These psychogenetic excitements of degenerates often simulate
symptomatologically genuine epilepsy so far as the ferocity of the
excitement and the state of consciousness are concerned. In some cases
the retention of suggestibility during the attacks shows clearly the
psychogenetic character of the disorder, while in others the tendency
toward the theatrical and exaggeration is so marked that we are forced
to think of an hysterical component. Certain slight symptomatologic
features of these psychogenetic states of excitement in degenerates
appear to furnish a differentiating point between them and the true
epileptic condition. Bonhoeffer refers to the strong tendency to
disgust-evoking manifestations, to copro-practice which manifest
themselves in the soiling of the walls and face with excrements, the
drinking of urine, etc. Another characteristic is the frequent total
misunderstanding of the situation by these individuals in that
they consider themselves to be threatened with impending grave
physical danger. In consequence of this they manifest a certain
over-aggressiveness, which goes far beyond mere protective reactions,
and manifests itself in a senseless breaking and demolishing of
furniture. These individuals can be easily distinguished by their
superficial intellectual endowment, by a tendency to change of
occupation, and early criminality. During imprisonment and under the
influence of the stress incident thereto, they develop an acute paranoid
symptom-complex, a delirium of reference, accompanied by ideas of
prejudice, isolated elementary hallucinations, and irresistible desire
to a depressive recapitulation of their past, and a nervous, irritable
temper. Consciousness is not clouded, and they remain perfectly oriented
in all spheres. The duration of the disorder may vary from a few months
to two years, with occasional intermissions. The delusional formation
continues only for a short period, and in no instance leads to a
retrospective change of the content of consciousness. Very frequently
the process subsides upon the removal of the patient into a new
environment without leaving any change in the personality of the
individual. Insight is not always perfect. The delirium of reference and
prejudicial ideas concerning the prison personnel may remain
unconnected.
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