Franz Kafka: An emblematic case of co-occurrence of sleep and psychiatryc disorders

Franz Kafka: An emblematic case of co-occurrence of sleep and psychiatryc disorders Medical literature robustly supports a close link between sleep disorders and psychiatric disorders. Recently, the co-occurrence of sleep dysfunctions and psychotic experiences (particularly insomnia with paranoia) has been reported, although the causal relationship is still unclear [1]. Moreover, Reeve et al. [2] have observed as insomnia, nightmares and circadian phase delay are associated with an increased occurrence of subsyndromal psychiatric symptoms in young people. In this paper, we report an emblematic case of co-occurrence of sleep and psychiatric disorders in one of the most influential writers of the 20th century: Franz Kafka (Prague, 1883-Kierling, 1924). He was affected by tuberculosis, but, as reported by Fe-lisati et al. [3], mental more than physical diseases have influenced his life and literary work. The main information on Kafka′ s health emerge from the large collection of private correspondence and diaries that were published after the writer′s death. From " Diaries " [4] and " Letters to Milena " [5] emerge: an insecure, frail, anxious and depressed personality, a distorted and unstable self-image, a gloomy relationship with his family, friends and loved women, a man living a state of alienation from the outside world and having a self-destructive tendencies. According with 5th edition of Diagnostic and Statistical Manual for Mental Disorders (DSM-V) [6], these impairments in self and interpersonal functioning and the presence of pathological personality traits (as emotional lability, anxiousness and de-pressivity) suggest that Kafka could have suffered from a borderline personality disorder with co-occurring anxiety and depression. Moreover, from " Letters to Milena " clearly emerges that the writer suffered from insomnia. Kafka wrote: " I have had increasing insomnia " and " my health is good, just that I don′t sleep well " [5]. The write knew the sleep′s importance and he lived his insomnia as a guilt: " sleep is the most innocent creature there is and sleepless man the most guilty " [5]. It is difficult to classify Kafka′s insomnia. We suggest that the causes have to be searched in his lifestyle and in his mental disorders. The writer deliberately did most of his intellectual work at night. This choice depends primarily on Kafka′s persuasion that writing in a sleep-deprived state provides access to otherwise inaccessible thoughts. From " Diaries " seems to emerge his fear of falling asleep: " my insomnia only conceals a great fear …