The Pathogenesis of Cataplexy on Anger.

Abstract

SOME narcoleptic patients complain of attacks of cataplexy occurring when they are angry. On first thought it might seem fair to assume that cataplexy thus provoked arises from the same mechanism as cataplexy on laughter, since in each case there is loss of power and muscle tone brought on by emotion. In this paper I shall try to show that the two mechanisms really are different. Concretely, we may consider a number of cases in which cataplexy occurred while the patient, in angry mood, was striking his child, or was about to strike him. I do not know in how many cases this phenomenon has occurred, but anyone familiar with the literature will agree that the number is large. The following are examples: Henneberg's case, Somer's case 1, Goldflam's case 1, Wenderowic's case 2. Janzen's case 2, Kinnier Wilson's case 3, Sperling and Wimmer's case, and van der Scheer's case 1. In all these cases cataplexy occurred when the patient struck, or was about to strike, his child. In three cases cataplexy occurred when the patient struck, or was about to strike, an animal: Wenderowic's case 1, Cave's case 24, and Thiele and Bernhardt's case 6. Another instance to be considered occurred in Wenderowic's case 2. The patient, a streetcar motorman, occasionally had cataplexy when angered by wagon drivers arrogating to themselves the right of way on the car tracks and refusing to allow him to pass. In considering the pathogenesis of these instances of cataplexy, I submit that the important thing about them is that the emotion in question, anger, is accompanied by an impulse to action which the patient, consciously or unconsciously, strives to suppress. Thus in Wenderowic's case 2 we may assume that the. patient felt a strong impulse to leave his streetcar and forcibly eject the wagon driver from his path. Actually he did not carry out this impulse. As a self-restrained person he suppressed it. This suppression, a psychological phenomenon, has its physiological correlate, which I shall now examine. In a consideration of the central processes correlative with movement, Hughlings Jackson's views are of the greatest importance. I shall therefore 140