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Mental Dissociation In Psychomotor Epilepsy

        THE patient is a German, thirty-three years of age; single. He has followed the seas for many years, in both the navy and the merchant arm of the service, chiefly in the capacity of fireman. Of his family, he can give but little information. His mother was a woman of violent temper; her rages have been marked by great excess and chronicity; of his father, he knows no facts of interest or importance. The status and education of both parents were ordinary. The memories of his childhood are rather scanty. His education was no more than that of the routine German common school.

        He was fairly interested and advanced in his work. There is no evidence of neurosis in his early history. Of the diseases of infancy nothing can be obtained. In his childhood he had measles and pertussis, neither of which was followed by any grave sequelæ. His later history, although more varied, is equally uneventful.

        His life as a seaman has subjected him to somewhat severe experiences. He has undoubtedly suffered numerous traumas. None of these, however, have invalided him to any extent. He has never contracted any specific troubles. He is moderate in his drink. The patient has had two severe fevers, from both of which he made a complete recovery. Later he continued his service in the navy. Three years ago, while upon shore duty, he became interested in a young girl who resided at his boarding-house; to her he represented himself as younger than his papers showed. The landlady quietly informed the young lady of this deception; a mutual upbraiding followed, and the girl deserted the patient. The distress of the patient induced him to drink, and for three days nothing but whiskey was taken.

        At the expiration of this period his condition was weak and overstrung. On the evening of the third day of this debauch, he entered the front door of the boarding-house. walked through the saloon, past the lunch bar, into the kitchen where he found the landlady. Towards her the patient directed his invective, as being the source of all his evil. As he was talking, suddenly his hands were extended, and he fell.

        He awoke in a dark room off the kitchen, and was told that he had been "sick." He could remember nothing beyond having talked to the woman, feeling weak, and falling. There was some stupor following the attack. There was no aura,―no sensations, general or particular,―preceding this attack.

        Since this time, he has had numerous attacks at varied intervals. In the beginning, the attacks occurred but once in two or four weeks; the interval gradually declined until, for the last six months previous to treatment, the attacks were manifested three or four times per week; at the latter end, once or twice per day. Preceding all attacks subsequent to the primary, there has been a feeling of pain and distress over the epigastrium; it proceeded upward, and was immediately succeeded by an attack. In these attacks he has usually fallen, lying quietly outstretched, with fingers clutched; sometimes he is restless, his hands fumbling aimlessly. At times he has had general motor disturbances, his arms and legs twitching. frothing at the mouth. Again, occasionally he did not fall, but sat upon a chair, staring fixedly before him. Any degree of excitement sufficed to initiate an attack. Card-playing altercations have invariably produced attacks. There has been complete amnesia succeeding all attacks. His stupor following has also been an unvarying feature. The change in his mental attitude has been very noticeable. He has become progressively less able to attend to his duties; constantly forgets; fails frequently to comprehend remarks or orders given to him. His memory as to the past antedating his attacks has been weakened. He has described himself as being in a state of constant confusion. His depression and so-called stupidity have been very evident. He has secluded himself; has become unsocial, brooding, irritable. He has evinced but little interest for his friends or occupation. His sleep has become light; his dreams distressing. Upon awaking, his depression is exceedingly acute. His somatic condition has been lowered; he is far below weight; his hands have become tremulous; his gait is uncertain.

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