DR. JOHN T. MACCURDY, New York: I have been very much interested in this
paper by Dr. Emerson and the part that has interested me most in it has been
the therapeutic side. I cannot feel, however, that it adds a great deal to
our knowledge of epilepsy, that is, of idiopathic epilepsy. That, of course,
is a tremendously difficult problem to tackle. If we are to regard it as a
psychosis then we expect it to show other reactions, just as dementia
praecox shows manic depressive symptoms. If we are to find out what the
epileptic reaction is, we must study it in those who are typically epileptic
and nothing else. Or else we may examine those with transitional states
grading over into hysteria, for example, excluding from our formulations
everything in them that is hysteric. This last case which Dr. Emerson
brought forward seemed to me to represent what is essentially an hysteric
reaction. The convulsive movements this man went through were symbolic. It
is difficult to regard these movements in epilepsy as symbolic because in
the true epileptic there is as typical unconsciousness as we know. How can
anything going on in almost absolute unconsciousness represent something
symbolic to the individual? This is possible however, when the condition
grades off from the hysteric side into the epileptic. The fundamental
epileptic phenomenon is the disturbance of consciousness, and that is what
must be explained.
DR. TOM A. WILLIAMS, Washington, D. C.: I don't know that we can say that
the fundamental differentiation of epilepsy is the unconsciousness. That is
a psychological division. The paper did not give any differential why they
were regarded as epileptics at all. There was no description of the
convulsion, except in so far as this formed the hysteric form of convulsion,
so I don't think we are in a position to discuss the paper without more
clear data of these instances.
DR. WALTER B. SWIFT, Boston: I was interested in hearing about the case of
stammering. That will be explained in my own paper and I have also run up
against several who have done the same. I should like to ask Dr. Emerson if
he considers stammering as an expression of an orgasm.
DR. L. E. EMERSON, Boston: Dr. MacCurdy well remarked that this adds
nothing to the understanding of epilepsy. In a certain sense this is true.
I do not feel that I could add anything to a deeper understanding of
epilepsy. The whole development of psycho-analytic theory, up to a certain
point, has been based on the actual recovery of patients, if you do not like
the use of the word cure, from particular symptoms. Then this has been
generalized. Now that has opened an enormous field for ratiocination.
Therefore, I am not at all sure that these conceptions will really apply to
essential epilepsies or to the real epilepsies. I do not know how far our
conceptions which originate in the therapeutic situation will apply to the
situation which appears to be absolutely beyond therapeutics. In regard to
what Dr. White said of starting from the known and going through
transitional stages to the unknown, you do get insight and it may be that
the condition as described in this broad way by Clark and by Stekel and
others may be true, but I am not perfectly sure. I am very grateful for Dr.
Allen's approval of this way of putting things because perhaps it is a
defence reaction on my own part that occasionally I feel it necessary to
report things I have seen with my own eyes and really experienced, instead
of following my natural tendency to go off into vague philosophizing.