A careful analysis of the personal histories of patients showing the clinical syndrome of idiopathic narcolepsy indicates that this condition is a personality reaction to emotional issues, rather than an organic disease as has formerly been assumed. The symptoms of excessive diurnal sleep, cataplexy, sleep paralysis, somnambulism, nocturnal hallucinations and frightening dreams, which occur singly or in combination, appear to be neurotic defenses, with symbolic significance, against primary anxieties associated with difficulties in realistic adjustments in personal relationships with others. The narcoleptic syndrome as a neurotic reaction seems similar in many respects to the hysterical reaction.
Patients showing the narcoleptic syndrome have in common a characteristic background of emotional conflict. They feel caught in a life-pattern to which they are expected to conform, but which they deeply resent. They become motivated by a need for autonomy and for self-differentiation along the lines of some alternative life-pattern of their own choosing. They are frustrated in their efforts to achieve this, because of the actual psychological ties which bind them to the life-pattern which they feel impelled to reject. In the tensions of the resulting emotional dilemma, the narcoleptic symptoms appear. As a result, a realistic showdown, with its associated anxieties, is avoided, and a substitute and more acceptable source of concern is provided.
In our experience, these patients have proved responsive to psychotherapy which should provide a fundamental approach to their difficulty.