital spirits, and takes all power from us, [that it] makes us think that

70 there were some unnatural burden or spirit lying upon us and holding us down” (Davies

2003:187). During the same time, Reginald Scot, an Elizabethan witchcraft skeptic, who was influenced by the Galenic medical views on SP of the day, wrote, “this Incubus is a

[bodily] disease,” and although some psychological turmoil may result, it is caused by a

“[heavy] humor” from poorly digested food in the stomach that sends a “thick vapor” up to the head, and weakens and incapacitates the person (Davies 2003:187). If the vapors do not rise to the head, they cause distention in the gut, which causes poor circulation and

“stagnation of the blood” (Davies 2003:183). It became the prevailing belief among physicians and scholars throughout the Renaissance that imbalanced humors were to blame for sleep paralysis (SP) and other conditions (Golzari et al. 2012; Gordon 2015).

One of these physicians, Isbrand van Diemerbroeck, is credited with perhaps “the earliest detailed scientific description of sleep paralysis” in 1664 (Golzari et al. 2012:229), although he still diagnosed his patient using incubus and nightmare terminology (Cox

2015).

As the Renaissance faded into the Age of Enlightenment, and into the Modern

Era, medical theory regarding sleep paralysis (SP) evolved, along with the all other areas of medicine, from humoral theory to more evidence based, clinical theory. The terminology for SP also began to change during this time. In an 1842 medical account,

Dr. Edward Binns termed SP during a daytime nap, daymares (Miranda and Högl 2013).

Silas Weir Mitchell is credited with coining the term night palsy for SP in 1876 (Golzari et al. 2012; Miranda and Högl 2013). In French medical literature, SP is known as “crise de l’état de veille (crisis of the waking state) or cataplexi du réveil (cataplexy of awakening), [and] in German as verzöchertes sychomotorisches Erwachen (delayed

71 psychomotor awakening)” (De Jong 2005:79). The term sleep paralysis was first used by

S. A. Kinnier Wilson in 1928 (De Jong 2005; Miranda and Högl 2013).

In the latter part of the nineteenth century and early twentieth century, psychology became the prevailing method of analysis and diagnosis for patients who experienced the paralysis, ‘imagined’ chest pressure and hallucinations associated with sleep paralysis

(SP) episodes. “[N]ew explanations for the nightmare were sought not in bodily malfunction but in mental conflict” (Davies 2003:183). Phrases such as the following were among language commonly heard in regard to SP: “underlying psychodynamic conflict . . . temporal lobe seizure, and . . . hypnotic confabulation” (Powell and Nielson

1998:239). In 1931, Ernest Jones, one of Freud’s students, gave an extremely “detailed psycho-analytical interpretation” of SP in his dissertation entitled “On the Nightmare.”

Jones believed that SP was the result of underlying pathology attributable to “repressed sexuality” (Davies 2003:183). “With the more sophisticated development of electroencephalography” in the 1950s, science would be better able to understand sleep cycles, normal phases of sleep and waking, in order to better understand the “physiology, phenomenology and neurology of sleep paralysis” (Davies 2003:183).

Modern Neurological, Psychological and Physiological Explanations of Sleep Paralysis

As research continues to increase knowledge and understanding of human physiology and neurology, every branch of science is benefitted—the social sciences included. The following section will highlight medical research, namely in the areas of physiology, neurology and psychology from the last few decades to illustrate how studies in these areas are contributing to overall understanding of the complex phenomenon that

SP is. Neurological explanations of the features involved with the sleep paralysis (SP)

72 experience serve to reinforce the theoretical framework that has been discussed in previous chapters. Both the experiential features and neurological evidence align with cultural narratives of SP, without sacrificing cultural integrity or relativity. This section will be another layer in the schematic design of SP explanations.

Prevalence of Sleep Paralysis

If a person were to take four friends to dinner and ask who among them had ever experienced sleep paralysis (SP), chances are very good that one or two of the friends would begin telling accounts of their frightful experience. Although the experience may seem out of the ordinary, SP is not uncommon. It is quite prevalent—more so in certain populations—and it is neither well-understood nor well-studied (Davies 2003; Powell and

Nielson 1998; Szklo-Coxe et al. 2007). The literature is full of lifetime prevalence reports; however, rarely do they match. Reported lifetime prevalence rates of SP range from 2.2 percent to 62 percent (Cheyne, Newby-Clark and Rueffer 1999; Girard and

Cheyne 2006; Ness 1978; Otto et al. 2006; Sharpless et al. 2010). There are typically higher rates of SP among those who suffer from sleep disorders, such as narcolepsy

(Girard and Cheyne 2006), and certain psychological conditions, such as PTSD and panic disorder (Hinton et al. 2005; Jalal and Hinton 2015; Mellman et al. 2008; Otto et al.

2006; Sharpless et al. 2010), however, these are not reflected in the overall numbers in the literature. For instance, the highest percentage, 62 percent, reflects the prevalence of

SP (Old Hag) in the general population in a small town in Newfoundland (Ness 1978).

More conservative and consistent data seem to report a range of about 20-40 percent of the general population having experienced SP at least once in life (Cheyne, Newby-Clark and Rueffer 1999; Davies 2003; Jalal, Romanelli and Hinton 2015).

Some data indicate differences in prevalence among males and females—some reports showing higher rates in women, some in men; some studies report no difference in prevalence between the sexes. When sex differences exist with respect to SP prevalence, it may be due to an imbalance of social pressures, even leading to chronic anxiety among one of the sexes (Jalal and Hinton 2015; Jalal, Romanelli and Hinton

2015).

Studies consistently point to adolescence as the average age of onset of sleep paralysis (SP) episodes (Paradis et al. 2009; Wing, Lee and Chen 1994). It is believed that a person’s age is “associated with differences in the variety and types of hallucinations but not their underlying structure” (Cheyne 2005:319). This suggests that prevalence is independent of age, but that the thematic content of the associated HH may be influenced by the individual’s social, biological, psychological and emotional maturity, and supports culture as the main influence on thematic content of hypnagogic and hypnopompic hallucinations (HH) (Cheyne 2005; Jalal 2016).

The statistical reported lifetime prevalence rates of sleep paralysis (SP) show variance based on ethnic background (Otto et al. 2006; Paradis et al. 2009; Sharpless et al. 2010; Wing, Lee and Chen 1994). These findings may seem to suggest a positive correlation between ethnicity and higher rates of SP; however, these data may be erroneous, due to inadequate study design and methodology. Other studies indicate that high rates of SP in a population are not representative of phenotype, but, more likely, of cultural features such as stress, social pressures (e.g. poverty or gender role) and even sleep deprivation (Cox 2015; Jalal and Hinton 2015; Mellman et al. 2008; Ramsawh et al.

2008).

In fact, stress may be one of the key underlying factors of higher rates of SP in the general population. Study participants have attributed SP episodes to disturbed sleep and stress (Mellman et al. 2008; Ramsawh et al. 2008; Wing, Lee and Chen 1994). Even stress that may be considered a normal part of life, such as attending college, may contribute to higher rates. Studies show that college students have much higher rates of

SP, ranging from about 21 percent to 43 percent (Cheyne, Newby-Clark and Rueffer

1999; Jalal and Hinton 2015; Otto et al. 2006; Paradis et al. 2009; Powell and Nielson

1998).

A pattern that emerges when analyzing the data regarding sleep paralysis (SP) prevalence is the positive correlation of higher average lifetime prevalence rates of SP with the degree to which the members of that particular culture endorse supernatural explanatory models of SP. For example, Ness’ ethnographic data from his Old Hag study in Northeast Harbour, Newfoundland in the 1970s, indicates a high level of belief in the

Old Hag among the population, from youth to elderly. This is coupled with an astounding 62 percent lifetime prevalence rate of SP (Ness 1978). Another example is the study done by Jiménez-Genchi et al., in Mexico, published in 2009, in which 92.5 percent of the adolescent study participants were familiar with the ‘a dead body climbed on top of me’ phenomenon, and although a very young study group, 27.6 percent had already experienced SP (Jiménez-Genchi et al. 2009). Jalal, Hinton and their colleagues also present evidence in agreement of this hypothesis from their studies done in Egypt.

