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The psycho-analytic treatment of a 10-year-old epileptic boy is presented and reviewed. Treatment revealed that either a meaningufl external situation or a self-initiated series of thoughts aroused in the patient memories of recent and past experiences having to do with dependent, sexual, and aggressive interchanges between key people of the past or recent present, with commensurate affect. The psychological compromise between these conflicts was experienced as a compulsion to go to a window screen and look through. If this was not interrupted, a 'screen' spell (epileptic) invariably started, which, following some psychotherapy, could be modified by verbal communication with the patient. Presumably, memories and thoughts (cortical activity) and the emotional components (subcortical activity) of these ideas modulated 3 c.p.s. spike and wave activity that in itself was not sufficient to cause a seizure. Under other (unknown) circumstances a seizure with highly integrated motor activity could ensue, associated with an altered state of consciousness from which the subject could sometimes be aroused. Sometimes, for no known reason, the relatively localized epileptic cerebral discharges would become diffuse, manifesting themselves as a grand mal seizure. A necessary condition for this sequence of events was a specific anatomical structure and neuro-chemical basis without which the behaviour associated with the psychological state would probably have been otherwise.
The therapeutic problems encountered in this patient illustrate the therapeutic value of psycho-analytic psychotherapy in the management of certain types of epileptics and the value of such studies to our understanding of the interplay of the neural and experiential bases of emotional disorder.