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Psychoanalytic insight gained in the analyses of seven patients with epilepsy was applied to the treatment in a clinic of children with petit mal. A seven-and-one-half-year-old boy suffered his first attack of petit mal when, at the age of four and one half years, he was frightened while crossing the street and had to hold on to his mother to keep from falling. In play sessions he would shoot at others, then pretend to shoot and kill himself. Discussion of a recurrent nightmare about a murderer coming into the house revealed the boy's jealousy and hostility against his brother, his resentment of his mother, and his conflict over whether to submit to her passively or to free himself from her by overcoming her or leaving her.
His sensation of falling in the street was related to unconscious suicidal impulses; the attack of petit mal expressed his wish to fall and be run over, and his defense against the wish. As analysis proceeded, the attacks became shorter in duration but the boy became more aggressive, developing tantrums and a tendency to use bad language. At this time it was necessary to give therapy to the mother to prevent her restricting the boy too severely.
He now drew pictures of devils, telling the therapist, 'The devil is dead. I have killed him and now he does not bother me any more.' He complained outspokenly about his mother, and his sexual wishes and fantasies began to emerge. Homosexual impulses, mobilized in defense against his intense castration anxiety, appeared. The petit mal now disappeared, replaced by 'headaches' described as waves of dizziness.
Psychogenic headache is related to petit mal and other forms of epilepsy; both conditions are derived from the reaction in childhood to overwhelmingly strong destructive impulses. The transformation of the patient's symptoms from petit mal to 'headaches' indicated a change in attitude toward his 'unconscious' and a consequent change of his mechanisms of defense against dangerous and objectionabl