They report that 43percent of college students had experienced SP, which seems out of the ordinary; however, they also state that this number is representative of the general population in Egypt as well (Jalal and Hinton 2015). Also discovered, was “that as many

75 as 71 % of Egyptians from the general population explain SP supernaturally; and 48 % specifically believe their SP to be caused by the jinn” (Jalal, Romanelli and Hinton

2015:653). This topic of the cultural endorsement of supernatural causation of SP, and its impact on prevalence, intensity, persistency, as well as the post episodic distress of SP will be discussed later in this thesis, but it seems clear from this data that a positive correlation may be inferred.

Researchers have uncovered many of the conditions and prerequisites that increase rates of SP in certain populations, and have ruled out others; however, the discrepancy in the range of reported lifetime prevalence rates (2.2 percent to 62 percent) in the general population cannot be accepted as accurate, nor can it be overlooked.

Sharpless et al. (2010) believe that underlying reasons for such ‘pronounced interstudy variability’ include the following:

First, a “wide range of SP assessment methods (i.e., various self-report instruments and structured interviews)” was used. Secondly, across the field there is non- uniformity in “definitions of sleep paralysis, and different levels of reported detail.”

Thirdly, data are “obscured by the fact that individuals with other conditions (especially narcolepsy, seizure disorder) were often not documented and/or excluded from the samples, a factor making diagnosis of [SP] impossible.” Finally, “[f]ew systematic demographic correlates have been found” (Sharpless et al. 2010:1293).

Timing and Triggers of Sleep Paralysis Episodes

Typically SP episodes occur just as a person is falling asleep or waking up. With the advancements in the scientific understanding of sleep-wake cycles, it has been discovered that SP is “associated with the disturbance of rapid eye movement (REM)

76 sleep, and usually occurs immediately before sleep onset or upon awakening, most often in the early hours” (Davies 2003:182). However, it has more to do with the way an individual shifts in and out of REM sleep throughout a block of sleep, than it does, necessarily, on the time one goes to bed, or wakes up (Girard and Cheyne 2006).

Sleep paralysis (SP) episodes typically last anywhere from seconds to a few minutes, although episodes lasting a half-hour, and even up to over an hour have been reported (Davies 2003; De Jong 2005; Hinton, Hufford and Kirmayer 2005). It is not uncommon for individuals to “feel their paralysis has lasted much longer” than it actually has (Davies 2003:182). Once a person regains motor control and hallucinations have abated, the individual is often left sweating, having heart palpitations, shaking and feeling extremely exhausted (De Jong 2005).

Fatigue and sleep deprivation have been shown to contribute to higher frequencies of sleep paralysis (SP) (Cox 2015; Girard and Cheyne 2006). A late nineteenth century elderly Scottish servant once commented that the female servants, with heavy workloads and long stints at the spinning wheel, who were often very tired and anxious from their work, were very “liable to take the 'Mare'” (Davies 2003:189). Frequent waking during the night is also shown not only to decrease the restful quality of sleep, but also to increase the probability of SP episodes (Girard and Cheyne 2006; Hinton et al. 2005a).

The literature is full of first-hand accounts and clinical reports that sleeping in the supine position is a trigger for sleep paralysis (SP) (Cheyne 2002; Dahmen and Kasten

2001; De Jong 2005). One informant recounts, “Sometimes I see a frightening shade coming into my room. He only shows up when I sleep with my belly upward” (De Jong

2005:85). The supine position is reported in more than 50 percent of SP cases. Even if

77 an individual does not normally sleep in the supine position, because of higher levels of motility during transitions in the sleep stages, before an individual enters into REM sleep, he or she may inadvertently turn onto his or her back without realizing it (Cheyne 2002).

Although there has not been much research conducted on this specific aspect of sleep paralysis (SP), there are some reports that SP increases during the second and third trimesters of pregnancy, although most other parasomnias decrease during this life stage.

This is believed to be attributable to increased waking through the night, increased difficulty in finding a comfortable position, and more often resorting to sleeping on one’s back (Davies 2003).

Relationship between REM Sleep and Sleep Paralysis

As mentioned in the previous chapter, “Historical Medical Explanations of Sleep

Paralysis,” since the 1950s, physicians and neurologists have developed an understanding of the transitional stages that make up sleep. Though it may seem a fairly simple concept, ‘not awake,’ sleep actually “ involves transitions between three different states: wakefulness, rapid eye movement (REM) sleep, which is associated with dreaming, and non-rapid eye movement (N-REM) sleep” (National Sleep Foundation 2017b). It is believed that cholinergic neurotransmission in the brainstem produces and regulates REM sleep (Torontali et al. 2014). Electroencephalography recordings show that during REM sleep, electrical activity in the brain looks very similar to that which occurs in the brain during waking (National Sleep Foundation 2017b). Although the neurons in the brain are functioning essentially as they do during waking, the brain is sending messages to other bodily systems to keep skeletal muscles paralyzed, which normally prevents a sleeping individual from acting out dreams. It is believed that sleep paralysis (SP) may occur

78 because the consciousness of wakefulness begins during an REM sleep phase; the wake cycle and REM sleep cycles essentially overlap. Since the central nervous system is highly active during REM sleep, the person experiencing SP can see and hear, and believes himself or herself to be awake, although paralysis may persist (Davies 2003;

Jalal and Hinton 2015 Jalal, Romanelli and Hinton 2015; National Sleep Foundation

2017b; Ramsawh et al. 2008; Parker and Blackmore 2002).

In the words of Jalal and Hinton, “SP is a psychobiological phenomenon caused by transient desynchrony in the architecture of REM sleep,” which “consists of the intrusion of REM mentation into the time before falling asleep or upon awakening” (Jalal and Hinton 2015:871). In simpler terms, SP happens when the paralysis, and sometimes dreams (hypnogogic hallucinations), of REM sleep set in before an individual slips into the unconscious state of sleep, or when the paralysis and/or dreams (hypnopompic hallucinations) of REM sleep persist temporarily, although an individual has regained consciousness upon waking (Brooks and Peever 2012; Cheyne, Newby-Clark and

Rueffer 1999; Cheyne, Rueffer and Newby-Clark 1998; Dahmen and Kasten 2001; Jalal and Hinton 2015; Sharpless et al. 2010).

Neurological Explanations for the Phenomenology of Sleep Paralysis

The phenomenological features that an individual experiences during a SP episode, including skeletal muscle paralysis, chest pressure, perceived consciousness, intense emotions and hallucinations (Cheyne 2005), have been discussed in detail in previous chapters of this text; however, the underlying mechanisms for these features require further scrutiny. Since the 1950s, through brain mapping and neurological research, the knowledge that neurologists have about sleep and the entire central nervous

79 system has increased exponentially (Blanke et al. 2004; Blanke et al. 2005; Davies 2003;

Jalal and Ramachandran 2014). Polysomnographic studies show electroencephalographic evidence of “mixed REM and waking components during SP episodes” (Cheyne and Girard 2009:201). Having examined the coordination of transitions of sleep cycles (Cheyne and Girard 2009), this section will explore the functions of the central nervous system, including parts of the brain, neurons, neurotransmitters, motor neurons and their communication with peripheral and sensory nerves during sleep paralysis (SP).

The medical term for the gross motor paralysis that occurs during SP is ‘atonia.’

