<noinclude><pagequality level="1" user="Hertro" /><div class="pagetext">
</noinclude>96 II. CASE HISTORIES
Others of the patient's somatic symptoms were not of a
hysterical nature at all. This is true, for example, of the neck-
cramps, which I regard as a modified form of migraine
[p. 71 n.] and which as such are not to be classed as a neurosis
but as an organic disorder. Hysterical symptoms, however,
regularly become attached to these. Frau von N.'s neck-cramps,
for instance, were employed for the purpose of hysterical
attacks, whereas she did not have the typical symptomatology
of hysterical attacks at her disposal.
I will amplify this description of Frau von N.'s psychical state
by considering the pathological changes of consciousness which
could be observed in her. Like her neck-cramps, distressing
present-day events (cf. her last delirium in the garden [p. 73])
or anything which powerfully recalled any of her traumas
brought her into a state of delirium. In such states and the
few observations I made led me to no other conclusion there
was a limitation of consciousness and a compulsion to associate
similar to that prevailing in dreams [p. 69 n.] ; hallucinations
and illusions were facilitated to the highest degree and feeble-
minded or even nonsensical inferences were made. This state,
which was comparable to one of hallucinatory alienation,
probably represented an attack. It might be regarded as an
acute psychosis (serving as the equivalent of an attack) which
would be classified as a condition of 'hallucinatory confusion'.
A further resemblance between such states of hers and a typical
hysterical attack was shown by the fact that a portion of the
old-established traumatic memories could usually be detected
underlying the delirium. The transition from a normal state to
a delirium often occurred quite imperceptibly. She would be
talking quite rationally at one moment about matters of small
emotional importance, and as her conversation passed on to
ideas of a distressing kind I would notice, from her exaggerated
gestures or the appearance of her regular formulas of speech,
etc., that she was in a state of delirium. At the beginning of the
treatment the delirium lasted all day long; so that it was difficult
to decide with certainty whether any given symptoms like her
gestures formed part of her psychical state merely as symp-
toms of an attack, or whether like the clacking and stammering
they had become genuine chronic symptoms. It was often
only possible after the event to distinguish between what had
happened in a delirium and what had happened in her normal<noinclude><references/></div></noinclude>
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