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.
22/280 page 4
![4 Schizophrenia: the epigenetic puzzle became quite suspicious of his wife, accused her of extramarital sexual activity, and when driving his car, looked back constantly, believing someone was following him. As he became more disturbed, his wife reluctantly agreed to have him return to the hospital. This was his fourth admission. He remained with us for another 3 weeks, and during this time he felt he had had a brain operation that had removed all of his senses, each of which was replaced intact except for his sense of smell. In December. .., on his outpatient visit return, he reported that he had been taking his medicine regularly, said he was no longer troubled by smells, but was worried because he had fewer erections. However, he no longer believed that something from within his wife was put inside him. He blamed his wife for his lack of potency. Because he felt less like a man, he wondered if he should divorce her; yet he felt that he would miss her and the children. He was pursuing plans for a job through rehabilitation service. He still smiled somewhat vacuously, his wife looked more tired, and one sensed the extraordinary burden she was carrying with her six children and her sick, dependent, unpredictable, and at times frightening husband. The therapeutic program attempted to reinforce the patient's self-esteem; to clarify and at times to challenge his delusional notions; to insure his taking his medicine; and to encourage him to prepare himself for a wage-earning position. In addition, support was given to his wife through the county welfare social worker and through the psychiatrist who saw the patient. The fifth hospital admission, in October [the next year], for a 2-week period, was the first on an involuntary basis. He became progressively less withdrawn and delusional after resuming his medication, and with improvement, he was discharged with arrangements made again to introduce him into a vocational rehabilitation program. In December. .. the patient started a job in automotive training 24 miles from his home. At that time, he was better and the children were doing well. Early in February [the next year] the wife called again to say that the patient was becoming depressed and was not taking his medicine. She explained that he worried about his maternal grandfather's health and felt he was making both his grandparents worse. The patient has had five hospital admissions since November 197[ ], each for a period of less than 30 days. Although he lives some distance from the hospital, he returns, albeit reluctantly, with his wife and three youngest children for periodic visits. At the urging of his wife and the psychiatrist, he does take the medication, but at times suddenly stops taking it. He remains unemployed, although efforts are repetitively made to engage him in a rehabilitation program leading to a semi-skilled job. He, his wife, and six children are supported totally by county welfare funds. The oldest son, age 10, because of past temper tantrums, was seen by a school psychologist. The family is visited regularly by a county welfare office social worker, who communicates with us about the state of the family. The social worker and those of us in the hospital are continuously concerned about the unpredictability of the patient and the possibility of his injuring himself, his wife, or his children. The wife is hesitant to initiate movement toward hospitalization because of his threats to kill her if she persists in hospitalizing him. The wife is clearly tyrannized by the patient's threats to harm her and the children should she arrange for emergency hospitalization without his consent. She is aware that she can call the police, who would respond to her call and make a decision whether they believe the patient is sufficiently sick or disturbed to be brought to the nearest county mental health facility. Up to the present time the wife has been reluctant to do this. She has also refused to initiate any involuntary hospitalization through court order of the Town Justice. She has a good relationship with the county](https://iiif.wellcomecollection.org/image/b18029735_0023.JP2/full/800%2C/0/default.jpg)
