It would only begin to make sense, years later, after my formal medical education was complete, when my nocturnal “demon” was finally dethroned. His supernumerary power, in which I once believed, would be exposed. I was twenty-three years old, studying abroad in Japan, willing to create my own version of “Japan,” not unlike Roland Barthes in Empire of Signs. My quixotic nature had set in, and though I’d only begun to learn the language, the hiragana and katakana syllabary, my aim, really, was “to know a foreign (alien) language [but not necessarily] to understand it.” To immerse myself in the maelstrom of a culture so radically different from my own.
Adding to this sense of uncanniness, a statue of the Fox God “Inari,” the Shinto deity of rice, agriculture, and industry, was situated just outside my small, sparse room in Totsuka-ku, a small ward of the city of Yokohama in Kanagawa Prefecture. Visitors to his modest shrine would offer grains of rice and small coins for a promise of a better future, replete with wealth and success. Encountering the metal effigy of this fox-man, I’d immediately felt an affinity toward him. He towered high above me, at least ten feet in height, possibly taller, and his facial expression was stern yet somehow inviting. Fox-faced, he had the body of a man, for the most part. Caught in an awkward position: ready to pounce at a moment’s notice, yet able to be restrained if his muscles contracted in time. It was this instantaneity, two divergent positions at once, that was so exciting. The digits of his metal paws were flexed, clawed, but eroding, evidence of existence in the bamboo forest, pigeon dung likely have caused the erosion. This flaw highlighted his man-ness even more clearly—a Barthesian punctum simultaneously pricking and soothing. I empathized with this aspect of his mortality. Yet, he was still god, this fox, and you only had to see him in his statuesque rawness to believe it. In this small village, the statue appeared to me like a diasporic hallucination, there but not there.
A hallucination is nothing strange, really. We all recognize that it’s a form of perception—whether auditory, visual, olfactory, or tactile—that’s been severed from a stimulus, yet still evoking an external reality “out there” in a conscious and awake state. This is opposed to the related phenomena of a dream you experience while asleep. There are myriad causes of hallucinations, ranging from the psychophysiologic to the psychobiochemical, from a disturbance in the brain “architecture,” as in schizophrenia, to the use of drugs, like “acid.”
My experiences in Japan became even more uncanny and puzzling when I’d try to sleep. Although I was sleeping in a foreign environment near a dense bamboo forest, my sleep was disrupted for other reasons: a circadian arrhythmicity and a general, self-imposed sleep restriction to ensure that I’d see all Japan had to offer before I left.
One night, drifting to sleep, I felt Inari’s presence in my room, his bronze fox head floating and bobbing high above me. Paralyzed, powerless, I could neither scream nor flee. Lasting only a few minutes, the vision nevertheless felt like a never-ending repetition of the same—the always already there.
Later, drifting again into sleep, I saw not-quite-dead shadow people levitating me and trying to throw me off a two-story balcony. (They were unsuccessful, as I awoke before they performed their deed.) These two discrete episodes caused great nocturnal fear and dread in me whenever I’d try to sleep. Fearing Inari himself was somehow responsible for these episodes, I, like his Japanese worshippers, began offering him rice, with hope he’d disengage himself from my much-needed sleep.
I kept these experiences to myself for several years, until I matriculated at medical school at twenty-seven. Listening to a lecture on sleep physiology, I learned that what I’d experienced was a phenomenon of sleep paralysis, with its associated hypnagogic hallucinations. What I’d feared about and ascribed to Inari was nothing more than a misplaced remnant of a disrupted sleep “architecture.” As adults, we undergo sleep cycles that are normally entered through stage one sleep and progress to more restful and deeper stages, culminating in rapid eye movement (REM) sleep, named for saccadic movements of the eye associated with dreams and nightmares.
Sleep paralysis occurs when REM sleep commences instantaneously as you’re is drifting to sleep, but not quite asleep. During REM, your body becomes becomes paralyzed (although there are pathological variants of this stage), except for the ocular and respiratory muscles, to ensure your body’s safeguarded from potential physical injuries that can occur if a dream is enacted. If REM is displaced onto the awake state, you’re aware but paralyzed and susceptible to various dream-like visual, auditory, gustatory, and tactile sensations. Hypnagogia—a term coined by the French scholar Alfred Maury—describes the transitional stage between wakefulness and sleep, while hypnopompia, its twin counterpart—named by the spiritualist Frederick Myers—describes the state leading out of sleep. Many kinds of hallucinations can occur during these liminal periods.
