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I 



and Mental Disease Monograph Series No.33 



A Psychoanalytic Study 
Psychoses with Endocrinoses 



By 
DUDLEY WARD FAY, Ph.D. 



WASHINGTON. D. C. 
1922 






<f* A^ 







No8. 2. 3. 6. 8. 9. 10. 11, 15, 17, 19. 22, 27. 30 Out of Print 

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rT-^-r-r-f r -r r r i 



I 

Nervous and Mental Disease Monograph Series No. 33 



A Psychoanalytic Study 
of I Psychoses with Endocrinoses 



BY 

DUDLEY WARD FAY, Ph.D. 



NEW YORK AND WASHINGTON 

NERVOUS AND MENTAL DISEASE 
PUBLISHING COMPANY 

1922 



NERVOUS AND MENTAL DISEASE 
MONOGRAPH SERIES ., 

Edited by > ^'!) 

Drs. SMITH ELY JELLIFFE and WM. A. WHITE 

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©CLA659^60 

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MAr. 2c 1922 



-Vv|> \ 



CONTENTS 



Page 

Foreword • • v 

Introduction i 

Case Histories (including in each case the Ufe history, sex 
life, fantasies, general observations, the effects of occupa- 
tional therapy, physical examination, endocrine diagnosis, 
the effects of glandular therapy, condition of the patient 

four months later, and the mental diagnosis) r 

Conclusions on Occupational Therapy 109 

Conclusions on Glandular Therapy no 

Conclusions on Psychoanalytic Treatment in 

General Correlations 113 

General Conclusions ng 

Discussion no 



111 



FOREWORD 



I wish to thank Dr. William A. White, Superintendent of St. 
Elizabeth's Hospital, for his permission and support in making 
this experiment, Dr. Nolan, D. C. Lewis and Dr. Gertrude H. 
Davies for their assistance in studying the cases, and Dr. Shep- 
herd Ivory Franz for his advice and criticism in preparing this 
thesis. Dr. Lewis furnished the reports of the physical examina- 
ations which are included in the case histories. 

The names of the patients are fictitious. In quoting their 
talk I have often translated obscene words into more technical 
language but I have not altered the meaning in any way. 



INTRODUCTION 

This thesis is a psychoanalytic study of twenty-two male pa- 
tients in an experiment on psychoses associated with recognized 
endocrine disorders conducted in St. Elizabeths Hospital, Wash- 
ington, D. C, by Dr. Nolan D. C. Lewis with the assistance of 
Dr. Gertrude H. Davies and myself.^ 

The object was to discover whether there was any correla- 
tion between certain endocrine disorders and certain psychotic 
syndromes. It is well known, of course, that there are glandular 
troubles among both sane and insane. According to Laignel- 
Lavastine^ mental disorders can cause endocrine disturbances, 
and endocrine disturbances can cause mental disorders, or the 
two processes can coexist. Irrespective of which is the cart or 
which is the horse, it would be of value to learn what sort of 
mental disturbance is associated with a disorder of each particular 
gland or combination of glands, or vice versa. 

At one time Kraepelin^ suspected there was some connection 
between dementia precox (or schizophrenia) and endocrine dis- 
orders, but later considered that he had failed to prove it. In 
the recent English translation of the portion of his work which 
deals with dementia precox he says : " Many years ago I en- 
deavored for a long time to acquire influence on dementia precox 
by the introduction of preparations of every possible organ, of 
the thyroid gland, of the testes, of the ovaries, and so on, 
unfortunately without any result." The results of our study 
seem to corroborate his original hypothesis. 

From the various white male wards of the hospital there was 
selected a group of patients who had recognizable endocrine 

1 Lewis and Davies, A Correlative Study of Endocrine Imbalance and 
Mental Disease, Journal of Nervous and Mental Diseases, vol. 53-54, 
1 921. 

2 Laignel-Lavastine, M., The Internal Secretions and the Nervous 
System, Nervous and Mental Disease Monograph Series No. 30, 1919, 

p. 34. 

3 Dementia Praecox and Paraphrenia, 1919. 

vii 



Vlli INTRODUCTION 

disorders. No selection was made on a basis of mental dis- 
order; this is important to keep in mind in view of the findings 
reported in later sections of this thesis. Our group included 
patients ranging from badly deteriorated old timers to newly- 
admitted boys from the army, navy and civil life. What they 
had in common was some kind of a disorder of one or more of 
the ductless glands. 

