We are including this third form because it is relatively common. The onset of the disorder occurs fairly rapidly; in just a few weeks, and for no apparent reason, patients exhibit serious symptoms which last for weeks or months. Then, suddenly, the symptoms disappear and patients think they are cured. They go back to work, and resume a normal lifestyle. This period of remission may last for several months, or even years; then once again, patients undergo another crisis, with little or no warning beforehand. Or the illness may be periodic, in which case patients usually suffer through a crisis stage once or twice a year.
The sudden return to health, so convincing to patients and the people close to them, is more apparent than real since, when carefully examining patients during their periods of remission, I have always observed them to be mentally overexcited, a state which cannot last indefinitely and which must, sooner or later, depending on its intensity, bring on another relapse. The prognosis for such intermittent cases, despite their return to health, is no better than for patients suffering from the essential form of the disorder.
These three forms, so different in terms of their causes, beginnings and development, are not really so dissimilar if they are considered from the point of view of defective control. In its essential form, we clearly find the presence of an inhibition of the development of this faculty. In other cases, the problem is the instability of control. Therefore,
the three forms are the result of nothing more than varying degrees of insufficient control. As for their prognosis, it is obvious that total inhibition of the development of control makes a cure much more difficult to achieve.
No longer is it a question of rediscovering a faculty which has been suspended by shock or fatigue. The faculty must, in a sense, be created from scratch, and this requires long months of struggle and perseverance on the part of patients and their therapists. Instability in its intermittent form should be easier to cure; but here another factor comes into play -patients do not willingly submit to rigorous treatment since they know that they will recover without making any effort, if they just wait long enough. However, what they are not aware of is that their recovery is only artificial, and a relapse
can be very dangerous, and even fatal.