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Boris Sidis, M. A., Ph.D.,
FIRST ATTACKS AND AURA
WITH this history the patient presented himself on the [Monday]14th of October, 1901. A history like this is without any hesitation regarded as epilepsy, and in fact the physician who treated the patient pronounced the case as that of typical epilepsy, with petit mal attacks as the predominating "symptoms." Let us see what a closer scrutiny revealed. There were certain features about the case which did not seem to indicate epilepsy. There was the absence of any aura at the initial attack, with later an appearance of a very definite aura at succeeding attacks. Further, the patient now and again could give a stray memory from one of the attacks. This aroused our suspicions. The definiteness of the flash of recovered fragments of memory did not quite resemble the mental condition of the attacks of typical organic epilepsy. Should he now be able to give a full account of experiences during one of his attacks, his condition would still less resemble organic epilepsy. If memory of one attack could be regained, the entire series might well be recoverable. This would definitely prove a functional psychosis, a psychosis simulating epilepsy.1 With these possibilities in view, on the [Tuesday] 22d of October, one week after initial examination of the patient, systematic work was begun. The patient was deeply hypnotized. During this condition there was a strong insistence upon his recalling all the incidents of his first attack.
The patient was profoundly affected. He spoke at first hesitatingly, with some motor disturbances, his hands twitching. He was very restless until he had begun; after this but little assistance was needed. He said: "I was standing in the kitchen, talking with the landlady, when I felt weak and fell."―"No, I was not dizzy, simply weak." He was asked, "What were you thinking of?" He answered, "Of the girl." He was asked, "Did you fall to make the landlady feel badly?" He answered: "No, I fell because I was weak. Then, when I fell, the missus called to her man, and he came and picked me up." When asked, "How?" he said: "By the shoulders. The woman said, 'William is sick.' I remember it all now. Then they carried me to a little dark room and laid me down, and I asked where I was and why they do that. Then the girl she came in and asked me, ‘Billy, what is the matter?' and I told her, 'Nothin', everything is all right.' Then she asked if it is her fault, and I said, ‘No, it has nothing to do with you’. Then the missus say to her, ‘You go away now,' and the girl goes away crying. Then I wake up and ask all about it, but they tell me nothing, except that I was sick."
Interruptions in the form of questions retarded and troubled him, thereby causing a mild excitement. A short rest was given, during which the patient sank to the former depth of hypnosis, from which he had partially risen during the revival of these memories.
A description of the next attack was entered upon. There was hesitancy at first, soon followed by great ease and facility of reproduction. He said: "I was standing in front of the house, talking with a fellow, in the evening, when I suddenly get dizzy and fall. As I lie on the ground, I remember now seeing him run to the house for the boss, saying, 'Come out, William is sick.' Other people were there. Yes, I remember them now. They were from the same house, and they all looked frightened and asked what was the matter with me. I remember the boss coming out with the men and putting me in a chair, and then I woke up."
He was awakened gradually and slowly. When asked, if he now remembered about his first attack, he assumed an attitude and expression of extreme abstraction. In this condition, with great detail, he related all the incidents previously given. The emerged memories were very vivid. "I see them out of my own head," he said. "I see the people, the street; God! I see it all. It is not like some one telling me; it is like seeing it yourself. I remember it all now."
We have here seen that the memories of the first two attacks were fully recovered. If now we could trace the genesis of the aura and the content of experiences of the psychomotor attacks, the functional character of the epilepsy could be clearly demonstrated.
During the latter course of the previous conversation, the patient voluntarily stated that he had just recalled that, beginning with his second attack the seizures had been preceded not only by a stomach pain, but also by an immediately succeeding foul taste in his mouth, accompanied by a most fetid odor.
A sense of nausea overlaid all. Particularly, it is to be noted, that this aura appeared at the second attack. This would seem to refer the time of its genesis to that of the initiatory attack; yet nothing that could be elicited from the patient in his waking state seemed to strengthen the supposition. At the time he fell in the kitchen, dinner was being prepared. The smell was like nothing there. To him the smell resembled that arising from the floor of the fire-room in a steamboat upon which has escaped the surplus oil, remaining there until it has become rancid. Were this, however, the true genesis, then the first attack should have been so conditioned equally with those succeeding. Again, it will be recalled that the patient had been seriously ill with both yellow and malarial fevers, with general delirium. No medicine taken at the time, no odor of the hospital, nor of the forecastle resembled that of the aura. Moreover, the same objection can be made against this supposition as against the immediately preceding one,―the aura should have then been present at the first attack. It was evident that nothing further could be gained in the waking state. It remained only to tap the subconscious. Hypnosis was easy, as usual. An immediate search after the origin of the aura followed.
There was first an insistence upon the patient's recollecting the taste and the smell constituting the aura, as to how they came. With but slight hesitation the patient said, "It was a bad taste, like the taste of bad meat." When asked, if it was like the smell of bad meat cooking, he said: “No, it was like the bad meat―the same bad meat that I take from the bar and eat as I go through the kitchen, when I go to talk to the missus, just a moment before I have my attack. I had it in my mouth when I fell. I remember it all now."
It will be seen that thus readily we have traced the genesis of the aura and psychomotor attack to a previous dissociated psychic experience with which subconscious states became accidentally associated through the intense unpleasant affective tone. This experience occurred at the time of his first attack. The appearance of a definite aura only at the second and all succeeding attacks is hence explained.
Upon emerging from hypnosis all previously given details were retained by the patient. This particular memory, initially dissociated, had been recovered. The recovery and reassociation or synthesis of these dissociated memories, with the method employed for so doing, will be exemplified in details to follow.
On the evening of this same day on which we found the origin of the aura the patient had a light attack while at dinner. He recalled putting his knife and fork upon the table, staring absently in front of him. He forgot all subsequent occurrences until some one grasped his arms, at which he awakened. There was no aura. This attack, however, had been unusually light. Further, after his emergence, he was aware that he had experienced it. Upon the day previous a similar attack had occurred, this time, however, without absolute amnesia. Within a few moments after the occurrence he had recalled all that had happened.
His appearance began to improve. He was brighter and less tardy in responding. He states that he remembers more accurately; his head feels clearer. His sleep is easier and less disturbed. It is to be noted that although he recalls all the reassociated attacks, beyond this he cannot go.
The first attack has been fully verified by the proprietor of the house. The latter has described the patient's falling down, remaining stretched out upon the floor, unable to be roused, later being carried to the dark room, where the girl came in and spoke to the patient, then left; of his remaining in this state for half an hour; of his finally emerging, being somewhat stupefied, and recalling none of the particulars of the attack, everything being a blank to him.
1. See introduction, also pp. 199, 212, 218.
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