Psychosomatic Medicine 7:279-290 (1945)
© 1945 American Psychosomatic Society

Psychosomatic Regression in Therapeutic Epilepsy

¹ County Mental Hospital Brentwood, Essex, England

A variety of evidence has been considered which suggests that the convulsive process involves a recapitulation of former behaviour patterns and modes of thought. In the somatic field we find that the therapeutic fit is ushered in by a start, or series of starts, which resemble the Moro reflex of infancy, or a modification of it. The start is followed by tonic and clonic spasms, which have been compared to the "sustained" and "jerky" movements described by Barcroft as occurring in the developing sheep foetus. In the latter these movements become inhibited as development proceeds, but under the influence of asphyxia they can be reactivated in the reverse order to that in which they were evolved. It is suggested that during the dissolution of the therapeutic convulsion a similar process of reactivation of foetal movements occurs. Comparison is further made between the decerebrate rigidity noted by Barcroft in the sheep foetus and that which arises in the human convulsion, and attention is called to the fact that infants born prematurely tend to show signs of decerebrate rigidity.

After the termination of the convulsion, but before consciousness shows any signs of returning, certain behaviour patterns appertaining to infancy may be observed. They include sucking movements, the performance of various antics, and babyish crying. The regressive character of this behaviour is very impressive.

Later in recovery, when it becomes possible to establish some sort of rapport with the patient, there are signs of aphasia, a symptom in which Head and others have recognized elements of regression. In speaking, reading and writing the post-convulsive aphasic partly reverts to the methods of childhood. Moreover, in the domain of writing the material written may indicate that in certain respects the patient is living in the past. Former addresses are substituted for present ones, and where the name has been changed the older one is given in preference to the one which is more recent.

The same tendency to slip back into the past continues to be displayed throughout the whole period of recovery, but in the later stages the regression does not necessarily extend back to childhood; only a few years may be involved. Thus, the patient is liable to give his age as less than it is, to price cigarette cartons at their pre-war cost, to think he still has his own teeth when he is in fact edentulous, to believe that his hair is black when it is grey, and to deny that he needs spectacles for reading. These findings are by no means invariable, but the fact that they occur frequently justifies their inclusion as contributory evidence of regression.

Although in many respects the patient is living in the past, he is also to a certain extent living in the present. This sometimes leads to a fusing of psychic material, so that composite formations appear. For instance, descriptions of the present war may be distorted by the inclusion of circumstances of the last one; or the doctor may be identified with persons who in the past exercised authority over the patient. However, this telescoping of psychic material is not confined to the merging of the remote past into the present, for, as a result of perseveration, the immediate past can also impose itself on succeeding events. For example, a word written or spoken a short time previously may reappear and fuse with another word to form a neologism; or a movement recently performed may intrude upon and modify a later movement.

Repetition and perseveration, in some form or other, are almost invariable features of the post-convulsive state. The phenomenon may be exhibited at the reflex level in the form of a sustained or repetitive type of knee jerk. Later in recovery purposeful movements become implicated, and, as a result, an action which has achieved its object may continue to be rhythmically performed. Still later, repetitive movements give place to repetitive or fixed ideas of varying degrees of complexity. In every aspect of psychosomatic functioning this tendency to repeat is liable to present itself. But repetition is also a characteristic of infantile thought and behaviour. The child's first words consist of reiterated syllables, and later there is babbling; moreover, much of the play of infancy and childhood is associated with repetition. Freud noted this feature of the behaviour of children, and from it, as well as from other evidence derived from psychoanalytic experience, he came to the conclusion that the compulsion to repeat was a basic characteristic of primitive instinct. The suggestion is, therefore, made that post-convulsive repetition has a twofold significance: firstly, since reiteration is a normal mechanism of childhood, it indicates regression; and secondly, it can be regarded as the surface sign of a fundamental neural process whereby the psychic and somatic past strives to repeat itself, and succeeds in doing so when the higher cerebral functions are in abeyance.

Finally, in the post-convulsive state there is retrograde amnesia. There is total loss of memory for events which have immediately preceded the fit, and partial loss of memory for earlier events. During recovery from the fit events which are more remote in time are remembered before more recent happenings. This disturbance of memory is claimed to be in harmony with a theory of regression.