It is believed that atonia functions to protect individuals from acting out their dreams during REM sleep. When certain REM features, such as atonia, and often dreaming, persist into wakefulness, a SP episode is experienced (Brooks and Peever 2012; Jalal and

Hinton 2013; Miranda and Högl 2013; Jalal and Hinton 2015; Jalal, Romanelli and

Hinton 2015). Atonia during REM sleep typically prevents all voluntary muscle movements, with the exception of ocular movements. Involuntary muscle movement of the circulatory and respiratory systems continues. This means that during SP, trunk, limb and head movements, and voluntary breathing typically are not possible, although the individual can see and hear, and feels awake (Golzari et al. 2012; Jalal, Romanelli and

Hinton 2015; Sharpless et al. 2010).

There seems to be some debate as to whether atonia during REM sleep and SP is a result of “active inhibition or reduced excitation of somatic motoneuron activity” (Brooks and Peever 2012:9785). There is agreement among neurologists in recent literature that the systems responsible for atonia are located in the upper spinal cord (Brooks and Peever

2012; Evans 2006; Jalal and Hinton 2013), specifically in the medulla and pons (Jalal and

Hinton 2013). Research teams, Brooks and Peever, and Jalal and Hinton, both present data promoting the ‘active inhibition’ theory for atonia during REM. According to cognitive neuroscientist Baland Jalal and his associate, psychologist and medical anthropologist Devon Hinton, the medulla and pons, structures in the upper spinal cord

“contain a system that actively suppresses skeletal muscle tone during REM through inhibition of spinal motor neurons, possibly by glycinergic inhibitory interneurons in the spinal cord” (Jalal and Hinton 2013:535). Neurobiologists Patricia L. Brooks and John

H. Peever present further evidence that “a powerful GABA [gamma amino butyric acid] and glycine drive triggers REM paralysis by switching off motoneuron activity. This drive inhibits motoneurons by targeting both metabotropic GABAB and ionotropic

GABAA /glycine receptors” (Brooks and Peever 2012:9785).

An alternative explanation is given by Randolph Evans, MD, who attributes atonia during REM sleep to “the cholinergic neurons in the brainstem” (Evans 2006:683).

Further research is needed to determine whether these are competing theories, and which is correct.

The sensation of chest pressure is a byproduct of atonia during sleep paralysis

(SP). The often subsequent manifestation of hallucinations that one is being sat on or straddled is a byproduct of paralysis and continued dream mentation into consciousness during a SP episode. During REM atonia, voluntary respiration is suppressed. The brain takes over, and only shallow, involuntary respiration continues through most of the sleep cycle. The medical terms for REM respiration are “hypoxia and hypercapnia, occlusion of airways and shallow rapid breathing” (Jalal 2016:2). If a SP episode occurs, and

81 consciousness is regained while REM respiration persists, a person becomes aware that he or she is unable to move or to take a voluntary breath. This sensation may be translated in the brain as a feeling of suffocation, strangulation, a weight on the chest, or being held down (De Jong 2005; Jalal 2016). A resulting feeling of panic, triggered by a fight-or-flight reaction in the amygdala may set in (Cheyne and Girard 2007; Jalal 2016), which heightens the sensation of pressure, which, in turn, heightens the panic; this instigates “a positive feedback loop” which “worsens the attack” (Jalal 2016:2).

As previously mentioned, the emotionally intense, elaborate, vividly realistic hallucinations that often accompany SP are the result of the normal REM sleep function of dreaming spilling over into conscious wakefulness (Cheyne 2005; De Jong 2005; Jalal and Hinton 2013; Jalal and Hinton 2015). According to Jalal and Ramachandran, these realistic hallucinations are experienced “in all sensory modalities,” and are essentially equivalent to “dreaming with one’s eyes open” (Jalal and Ramachandran 2014:756). It is understood that the central nervous system, which is very active during REM sleep, is responsible for dreams; however, to determine the specific parts of the brain responsible for dreams, and more specifically, the systems in the brain that cause hypnagogic and hypnopompic hallucinations (HH) to be distinct from normal REM dreaming and drowsy pre-sleep visualizations, requires more investigation. The various types of HH seem to be the result of several brain systems interacting in ways specific to SP (Cheyne 2005;

Cheyne and Girard 2007; Cheyne and Girard 2009; Jalal 2016; Jalal and Ramachandran

2014; Parker and Blackmore 2002). The following excerpt by Baland Jalal is an ideal summation of the neurological explanations for HH during SP:

The content and interpretation of hallucinations, are driven by multiple processes including hypervigilance for threat, the emotion of fear, and somatic sensations

such as pressure on the chest and limbs, and REM-induced sexual arousal (i.e., hence common “rape scenarios”; see Jalal et al., 2014a); these are then imbedded in the experiencer’s socio-cultural framework . . . [Jalal 2016:2]

The three-category theoretical model of HH introduced by Cheyne and his colleagues in the late 1990s—Intruder, Incubus and Vestibular-Motor Hallucinations— have become the accepted framework for most academic and scientific research on HH during SP for the past two decades (Cheyne 2005; Cheyne and Girard 2007; Cheyne,

Newby-Clark and Rueffer 1999; Cheyne, Rueffer and Newby-Clark 1998; Jalal 2016;

Jalal and Ramachandran 2014). This section will utilize Cheyne’s framework as a theoretical basis by which to explore the various neurological functions that researchers believe to be responsible for experiences of HH during SP.

The cerebral cortex is the 2-3 mm thick outer layer of gray matter that covers the hemispheres around the human brain. The cortex comprises cortical regions called

‘primary cortices,’ which perform some of the more simple neurological functions, such as receiving sensory input and producing limb and ocular movements, and ‘association cortices,’ which serve the more complex neurological functions such as “memory, language, abstraction, creativity, judgment, emotion…attention…[and] the synthesis of movements” (Swenson 2006). REM sleep is “associated with activation of cortical and subcortical areas associated with sensory, motor, vestibular, and affective experiences and their integration” (Cheyne 2005:320).

The front of the brain, the prefrontal cortex, “which is extremely well developed in humans,” is involved with ‘executive functions’ such as memory, judgment, impulse control, reasoning, planning, personality and mood (Swenson 2006). The frontal lobe, which lies just beneath the prefrontal cortex, is also involved in the same functions as the

83 prefrontal cortex, with the addition of language, social and sexual behavior, and motor functions (Neuroskills 2017). ‘Association fibers’ connect the frontal lobe to all cortical regions in the brain (Swenson 2006).

The motor cortex within the prefrontal cortex initiates movement in the body.

When systems within the medulla and pons are working to suppress motoneuron activity during REM sleep, and subsequently during SP, although the motor cortex is sending motion signals to the body, the body cannot move; the result may be pain or spasms in the limbs that are paralyzed. During the consciousness of sleep paralysis (SP), this may be interpreted as pressure, or being held down, and hallucinations of an intruder or attacker may coincide; as a person fights to move, the spasms and hallucinations may worsen. Alternately, these signals can contribute to the benign floating and flying sensations of V-M Hallucinations (Cheyne 2005; Cheyne and Girard 2007; Jalal 2016;

Jalal and Hinton 2013; Jalal and Ramachandran 2014).

The frontal lobe receives particularly strong input from the limbic system, including the amygdala, “the emotion center of the brain,” and the hippocampus, which

“plays an essential role in the formation of new memories about past experiences”

(Boundless 2017). These systems affect the fear responses and memory coding of sleep paralysis (SP) experiences (Boundless 2017; Burgess 2002; Cheyne 2005; Cheyne and

Girard 2007; Fukuda 2005; Llewellyn 2013).

