WHEN a new method of working in any field of endeavor is devised, or a new point of view is discovered, it is natural to turn to other similar fields to see if the method will work there. This is what is done when one approaches the study of Epilepsy from the point of view of psychoanalysis.
It is not my purpose to undertake an exhaustive psychoanalytic study of Epilepsy. Neither is it my purpose to enter into a discussion of the problems of differential diagnosis. It has already been shown, in borderland cases, that one cannot tell the difference between epilepsy and hysteria, without a prolonged psychoanalysis, and even then one cannot be certain. This suggests that the whole thing is more or less a matter of definition. Into such questions I cannot enter. My aim is much more modest. The immediate purpose of my paper is to study some of the problems of therapy, from the psychoanalytic point of view, of that small class of patients on the borderline between hysteria and epilepsy, or patients with epileptiform attacks.
The first publication of studies of this general nature was made by Dr. James J. Putnam and Dr. George A. Waterman in the Boston Medical and Surgical Journal for May, 1905, under the title "Certain Aspects of the differential Diagnosis between Epilepsy and Hysteria." In this paper the authors say, "No one, so far as we are aware, has as yet studied with sufficient thoroughness the subconscious memories of epileptics, and for all we now can say, closer resemblances may be found between these and the subconscious states of the hysterics than we now imagine." p. 513.
In this paper, however, therapy is only hinted at.
A contribution to our insight as to the epileptic state of mind is made by
Jung, under the title, "Analyse der Assoziationen eines Epileptikers," in
his, "Diagnostische Assoziationsstudien. Beitrage zur experimentellen
Psychopathologie." p. 175 (1906).
He found an extraordinary number of emotionally toned, egocentric relations. There were some signs to suggest that the emotional tone in the epileptic was unusually lasting.
The first thing published on epilepsy avowedly from the psychoanalytic view-point was by Maeder: "Sexualitat und Epilepsy." Jahrbuch BI HI, 1909.
Maeder goes into the subject rather exhaustively, after characteristic German fashion, but his conclusions are comparatively simple. He says, "The sexuality of the epileptic is characterized by the prominence of auto- and allo-erotism. It retains much of the infantile form, but has undergone, nevertheless, a certain development, which I designate as 'sexual polyvalence.' For some unknown reason the libido seems to have an abnormal intensity." p. 154.
This is an important contribution to our knowledge of the psychic state of epileptics but it is notable that not a word is said as to therapy.
Sadger published the same year, "Ein Fall von Pseudoepilepsia hysterica psychoanalytisch erklart." (Wiener klein. Rundschau, p. 212, 1909.) But neither does he have anything to say about therapy.