Schizophrenia : the epigenetic puzzle / Irving I. Gottesman, James Shields, with the assistance of Daniel R. Hanson.
- Irving Gottesman
- Date:
- 1982
Licence: Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)
Credit: Schizophrenia : the epigenetic puzzle / Irving I. Gottesman, James Shields, with the assistance of Daniel R. Hanson. Source: Wellcome Collection.
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![Diagnosis and classification 3 The patient-a 33-year-old, white, unemployed husband and father of six living children - dates the onset of his distress to early 197[ ]. His maternal grandmother had broken her leg, and his mother had died of cancer. After the birth of a sixth child, his wife had her gallbladder as well as her remaining ovarian tube removed. After he had signed the form giving consent for his wife's sterilization procedure, he became quite upset at the prospect of having no more children as he felt this had destroyed him. He thought that because he had signed the sterilization consent form, he too had been sterilized. Since the operation, he felt his wife had less vaginal lubrication, which made it difficult for them to have intercourse. He felt the doctors had put a tube in his wife's vagina and the tube, in tum, had been introduced into his penis, which had made him impotent. Eventually, he began to smell odors, the nature of which was impossible for him to describe. But the smells would be persuasive and would in fact drive him toward or away from that which he was to do, abnost as if there was an invisible wall of smell he could not penetrate. At times the messages from the smell would be similar to the impressions he would get from his boss to hurry up at work. Some of the smells were unpleasant; some were vaginal smells. Smells had powers over him. In some way the town banker was involved with the smells, and he told the banker to quit it because he had heard voices telling him that the banker had drags in the bank. Later he heard voices - including the voice of the man who had sold him his house - telling him to Change your sewer system, which he proceeded to do. He had peculiar tactile sensations. He felt houseflies in an envelope, and the vibrations told him not to throw it away. Upon picking up the mail, he could tell through smell and touch whether or not to open it. He was aware of other smells on his children's school papers. He heard voices saying, We don't care, and he thought this meant that he should kill himself. He almost did this with his shotgun but stopped after he thought about leaving his wife and children alone. There was evidence of thought broadcasting, thought insertion, and somatic hallucinations, including the feeling of a hammer hitting him on his tailbone, ramp, scrotum, and penis. He said he had trouble maintaining an erection and ejaculated quickly. He said there were wires in his nose and head with repetitive banging, almost like a heartbeat. At his wife's urging, he was hospitalized on two occasions in a general hospital near his home in November .. . and again in April [the next year], each time for about a 10-day period. After treatment with [trifluoperazineJ, he improved to some degree but about December . .. stopped taking his medication. In April [the next year] he was seen in the medical clinic of the university hospital, where he was treated for a minor skin rash. As his behavior was manifestly psychotic, he was admitted for the first time to the university hospital psychiatric service for a 3-week-period. (This was his third hospital admission.) On my teaching rounds I saw him shortly after his admission, at which time I also interviewed his wife. He responded favorably quite quickly to [haloperidol] and to hospital milieu treatment, and his delusions diminished but did not disappear. To deal with some of their marital conflicts, he and his wife began couple psychotherapy, but this could not be continued because they lived far from the hospital. He was referred to a psychiatrist in his community but failed to follow through. In July ... on a return outpatient visit, he looked intent, shook one leg throughout much of the session, remained fixed in his delusion about the smells, and still believed that there was a tube in his penis. His wife corroborated the fact that he continued to act quite odd and at times had a fixed smile on his face. The patient, his wife, and usually the three youngest children were seen at 2-week intervals. Medication was changed to [thiothixene], which he tolerated better. When the smells came back, the patient](https://iiif.wellcomecollection.org/image/b18029735_0022.JP2/full/800%2C/0/default.jpg)