When the amygdala, or amygdaloid complex, is activated during a SP episode, it produces intensely negative emotions such as panic, fight-or-flight responses and fear of impending death. The disproportionately negative emotions produced during SP are a prominent difference between dreaming and the hallucinations (HH) that occur during SP

(Cheyne 2005; Cheyne and Girard 2007; Fukuda 2005). Research has shown that college students, a group among which SP has been shown to be prominent, reported experiencing fear only 30 percent of the time during normal dreaming, while they experienced fear during 90 percent of SP episodes (Jalal, Romanelli and Hinton 2015).

Sharpless and his colleagues report a 98 percent rate of fear among their web-based participants (Sharpless et al. 2010), and several researchers report that aggression is much more highly associated with SP episodes than normal dreams (Parker and Blackmore

2002; Sharpless et al. 2010).

The amygdala is described as “a nucleus of a vigilance system,” which functions to gather information regarding potential threats, and to identify and clarify warning signs of danger (Cheyne and Girard 2007:961). Cheyne and colleagues hypothesize that the state of being conscious, paralyzed, and feeling helpless during SP may trigger fight-or- flight responses in the amygdala, which “initiates enhanced and biased vigilance for threats” (Cheyne and Girard 2007:961). “Predator detection and risk assessment mechanisms are among the most fundamental evolved strategies of organisms” (Cheyne and Girard 2007:961). These mechanisms enhance the danger cues especially when the threat is obscured or hidden, such as a predator lurking in the dark or out of visual accessibility. The amygdala functions to produce negative emotional reactions that promote quick decisions and a fast getaway if necessary. Increased vigilance of these systems during sleep and darkness is evidence “that the architecture of mammalian sleep appears to have been importantly shaped by such pressures” (Cheyne and Girard

2007:961).

Intruder and incubus hallucinations are both associated with much higher levels of fear than either normal unconscious REM dreams, or V-M hallucinations (Cheyne 2005;

Cheyne and Girard 2007; Fukuda 2005; Jalal, Romanelli and Hinton 2015), and they

“typically include a vague sense of a threatening presence accompanied by assorted noises, footsteps, gibbering voices, humanoid apparitions, and sensations of being touched or grabbed” (Cheyne 2005:320). Additionally, Incubus experiences include sensations of pressure and pain, difficulty breathing, feelings of suffocation and choking, and “morbid thoughts of impending death” (Cheyne 2005:320). Neurologists believe that intruder and incubus experiences are related to one another, and that similar brain functions are contributing factors to the hallucinations (Cheyne 2005; Jalal and

Ramachandran 2014). The amygdala is activated, and sends out messages to other parts of the brain, which interpret them both as threat of assault by a predator or an outside agent (Cheyne 2005). The frontal lobe and prefrontal cortex interpret the sensed threat of attack by predator, and assign an identity to it based on the individual’s cultural framework (Boundless 2017; Jalal 2016; Jalal and Ramachandran 2014; Neuroskills

2017; Swenson 2006), but these systems are not the only brain systems to contribute overall to intruder and incubus experiences.

The temporal and parietal lobes are shown to be the location of several key functions involved with intruder and incubus hallucinations (Cheyne 2002; Jalal and

Ramachandran 2014); Jalal and Ramachandran hypothesize that the temporoparietal junction plays an especially critical role (Jalal 2016; Jalal and Ramachandran 2014). The function of the temporal lobe is to process sensory, especially auditory input (Neuroskills

2017). The medial temporal lobes and the hippocampus cooperate to process

86 spatiotemporal information, and to form memories of environments and the events that occur within them (Burgess 2002; Cheyne 2002). Research shows that spatiotemporal patterning during sleep paralysis (SP) is very different from that during normal, unconscious REM dreaming (Cheyne 2002; Cheyne and Girard 2004).

The parietal lobes also process incoming sensory input, particularly those of perception and sensation, integrating these incoming signals with visual signals, and converting them all into cognition (Neuroskills 2017). The parietal lobes “monitor the commands and receive feedback from the limbs about their position and velocity of movements” (Jalal and Ramachandran 2014:756). According to Jalal and Ramachandran, the parietal lobes play a crucial role in body image, “[e]specially the right superior parietal lobule,” which “is involved in the construction of a neural representation of the body,” which may become distorted during SP (Jalal and Ramachandran 2014:756).

Jalal and Ramachandran hypothesize that intruder and incubus hallucinations result from a “projection of [this] genetically ‘hard-wired’ body image (homunculus), in the right parietal region” (Jalal and Ramachandran 2014:755). Evidence in favor of this hypothesis is the fact that reported experiences of these perceived predators are humanoid, with roughly the same frame size and morphology of a person–never giant, and never miniature (Jalal and Ramachandran 2014). Moreover, they do not have detailed facial features or other defining characteristics, but are often obscured (Jalal and

Ramachandran 2014). The researchers attribute the intruder and incubus hallucinations

“to a disturbance in the multisensory processing of body and self at the temporoparietal junction” (Jalal and Ramachandran 2014:755).

Jalal and Ramachandran also point out that the right parietal region, which is responsible for self-body image, also “dictate[s] aesthetic and sexual preference” in sexual partners (Jalal and Ramachandran 2014:755); for this reason the hallucinations involving the incubus are often sexual in nature (Jalal 2016; Jalal and Ramachandran

2014). The face or identity of this intruder or incubus character will be applied in other parts of the brain, namely the prefrontal cortex, which interprets the figure according to culturally specific ideas or concepts (Jalal and Ramachandran 2014). When the hippocampus, in the limbic system, is activated during SP hallucinations, memory distortion may occur. When this occurs during a sexual hallucination, the result may be such that sexual assault is believed to have occurred, and controversial rape accusations may be made (Boundless 2017; Burgess 2002; Clancy et al. 2000; Jalal 2016; Llewellyn

2013; Loftus 1993).

As was previously mentioned, miscommunication between the motor cortex, vestibular centers, movement commands by the parietal lobes and the paralyzed skeletal muscles can lead to pain and spasms, which can become incorporated in the intruder and incubus hallucinations. This desynchrony between motor command and muscle function also contributes to a distortion in the body self-image housed in the temporoparietal junction, causing hallucinations associated with the body, such as phantom limbs, floating and falling sensations, autoscopy and out-of-body experiences (OBEs) (Blanke et al. 2004; Cheyne and Girard 2009; Jalal 2016; Jalal and Ramachandran 2014).

These V-M hallucinations are very different experiences from intruder and incubus hallucinations, both in manifestation and a higher level of neurological complexity. They are much less associated with fear; to the contrary, they are often

88 pleasant, which suggests that activation of the amygdala does not play a role in these types of hallucinations (Cheyne 2005; Cheyne and Girard 2007; Jalal 2016; Jalal and

Ramachandran 2014). V-M hallucinations are associated with spatial characteristics, such as sensations of moving through the local environment, which are not associated with intruder and incubus experiences (Cheyne 2005; Cheyne and Girard 2004; Cheyne and Girard 2007). Even the dominant hand or side can play a role in the body movement sensations of V-M hallucinations (Girard and Cheyne 2004). According to Cheyne and colleagues, this is “hypothesized to be associated with REM associated changes in the functioning of pontine and cortical vestibular centers and motor programs” (Cheyne and

Girard 2007:962).

Cheyne and Girard further clarify that research shows decreased cerebral blood flow to the prefrontal cortex and parietal lobes during REM sleep, areas “long associated with body schemes and vestibular functioning,” and explain that V-M hallucinations may result from a failure in communication between incoming tactile, motor and visual sensory input and the neuromatrix, comprising cell assemblages within “thalamic, somatosensory, limbic and parietal areas,” essentially arguing that V-M hallucinations are a failure of the brain to signal that the body is intact (Cheyne and Girard 2009:202).

