and there which could be interpreted as manifestations of exhaustion. The question arises whether the early lapses and later somnambulic attacks could not be conceived as states of exhaustion, so-called "neurasthenic crises." We know that in the realm of psychopathic mental deficiency there can arise the most diverse epileptoid accidents, whose classification under epilepsy or hysteria is at least doubtful. To quote C. Westphal: "On the basis of numerous observations, I maintain that the so-called epileptoid attacks form one of the most universal and commonest symptoms in the group of diseases which we reckon among the mental diseases and neuropathies; the mere appearance of one or more epileptic or epileptoid attacks is not decisive for its course and prognosis. As mentioned, I have used the concept of epileptoid in the widest sense for the attack itself."[15]
The epileptoid moments of our case are not far to seek; the objection can, however, be raised that the colouring of the whole picture is hysterical in the extreme. Against this, however, it must be stated that every somnambulism is not eo ipso hysterical. Occasionally states occur in typical epilepsy which to experts seem parallel with somnambulic states,[16] or which can only be distinguished by the existence of genuine convulsions.[17]
As Diehl shows,[18] in neurasthenic mental deficiency crises also occur which often confuse the diagnosis. A definite presentation-content can even create a stereotyped repetition in the individual crisis. Lately Mörchen has published a case of epileptoid neurasthenic twilight state.[19]
I am indebted to Professor Bleuler for the report of the following case:—
An educated gentleman of middle age—without epileptic antecedents—had exhausted himself by many years of over-strenuous mental work. Without other prodromal symptoms (such as depression, etc.) he attempted suicide during a holiday; in a peculiar twilight state he suddenly threw himself into the water from a bank, in sight of many persons. He was at once pulled out and retained but a fleeting remembrance of the occurrence.
Bearing these observations in mind, neurasthenia must be allowed to account for a considerable share in the attacks of our patient, Miss E. K. The headaches and the teno-synovitis point to the existence of a relatively mild hysteria, generally latent, but becoming manifest under the influence of exhaustion. The genesis of this peculiar illness explains the relationship which has been described between epilepsy, hysteria and neurasthenia.
Summary.—Miss Elise K. is a psychopathic defective with a tendency to hysteria. Under the influence of nervous exhaustion she suffers from attacks of epileptoid giddiness whose interpretation is uncertain at first sight. Under the influence of an unusually large dose of alcohol the attacks develop into definite somnambulism with hallucinations, which are limited in the same way as dreams to accidental external perceptions. When the nervous exhaustion is cured the hysterical manifestations disappear.
In the region of psychopathic deficiency with hysterical colouring, we encounter numerous phenomena which show, as in this case, symptoms of diverse defined diseases, which cannot be attributed with certainty to any one of them. These phenomena are partially recognised to be independent; for instance, pathological lying, pathological reveries, etc. Many of these states, however, still await thorough scientific investigation; at present they belong more or less to the domain of scientific gossip. Persons with habitual hallucinations, and also the inspired, exhibit these states; they draw the attention of the crowd to themselves, now as poet or artist, now as saviour, prophet or founder of a new sect.
The genesis of the peculiar frame of mind of these persons is for the most part lost in obscurity, for it is only very rarely that one of these remarkable personalities can be subjected to exact observation. In view of the often great historical importance of these persons, it is much to be wished that we had some scientific material which would enable us to gain a closer insight into the psychological development of their peculiarities. Apart from the now practically useless productions of the pneumatological school at the beginning of the nineteenth century, German scientific literature is very poor in this respect; indeed, there seems to be real aversion from investigation in this field. For the facts so far gathered we are indebted almost exclusively to the labours of French and English workers. It seems at least desirable that our literature should be enlarged in this respect. These considerations have induced me to publish some observations which will perhaps help to further our knowledge concerning the relationship of hysterical twilight-states and enlarge the problems of normal psychology.
Case of Somnambulism in a Person with Neuropathic Inheritance (Spiritualistic Medium).
The following case was under my observation in the years 1899 and 1900. As I was not in medical attendance upon Miss S. W., a physical examination for hysterical stigmata unfortunately could not be made. I kept a complete diary of the séances, which I filled up after each sitting. The following report is a condensed account from these notes. Out of regard for Miss S. W. and her family a few unimportant dates have been altered and a few details omitted from the story, which for the most part is composed of very intimate matters.
Miss S. W., 15½ years old. Reformed Church. The paternal grandfather was highly intelligent, a clergyman with frequent waking hallucinations (generally visions, often whole dramatic scenes with dialogues, etc.). A brother of the grandfather was an imbecile eccentric, who also saw visions. A sister of the grandfather, a peculiar, odd character. The paternal grandmother after some fever in her 20th year (typhoid?) had a trance which lasted three days, from which she did not awake until the crown of her head had been burned by a red-hot iron. During states of excitement later on she had fainting fits which were nearly always followed by a brief somnambulism during which she uttered prophesies. Her father was likewise a peculiar, original personality with bizarre ideas. All three had waking hallucinations (second-sight, forebodings, etc.). A third brother was also eccentric and odd, talented but one-sided. The mother has an inherited mental defect often bordering on psychosis. The sister is a hysteric and visionary and a second sister suffers from "nervous heart attacks." Miss S. W. is slenderly built, skull somewhat rachitic, without pronounced hydrocephalus, face rather pale, eyes dark with a peculiar penetrating look. She has had no serious illnesses. At school she passed for average, showed little interest, was inattentive. As a rule her behaviour was rather reserved, sometimes giving place, however, to exuberant joy and exaltation. Of average intelligence, without special gifts, neither musical nor fond of books, her preference is for handwork—and day dreaming. She was often absent-minded, misread in a peculiar way when reading aloud, instead of the word Ziege (goat), for instance, said Gais, instead of Treppe (stair), Stege; this occurred so often that her brothers and sisters laughed at her. There were no other abnormalities; there were no serious hysterical manifestations. Her family were artisans and business people with very limited interests. Books of mystical content were never permitted in the family. Her education was faulty; there were numerous brothers and sisters and thus the education was given indiscriminately, and in addition the children had to suffer a great deal from the inconsequent and vulgar, indeed sometimes rough, treatment of their mother. The father, a very busy business man, could not pay much attention to his children, and died when S. W. was not yet grown up. Under these uncomfortable conditions it is no wonder that S. W. felt herself shut in and unhappy. She was often afraid to go home, and preferred to be anywhere rather than there. She was left a great deal with playmates and grew up in this way without much polish. The level of her education is relatively low and her interests correspondingly limited. Her knowledge of literature is also very limited. She knows the common school songs by heart, songs of Schiller and Goethe and a few other poets, as well as fragments from a song book and the psalms. Newspaper stories represent her highest level in prose. Up to the time of her somnambulism she had never read any books of a serious nature. At home and from friends she heard about table-turning and began to take an interest in it. She asked to be allowed to take part in such experiments, and her desire was soon gratified. In July 1899, she took part a few times in table-turnings with some friends and her brothers and sisters, but in joke. It was then discovered that she was an excellent "medium." Some communications of a serious nature arrived which were received with general astonishment. Their pastoral tone was surprising. The spirit said he was
