Dr. Wilhelm Stekel, however, treats the problem from the therapeutic point of view in, "Die psychische Behandlung der Epilepsie." (Zentralblatt fur psychoanalyse p. 220 No. 5-6, Vol. 1).
The essential kernel of Stekel's view is that the epileptic is a repressed criminal. The convulsion is a substitute for the criminal act. He announces categorically that pseudoepilepsy is curable by psychoanalytic procedures. Of three cases which he completely analysed, two were cured. His final conclusion is fourfold: (1) Epilepsy, more often than we have hitherto thought, is of psychogenic origin. (2) In all cases there is a strong tendency to criminality which is unbearable to consciousness. (3) The attack is a substitute for an offense, hence, eventually a sexual offense. (4) Pseudo-epilepsy is curable by psychoanalysis.
Spratling calls attention "to the value of an occasional convulsion in certain cases. In some patients the fit acts as a safety valve that unquestionably permits escape from insanity. . . In many cases the convulsion seems t o come as the termination of an obscure (auto-toxic) cycle which varies in duration in different individuals and bears some relationship to the ascending period of the folie circulaire of the French. It seems that the specific cause of the fit in these cases is something that permeates the entire organism; something that comes and goes; that grows rapidly in intensity, exerting a pernicious influence on the patient by making him act out of harmony with his normal state, until the limit is reached and the mind loses its direction and control. The power of inhibition being finally destroyed, the nervous storm breaks with great force and violence." p. 361.
Although Spratling had in mind a toxic agent, one cannot but be struck with how completely his terms describe an emotional outburst.
In a paper read in Boston last winter, Dr. L. Pierce Clark advanced the view that the epilpetic seizure was the symbolical expression of the desire of the patient to return to the mutterleib. The convulsive moments were such reflect and random acts as one sees in infants or infers in the embryo. Regard for social sanctions is lost. This, of course, suggests the first step in criminality. Clark found that favorable cases were amenable to psychic treatment and said that some cases had been very much helped by psychoanalysis. I am not certain whether he claims to have cured any particular case of pseudo-epilepsy or epileptiform attacks, by psychoanalysis. In presenting some of my own cases let me begin with one that certainly was not a complete success, but nevertheless was much helped by psychoanalysis.
This case is that of a young girl, aged 14, without known inherited tendency. Her first attacks had occurred about a year previous in the form of fainting spells. These were afterwards followed by convulsions. In convulsions the patient thrashed about, kicking her legs and clawing at her chest. These convulsive movements stopped after a while and were followed by a deep sleep, after which the patient awoke without any memory of what had happened.
It was found that during the convulsion the patient imagined she was being pursued by a black-faced figure with claw-like hands, of a peculiar shape like her father's.
Further investigation showed that her father got drunk and did chase her, sometimes kicking her out of the house. She would undress her father sometimes and put him to bed. Once when taking off his shoes he kicked her, as she was bending over him, in the lower part of the abdomen. This was just before the convulsions developed. The fainting spells occurred soon after she had first seen her father naked. The image of his nakedness so distressed her by continually coming before her mind that she made the most desperate efforts to repress it, finally partially succeeding. Speaking of her father she said, "Every time I think of him I feel like taking a fit. Oh! It makes me feel terrible."
Her father had kicked her in the chest, too, which perhaps partially accounts for the clawing.
In the light of this knowledge the convulsive movements become a little more comprehensible. They are futile attempts to run away. They are the partial movements of flight.