Correlation between Sleep Paralysis and Other Sleep Disorders

According to the American Psychiatric Association, sleep paralysis (SP) is classified as a parasomnia, or sleep abnormality (Sharpless et al. 2010); however, it is not considered to signify any pathology when experienced occasionally in otherwise healthy people (Hinton et al. 2005a; Jalal and Ramachandran 2014). SP and other sleep disorders share a key element in common: they are involved with the malfunction of the

89 neurological distinctions between sleep stages (National Sleep Foundation 2017b).

However, there are key distinctions between SP and other sleep abnormalities—some abnormalities that may indicate pathology to some degree—including REM sleep behavior disorder, night terrors, narcolepsy and exploding head syndrome (De Jong 2005;

Evans 2006; Jalal, Romanelli and Hinton 2015; Ramsawh et al. 2008).

During REM sleep, muscle atonia keeps most people from acting out their dreams. Sleep paralysis (SP) occurs when atonia persists into wakefulness (Brooks and

Peever 2012; Jalal and Hinton 2013), whereas in REM sleep behavior disorder (RBD), muscle tone persists during sleep, enabling “behavioral release during REM sleep”

(Miranda and Högl 2013:579). People who suffer from RBD may not experience the muscle paralysis that is that is normal during REM sleep. They act out their dreams, and are known to engage in certain activities associated with being awake, including sleep walking, talking, shouting, screaming, hitting, leaping out of bed, and eating (National

Sleep Foundation 2017b). Sometimes RBD results in the sufferer causing harm to self or others; in fact, this is the normal trigger for an RBD diagnosis. Treatment of RBD is often successful (National Sleep Foundation 2017b).

After a sleep paralysis (SP) episode, an individual typically has nearly complete recollection of the event. This is due to the intensity of SP episodes, high levels of fear that are typically experienced, and the fact that the person has retained consciousness throughout the event (Cheyne and Pennycook 2013; Jalal 2016). A person who suffers from night terrors, however, awakens with panic-like fear, disorientation and agitation; he or she may flail about, scream, or talk loudly, but shortly will fall back to sleep and later will have no recall of the event (De Jong 2005; Hinton, Hufford and Kirmayer 2005).

Sleep paralysis (SP) occurs both as an isolated form, and as a classic symptom of narcolepsy (Golzari et al. 2012). Some researchers and medical or neurological professionals use the term ‘isolated sleep paralysis’ (ISP) when referring to SP in the form which presents itself independent of narcolepsy, as this text has been discussing thus far (Golzari et al. 2012; Jalal, Romanelli and Hinton 2015; Otto et al. 2006;

Ramsawh et al. 2008; Sharpless and Grom 2016). Because narcolepsy is so rare, occurring in only .0005 to ˃1 percent of the population, many researchers choose to abandon the term ISP, and simply use the term SP for all cases, as it will apply to most

(Jalal and Hinton 2015; Jalal and Ramachandran 2014; National Sleep Foundation

2017a). As mentioned previously, when sleep paralysis (SP) occurs in its isolated form in otherwise healthy individuals, it is not considered to signify pathology (Hinton et al.

2005a; Jalal and Ramachandran 2014). However, when an individual exhibits others of the classic tetrad of narcolepsy symptoms, SP becomes an indicator of a more serious condition (Golzari et al. 2012; Jalal, Romanelli and Hinton 2015; National Sleep

Foundation 2017a).

Narcolepsy is characterized by blurred boundaries between wake and sleep.

People with narcolepsy often have trouble maintaining restful sleep at night, as well as trouble staying awake during the day. They experience SP and vivid nightmares, hallucinations while awake, excessive daytime sleepiness and may also exhibit characteristics of sleep while awake, including falling asleep and suffering loss of muscle tone in the midst of daily activities. When atonia is experienced during normal waking hours as a symptom of narcolepsy it is called ‘cataplexy,’ and can be triggered by strong or sudden surge of emotion. The loss of muscle tone may be partial, resulting in slack

91 jaw, weakness in the limbs or torso, or it may be more severe or total, resulting in potentially dangerous situations, and other REM activity and hallucinations may occur

(Krahn and Gonzalez-Arriaza 2004; McCarty and Chesson 2008; National Sleep

Foundation 2017a).

Researchers believe that a significant characteristic of narcolepsy may be frequent periods of REM sleep occurring at sleep onset (Girard and Cheyne 2006). Neurologists hypothesize that narcolepsy happens as a result of “the autoimmune destruction of neurons in the hypothalamus that produce the peptide hypocretin (orexin) (hormones that regulate the sleep cycle)” (Jalal and Ramachandran 2014:755). Narcolepsy is typically treated by the patient practicing good sleep hygene, by keeping both the sleep schedule and sleep environment sufficient and consistent, by taking prescription antidepressants, or a combination of both (Krahn and Gonzalez-Arriaza 2004).

Exploding head syndrome (also classified as migraine aura) is a rare phenomenon that may be related to sleep paralysis (SP). As an individual is passing from wakefulness to sleep, he or she perceives a sudden, loud sound, followed by a few seconds of paralysis, and a subsequent migraine headache. Patients who have complained of experiencing exploding head syndrome have been tested for epilepsy, but researchers have found no evidence of “epileptogenic discharges” (Evans 2006:683). Neurologists suspect a dysfunction of brainstem activity at sleep onset, which through some “unknown mechanism,” activates “the trigeminal vascular system, resulting in migraine headache”

(Evans 2006:683).

Comorbidity of Sleep Paralysis with Psychological and Mood Disturbances

Sleep paralysis (SP) is shown to have a high correlation to many anxiety disorders, including post-traumatic stress disorder (PTSD) (Hinton et al. 2005a; Hinton et al. 2005b; Jalal and Hinton 2015; McCarty and Chesson 2008; Paradis et al. 2009;

Yeung, Xu and Chang 2005), other types of trauma, such as a history of childhood sexual abuse (Clancy et al. 2000; Hinton et al. 2005a; Ramsawh et al. 2008), panic disorder

(Hinton et al. 2005a; Ramsawh et al. 2008; Yeung, Xu and Chang 2005), anxiety (Hinton et al. 2005a; Jalal and Hinton 2015), including general anxiety disorder (GAD), anxiety sensitivity, pathological worry (Jalal and Hinton 2015), social phobia (Paradis et al.

2009) and chronic fear (Sharpless et al. 2010), as well as a debated link to depression (De

Jong 2005; Otto et al. 2006; Szklo-Coxe et al. 2007). Many of these conditions, such as anxiety, fear, and even trauma, not only trigger SP, but also result from SP (Hinton et al.

2005a; Jalal 2016; Ramsawh et al. 2008; Sharpless et al. 2010). Devon Hinton and his colleagues report that among the subjects of their study on sleep paralysis (SP) rates among Khmer Refugees, 67 percent of those individuals with PTSD also experienced SP, with monthly frequency almost unanimously reported, while only 22.4 percent of those without PTSD experienced SP (Hinton et al. 2005b). It should be noted that the comorbidity of SP and anxiety and depressive disorders is not solely correlated with the occurrence of SP, but with the intensity of the experience and high frequency of fearful hallucinations associated with episodes (Hinton et al. 2005a; Jalal and Hinton 2015).

One of the primary things attributed to the increased frequency of SP among patients with anxiety and depressive disorders is sleep deprivation. Disturbed sleep, including sleeplessness, inability to fall asleep and frequent awakenings, are common

93 complaints among patients with anxiety and depressive disorders, and can trigger SP

(Hinton et al. 2005a; Jalal and Hinton 2015; Ramsawh et al. 2008; Yeung, Xu and Chang

2005). A primary contributing factor to high frequencies of SP reported in the literature is anxiety. Patients who experience chronic or profound levels of anxiety not only experience sleep disturbances, but seem to have increased activity in the brain’s fear systems during both wakefulness and sleep. Moreover, anxiety patients often assign greater significance to the SP experience itself, especially since SP phenomena can mimic panic attack symptoms, such as tachycardia, difficulty breathing and chest pressure, thus increasing levels of anxiety and fear, which, in turn, increases the frequency and intensity of episodes (Hinton et al. 2005a; Jalal and Hinton 2015;

Ramsawh et al. 2008).