I purposely kept myself as much as possible in ignorance of 
the glandular disorders of the various patients so that my diagno- 
sis of their mental syndromes might not be influenced by their 
physical condition. Only after I had drawn up the case histories 
and divided them into mental groups did I compare them with 
the physical groups and determine the correlations. 

The term schizophrenia I used to denote the splitting of the 
mind by means of which the patient lives in two worlds, one of 
reality, the other of fantasy. In simple schizophrenia without 
projection he indulges his cravings in imagination and is at peace 
with himself. In schizophrenia with projection he resists his 
socially undesirable cravings and refuses to recognize them as 
originating in himself ; he projects the blame on others and be- 
lieves they put these immoral thoughts and wishes into his mind 
or even use physical force on him. The mechanism of pro- 
jection grows out of his refusing to face himself and his latent 
possibilities for evil, but once he has developed the habit he may 
project the most innocent ideas as well. 

In making the endocrine diagnoses not only was the physical 
condition of the patients examined, but they were subjected to 
two tests, the sugar ingestion and the thyroid feeding tests. 

The experiment lasted six months. After its conclusion the 
ward was broken up and the patients were soon redistributed 
throughout the hospital. Four months later I revisited the hos- 
pital and noted the condition of all our patients who were still 
there. 



J* 



CASE HISTORIES 
Abrams 

History: He was a Jew thirty-four years old. His father 
was a carpenter and the family lived in a village of southern 
Russia. The boy attended the local school until his father died 
and his mother remarried. He then went to a school in the city 
of Pinsk, where he associated with boys who cared little for their 
studies and spent their time in each other's rooms, discussing 
politics and the condition of the peasants, and dreamed of strikes, 
boycotts and revolution. The Japanese war broke out, and the 
boys became pacifists hostile to the government. He philoso- 
phized and dreamed of the future but neglected school work. 
His only sports were swimming and skating. He did not dare 
try the examinations for a high diploma but obtained a diploma 
for work equivalent to that of an American grammar school. 

By teaching during his eighteenth year he earned enough 
money to emigrate to the United States, and came to the home of 
an uncle. The first year he worked ten hours a day in a chair 
factory. During the next four years he attended high school 
mornings, worked in the factory afternoons, and taught English 
to a class of foreigners in the evenings. "I was just learning 
English myself, I had no time to dream. I had physical work 
in the factory which I had to do, and that was a stimulus. I felt 
self-supporting. I was earning my own way. I was like a 
soldier fighting." He was twenty-four years old when he grad- 
jUated from high school. 

In the autumn he entered a college that offered a three-year 
course leading to the degree of A.B. He managed to live the 
first year on two hundred dollars he had saved. During the 
summer vacation he earned a hundred dollars peddling aluminum 
kitchen ware from door to door. By December his funds were 
gone. The college loaned him money without interest to com- 



2 CASE HISTORIES 

plete the second year. "That boosted my self respect. If I 
hadn't been a good student, they wouldn't have lent me it. I 
boasted of it to my relatives. Those were two fine years." 

The college advised him to stay out a year and work to earn 
money to complete the final year. He went back to peddling 
but could not make a success of it. " College had made me finer, 
more classical. I didn't like peddling now. I hated to knock on 
doors. After two weeks I gave it up. I loafed or worked in the 
chair factory the rest of the summer. I didn't like that sort of 
work and wanted to return to college. My uncles borrowed 
money from banks and let me have it so I could continue my 
studies. And that's the reason I failed. I had no solid footing. 
I was living on borrowed money. I couldn't concentrate my 
mind. The money lent me by the college had no interest 
attached and so it didn't worry me. I worried over the interest 
my uncles had to pay. What if I failed to get a good position 
after I graduated and were unable to repay them. I was proud. 
I wanted to do it myself and not feel I had to have the help 
of hard-working relatives. And so I failed. I lost at both ends. 

"A college education was to me a sort of religion. Most 
students go for practical purposes. I looked on it differently 
from American boys, as a spiritual endowment rather than 
practical. At that time I was soaring, dreaming to be a poet. 
But I couldn't write my thoughts as a poet does. I wasn't a 
soldier, do you see ? I wasn't practical. I was in a passive state. 
I dreamed of writing, of being a professor. One of my profes- 
sors said I had ' abortive sentimentalism.' Too much poetry, not 
enough buckling down to work. I wasted time hanging around 
the Y. M. C. A. playing checkers or in the gymnasium. The 
personality of the French teacher annoyed me. I flunked French 
right along and at midyears I flunked experimental psychology. 
In April I was suspended. That burst the bubble. After that 
I wanted a change of environment. I peddled for a week, 
worked a few days, and then went home. One of the professors 
wanted me to assist him in social service in a nearby city. He 
put me to work making notes on the condition of back yards, 
but I didn't satisfy him, and quit. I started for my married 
sister's home, and the train passed through the city where my 



CASE HISTORIES 3 

college was situated. It was graduation time in June, and one of 
the professors and a student got on the train. I hid myself from 
them, jealous, disappointed and ashamed. I staid all summer 
at my sister's trying to get a job but couldn't. I had to earn 
money so I went to New York and got work as dishwasher in 
a summer hotel. It was terribly hard. In a week I quit and 
returned to my sister's where I attended a state normal school 
with free tuition and got my A.B. 

