When a normal individual (normal being the term for average, not a value judgment) gets drunk, he displays a statistically average form of behavior, called normal or simple inebriety. This is characterized by a change in mood (which becomes expansive or, less frequently, depressed), behavior, attention and in motor function. It has three phases. The first shows a pattern of hypomania: the individual is euphoric, abnormally talkative, carefree, mentally agile and intellectually hyper-productive — but this is accompanied by a decrease in self control, as well as in attention and vigilance, which together with the release of his inhibitions causes him to speak tactlessly. In the second stage there is incoherence of speech, the faculty for self-criticism decreases or disappears completely, motor coordination is impaired (difficulty in articulation, unsteady gait and clumsy gesticulation), swings in mood increase — he is easily offended, flies into rages, sings, and displays general sensory hypoesthesia. In the third phase the subject collapses, vomits, his breathing becomes labored, his breath smells of acetone, his reflexes diminish, his body feels anesthetized and he may become incontinent. After sleeping for several hours he wakes up quite normal, unless ingestion was excessive in which case he passes from a coma to complete collapse — or a better life. Preceding these phases is the pre-clinical phase, where alcoholemia reaches 0.80 gr/l. In this phase the individual does not display symptoms but if tested psychometrically, alteration in sensory function and decrease in sensory motor activity can be observed.

The difference between simple and complicated inebriety is in the intensity of the latter, namely a quantitative difference, since complicated inebriety presents the symptoms of simple inebriety but in a more exaggerated form.

Biochemically, the pre-clinical state is considered to occur between 0.5 to 1 gr/l of alcohol; inebriety at 1 gr/l; between 1 and 1.5 gr/l signs of intoxication are evident; between 1.5 and 2 gr/l there is a state of intoxication; above 2 gr/l intoxication is deep with the lethal dose between 4 and 5 gr/l.

Pathological intoxication, as differentiated from the simple and complicated forms, is displayed in individuals whose constitution is so predisposed — suffice to say that it is typical among neuropaths, hysterics, schizophrenics, epileptics and psychopaths. It can also, however, be caused by abuse of alcohol (in chronic alcoholism), by cranioencephalitic traumatism, severe cerebral illness, syphilis etc. There are six main characteristics of pathological intoxication: 1) the insignificant amount of alcohol which is necessary to unleash it; 2) the almost immediate surrender of oneself to the consumption of alcohol; 3) its duration, either very short or very long (up to 24 hours); 4) extreme violence, which is why homicidal assaults, pyromania, rapes, exhibitionism and pederasty are frequent; 5) almost total lack of recollection afterwards; 6) tendency to relapse.

Pathological intoxication can be classified into three types: excitomotory, hallucinatory, and delirious. In the excitomotor type the individual is possessed for several hours by an uncontainable fury, he brushes everything aside, strikes out in any direction, gesticulates threateningly, and displays great anguish on his face with bulging eyes and fixed stare. In the hallucinatory form the subject lives his visual or auditory hallucinations, confusing them with reality, as is the case in delusions of flagrant infidelity, of massacres, threatening gangs, etc — with the possibility of impulsive homicidal reactions. The third form is the delirious form. Here confabulation preponderates, with four main themes: self-accusation, megalomania, jealousy and persecution. In delirious self-accusation, the drunkard goes to the police station to denounce himself for a crime which is currently in the headlines. In these cases it is necessary to guard the individual from suicidal impulses. In megalomania the drunk presents himself at the presidential mansion, demanding entry because he is the president. When the theme of his delirium is jealousy, the victim can see and hear his wife’s lovers. In these cases the person to be protected is the wife, since he may kill her. When the delirium is persecutory, the individual seeks protection desperately from the police since he feels threatened by a gang of crooks that want to trash him and he may, in his panic, have defensive and aggressive reactions.

This article is not entitled ‘Drunk with Love’ by chance. As I was writing it I found similarities between the stages of falling in love and the phases of drunkenness. In a love affair the conscience recedes into the background, resembling a pattern of hypomania: the individual is euphoric, abnormally talkative, carefree, mentally agile, intellectually hyper-productive (works and thinks better) — but at the same time self-control is reduced (saying inappropriate things like ‘if I ever stop loving you I will give you an income for life’), attention and vigilance diminish (he doesn’t notice that his future mother-in-law is intolerable and will make life impossible for him). In a second stage after marriage two things can happen: either compatibility and mutual tolerance prevail in the relationship — or, as happens in the majority of cases — incompatibility. If the latter occurs one observes verbal incoherence, decreased or zero facility for self-criticism in both persons, impaired motor coordination (stammering, prolonged silences, staggering gait upon arriving home at dawn and clumsy gesticulation during explanations) and increased swings in mood (morning irritability and evening irascibility) interspersed with periods of reconciliation which, again, suggest a pattern of hypomania.



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Lida Prypchan

Lida Prypchan

Psychiatrist & Writer — Writing and meditating at the intersection of psychiatry, philosophy, Buddhism and the arts. More information at www.lidaprypchan.com