Weill Cornell Medical College, New York, NY, USA.
Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
J Gen Intern Med. 2023 Dec;38(16):3621-3627. doi: 10.1007/s11606-023-08414-x. Epub 2023 Sep 22.
Harriet Tubman, a hero of the abolitionist movement and early civil rights advocate, suffered a head injury in childhood and subsequently developed sleep attacks associated with visions that were extensively documented in historical accounts. Her contemporaries perceived these visions together with unpredictable and unavoidable urges to sleep as manifestations of her deep faith, rather than as symptoms of an illness. While religious perspectives remain crucial to understanding Tubman's sleep-related experiences, some may consider them insufficient in view of modern medical advances. We propose the parallel explanation that her sleep attacks, usually attributed to temporal lobe epilepsy, actually represent a hypersomnia that is most consistent with the modern diagnosis of post-traumatic narcolepsy. Using historical analysis as well as current understandings of sleep medicine, we aim to shed light on this under-recognized aspect of Tubman's life. In addition, this case study allows us to review the potential long-term effects of severe traumatic brain injuries; consider a differential for excessive daytime sleepiness and hypnagogic hallucinations; and familiarize readers with the pathophysiology, diagnosis, and treatment of narcolepsy. Whether her symptoms are viewed through the lens of the past or measured against current biomedical standards, Tubman demonstrated an inspiring ability to persevere despite intrusive sleep episodes and to realize her dreams for the betterment of others.
哈丽特·塔布曼是废奴运动和早期民权运动的英雄,她在童年时头部受伤,随后出现了与幻觉相关的睡眠发作,这些在历史记载中都有详细记录。她的同时代人将这些幻觉以及不可预测和不可避免的睡眠冲动视为她深厚信仰的表现,而不是疾病的症状。虽然宗教观点对于理解塔布曼的睡眠相关经历仍然至关重要,但从现代医学进步的角度来看,有些人可能认为这些观点不够充分。我们提出了一个平行的解释,即她的睡眠发作,通常归因于颞叶癫痫,实际上代表了一种嗜睡症,这与现代创伤后发作性睡病的诊断最为一致。我们使用历史分析以及当前对睡眠医学的理解,旨在揭示塔布曼生活中这一未被充分认识的方面。此外,这个案例研究使我们能够回顾严重创伤性脑损伤的潜在长期影响;考虑白天过度嗜睡和催眠幻觉的鉴别诊断;并使读者熟悉嗜睡症的病理生理学、诊断和治疗。无论从过去的角度还是从当前的生物医学标准来看待她的症状,塔布曼都表现出了令人鼓舞的毅力,尽管她会受到睡眠发作的干扰,但仍能坚持实现她为他人谋福利的梦想。