"The next year I taught in a small school for boys and was 
able to repay part of the debt to my uncles. I got on fairly 
well but I didn't want to stay. I returned to my sister's and 
studied for an A.M. I worried over lack of money, and studied 
also for civil service examinations, neglecting my post-graduate 
work. I flunked some courses and quit in May. One of the 
teachers said I would have gotten my A.M. if I hadn't dreamed 
so much." 

The ensuing year and a half was one long succession of jobs 
lasting anywhere from one week to six months. He worked as 
busboy in restaurants, translated Russian, canvassed for a maga- 
zine and a sewing machine company, sold life insurance and 
clerked in a store, earning just enough to live on. Half a year 
after the United States entered the war he enlisted in a naval 
aviation school. '* I flunked my exams. They were too tech- 
nical ; I don't know mechanics. Then they transferred me to 
duty as a seaman in the same camp. I had to leave my class 
just as at college. Life was very unpleasant. A scholar hates 
to flunk." 

Not even as seaman could he give satisfaction. He became 
absorbed in his own thoughts and did not seem to comprehend 
his duties, and often was seen smiHng to himself without ap- 
parent reason. He was sent to a psychopathic ward for obser- 
vation. There he lay in the sun for hours at a time. He did 
not resent this detention and said he had been nervous and needed 
a rest. There was nothing the matter with his mind, he declared, 
he could think and remember as well as ever. As he made no 
improvement he was transferred to St. Elizabeths, where he 
stayed in bed for several weeks and had to be tube fed for two 



4 CASE HISTORIES 

days. Neither in navy or hospital did he associate with anybody. 
He denied hallucinations and delusions. 

Sex life: He was very reticent about his sex history and 
thoughts, and resisted questioning passively but effectively, 
answering " I don't know. If that is universal as you say, then 
probably I must have experienced it also. I don't remember." 
He claimed to have no memory of masturbating but perhaps he 
had done it as a child. He denied having heterosexual inter- 
course, but once when he was feeling lonely he had paid a girl 
to strip before him, and he stript too, but what happened after 
that he '' couldn't remember." He liked to dance, but wasn't 
much of a ladies' man. They never liked him, but men did. 
" It is not desirable to change my temperament. I couldn't 
marry for I had no money. A student has no money. I didn't 
focus my attention on any particular girl. I wasn't ready to 
marry. I didn't have the time to bother^ — No, that isn't correct, 
I had lots of time." Nothing could be elicited on the subject of 
perversions. " I'm sure I can't remember whether I've ever 
heard of them or not." He used to have two or three night 
pollutions a month, usually after a heavy supper. He could 
remember no accompanying dreams. 

Fantasies: Most of his time was spent in thinking, but he 
was disinclined to tell what about, " I don't think of anything in 
particular. I think of books I've read. I began day-dreaming 
in Russia. Here in this country students play baseball and foot- 
ball and haven't much time for thinking. I think of my boyhood 
in Russia, of my relatives, of past experiences and scenes, of 
people I've met, fancies, imagination. Fancy is playful, colorful 
imagination. I don't think of one continuous thing. I make no 
effort to. One thought follows another. A young man naturally 
has fancies, dreams of the future. As a school boy I dreamed 
of writing books, but I'm not good at fiction. I'm better at close 
thinking, reasoning, philosophy. It is impossible to think of 
nothing. I was evading the issue. A person doesn't like to tell 
his thoughts. ("Are they of love?" He snickers.) Yes, I used 
to study belles lettres, be romantic, but now I'm like Benjamin 
Franklin with both feet on the ground, a practical man. He was 
a good model for me. 



CASE HISTORIES 5 

"At twenty-six I had romantic fancies. I was young and 
strong, and finally the dreams ended in sexual intercourse. But 
now I don't feel well, and women don't figure in them. I 
feast my eyes on the nurses now, a sort of mental healing." 

