There was no doubt that simulation could be ruled out; the differential diagnosis lay between a “confused state of emotional origin” and an “epileptic dazed state.”
For epilepsy there was a history of attacks with falling to the ground and loss of consciousness, without involuntary micturition or biting of tongue, during the time when he was a sergeant. Moreover, irritability and unwarranted suspiciousness had been present at these periods. However, there were no other epileptic symptoms; these two attacks were isolated and of quite long duration, leaving no headache or malaise after them. Also there was no basis for the diagnosis “epileptic dazed state,” since there was no abrupt commencement; the loss of consciousness was never complete (the subject was able to converse with persons while the attacks were on); and some remembrance was present of incidents during the attacks.
For Barat, the important points are that the attacks were preceded by long periods of anxiety and the disturbances resulted more from moral than physiological causes.
The importance of the psychological factors lead the author and his colleagues to the diagnosis “Mental confusion of emotional origin.”
The board decided to return him to the interior and give him a barracks position at the reduced rank of drill sergeant.
A solitary epileptic episode in an artillery officer (slight concussion of the brain two years before) following extraordinary campaign stress (38 artillery battles in two months).
Case 76. (Bonhoeffer, July, 1915.)
A first lieutenant of artillery, 35, was able to count 38 artillery clashes in which he had taken part in two months of very strenuous, almost daily fighting. Then appeared headaches, anxiety, dizzy feelings, insomnia. Finally one day suddenly, after eating, the lieutenant sustained a loss of consciousness with convulsions, which sent him to his home reserve hospital. The officer had felt nothing before his convulsions came on. The medical report, however, yields no doubt of the epileptic character of the attack.
When he was examined, there was a slight psychopathic depression with a feeling of insufficiency, anxiety, insomnia, restless dreams, over-sensitiveness, and a pessimistic outlook on the future. There were no epileptic traits whatever. There was nothing alcoholic, luetic, or arteriosclerotic about the officer. There was nothing in the childhood or youth of the patient, though there had been a fall two years before, with phenomena of concussion without sequelae. In fact, this fall with concussion had led to no medical examination.