Periodical Insanity.
Just as in cases of non-periodical mania, an abnormal intensity or a noticeable prominence of the sexual sphere is very often manifested in the periodical attacks (v. infra, “Mania”).
The following case, reported by Servaes (Arch. f. Psych.), shows that it then may also be perverted:—
Case 161. Catharine W., aged 16; she has not yet menstruated; previously healthy.
Seven weeks before admission (December 3, 1872), melancholic depression and irritability. November 27th, maniacal outbreak, lasting two days; thereafter, melancholic. December 6th, normal condition.
December 24th (twenty-eight days after the first maniacal attack), silent, shy, depressed. December 27th, exaltation (jolly, laughing, etc.), with violent love for an attendant (female). December 31st, suddenly melancholic catalepsy, which disappeared after two hours. January 20, 1873, new attack like the previous one. A similar one on February 18th, with traces of menses. The patient had no memory whatever for what occurred in the paroxysms, and blushed scarlet with astonishment and shame when told about them.
Thereafter there were abortive attacks, which entirely disappeared, to give place to the normal mental condition in June.
In a case reported by Gock (Arch. f. Psych., v), which was probably circular insanity, in a man of very bad heredity, during the stage of exaltation there was manifestation of sexual feeling for men. In this case, however, the patient thought himself a girl, and it is questionable whether the sexual inclination was induced by the delusion or by a contrary sexual instinct.
In connection with these cases of abnormal manifestation of the sexual instinct are those which, as a symptom of mania, manifest an abnormal and frequently a perverse sexual instinct in an impulsive way, analogous to dipsomania, which forms the nucleus of the psychical disturbance, while in the intervals the sexual instinct is neither intense nor perverse.
Quite a pure case of such periodical psychopathia sexualis, connected with the process of menstruation, is the following, reported by Anjel (Arch. f. Psych., xv, H. 2):—
Case 162. A quiet lady, near the climacteric. Very bad heredity. In her youth, attacks of petit mal. Always eccentric, quick-tempered; very moral; childless marriage.
Several years ago, after a violent emotional disturbance, a hystero-epileptic attack, with post-epileptic insanity of several weeks’ duration. Thereafter there was sleeplessness for several months. Following this, there was always menstrual insomnia, and the impulse to embrace and kiss boys of ten, and fondle their genitals. During this excitement there was no desire for coitus; certainly not for intercourse with adults.
The patient often speaks openly of this impulse, and asks to be watched, as she is not to be trusted. In the intervals she anxiously avoids all talk of it, is very modest, and in nowise passionate sexually.
With reference to the still imperfectly-known cases of periodical psychopathia sexualis of this kind, Tarnowsky (op. cit., p. 38) has made valuable contributions, though his cases were not all of a periodic nature; and one of the cases, taken from a work of the author’s, is not rightly understood (Case 8, p. 37), since sodomy was only subsidiary, and the abnormal intense libido sexualis was not periodic.
Tarnowsky reports cases where married, cultured men, the fathers of families, were, from time to time, compelled to perform the most terrible sexual acts, while during the intervals they were sexually normal, abhorred their paroxysmal sexual acts, and shuddered before the expectation of their repetition.
If a new paroxysm came on, the normal sexual instinct disappeared; a state of mental excitement arose with insomnia, and thoughts and impulses to commit the perverse sexual acts, with anxious confusion and an increasing impulse to the abhorred indulgence. In this state the act was a relief, because it ended the condition. The analogy with dipsomania is complete.
For other cases (of periodical pederasty), vide Tarnowsky, op. cit., p. 41. The case there reported, on page 46, belongs in the category of epilepsy.
The following case, reported by Anjel (Arch. f. Psych., xv, H. 2), is one of the most typical of the convulsive-like occurrence of sexual excitement:—
Case 163. A gentleman of high social position, aged 45; generally respected and beloved; heredity good; very moral; married fifteen years. Previously normal sexually; the father of several healthy children, and living in happy matrimony. Eight years ago he suffered a violent fright. For some weeks thereafter he had a feeling of apprehension and cardiac attacks. Then came attacks, at intervals of several months or a year, of what the patient called his “moral catarrh.” He became sleepless. After three days, loss of appetite, increasing irritability, strange appearance; fixed stare, staring into space; paleness, changing with redness; tremor of the fingers; red, shining eyes, with peculiar glassy expression; and violent, quick manner of speech. There was a desire for girls of from five to ten years, even for his own daughters. He would beg his wife to guard the children. For days at a time, while in this state, he would shut himself in his room. Previously he was compelled to pass school-girls on the street, and he found a peculiar pleasure in exposing his genitals before them, by acting as if about to urinate.
For fear of exposure, he shuts himself in his room, full of desire, incapable of movement, and torn by feelings of fear. Consciousness seems to be undisturbed. The attacks last from eight to fourteen days. The cause of their return is not clear. Improvement is sudden; there is great desire for sleep, and, after this is satisfied, he is again well. In the interval there is nothing abnormal. The author assumes an epileptic foundation, and considers the attacks to be the psychical equivalents of epileptic convulsions (!).
Mania.—With the general excitation that here exists in the psychical organ, the sexual sphere is likewise often implicated. In maniacal individuals of the female sex, this is the rule. In certain cases, it may be questionable whether the instinct, which, in itself, is not intensified, is simply recklessly manifested, or whether it is present in actual abnormal intensity. For the most part, the latter is the true assumption,—certainly so where sexual delusions and their religious equivalents are constantly expressed. In accordance with the degrees of intensity of the disease, the intensified instinct is expressed in different forms.
In simple maniacal exaltation in men, courting, frivolity, and lasciviousness in speech, and frequenting of brothels, are observed; in women, inclination for the society of men, personal adornment, perfumes, talk of marriage and scandals, suspicion of the virtue of other women; or there is manifested the religious equivalent,—pilgrimages, missionary work, desire to go into a cloister or to become the servant of a priest; and in this case there is much talk about innocence and virginity.
At the height of mania there may be seen invitations to coitus, exhibition, obscenity, great excitation at sight of women, tendency to smear the person with saliva, urine, and even fæces; religio-sexual delusions,—to be under the protection of the Holy Ghost, to have given birth to Christ, etc.; open onanism, and pelvic movements of coitus.
In maniacal men care must be taken to prevent shameless masturbation and sexual attacks on women.