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Heilbrunn, G. (1950). Psychodynamic Aspects of Epilepsy. Psychoanal Q., 19:145-157.

(1950). Psychoanalytic Quarterly, 19:145-157

Psychodynamic Aspects of Epilepsy

Gert Heilbrunn, M.D.


Observations from the analysis of a group of five patients with idiopathic convulsive seizures lead to the conclusion that passive dependency on their mothers was the psychodynamic substratum from which secondary mechanisms emanated. The clinical psychopathological variations correspond with the patient's early and later experiences and serve as defenses against or as reactions to the original dependency. The epilepsy appeared as a sign of physiologic disintegration of one or several impulses at a critical moment, when rising emotional tensions overwhelmed the available countercathexes, or when the waning forces of the ego offered too little resistance to the pressure of the repressed. Oral, submissive and ingratiating traits of character signified a craving for the gratification of powerful narcissistic dependent needs and thus counteract the inherent weakness of the ego. It is conjectured that nocturnal grand mal seizures arise from a disequilibrium between forces of the id and the ego, physiologically prevalent during sleep, and, further, that the peak age for the development of such seizures during the first two years of life is determined by the relatively immature state of the ego at that period.

The patients studied could not tolerate any interference with their drives for dependent security and reacted with immediate motor discharge to any such threat, with complete disregard for reality. In the presence of the predisposing paroxysmal cerebral dysrhythmia, whenever the strength of the ego was exceeded by forces of characteristic dynamic proportion,

epileptic symptoms ensued. The reason for the varied symptomatologies of grand mal, petit mal or psychomotor equivalent is not clarified. The impressive intensity of the patients' emotions suggests the assumption of quantitative factors. The lack of precise measurements precludes the possibility of objective comparison. Whether the clinical variations are prompted by additional emotional factors which have so far escaped apprehension, or whether the varied responses can be expressed as quantitative ratios of the various components, must be reserved for future studies.

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