Culture specific stress is a leading correlate in the frequency and intensity of sleep paralysis (SP) episodes and the accompanying hallucinations, and falls within the category of pathological worry, chronic stress and chronic anxiety (Hinton et al. 2005a;

Jalal and Hinton 2015; Ramsawh et al. 2008). Whether culture specific stress is related to PTSD caused by war or some other extreme trauma, or if it is more subtle, such as day- to-day chronic stress caused by some other aspect of culture, like poverty, political oppression, gender oppression, or even culture change, chronic anxiety has a physiological effect on individual sufferers. Research shows that such stress triggers fear responses in the brain, and when combined with disturbed sleep, leads to higher frequency of SP episodes, as well as more intensely fearful hypnagogic and hypnopompic hallucinations (HH) (Hinton et al. 2005a; Jalal 2016; Jalal and Hinton 2015; Ramsawh et al. 2008; Yeung, Xu and Chang 2005). When a culture more strongly endorses negative

94 or fearful beliefs regarding the causality and/or ramifications of SP, the anxiety is amplified, and can, in turn, worsen SP episodes and increase their frequency (Cox 2015;

De Jong 2005; Jalal 2016; Otto et al. 2006; Young et al. 2013).

Solomonova, et al. (2008) and Parker and Blackmore (2002) have published articles in which they highlight some controversy surrounding the relationship between sleep paralysis (SP) and psychological disturbances, and the implications thereof. Both of these articles report that some researchers and psychological professionals have considered SP to be an indicator of psychopathology, leading to erroneous diagnoses and unnecessary treatments. Typical indicators of certain psychopathology including feelings of paranoia, feeling watched, and frequency of negative emotions, such as fear of aggressive interactions, feeling powerless, fear of being a victim and fear of being physically injured, have been translated as being signs of mental illness or instability when they occur during wakefulness or in normal, unconscious REM dreaming. SP, especially when accompanied by fearful intruder and incubus hallucinations, has therefore been mistakenly placed in the same category by many psychiatric professionals, and many people have suffered unnecessary treatment and stigma (Parker and Blackmore

2002; Powell and Nielson 1998; Solomonova et al. 2008).

Because sleep paralysis (SP) has been understudied until recently, some researchers have assumed that the same brain functions that occur during normal REM dreaming also occur during SP, and that the same implications may be assumed about both. Now researchers and psychological professionals are beginning to better understand SP, and the brain functions that go along with it. SP differs from dreams in many categories, and is not an indicator of psychopathology, even when similar content

95 occurs as in dreams that would be considered to indicate some underlying psychiatric condition (Parker and Blackmore 2002; Powell and Nielson 1998; Solomonova et al.

2008).

Modern Treatments for Sleep Paralysis

Since sleep paralysis (SP) has become much better understood in the past few decades, and is not considered to imply any pathology when experienced by otherwise healthy individuals (Hinton et al. 2005a; Jalal and Ramachandran 2014; Powell and

Nielson 1998), treatments for the phenomenon largely center around education and awareness of the psychobiological factors involved in SP, and the physical and emotional manifestations experienced during an episode (De Jong 2005; Jalal 2016; Jalal,

Romanelli and Hinton 2015). Even narcolepsy, which is considered a diagnosable and treatable disorder, although more serious than SP, is treated mainly with recommendations for good sleep hygiene, with the addition of antidepressant medication if necessary (Krahn and Gonzalez-Arriaza 2004). Researchers believe that, in the majority of cases, stress management and good sleep hygiene, including keeping a regular sleep schedule, getting enough sleep, not falling asleep in the supine position and reducing other conditions that prevent solid sleep, such as sleep apnea, are sufficient to drastically reduce occurrences of SP episodes (Hsieh et al. 2010; Jalal 2016; Krahn and

Gonzalez-Arriaza 2004; Ma, Wu and Pi 2014; Menuzawa et al. 2011; Ramsawh et al.

2008; Sharpless and Grom 2016).

Evidence has shown that even in cases in which a strongly negative cultural connotation has served to explain sleep paralysis (SP), individuals that are made familiar with the physiological explanation of the experience are less fearful should another

96 episode occur (De Jong 2005). It is believed by researchers, such as Baland Jalal, that if people understand SP as a benign experience, although a frightful one, they may be able to relax during episodes, control their cognition and minimize negative experiential factors (De Jong 2005; Jalal 2016; Jalal, Romanelli and Hinton 2015). He and other researchers recommend speaking to someone, such a friend or clergy member, about SP experiences prior to subsequent episodes; should an episode occur, the recommendation is to use focused, positive thought, including meditation or prayer, during the episode in order to reduce the intensity, shorten the length, and even disrupt it (Jalal 2016; Ramsawh et al. 2008; Sharpless and Grom 2016).

CHAPTER 7

DISCUSSION

Key Contributors to the Anthropology of Sleep Paralysis

This investigation simply cannot be considered complete without acknowledging key players and their contributions to this field. The following is not a complete list, by any means, but will highlight many of the major contributors to this investigation.

Robert C. Ness (1978) may be credited as the pioneer of sleep paralysis (SP) ethnography. He astutely observed the connection between ‘the Old Hag’ and SP, and his subsequent ethnographic investigation helped to elucidate one culture’s explanatory model of the physiological phenomenon. Since Ness’s work in Newfoundland, many researchers have contributed greatly to the cross-cultural examination of SP: Jeffrey

Jacobson (2009), in Puerto Rico, Ayako Yoshimura (2015), in Japan, Wing, Lee and

Chen (1994), in China, Devon Hinton and his colleagues, in Egypt, Denmark, Italy and with Cambodian refugees (Hinton et al. 2005b; Jalal et al. 2014; Jalal and Hinton 2013;

Jalal and Hinton 2015; Jalal, Romanelli and Hinton 2015).

Devon Hinton and Baland Jalal have helped to increase psychological and anthropological understanding the psychological factors of SP in relation to culture and the human experience (Hinton et al. 2005; Jalal et al. 2014; Jalal and Hinton 2013; Jalal and Hinton 2015; Jalal, Romanelli and Hinton 2015). They have done much ethnography and other research collaboration with each other and colleagues. Jalal and Ramachandran

(2014) and another team, Brooks and Peever (2012), have teamed up to analyze the role of various neurological systems in the phenomenology features of SP. Owen Davies

(2003), Ann Cox (2015) and Stephen Gordon (2015) presented historical and literary evidence of SP going back thousands of years in genres such as ancient Biblical texts, medieval literature and witchcraft trials, to name a few.

Susan Clancy and Richard McNally have presented much controversial research regarding recalled memories of alien abduction and childhood sexual abuse actually being elaborations of sleep paralysis (SP) episodes (Clancy et al. 2000; Clancy et al.

2002; McNally et al. 2004; McNally and Clancy 2005; McNally and Clancy 2006). Otto et al. (2006), Jalal and Hinton (2015) and Sharpless et al. (2016), among many others have helped to increase knowledge about the comorbidity of SP with fear and anxiety.

Perhaps one of the most impactful of contributions is Cheyne’s three-category model of hypnagogic and hypnopompic hallucinations (HH), which has helped to solidify the universality of phenomenological features of SP (Cheyne 2002; Cheyne 2005; Cheyne and Girard 2007; Cheyne, Newby-Clark and Rueffer 1999; Cheyne, Rueffer and Newby-

Clark 1998).

