Psychosomatic Medicine 10:73-94 (1948)
© 1948 American Psychosomatic Society

Studies on Epilepsy: The Petit Mal Attack as a Response Within the Central Nervous System to Distress in Organism-Environment Integration

¹ New York Hospital and the Department of Medicine, Cornell University Medical College New York, N.Y.

A patient with typical petit mal was studied extensively and intensively. The study began with an investigation of the dynamic relationship between petit mal attacks and the situations in which they occurred. Free association revealed that, beneath the "neutrality" of situations and the patient's apparent responses, intense emotional reactions were concealed. These emotions were then traced to their origins in disturbing childhood experiences which had been "forgotten." The patient's real history was in sharp contrast to the chronology of unemotional events which she had first reported. Parental ambivalence and rejection had created a desperate need for security and peace. The patient sought tranquillity in life by attempts to impose it on external reality. The petit mal attacks, by preventing awareness of emotional responses to contemporary situations, preserved the facade of "neutrality" and "tranquillity." Investigation and therapy were aided by the fact that the growing discrepancy between illusion and reality threatened a complete breakdown of the patient's pattern of integration. The results of this study may be relevant to the general problem of epilepsy. The patient's attacks were historically, clinically, and electroencephalographically typical of petit mal.

In this patient:

The frequency of petit mal attacks is in part a function of the intensity of life situation stresses and the patient's ability consciously to face them.

The specific relation of petit mal attacks to particular life situations may be ascertained by free-associational reconstruction of the events immediately preceding the loss of consciousness.

The petit mal attack abolishes consciousness when unconscious emotional responses and their demand for action seriously endanger the patient's consciously acceptable patterns of behavior.

When petit mal attacks fail sufficiently to inhibit the elaboration in awareness of the emotional responses, other reactions may occur. "Psychosomatic" symptoms, appropriate to the conflict, may appear. When the emotions, whose suppression or symbolic expression are connected with the symptoms, continue toward awareness, narcoleptic sleep, psychomotor acting-out, major convulsions, and other "epileptic" symptoms may occur.

When these symptomatic blocks are in turn removed by analysis, "hysterical" episodes of dramatic reliving of the significant childhood traumatic experiences may occur.

The petit mal attack appears to be a specific response within the central nervous system which abolishes consciousness when awareness of the discrepancy in the immediate situation between consciously acceptable responses and the true unconscious reactions threatens to disrupt the patient's existing pattern of integration.