Isakower phenomenon

   The eponym Isakower phenomenon refers to the Austrian-American psychiatrist and psychoanalyst Otto Isakower (1899-1972), who in 1938 published a study, based in part on an autoreport, of compound " hypnagogic phenomena reminiscent of the very earliest sensory history of the child, notably nursing at the breast. These hyp-nagogic phenomena include the sensation of a shrinking, or - more often - a swelling of the hands or other body parts, as well as the sensation of having something dry, crumpled, or sandy on the skin or inside the oral cavity. These phenomena may be accompanied by a sensation of floating, or of derealization or depersonalization. As Isakower observed, "The state in question... is one in which sensations very different from those of waking life are experienced in certain regions of the body and conveyed to the subject by more than one of his senses. The principal bodily regions concerned are the mouth, the skin and the hand. In many cases there are, as well, distinct sensations of floating, sinking and giddiness... Most striking of all is the blurring of the distinction between quite different regions of the body, e.g. between mouth and skin, and also between what is internal and what is external, the body and the outside world. We note too the amorphous character of the impressions conveyed by the sense-organs. The visual impression is that of something shadowy and indefinite, generally felt to be 'round', which comes nearer and nearer, swells to a gigantic size and threatens to crush the subject. It then gradually becomes smaller and shrinks up to nothing. Sometimes there is fire somewhere in the room. The auditory impression is of a humming, rustling, babbling, murmuring, or of an unintelligible monotonous speech. The tactile sensation is of something crumpled, jagged, sandy or dry, and is experienced in the mouth and at the same time on the skin of the whole body. Or else the subject feels enveloped by it or knows that it is close at hand. Sometimes it feels as if there were a soft yielding mass in his mouth, but at the same time he knows that it is outside him." The symptoms described by Isakower would seem to occur most frequently during childhood and puberty. However, they can also occur during febrile or toxic states, and during psychoanalytic sessions. Although the phenomenon is considered quite common, there are only a few case reports. Isakower suggested certain parallels with " aurae preceding an epileptic seizure, and with phenomena such as déjà vu and déjà vécu. Nevertheless, he conjectured that the phenomena in question may well represent a revival of very early ego-attitudes, not necessarily related in a pathophysiological sense to focal epileptic seizures. The Isakower phenomenon is sometimes classified as a variant of the "blank hallucination.

   References

   Campbell, R.J. (1996). Psychiatric dictionary. Seventh edition. Oxford: Oxford University Press.

   Dann, O.T. (1992). The Isakower phenomenon revisited: A case study. International Journal of Psycho-Analysis, 73, 481-491.

   Isakower, O. (1938). A contribution to the patho-psychology of phenomena associated with falling asleep. International Journal of Psycho-Analysis, 19, 331-345.