On another day he said, " Here I sit and think. This morn- 
ing I thought of our talk yesterday and of my choice of words. 
I tried to find better ones. Then I tried for mental exercise to 
orient myself, to picture the lay-out of the hospital." 

On noticing a picture of a pretty girl on a calendar he smiled 
and said, " A picture like that evokes a smile from a young man. 
Yes, I like pretty girls very much, sir. ("Do you think about 
them much?") No sir, impossible. Well, occasionally. I 
hardly ever have unpleasant thought. Pretty girls, largely es- 
thetic. I admire beauty (gives a waggish grin). I think of 
la femme, her beauty, her voice. My mind is supreme. I get 
imagining, then I realize it isn't reality, and I wake up and check 
myself. It's delusional, but I'm matter of fact." 

General observations: He had been in the hospital a year 
and a half before he was admitted to the endocrine ward. His 
sole occupation had been to half-heartedly push a polishing block 
along the corridors. Although he had parole of the grounds he 
made no use of it, and only left the ward when forced to. Once 
I compelled him protesting to walk to a building several hundred 
feet away, and then abandoned him. He immediately turned 
and plodded back towards his ward, but had paid so little atten- 
tion to the surroundings that he had difficulty in recognizing 
which building he had come from. 

At our first interview he said in a whispering voice, " I feel 
weak, no, not weak but tired. I'm in a hospital and want to get 
well. I'm getting what I need, food and fresh air. Getting well 
and getting a rest to me seem the same thing. The Epicureans 
said eat, drink, and be happy. I'm contented at the way things 
are for the present. I'm just contented, that's all. I'm here 
under authority. I do what I'm told. After I'm discharged I'll 
visit my sister for a week, then get a job. I'm not afraid even 
of physical work. In an extremity I could go back to chair 
making. I might teach, but it's hard to find a job, for I speak 



6 CASE HISTORIES 

English imperfectly, with a foreign pronunciation, and most 
school teachers are women anyway." 

A few days later he said, " Tm not feeling very well. I felt 
better at college. Sitting quiet is very comfortable. I'm pa- 
tiently satisfied." This last phrase pleased him immensely. He 
repeated it several times and said it exactly expressed his 
sentiments. 

After explaining the self-preservative and creative impulses 
I asked what he loved most. " My three meals and myself, three 
square meals, warmth and a bed. In that respect I'm satisfied. 
I like woman's voice and companionship, looking at her, hearing 
her voice, but the meals and bed come first, more than la femme." 

All day he would sit in a chair or stand gazing out a window 
lost in his thoughts, his lips pressed tight together and pushed 
forward in a pout. Sometimes he moved them back and forth. 
When his tray was set on a nearby table he ate standing up, 
though there was a chair a few steps away and another patient 
called his attention to it. 

When I asked what he thought about so much he replied, " I 
think over past experiences or what I've read. Sometimes there 
is a vacuum and I think of and look at nothing. I just plod 
along. I feel satisfied. I take my situation as a matter of course. 
I've gotten so accustomed to this place I don't think I'll ever be 
discharged. I'm a stoic. I think I'm sane. I don't see how I'm 
insane but I really don't care. I take things as they are. (" What 
about your future?") In a hundred years we'll all be dead. I 
don't think of it, of anything. I feel fairly well physically and 
mentally. I suppose anyone would prefer to be with his kin, but 
it's up to the authorities as to discharge. When it's time for it, 
it will come. There's nothing to do but sit around and wait and 
make baskets. I don't care particularly about basket making." 

One day I called his attention to Irgocz squatting in a corner, 
eyes closed, and fingers to ears, and told him that was the end 
of the road he was traveling, a thing that could hardly be called 
a man, a mere vegetable, but it didn't jar him a bit. " He doesn't 
seem unhappy. If I get to be like him I suppose I shall still be 
patiently satisfied. ("Of what use will all your years of 



CASE HISTORIES 7 

study be then?") I don't know, but I'm patiently satisfied. 
(Then with a gleam of pleasure) : It is dramatic!" 

In conversation his voice constantly tended to fade to a 
whisper. He now began to mutter to himself, but always stopped 
before anyone could get close enough to hear what he was saying. 
Another habit developed, of hawking and spitting. He would 
stand in the toilet doing this for an hour at a time. There 
seemed to be no phlegm, only saliva. Questioning about it 
irritated him greatly ; it was the only subject that made him 
angry. "I'm sure I don't know why I do it. ("Think!") I 
don't think. ("You get nothing up, why do it?") For fun, I 
suppose. ("Do you think you have any disease?") I'm sure 
I don't know. You will have to ask the doctor." 

