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On Post-Epileptic States: A Contribution to the Comparative Study of Insanities

  • J. Hughlings Jackson (a1)

Section VIII. Need of Wide Clinical Knowledge.—If anyone thinks that the study of Diseases of the Nervous System as they are Dissolutions will take his attention from their clinical or practical consideration he is mistaken. I urge two methods of study, one scientific and one clinical. Without a considerable clinical knowledge of cases no one is fitted to begin the scientific, comparative, study of nervous diseases. For the scientific study of insanities a very wide clinical knowledge is necessary. It would never do to confine attention to cases described in text-books by Alienist Physicians, to what I may call “orthodox” cases of insanity. Not being an Alienist Physician I say this, and what follows in the present Section, under correction by the Members of this Society, who of necessity know very much more of “Diseases of the Mind” than I do. I should not presume to address Alienist Physicians on their special subject had I not the hope that from a long study of simpler diseases of the Nervous System, I might contribute something of at least indirect value for the elucidation of the most complex problems they have to deal with. In a later section I shall urge a study of cases of abnormal mental affections, many, of which are not, in a clinical regard, cases of insanity at all, and, so far as I know, are not dwelt upon in books on Insanity.

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I never use the expressions Evolution and Dissolution of the Mind. It would be convenient perhaps to use them sometimes if one could be sure that they would be taken to imply mere parallelism with Evolution and Dissolution of the highest cerebral centres of the Nervous System.

I speak at present of Dissolution after epileptic fits as being uniform, as if, that is, all the divisions of the highest centres were evenly lowered in function. Yet, I believe that the Dissolution in these cases preponderates in one lateral half of the brain; that there is local Dissolution of the highest centres. I shall rectify the statement made in the text later on.

* I use the term action in a psychical sense; actions are psychical states corresponding to certain movements of the limbs, etc., in the same way as the psychical states words (also actions) correspond to certain complex, etc., movements of the tongue, palate, lips, etc.

* There is nothing more important regarding Evolution and Dissolution than that they are processes, respectively, of increase and decrease in Compound Order. I have long been possessed by this notion. I gave an example of it (Med. Times and Gaz., Dec. 19, 1868) when stating details of the sequence of spasm in a case of epileptiform fits. It may be that in the sensory sphere Compound Order is analogous to Weber's Law. But speaking of the sensory sphere I would put it as follows, without any attempt at exact quantification: A certain degree of stimulus at the sensory periphery produces no effect (I mean that no sensation ultimately arises), as the stimulus does not overcome the resistance of elements of any lowest sensory centre. A stimulus somewhat stronger produces a very great effect; for being, the supposition is, just sufficiently stronger to overcome the resistance of elements of some lowest sensory centre, there is liberation of a large quantity of energy by those elements, and ultimately a great effect is produced on the highest sensory centres. An increase of the strength of a nervous discharge produces a compound effect. This applies to normal and abnormal discharges of sensory and of motor elements. The principle is exceedingly important with regard to differences in the physical processes during faint and vivid states of object consciousness, ideation and perception for example.

* I exclude “crude sensations” such as occur at the onset of epileptic fits.

* The images in dreams and in insanity are as certainly objective as the images of the sane man's ordinary, waking, perception are.

* I do not say “image of a cab” and “image of a bed.” I am not endorsing a crude popular psychological hypothesis that “real” outer objects, in themselves coloured, shaped, etc., photograph their colour, shape, etc., on us. What I call the image is a state of the mind (each person's), a “ghost,” standing as a symbol of something not us, of the nature of which something we know nothing.

In former papers (see this Journal, April, 1887, Section XVIII.), I have spoken of what is known as the Intellectual Aura (I call it “dreamy state“) as being the positive element in some cases of the first degree of post-epileptic states. In this paper a more inclusive expression is used. I now feel uncertain as to the exact symptomatological nature of the “dreamy state.”

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The British Journal of Psychiatry
  • ISSN: -
  • EISSN: 2514-9946
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On Post-Epileptic States: A Contribution to the Comparative Study of Insanities

  • J. Hughlings Jackson (a1)
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