Even more peculiarly, these sleep-caused hallucinations may be considered waste products of the body, or what Julia Kristeva would theorize as abject: “a ‘something’ that I do not recognize as a thing. A weight of meaninglessness, about which there is nothing insignificant, and which crushes me.” You may be able to see or hear or touch yourself as another, much like how I hallucinated hovering above the railing of the balcony, but “it is no longer I who expel, ‘I’ is expelled.” You’ve been “vomited,” perhaps in a different form. The hallucinations are, in another sense, imagery that’s wasted, one that should have come before or after but made it too late or too early: hypnopompic or hypnagogic. Somebody who experiences these hallucinations cannot really properly enjoy them either, since these terrifying images are bleeding into another transitional state: moving from pleasure into pain, what Lacan calls jouissance.
The purpose of dreams remains elusive, caught between a speculation that theorizes a processing and dispensing of information and memories, and one that proposes a random activation of the brain causing hallucinations, not to mention a final synthesis to make sense of the bizarreness of it all. There may be a telos for dreams, but the hallucinations inherent in a dream, at least as modern theories go, are byproducts, trash, simply there. They are the potential waste of a given day or several days previous, which need to be sorted either as rubbish or memories recycled for future use. These theories purport that the hallucinations are residues, not Freudian symbol-driven contents signifying hidden depth.
The hypnagogic and hypnopompic hallucinations highlight this fact: that the imagery could be meaningless since it can occur outside the dream and be displaced, that it can be mere hallucination and nothing more. A wide spectrum of hypnagogic hallucinations can occur, the most common being those that are, first, visual, comprised of images from the previous several hours; second, auditory, as in having one’s name called; and third, sensory, such as falling followed by a myoclonic jerk that jolts the sleeper back to wakefulness. Inari’s head, bobbing in the air, falls into the former category. The “Tetris effect”—named after the video game of the same name—is also another interesting variation whereby people who have engaged in a repetitive activity before sleep, usually involving motion, perceive their images as moving in a similar fashion when experiencing a hypnagogic hallucination.
It’s no wonder that sleep paralysis and its accompanying hallucinations have been associated with demons and hags, incubi and succubi. In African culture, the paralysis is referred to as “the witch riding your back,” while in China it’s known as the “ghost pressing on your body.” Japanese culture refers to isolated sleep paralysis (ISP)—distinguished from sleep paralysis arising from narcolepsy—as kanashibari, translated as “bound or fastened in metal.” Fascinatingly, Japanese people experience a higher frequency of sleep paralysis: there is a greater prevalence of narcoleptics in that country. (Sleep paralysis can be one of the criteria for the diagnosis of narcolepsy.)
Henry Fuseli’s painting The Nightmare is considered a classic portrait of sleep paralysis. It wonderfully captures the hallucinatory quality of an incubus pressing on a body, the body of a woman, in this case, which lies supine, presumably asleep, her arms dangling downward, powerless to flee. Even in 1781, Henry Fuseli got things right: He depicts the visual, often “demonic” hallucination that can be a part of sleep paralysis, the sense of suffocation, and the increased likelihood of experiencing it when sleeping face up, supine.
As I’d later learn in medical school, irregular sleep schedules and sudden environmental changes are risk factors in experiencing ISP, which, according to most epidemiological studies, occurs at least once in a quarter of the general population. These factors, no doubt, also brought me closer to my “demon” while I was in Japan, a “demon” that—in the end—was simply sleep debris, always arriving a little too early.
 Roland Barthes, Empire of Signs (Hill and Wang, 1983)
 Julia Kristeva, Powers of Horror: An Essay on Abjection (CUP,1982)
Pedram Navab is a neurologist and a Fellow of the American Academy of Sleep Medicine currently residing in Los Angeles. Educated at Brown and Stanford, he holds both a graduate degree in English/Modern Culture and Media and a JD. His debut novel, Without Anesthesia, was published in 2015. His second novel, This Will Destroy You, was published in 2019. In his spare time, Pedram acts and makes short films.