Hoffer had the unusual opportunity of analyzing a woman suffering from encephalitis whose only manifest symptom was a mental disturbance. Periodic attacks were characterized by a compulsion to smoke one cigarette after another, accompanied by agitation and depression, and ending in a few hours with symptomatic recovery or deep sleep. After ten months, neurological symptoms were demonstrable.

Hoffer gives special attention to the effect on the ego of encephalitis. The perception of loss of motor control produces a traumatic feeling of helplessness experienced as castration, which is then elaborated in accordance with the individual's developmental history. The disease in Hoffer's case progressed showly, and the patient tried at first to deny the threat to the ego. This mechanism failing, she attempted a neurotic compromise but finally surrendered to the disease. Abundant analytic material is given in support of these conclusions.