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Psychosomatic Medicine, 1946, Vol. VIII, No. 1, pp. 28–35.
The authors present the case of a 49-year-old female who suffered from attacks of uncontrollable sleep for over a year. Observation and treatment covered a period of six years. Brain tumour and encephalitis were ruled out. The duration of the attacks of pathological sleep varied from seconds to thirty-six hours: the depth varied also. The symptoms followed a fairly consistent, though not fixed, pattern. Ordinarily meek and compliant, the patient would have periods of sulkiness, followed by mild drowsiness and motor and sensory conversion phenomena and then the abnormal, deep sleep. She had been having continuous and concurrent sexual relations with her father since the age of six, with a lover since the age of fourteen and with her husband since nineteen. The relations with her father and lover had a strong masochistic and guilt-laden quality.
No significant material could be elicited by hypnosis (perhaps because the hypnotic trance was too similar to the symptom itself), and this approach was dropped after a year. Much material was elicited during a two-year period of direct interviews. During this period drowsiness and successful catharsis were in inverse relation to one another. For the next three years the approach was passive and analytic. During this period the conversion symptoms and attacks of sleep almost entirely disappeared, but a strong sense of guilt supervened. The authors conceive of the narcolepsy as a means of unconsciously satisfying the forbidden wishes without experiencing conscious guilt and also as a simultaneous punishment for the wishes. Because of the close relationship of the symptoms, Spiegal believes that the mechanisms of conversion and narcolepsy must be similar.