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Death stalks the sleepwalker



What led a young, successful artist to hang himself? Harry de Quetteville in London explores the terrifying phenomenon of parasomnia pseudo-suicide.



By Harry de Quetteville, The Daily Telegraph September 15, 2010

StoryPhotos ( 1 )





Tobias Wong's family says he could perform highly complex actions while remaining fast asleep -- cooking a meal, browsing the Internet, making purchases on eBay, even doing some design work.

Photograph by: Andrew H. Walker, Getty Images, The Daily TelegraphIt was on a warm and sunny Saturday in New York, back in May, that Tobias Wong killed himself.



The 35-year-old designer had slept in, then browsed a local farmers' market for flowers to plant in his window box. In the evening, he wrote some e-mails while lying on the couch, and then dozed off. The next morning, he was found to have hanged himself. The problem was that, according to his partner, who discovered his body, the dead man had, quite literally, not been in control of his own actions.



Wong, a brilliantly talented conceptual artist, had shown no signs of depression. On the contrary, he was excited by his growing reputation in the design world, where his witty, provocative pieces -- a duvet made from bulletproof Kevlar; a book of dollar bills assembled like a block of Post-It notes; a gold-plated, disposable pen -- had been highly praised. About to open a new design agency, he was working himself hard, but not into the ground. His eyes, said his boyfriend Tim Dubitsky, were fixed on the future. They had even talked about having a child through a surrogate mother.



But there was one long-term issue, a problem that had bedevilled Wong throughout his short life: sleepwalking. Bizarrely, he could perform highly complex actions while remaining fast asleep -- cooking a meal, browsing the Internet, making purchases on eBay, even doing some design work, such as whipping up costumes for his pet cats, or preparing and sending out bills to his clients. His family and friends had learned to look for the telltale signs -- a slightly glassy expression on his face; a sense that he was looking through people, not at them.



Sometimes, the sleepwalking would manifest itself through odd, out-of-character behaviour. Last year, a diner at a restaurant near his home in Manhattan's East Village was surprised to find Wong purloining sausages from his plate. He had turned up for a business meeting over breakfast, despite being fast asleep.



Inevitably, the condition had its dangers. When Wong returned home to visit his parents in their high-rise apartment, his mother would line up chairs in front of the balcony to prevent accidents, as well as laying out food to stop him rooting through the pantry. At times, he would appear to be stranded in a nightmare from which he could not wake -- a syndrome that researchers call "sleep terrors."



On these occasions, Dubitsky might find Wong sobbing to himself, or trying to flee an imaginary intruder. Once, when Wong mistook his partner for a murderer, Dubitsky struggled to reason with him. "I would hold him and talk to him, just reassure him it's something else," he said in an interview after Wong's death. "I'd try to bring him back to reality."



According to specialists, sleepwalking and sleep terrors are part of the same phenomenon, locking sufferers into a state between wakefulness and sleep. The symptoms Wong displayed are known as parasomnias, undesirable physical events that occur during entry to, or a disturbance from, sleep.



"Parasomnias occur with 12 per cent of children up to the age of 18, rising to a peak of 17 per cent at age 12," explains Dr. Michel Cramer Bornemann of the Sleep Disorders Center in Minnesota. "As the brain matures, these behaviours dissipate, but four per cent of adults continue sleepwalking."



Dr. Mark Mahowald, the director of the centre, says that chronic sufferers are "awake enough to perform very complex behaviours, but not awake enough to be aware of or responsible for what they're doing." Crucially, the brain's prefrontal cortex -- the part of the brain where intent, awareness and motivation reside -- is not engaged.



Such research leads inevitably to a chilling question: If sufferers are awake enough to perform complex actions, but stripped of awareness by sleep, might they, in an extreme case, unwittingly kill themselves? In other words, did Tobias Wong commit an act, while asleep, that he would have never contemplated while awake? And if so, can he rightly be said to have committed suicide?



Dubitsky is certain that this is the case. "This wasn't a typical suicide," he told the New York Times. "He wasn't angry, he wasn't sad, he wasn't upset. We were always thinking about our future. We wanted kids. We wanted to find a house."



Cramer Bornemann agrees. If the prefrontal cortex is not accessible, he says, "it's technically not suicide. It's an accident."



The idea that while sleepwalking, the body can overthrow the primacy of the mind, seems like a terrifying reversal of the natural order of things.



But Wong's case is by no means unique. Michael Cox, a trainee manager at a tool shop in Gloucestershire, England, hanged himself in 2001. At the inquest, the coroner's court heard that he was a frequent sleepwalker who had watched Schindler's List on the night of his death -- a film that ends with a graphic hanging.



Jonathan Bird, an expert in sleep disorders at Frenchay Hospital in Bristol, suggested at the inquest that it was possible, although highly unusual, that the scene had lingered in Cox's brain. "Michael's reported history of sleepwalking certainly makes a sleepwalking death more possible," Bird said. "I cannot absolutely rule out sleepwalking as the cause for death."



Cases of suicide while sleepwalking -- known as parasomnia pseudo-suicide -- are relatively rare. But there are many more deaths that occur due to accidents: sleepwalkers strolling into traffic, or falling from windows.



In 2008, Australian sports fans were shocked to learn that Clinton Grybas, a popular television presenter, had died, aged 32, after hitting his head while sleepwalking. Grybas had previously terrified himself by managing to get onto his balcony while asleep. As with Wong, his family was convinced he had never wanted to do himself any harm.



And although death is the most dramatic consequence of such extreme cases of sleepwalking, it is only one of several unwelcome outcomes. In 2006, the researchers in Minnesota began working with defence lawyers and prosecutors around the world who were concerned that their cases involved people who were not fully aware of -- and so not fully liable for -- their actions.



Over three years, the team was asked to investigate 130 cases. These included 41 charges of sexual assault; 31 of drunk driving; two of burglary; and 25 of murder or attempted murder.



The team found that while half of the cases could be attributed to the misuse of sleeping tablets or to narcolepsy (a condition whose sufferers suddenly fall asleep), 59 were due to parasomnias. Of those, four were cases of parasomnia pseudo-suicide.



The results have had such far-reaching legal consequences that Cramer Bornemann has set up a specialist unit, "sleep forensics," to help courts judge whether defendants are responsible for their actions or simply sleepwalking.



The first successful "sleepwalking defence," he observes, was made in Boston in 1846, when a man was acquitted of murder after claiming he was not conscious during the killing. A century-and-a-half later, a defendant in Canada was acquitted of murder and attempted murder after repeatedly stabbing his mother- and father-in-law while sleepwalking.



In the case of Michael Cox, the coroner recorded an open verdict, rather than consider it a suicide. "The experts say a sleepwalking death was very unlikely, but they cannot totally rule it out," he noted. "It is sufficient for the purposes of the law that other possibilities do exist."



In New York, a medical examiner ruled that Tobias Wong committed suicide by hanging. However, his partner, and many of his friends, continue to believe that the true cause of his death was murder -- and that the perpetrator was his own slumbering mind.



© Copyright (c) The Ottawa Citizen



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