Analysis and Structure of a Transient Hypomania

It was my good fortune to observe a definite hypomanic attack of seven days duration, which arose, developed and subsided during the analysis of a person with predominantly hysterical symptoms. The initial presenting symptoms of the hysteria were marked photophobia and sensitiveness to noises. The hypomanic attack occurred one month after she had been in analysis. To provide a background for the understanding of this episode I shall give a very brief account of the pertinent facts in her history.

The patient was an unmarried woman in the early thirties, reared in a puritanical home. Her father, a gentle ineffectual dreamer; her mother a rigid conventional person, with whom the patient had for a long while been on openly hostile terms; and a brother six years her junior, towards whom she was affectionate but "bossy," made up the household. Of her infantile sexual life, the important facts will appear in the discussion of her transient hypomania. Masturbation was never abandoned, and her pre-pubertal period and puberty were filled with overt sexual games and fantasies. The latter included rape and prostitution fantasies, frank fantasies of coitus with her brother, and a dream of overt sex relations with her father. In this dream, she and the father faced each other, kneeling, his penis touching her vulva. They remained perfectly immobile, and he urinated on her genital. This procedure corresponded to her theory of adult sexual intercourse. A game played with another little girl depicts a somewhat different theory of coitus. Each would alternately be the "man" or the "woman"; the "man" would expose the "woman." The day dream in common was, that they were