Once I asked what he would do if he were discharged. " I'd 
shift for myself. I should have to readjust, buck up against the 
world. ("Would you rather stay here and be patiently satisfied 
or go out and buck the world ? " He hemmed and hawed, evi- 
dently thinking he ought to say buck the world. "You really 
don't like to answer that question, do you? ") No, I don't like to 
answer." 

Occupational therapy: He consented to begin without urging 
and chose basket weaving, which he did beautifully. He 
wouldn't bother to learn any other kind of work, and subsequently 
admitted he had learned to weave baskets in another hospital. He 
became so expert that he could continue his fantasying as he 
worked. If he ran out of material or got stuck, he made no sign 
but sat thinking until the instructor noticed his idleness. 

After a few weeks he lost what interest he had and began to 
beg off, saying he'd rather think or he didn't feel well. 

He was very shy with the instructor, refusing to enter her 
small store closet with her. Only after she had come out would 
he go in. Once he wished to return a tool when she had both 
hands full, and when she told him to drop it into her apron 
pocket he became much embarrassed and laid it on the window^ 
sill. 

Physical examination: Short in stature. Skin dry and 
covered with fine flaky scales. Beard very heavy. Hair, male 



8 CASE HISTORIES 

type distribution, very extensive over chest and abdomen. Gen- 
italia normal. Extremities cold and cyanotic. All superficial 
and deep reflexes markedly hyperactive, but movements are slow 
and deliberate, though with no suggestion of catatonia. Heart 
rather rapid. 

Endocrine diagnosis: Submyxedema. 

Glandular therapy: While he was fed desiccated thyroid 
gland, nurses and attendants thought he seemed more alert and 
energetic. He talked sensibly with the occupational therapist 
and even joked with her. For two weeks he stopped his spitting, 
then began again. He went outdoors on his own initiative and 
lay on a bench. When asked why he had never done so before, 
he said that this was the first weather warm enough to make it 
pleasant (April 30). He stopped whispering with me and teas- 
ingly complimented my personal appearance. 

Four months later: He was still pouting out his lips and 
spending hours in spitting. When the male nurse tried to prevent 
the spitting he became very excited. He had shown distaste for 
food at times and talked of his mouth being dirty. He still 
kept by himself, smiling over his fantasies and doing no work. 

Mental diagnosis: Simple schizophrenia without projection. 
He found the inner world of fantasy so far preferable to the 
outer world of reality that he spent most of his time in thought. 
Just what his most intimate fantasies were could only be sur- 
mised. He would not divulge them. It was clear that some 
of them were heterosexual. I suspected others were homosexual 
for several reasons; his fear of the topic of homosexuality, his 
interest in my physical appearance, and his statement that women 
didn't like him but men did. He showed no signs of conflict or 
struggle against improper wishes and he projected none of these 
onto his environment. 

The only painful symptom of his psychosis was the mouth 
and throat obsession. There was much affect connected with it. 
It looked like a fellatio fantasy, a symbolic cleansing of the mouth 
and throat, such as Lady Macbeth's rubbing of her hands to 
cleanse them of the king's blood. The constantly pouted lips 
indicating oral eroticism supported this theory. 



CASE HISTORIES 9 

Even his education was an autoerotic pleasure. He made 
little effort to apply it in a constructive way, but regarded it as 
a spiritual endowment to play with in egotistical isolation. In 
this autistic thinking his mind was as he said supreme. But 
that he had sometimes attempted a self-cure was shown by his 
taking for a model Benjamin Franklin, the man with both feet 
on the ground. 

Bailey 

History: He was a thin, sallow fellow of thirty-three, the 
youngest of three children, and had been much indulged by his 
parents. He had always been sensitive, quiet and shut-in. In 
childhood he seemed bright and once skipped a grade at school. 
He stopped school at thirteen because a teacher unjustly accused 
him of throwing a spitball. He would not explain her mistake 
to her but absolutely refused to attend school any more. For 
the next three years he worked in the family grocery and then 
entered a machine shop. He apparently gave satisfaction to his 
employers, but if the family asked him any questions about his 
work he got very angry. He told me the work had been heavy 
there, and he wasn't strong. 

At seventeen he quit work and lived at home for fifteen years, 
supported by his father. His relatives secured jobs for him, 
but he always backed out at the last moment. He worked only 
at chores about the house. His amusements were talking and 
playing cards with one boy friend, who has since become " queer.'* 
Movies and other outside amusements made no appeal to him. 
He had no use for money and refused it when offered. Home 
and meals were all he wanted. His family did not consider him 
sick, but they continued to indulge him. 

