You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
Epileptic phenomena sometimes occur in manic-depressive states. Occasionally, a psychotic episode is preceded by a single convulsion or a series of convulsions. Occasionally a convulsion is followed by a change from a manic to a depressive phase or vice-versa. Occasionally the return to relative normality is accompanied by a single convulsion or a series of convulsions. Minor phenomena allied to petit mal, kinæsthesia allied to aura and psychic equivalents are more frequent than convulsions. Perhaps the most frequent phenomena allied to the epilepsies are those described as 'psycholeptic' by Janet and Adolf Meyer.
Winnicott (1931) discussed and stressed the importance of difficulties of oral instinctive development in children with convulsions. Kardiner (1932) reviewed the earlier rather speculative views concerning the connection between narcissism and epilepsy and published considerable case material supporting his view that epileptic patients had significant difficulties connected with mastery of oral sadistic impulses. Several of his patients who showed both convulsive disorders and marked regression to infantile states, with inability to walk, to talk, or to feed themselves, had been previously classed with the severe traumatic hysterias. Nevertheless they showed many psychopathological connections with the group of severe inhibited melancholic states which are accompanied by a wealth of nihilistic delusions. Ribble (1936) reported four months psycho-analytic treatment of a child of eleven with frequent petit mal attacks and confirmed Kardiner's views.
The two patients whose treatment is later described have perhaps enabled me to understand some further factors which may lead to convulsive phenomena in, at least, some manic-depressive states. I mention manic-depressive states advisedly as I