Future Anthropological Sleep Paralysis Research Opportunities

The anthropological study of sleep paralysis (SP) is no longer in its infancy;

Robert Ness was conducting his SP ethnography in 1973 and 1974, and for decades earlier, SP was studied from psychological and neurological perspectives (De Jong 2005;

Hishikawa et al. 1976; Miranda and Högl 2013). There are opportunities for new and continued SP research in anthropological subfields. Cultural anthropology, with continued ethnography and cross-cultural comparisons, can increase knowledge

99 regarding folk illness and healing concepts, as well as exploring SP as a universal hypothesis. Economic anthropology can make inquiries into the correlation of poverty as a culture-specific stress factor that increases episodes of SP. With the tie that SP inextricably has to neurology and psychology, anthropologists in the fields of medical anthropology, the anthropology of gerontology and evolutionary psychology have considerable opportunities for interdisciplinary research and publications.

Better communication and knowledge sharing between medical anthropologists and medical professionals, including physicians, nurses, neurologists and psychologists will not only reduce erroneous psychopathological diagnoses of SP and unnecessary treatments, but will also improve patient care and treatment outcomes by increasing medical practitioners’ familiarity with the cultural illness and healing beliefs, such as in the case of the Hmong (Lor et al. 2017; Young et al. 2013). Research in hospitals and clinics that have already implemented programs related to this would be valuable research subjects for applied anthropologists as well.

Future investigations on some of the controversial topics related to SP would certainly also shed light on some causes of suffering for certain individuals. Continuation and elaboration of the work begun by Clancy and McNally and their colleagues may assist in bringing understanding, and perhaps closure, to some of the questions surrounding the correlation between SP and recalled childhood sexual abuse (McNally and Clancy 2005b).

Perhaps the greatest opportunity for improvement in future anthropological research on SP would be in increasing uniformity in data collection and analysis methodologies. It was discovered in the fifth chapter that lifetime prevalence rates of SP

100 had a reported range of (2.2 percent to 62 percent); discrepancies of this nature cannot be accepted as accurate, and cannot be overlooked. Sharpless and his colleagues believe that underlying reasons for such variability include a “wide range of SP assessment methods,” non-uniformity in “definitions of sleep paralysis, and different levels of reported detail” and finally, the omission of individuals from tests with certain comorbid conditions tends to obsure data (Sharpless et al. 2010:1293).

The following are excerpts chosen from four articles, selected to highlight the wide range of assessment methods represented in the academic literature on SP. The purpose of this example is not to blame any one researcher, or group of researchers, for inconsistencies, nor to aver that any one method is the best, but to highlight the need for uniformity of the definition for SP, and consistency in language of questionnaires and other data-gathering and data-analysis tools, both qualitative and quantitative. The requirements for such tools being that they revere and elucidate various cultural narratives upon the backdrop of a universal scientific SP framework for analysis and comparison, and must accommodate various data collection techniques and methodologies, allowing all SP researchers to incorporate learned knowledge into a cohesive whole.

First, in his 1978 article “The Old Hag Phenomenon as Sleep Paralysis: A

Biocultural Interpretation,” Robert Ness used the Cornell Medical Index (CMI) to analyze the responses of his 69 adult study subjects in order to verify that the people who have experienced Old Hag are as psychologically and physically healthy as the people who have not had the experience.

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Secondly, in their 2009 article “The Assessment of the Phenomenology of Sleep

Paralysis: The Unusual Sleep Experienced Questionnaire (USEQ),” Paradis et al. presented the results of their pilot study, conducted to test an assessment instrument called ‘the Unusual Sleep Experiences Questionnaire (USEQ),’ which they developed in order to expand and improve cross-cultural investigations of SP. The study included 208 subjects from a small, college in the United States who all spoke English. The questionnaire incorporated various qualitative and quantitative portions, including administered and self-report portions, a yes/no question portion, a likert scale response portion (i.e., 1 = never; 4 = always), and a portion for descriptive, written responses following prompts.

Thirdly, in the study conducted in order to publish their 2015 article, “Cultural

Explanations of Sleep Paralysis in Italy: The Pandafeche Attack and Associated

Supernatural Beliefs,” Jalal, Romanelli and Hinton, utilized a questionnaire designed by them, called ‘the sleep paralysis experiences and phenomenology questionnaire (SP-

EPQ).’ The enhanced data collection tool is “an elaborated version of the sleep paralysis questionnaire (SPQ), which has previously been utilized in Cambodian, Nigerian,

Chinese, American, Egyptian and Danish populations” (Jalal, Romanelli and Hinton

2015:654).

Fourth and finally, J. A. Cheyne, prominent psychologist, is perhaps the researcher who has made the most progress in promoting theoretical and methodological approaches that assure uniformity and consistency in data on the hallucinations and the hallucinatory experiences associated with sleep paralysis (SP). He has developed a three- category hallucination framework, within which any SP hallucinatory experience, from

102 any cultural perspective, may be aligned, while accommodating for cultural or individual thematic content, intensity, frequency, and any combination thereof. In his 2005 article

“Sleep Paralysis Episode Frequency and Number, Types and Structure of Associated

Hallucinations,” he utilizes the Waterloo Unusual Sleep Experiences Scale, which specifies 18 different hallucination types, a likert scale portion regarding intensity and vividness (1 to 7) of hallucinations, a written response portion, and a frequency and persistency scale.

Certainly these examples are not a comprehensive example of variability in anthropological research methodology in sleep paralysis (SP), and variability is not always a negative concept. In fact, some variation in methods and materials is essential to the development of more efficient research tools. However, when researchers are testing for the same variables, it is beneficial to develop and implement common research tools, such as a unified SP questionnaire. Commonalities and communications will allow for a better and more complete understanding of the human experience with SP.

Anthropological Patterns, Themes and Directions in Sleep Paralysis Research

Having explored the sleep paralysis (SP) literature in five different genres, including the phenomenology, cross-cultural perspectives, SP in ancient to contemporary literature and art, the etymology of SP and old and new medical explanations of SP, the questions arises: how does it all fit into anthropological theory? How do cultural explanatory models of sleep paralysis (SP) inform on cultural and individual attitudes toward health, illness, treatment of illnesses; what is the role of the supernatural in the human experience with illness concerns and other aspects of human existence; how do these belief models inform the position that humans believe they hold in the universe?

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Several major themes and patterns have emerged. The first is that SP is an apparently universal phenomenon. This is evidenced by the widespread cultural narratives that align with the phenomenological framework and neurological explanations, as well as being supported by the etymological evidence of SP, showing phenomenological features of SP represented in the morphological roots of ‘nightmare’ in many languages (Cheyne 2005; Davies 2003; Jalal 2016; Mason 2012). No evidence arguing a common physiology has thus far been uncovered. Although there are no reports indicating, nor hypothesizing, a 100 percent lifetime prevalence of SP, it appears to exist at rates of about 20 to 40 percent in every culture that has been studied. To this date there has apparently been no data published that challenges Cheyne’s three-category framework for hallucinations (intruder, incubus and vestibular-motor) associated with SP, nor any challenge to the cross-cultural appearance of the other SP phenomenological features that have become to be accepted by scientists, such as near-complete bodily paralysis, chest pressure and a sense of being awake (Cheyne 2005; Hinton, Hufford and

Kirmayer 2005). For these reasons, it would make sense to hypothesize that SP is a universal human phenomenon, and to test these theoretical models with further ethnography and clinical collaboration.

Secondly, the phenomenological features, including paralysis, chest pressure, a feeling of being completely awake, and the hallucinations that often accompany SP are personalized thematically, and interpreted through a cultural lens (Jalal 2016; Otto et al.