After nine years of this life at home he had a *^ breakdown," 
and was confined to bed for two weeks during which he refused 
to eat. A physician was called and informed the family he was 
mentally sick. From this time on he did no work whatever 
about the home and gradually became untidy. He had to have 
his food just so, and insisted on preparing it himself. He 
wouldn't change his clothes or bathe and he let his hair grow 
long for a year and a half. The family brought barbers to the 

2 



10 CASE HISTORIES 

house, but he would not let them touch his head. He read a 
great deal, particularly the daily papers. Finally he became 
irritable, smashed dishes and threatened his father and sister. 
Very reluctantly the mother consented to his being sent to 
St. Elizabeths. 

He submitted to being bathed and shorn without fuss, appar- 
ently realizing that opposition would be useless. He said he had 
worn his hair long and stuffed cotton in his ears as a protection 
against cold, and that he had come to the hospital because he 
had a cold. He didn't feel well physically but he was mentally 
well. The result of his mental examination was fairly good; it 
was evident that his failures were due to inattention. He 
resented personal questions and said such things were nobody's 
business. Whatever answers he made were brief and to the 
point. The family history showed no insanity in direct line, but 
two cousins were insane. 

Sex life: He was very reticent on this subject and delicately 
conveyed his sentiments by interpolating that he did not like to 
pry into other people's affairs. He hinted he had had heterosexual 
experiences but that lack of money had hindered him. Night 
emissions he considered shameful, as bad as urinating in bed. 
His sister said he had masturbated a great deal. 

Fantasies: He would not tell what his thoughts were, but 
said they were not unpleasant. However, he never smiled or 
showed signs of enjoying his fantasies like Abrams. Sometimes 
he muttered about not earning enough wages and having the 
family on his hands to support. He once told his sister he had 
supported her for years. 

General observations: He spent nearly all his time sitting 
quietly in a chair or lying on a bed. There was no expression 
on his face either of pleasure or distress. He said he didn't feel 
sick, but weak. He did not believe there was anything the matter 
with his mind. " I have no worries, I just take each day as it 
comes. Sometimes I just rest and have no thoughts at all. I 
have no plans for the future, and no complaints. I feel bashful, 
and if there isn't any particular business to talk about I find it 
difficult to make conversation. When I read the papers the 



CASE HISTORIES 1 1 

big print of advertisements naturally attracts me most. There is 
no particular kind of news that I am most interested in." These 
answers he gave very slowly after much waiting, and he seldom 
looked at me. During our interviews he almost constantly moved 
his forehead and scalp and the tops of his ears. 

He seemed to be irritable towards his sister and sometimes 
was upset after her visits. 

Occupational therapy: He refused all attempts to interest 
him, saying he felt tired. 

Physical examination: Slender type of skeleton. Skin pale. 
Body surface presents scanty amount of hair. A few long hairs 
about the nipples. None over face. Genital hair of male type. 
Grenitalia normal. Heart regular but shows incompetence of 
valves. Respiration increased. Extremities cold and bluish. 
Reflexes normal. 

Endocrine diagnosis: Submyxedema. 

Glandular therapy: He was given desiccated thyroid gland. 
Coincident with the first feeding he consented to try basket 
weaving which he was able to do well, and he continued to work 
without urging. He did not mutter to himself as much as before 
and he took part in the ward work on his own initiative. Form- 
erly he did so only when ordered. He stopped lying on his bed 
in the day time, and seemed to pay more attention to what was 
going on around him although he kept strictly to himself. 

Four months later: He seemed unchanged. He still mut- 
tered to himself, and felt resentful towards his family for 
depriving him of his liberty. He said he wanted to make money 
and be free. He would not go on excursions but preferred to 
hang about the ward. 

Mental diagnosis: Simple schizophrenia without projection. 
Finding the demands of reality too hard he retired into himself 
and a life of thought. He carefully guarded the secrets of this 
inner life. Although he said his thoughts were not unpleasant 
he never betrayed any signs of pleasure. The only emotions he 
gave outward expression to were irritation and resentment, par- 
ticularly towards his family. Probably they had at times re- 
proached him for his useless life, and his delusion that he had sup- 



12 CASE HISTORIES 

ported them was a protective device against the painful realiza- 
tion that he had done nothing but sponge off them for fifteen 
years. He gave up in early adolescence the struggle for a con- 
structive life and retired into himself and the easy satisfactions 
of autoeroticism. 

