Twilight state

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A state of twilight or twilight is a state of mind caused by a clouding of consciousness or a narrowing of consciousness of relatively sharply limited, usually short duration. The term is derived from twilight , whereby this origin of the word already means a clouding of consciousness in an etymologically original sense of "twilight". Seen in this way, the meaning of the term "twilight state" is close to "inattention" and "absent mind". According to Uwe Henrik Peters , the term is derived from colloquial language. Scientific language has been common since the middle of the 19th century. This refers u. a. Changes in consciousness in epilepsy , brain traumas, progressive paralysis , metabolic diseases , under the influence of alcohol or medication, strong affect pressure, in hysteria and in hypnosis . This includes a wide range of medical applicability. To other authors it seems questionable whether there are twilight states independent of epileptic seizures. The epileptic twilight state has always been the starting point and reference point for all twilight states.

Attempt to delimit terms more closely

Colloquial word origin

The loss of brightness of consciousness meant by the original meaning of “twilight” can of course also be understood and defined the other way round as the increasing activation of functions (in the sense of “dawn”). If one assumes that functions are inhibited by the individually floating everyday consciousness - for example in the sense of the collective psyche - then the removal of such inhibitions and fears leads to the stimulation of previously inhibited functions, cf. a. → somnambulism . This assumption also leads to the idea of ​​an alternating consciousness or a doubling of personality . The idea of ​​an epileptic equivalent also serves such an energetic and possibly also psychodynamic understanding. Thus, in a positive sense, “twilight” can also be understood as “dawn”, whereby not only quantitative, but also qualitative changes in consciousness are taken into account when diseases arise. The previously practiced twilight sleep served such a therapeutically positive goal of qualitative change in consciousness. The hypnosis has similar effects in terms of a healing process.

Non-medical use of the term

An example of a non-medical use of the term “twilight state” is the novel The Golem . In the context cited here, the term is used ambiguously. Neither the positive meaning of the change in consciousness, nor clearly the negative one, is meant, as an alternative to the positive qualitative change in consciousness is also spoken of a pathological state of consciousness that requires psychiatric treatment.

Psychiatric and neurological technical term

Karl Jaspers (1883–1969) counts the concept of the twilight state to be one of the key characteristics for determining the course of disease units. Status pictures represent temporary manifestations of a disease. Such status pictures may characterize a disease process. Follow-up observations have been included in the psychiatric system of diseases since Emil Kraepelin (1856–1926). Symptom complexes are typifications of such conditions.

The concept of twilight is to be distinguished from that of terminal sleep . While the terminal sleep is used for recovery, the twilight state is often an expression of a pathological occurrence. Walter Christian is of the opinion that twilight states do not always count among the pathological phenomena.

Furthermore, the term twilight state must be distinguished from the frequently used term twilight attack . The twilight attack is even more sharply delimited in terms of its duration and therefore relates even more to paroxysmal processes, as observed in epilepsy. While the twilight state can last for a maximum of several months, the duration of the twilight attack is limited to 30 seconds up to 2 minutes.

In the so-called ordered or oriented twilight states , the clouding of consciousness is not recognizable. They are also called thoughtful twilight states . The external behavior is inconspicuous when viewed superficially. Even complex actions can be performed and conversations conducted. These conditions can therefore also be assigned to the passage syndromes. It is more qualitative disorders of consciousness that impress here . The name is held to be misleading, as the consciousness is disturbed in any case. The patients behave only apparently and 'prudently' when viewed superficially.

Classification according to Landolt

The Swiss psychiatrist and epileptologist Heinrich Landolt (1917–1971) differentiates between the following four forms of twilight states:

  1. The post-paroxysmal epileptic twilight states
  2. the petit mal status according to William G. Lennox (1884–1960)
  3. the twilight states of organic character (not directly related to epilepsy)
  4. the productive-psychotic epileptic equivalents with forced normalization in the EEG

The equivalents mentioned under item 4 are psychological status pictures that are occasionally associated with a certain normalization of the brain wave picture. In particular, this means that previously detectable b / w complexes typical of epilepsy are missing in the EEG.

Web links

Wiktionary: twilight state  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. ^ Günther Drosdowski: Etymology . Dictionary of origin of the German language; The history of German words and foreign words from their origins to the present. Dudenverlag, Volume 7, Mannheim, 2 1997, ISBN 3-411-20907-0 ; P. 115 on Wb.-Lemma "Twilight".
  2. ↑ a b c Uwe Henrik Peters : Dictionary of Psychiatry and Medical Psychology . Urban & Schwarzenberg, Munich 3 1984; P. 101 ff. On the “Twilight state” district.
  3. ^ A b c Walter Christian: Clinical electroencephalography. Textbook and atlas. Georg Thieme, Stuttgart 2 1977, ISBN 3-13-440202-5 ; (a) p. 164 f. to Stw. “Occurrence of twilight states independent of seizures? - e.g. B. Somnambulism ! "; (b + c) p. 165 - to Stw. “more or less pronounced changes in mood that are not necessarily to be regarded as pathological, as well as the twilight states of organic character that are not directly related to the actual epileptic process”.
  4. ↑ Hans Walter Gruhle : Understanding Psychology . Experiential theory. Georg Thieme, Stuttgart 2 1956; P. 304 - on Stw. "Unusual abilities of night walkers"; P. 311 on Stw. "Hypnosis" and "Doubling of Personality".
  5. ↑ Gustav Meyrink : The Golem . Anaconda Cologne, 2006, ISBN 3-86647-001-0 , pp. 220-225.
  6. ↑ Karl Jaspers : General Psychopathology . Springer, Berlin 9 1973, ISBN 3-540-03340-8 ; Pp. 487, 498 f.
  7. ↑ Gustav Bodechtel : Differential diagnosis of neurological diseases . Georg Thieme, Stuttgart 3 1974, ISBN 3-13-309103-4 ; Pp. 1022-1014.
  8. ↑ Gerd Huber : Psychiatry. Systematic teaching text for students and doctors. FK Schattauer, Stuttgart 1974, ISBN 3-7945-0404-6 ; P. 40 to district “Consciousness clouding”.