VI1 THE SCOPE OF PSYCHOTHERAPY 293
to above, marks an advance in the methods of dealing with mental disease.
According to Stekel2I4 (p. 32) in true epilepsy the attacks begin as fits in the first years of life. If they first appear in later life they are psychological in origin. These cases are due to strong cravings which are rejected by the unconscious as unwholesome. In the cases he studied the craving was of a criminal nature. In support of his theory he quotes Dostoievsky who, describing the depression following a seizure, says, ' I feel like a great criminal; it seemed as if some unknown guilt, a criminal deed oppressed my conscience \ Dostoievsky's crime was child-rape. The analysis of such cases takes a very long time, and he knows no more difficult task and would only entrust it to a very skilful and experienced psychotherapist.
In most illnesses, even in those like typhoid or pneumonia, which are considered to be wholly physical, the sufferer's mental attitude is important. This belief is the direct result of observation of the physiology of the nervous system and of what takes place on its highest levels, namely, those in relation to consciousness.31
Medical interest in the psychophysiological processes of life, both healthy and diseased, is so obviously on the increase that it is even said to be a little surprising to find a disease so important to our age as cancer left almost entirely uninvestigated on the mental side. Groddeck's own experience in cases of cancer leads him to associate it with the personal attitude of the sufferer towards motherhood 90 (p. 160).
Even in cases of accident the psychological factor cannot be ignored. ' It is my custom \ said Groddeck 90 (pp. 81-95),'t0 ask a patient who has slipped and broken his arm, " What was your idea in breaking your arm ?" So far I have never failed to get a useful reply to such