Carhart 

History: He was a pleasant, courteous little fellow nearly 
twenty-one years old. He was the second of five children. The 
father was a musician. Nothing was known of the family 
history, but a photograph of the mother showed a woman with 
a tense, high-strung face. As a child he said he was active, play- 
ing first with hoops and carts, and later bicycling and playing 
baseball, football, tennis and swimming. He was very imagina- 
tive and loved fairy stories. He would imagine toys he did not 
possess and play with imaginary toy forts and soldiers. He 
wanted the things money would buy and envied the rich riding 
past in their automobiles. 

He said he was happy as a schoolboy, got along well in 
school, and was considered a good fellow. He never failed to 
pass and finished the eighth grade at the age of fourteen. He 
wanted to continue into high school, but his father said he could 
not afford to support him any longer and got him a job as office 
boy. For two years he attended night business school. He was 
very ambitious to earn money. At the outbreak of the war he 
enlisted and saw service at the front in a machine gun unit. The 
horrors of battle, the noise and blood. and death made a deep 
impression on him, but he did not break down under the strain. 
After the armistice he was sent to Coblenz in the army of occupa- 
tion. He returned with his regiment to the United States in the 
summer of 1919 and was discharged from the service. The 
family had moved to Chicago during his absence. He rejoined 
them there and got a position as clerk in an office. 

He didn't get on well in his work and suffered a great deal 
from " nervousness." His mind began to be " torn up, and he 
couldn't look people in the face." He became depressed and 
once stepped purposely in front of an approaching automobile, 
"but something seemed to pull him back." He entered a local 



CASE HISTORIES I 5 

hospital willingly. The records of the hospital stated that he 
was emotionally unstable, often depressed, disoriented for time, 
heard voices, smelled bad odors from his chest, thought his mind 
was changing and going up into the air, and had delusions of 
continual emissions of semen. 

He was soon transferred to St. Elizabeths and was confined 
to bed after his arrival, confused, retarded, hallucinated, and 
complaining of headache and gastric upset. In a few days he 
was up and around, cheerful and fully oriented, but still hal- 
lucinated and suffering transitory excitements. 

Sex life: He had a strong sex taboo and considered that such 
matters should be hushed up, but as he gained confidence in me 
he told me more and more, though he often became emotionally 
blocked and changed the subject abruptly. 

When he was seven he tried to have intercourse with his 
one year older sister but was not able. There was another girl 
he wished to try it with but he was too bashful. He had always 
been very bashful and modest. He saw her brother smell of her 
genitals. He smelled of the ''cheese" on his own glans penis 
and was disgusted at the fishy odor. He hated the smell of fish 
and never ate fish. He hated to look at a penis. 

When he was eight he agreed to perform mutual fellatio with 
a playmate but the other boy backed out at the last moment. 
That wasn't fair (great emotion). His conscience had bothered 
him over this attempt. He denied having committed any per- 
version. (''Did you ever dream of committing one?") "Yes, 
a dream of a darky boy." Then a wave of emotion swept through 
him, he jumped to his feet, paced the floor, grabbed a magazine, 
and feverishly turned the pages to find anything to get his atten- 
tion away from the painful memory. He was so upset that I had 
to terminate the interview. 

He began masturbation before he reached puberty and had 
sometimes indulged in it excessively. When his will power was 
strong enough he resisted it. He used to worry over masturba- 
tion and night orgasms. At sixteen he tried coitus with a 
prostitute but could not get an orgasm. He made several more 
unsuccessful attempts before he went to war. In France he tried 
again twice and failed. Once he masturbated while still in the 



14 CASE HISTORIES 

girl's presence and got an ejaculation. In his third attempt at 
coitus he got an orgasm but it was not as pleasurable as mas- 
turbation. 

His mind dwelt a good deal on sex matters. He had heard 
of bestiality, and a buddy had described the sensations enjoyed 
when allowing fellatio to be done on oneself, which greatly 
stirred his imagination. He said that in Coblenz he had several 
times gotten an orgasm merely by willing it. He held strange 
theories over the predetermination of sex in embryos and be- 
lieved in the existence of eunuchs, who had no sexual organs, 
and "morfudites," a creature who had the organs of both sexes 
and could hold intercourse with either sex or with itself. At 
times he talked of his heterosexual experiences with an exuber- 
ance of sensual enthusiasm, and at other times he expressed 
dissatisfaction over them and stated he was glad he had gone 
only with girls who made a business of it, and so had never 
ruined any girl's good name. 

