Intoxication and neurology: A Dream Within a Dream



    The author Edgar Allan Poe is one of many artists who describe how it feels to live with major, involuntary changes of consciousness. Are the large upturns and downturns in his life attributable to a neurological conditions, or can substance use and depressive thoughts explain these fluctuations?

    The life and health of Edgar Allan Poe (1809–49) were out of the ordinary and may perhaps have left their mark in his subtle way of expressing himself. The contemplations in the famous poem A Dream Within a Dream (1849) may be regarded as a backdrop to the final years of his life.

    Speculations on the cause of death

    Speculations on the cause of death

    It was said that on the day he died, at the age of only 40, he had drunk only a single glass of alcohol in a bar. Shortly after, he was found unconscious in the street (1). He was taken to hospital, and on the way there he was partly conscious and complained of a headache. He then lapsed into hallucinations, followed by unconsciousness or coma. Three days later, he died.

    Some people claim that he died from non-convulsive status epilepticus (1). Others believe that the cause of death was encephalitis, delirium tremens, pneumonia (2), rabies (3), syphilis (4), head trauma (5) or diabetic coma (6).

    A few months before his death he had published one of his most famous poems, A Dream Within a Dream, which is presented here as a condensed part of his literary career. The poem illustrates how Poe lost control of himself, his memory and his consciousness. Most likely, he also ponders on the opportunities he has missed by being absent and intoxicated.

    A Dream Within a Dream

    Take this kiss upon the brow!

    And, in parting from you now,

    Thus much let me avow —

    You are not wrong, who deem

    That my days have been a dream;

    Yet if hope has flown away

    In a night, or in a day,

    In a vision, or in none,

    Is it therefore the less gone?

    All that we see or seem

    Is but a dream within a dream.

    I stand amid the roar

    Of a surf-tormented shore,

    And I hold within my hand

    Grains of the golden sand — 

    How few! yet how they creep

    Through my fingers to the deep, 

    While I weep — while I weep!

    O God! Can I not grasp

    Them with a tighter clasp?

    O God! can I not save

    One from the pitiless wave?

    Is all that we see or seem

    But a dream within a dream?

    Edgar Allen Poe

    First published 31 March 1849 ( (7) )

    Living in a dream

    Living in a dream

    The obvious interpretation of the poem is that it is a reflection on his love life, whereby he attempts to look back to relive the events of times past. His memories of love are very vague. To his despair, he can no longer recall the things that are valuable to him. There may be multiple reasons why his memory fails. Perhaps his frequent state of intoxication made it difficult for him to identify the real events? Is this the reason why his memories were vague or non-existent? Perhaps he was heading into an alcohol-induced condition such as Wernicke's encephalopathy in his final year of life?

    His alcohol intake can nevertheless not fully explain his condition, for example because he remained articulate and reflective up to the final moment. Korsakov's psychosis is not a plausible explanation, because his presence of mind fluctuated, and he was able to absorb new information.

    In his writings, Edgar Allan Poe describes layer upon layer of dreams and layer upon layer of uncertainty regarding his own consciousness and memory. Most likely, intoxication combined with depression, self-destructive behaviour and seizures of unknown cause all helped gradually exacerbate his health condition. In his poem, he captures something universally human: the feeling that life is transient and memory unreliable. Paradoxically, in his intoxicated state, he succeeded in describing something that applies to us all.


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