CASE HISTORIES 2Q 



He usually knew the date, said this was an insane asylum 

 and knew how long he had been here, but he didn't know 

 people's names or positions. 



Occupational therapy: He could play casino, but forgot his 

 turn or played ahead of turn. He couldn't seem to learn basket 

 weaving, and did poor work because he was unable to concentrate. 

 He could catch a ball even when thrown at him suddenly in a 

 tricky way. His greatest delight was to take a pencil and cover 

 a sheet of paper with numbers (he had worked as a commissary 

 in the army). Sometimes he wrote sentences such as "Please 

 acknowledge I am a deserter " or " The best thing a man can do 

 is to keep clean and be respectable." 



Physical examination: Medium type of skeleton. Skin scaly. 

 Hair dry and fragile. Beard scanty. Genital hair normal. Gen- 

 italia normal. Abdomen protuberant. Heart rate slow. Pupil- 

 lary excursions limited. Reflexes hyperactive. 



Endocrine diagnosis: Submyxedema. 



Glandular therapy: Desiccated thyroid gland made him 

 much more irritable and somewhat more active. His wife said 

 he talked more freely to her than for years. In the ward he 

 several times went into the worst fits of storming and scolding 

 we had yet seen. He said he heard lots of voices all the time. 

 While formerly he had to be undressed before a bath because if 

 left to himself he would stop and go off into his thoughts, he 

 now undressed and bathed himself without urging. He seemed 

 to grow more uneasy and to fear I was investigating and trying 

 to fix some crime on him. 



Four months later: He appeared the same as before gland- 

 ular feeding was tried. The summer records stated he had had 

 delusions of grandeur and of electricity playing on him. He 

 showed no such symptoms while in the endocrine ward. 



Mental diagnosis: Schizophrenia with projection. His 

 troubles were pretty evident. He had a tic of the lips and 

 tongue, voices called him a fellationist, and at the outbreak of 

 the psychosis he had choked and his throat felt sticky. Other 

 men wanted to marry him, and he angrily resisted their advances. 

 Dirtiness was " all the trouble," and his main idea in life was to 