2006). Ethnographic evidence exhibits wide variation in cultural narratives and explanations of causality and meaning of SP, although shocking similarity in descriptions of phenomenological and emotional factors consistently exists cross-culturally (Jalal,

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Romanelli and Hinton 2015). The resulting identities of these incubus characters and causal explanations are built into elaborated explanatory models, often fitting into the larger cultural cosmologies (Jalal 2016; Kleinman 1980; Otto et al. 2006). The Hmong, for example, have two categories for illness, spiritual and physical. Sleep paralysis (SP) falls into the spiritual illness category, and must be treated by a shaman (Lor et al. 2017).

In the Cambodian model SP is considered both a spiritual and physiological illness

(Hinton et al. 2005a). In ancient China and ancient Greece the soul was believed to be able to ambulate through another plane of existence during sleep; however it was also extremely vulnerable to other spiritual forces during the sleep state, and SP attacks were an example of this vulnerability (Gordon 2015; Siegel and Kryger 2016; Wing. Lee and

Chen 1994). There is rich variation in cultural identities that are assigned to the incubus character blamed for nocturnal attacks (SP); these include ghosts, demons, witches, elves, extraterrestrial aliens and other culture specific entities (Davies 2003).

Thirdly, because of the realistic, vivid, multisensory, frightening and mysterious qualities of the sleep paralysis (SP) experience, for most of history it has been explained supernaturally (Cox 2015; Davies 2003; Gordon 2015; Otto et al. 2006). This is not unlike other areas of science and physiology, such as the conflict over whether or not the

Earth was the center of the universe in the Middle Ages, or the debate about the age of the Earth contemporarily (Miller 2002). Cultural saliency and belief in the supernatural go hand in hand in many aspects of the human experience—sleep paralysis (SP) included.

Ethnographic and psychological evidence shows that the greater extent to which a culture endorses supernatural narratives as explanations for the SP experience, the higher the prevalence of SP with fearful hallucinations is in the population (Davies 2003; Jacobson

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2009; Jalal 2016; Jalal, Romanelli and Hinton 2015; Otto et al. 2006). This produces a positive feedback response, reinforcing belief in the supernatural narratives in individuals, which reinforces them in the culture as a whole (Jalal 2016). When culture- specific stress is a factor, the saliency factor is magnified (French, Rose and Blackmore

2002; Jalal and Hinton 2015; Lor et al. 2017; Ramsawh et al. 2008; Yeung, Xu and

Chang 2005). When Jalal and Hinton (2015) compared Danish and Egyptian populations, they found that Egyptians have a fear evoking supernatural explanation for

SP that is accepted by most of the general population, and higher rates of SP than their

Danish counterparts who do not have a single cultural view of the phenomenon. Fukuda,

Ogilvie and Takeuchi (2000) had similar findings among their Japanese and Canadian test subjects. Japan’s kanashibari concept is familiar to the majority of Japanese people of all ages, many of whom have experienced it. While Canadians show lower average rates of SP, and have no apparent cultural framework for the phenomenon.

A fourth interesting pattern that has emerged through this investigation is a remarkable similarity in folk remedies cross-culturally, as well as a unifying theme in folk and modern remedies. It may not be surprising that with an experience that instills such confusion and fear as sleep paralysis (SP) does, that folk and modern, religious and secular remedies center on prevention of SP. While folk remedies focus on warding off the malevolent spirits who cause it, modern remedies attempt to combat stress, anxiety and sleep disturbances to reduce likelihood of episodes. Piles of salt or sand near the bed, knives under the pillow, silver items buried nearby, religious ritual such as exorcism or keeping a crucifix near and prayer are common folk remedies in the ethnographic record

(De Jong 2005; Ivanits 1989; Jacobson 2009; Jalal, Romanelli and Hinton 2015).

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Modern remedies are largely focused on maintaining good sleep hygiene and stress reduction, and like folk remedies include recommendations for meditation and prayer

(Hsieh et al. 2010; Jalal 2016; Krahn and Gonzalez-Arriaza 2004; Ma, Wu and Pi 2014;

Menuzawa et al. 2011; Ramsawh et al. 2008; Sharpless and Grom 2016).

Fifthly, and perhaps the most impactful of the major themes in this investigation is that the phenomenological, neurological and cultural explanations of sleep paralysis

(SP) all align with each other cross-culturally, none necessarily abrogating another.

‘Necessarily’ is the key word in the previous sentence. Undoubtedly, the understanding of the physiology involved with SP can, and does, diminish the perceived validity of supernatural cultural explanations of SP for many; however, not all people will abandon cultural explanations completely, and supernatural remedies are likely to persist. Many cultural groups have, and more continue, to accept western biomedical explanations of

SP, especially the younger generations, which is a common theme in anthropology (De

Jong 2005; Jalal and Hinton 2015; Law and Kirmayer 2005; Lor et al. 2017). The perspective of medical pluralism is an ideal anthropological approach to these concepts.

When western biomedical or physiological explanations challenge cultural explanatory models, cultures are forced to react. They can do so by rejecting the biomedical theories of illness and treatment, they can abandon the traditional cultural models, or they can incorporate them into new and evolving, integrated cultural philosophies on health, illness and treatment. The latter is the norm. The ways in which various cultures do this is extremely diverse. The opportunities for medical anthropologists to expand knowledge of these aspects of culture and the human experience are seemingly endless (Čebron

2008).

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Maintaining an attitude and approach of cultural relativity and observation without influence are the anthropologist’s responsibilities; most anthropologists will admit though, that ethnographers cannot help but cause change (American

Anthropological Association 2017). Respect for the cultures being studied is of fundamental importance academically; however, ethical questions arise when offering assistance seems warranted on a human level. If one is convinced that not offering change would be harmful to the people in question, the responsibility becomes considering the most appropriate and least culturally damaging way to offer help

(American Anthropological Association 2017). In these cases, requesting the assistance of informants from the specific culture is valuable. In the case of SP, especially where culture-specific stress is a concern, and most importantly in cases in which the consequences of culture-specific stress seem to be dangerous, as in SUNDS among the

Hmong, surely it is the responsibility of the anthropologist to educate people on the physiological explanations of SP in respectful ways that do not seem to attack their cultural values (Young et al. 2013). Physiological explanations will be valuable in the prevention and treatment of SP, without requiring people to reject their cultural values

(De Jong 2005). Applied anthropologists can indirectly impact patient care by expanding their own knowledge about various cultural views on illness and treatment, and educating health professionals on ways to integrate traditional and biomedical treatment options

(Čebron 2008; De Jong 2005; Lor et al. 2007).

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CHAPTER 8

CONCLUSION

The objectives of this investigation were to provide a comprehensive overview of sleep paralysis (SP) in the literature, to identify major themes, patterns and theoretical approaches, as well key contributors to the ever-expanding body of knowledge about SP.

This has been accomplished through the exploration of SP in the literature from various perspectives within several different genres: the phenomenology of SP, cross-cultural comparison of explanatory models, SP in ancient, historical and modern literature and art, the etymology of SP, and medical perspectives on SP.

The operative theory that SP is a universal human experience has not been disproven, but has been supported by evidence in the phenomenological, neurological, ethnographic, and etymological data that has been explored in this thesis (Davies 2003;

Cheyne and Girard 2007; Jalal and Hinton 2013; Jalal and Ramachandran 2014). The literature has shown this apparent universality is juxtaposed by considerable variability in cultural thematic content of associated hallucinations, as well as cultural narrative explanations of meaning and causality of the SP experience (Gordon 2015; Jalal,

Romanelli and Hinton 2015).

This investigation has also demonstrated that phenomenological, neurological and cultural explanations align with one another, and when approached with respect and an

109 attitude of cultural relativity, no explanation necessarily abrogates another, but may serve to complement one another to the extent of being therapeutic.

Finally, the role of anthropologists in the exploration of SP has been examined.

Many of the various subfields of anthropology will provide benefits to, and benefit from the increase in the overall understanding of the human experience with SP. Certainly the opportunities are many.

110

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