His sexual preoccupations persisted after his return home. 
He slept with a younger brother and often woke up to find 
himself on top of the boy with an erection, but he never com- 
mitted pederasty on him, the brother "was too small." He 
fondled his fifteen-year-old sister and tickled her nipples. Fear 
of his father prevented his attempting incest. With great satis- 
faction he said he knew his sister loved him very much, and then 
asked me if a girl that young could have a baby. If he had 
made her pregnant he would have married her, of course. When 
I told him the law would not allow them to marry, he became 
very angry, said it was the only decent thing to do in such an 
eventuality and that some things were higher than the law. 

After having an orgasm from will power he went up almost 
into " Morphia," it felt like dying. Sometimes it felt like going 
up into the air (an interesting corroboration of the theory that 
dreams of flying have a sexual meaning) . He would hear a girl's 
voice from a distance asking if he wanted coitus, and then she 
would " bull " him, that is, cause his semen to go off. It felt 
like going to heaven. He too had the power of bulling. By 
nodding his head he could break another man's neck without 



CASE HISTORIES 1 5 

touching him. That was a headbull. He himself was a bullprick ; 
once in a street car he bulled the other passengers, men and 
women, till they nearly had orgasms. Then he got scared and 
feared they might see something queer in him. 

In another talk he showed insight and volunteered that these 
bull incidents might have been only imagination. " My thoughts 
are lewd. I have a lot of fear, I don't know what of. I'm 
like this" (making a gesture indicating vacillation and instabil- 
ity). The fear was evident. He had a constant fine tremor 
and when spoken to suddenly or told that someone wished to 
see him, he would tremble visibly. 

Fantasies: Thoughts both pleasant and distressing intruded 
constantly into his mind. Our talks were badly interrupted by 
these excursions into fantasy. When they were agreeable he 
smiled or even laughed aloud, but when they met resistance he 
became frightened and excited, often pacing the floor and trying 
desperately to find something to divert his attention from the 
painful subjects. This explains his statement, *^When Vm in 
motion, it takes away the fear. Fear is caused by what other 
people think of me or want to do to me. I called on the Maker to 
remove the fear." 

The Maker was the All-powerful, the Creator of all. This 
idea was of great emotional importance to him. He took Maker 
for his middle name, calling himself John Maker Carhart, and 
every letter home began with the set phrase, ''Just a few lines 
to hope you are in the way of the Maker, and well, and happy." 
Every day he wrote a letter to each of his parents. This pre- 
occupation with the Creator looked like an attempt to sublimate 
his creative libido in religion. 

As a child he had many fear dreams. One was of running 
down a street with fear coming down out of the sky; the world 
seemed to be coming to an end. Others were of falling off high 
places. Recent fear dreams were of men shooting him below 
the umbilicus. The night nurse said he trembled in bed as if 
having a chill, pinched himself and hunted in his clothes as if 
looking for bugs or lice. In the daytime he grabbed at his 
trousers and said there were snakes in them. 



1 6 CASE HISTORIES 

He believed in reincarnations and said he had been living two 
billion years and his father had lived fourteen hundred years. 
He could not remember his former lives. At death he went into 
his mother and was reborn a baby, but this time he had asked 
the Maker for manhood. If he were killed now, the world would 
come to an end. He feared the doctors were going to injure him. 
In one of his former lives he was Pharaoh. A snake bit him 
below the umbilicus and killed him. He had a vision of a house 
smeared with blood, snake blood, and it was connected with fear. 
Another vision was of a lighted candle several feet high coming 
up through the floor. (Symbol of the big potent penis. Some 
prostitutes had told him his penis was too small.) 

He could hear the voice of his father or his first employer. 
Sometimes it was the Maker giving him hints. These voices 
seemed to be in his head, just like one's conscience. He thought 
it might be possible to throw one's voice from one city to another, 
but he wasn't sure and couldn't prove it. 

He was beginning to believe he had two sets of parents, one 
pair tender and loving were back in the old home town, and the 
other pair harsh and unsympathetic were the ones in Chicago. 
He wanted to revisit both cities and clear up the mystery, then 
he would travel all over the world and bring about equality, 
brotherhood and happiness. As a boy he had great ambitions, 
he had chased the rainbow and wanted to be a big man. 

While still in Chicago he had pulled the sun over the horizon 
several mornings. That gave him a manly sense of power. On 
the way to Washington the sun had been attached by a cord to 
the back of his head and was towed behind the train. The back 
of his head had burned and felt as if wheels were revolving in it, 
and he had suffered much. He had fallen in love with the pretty 
nurse in the receiving ward, and his heart grew big and extended 
way down into his abdomen. 

His father was a magician and had purple eyes. Some day he 
would be one and have purple eyes too. Since being in the hos- 
pital he had grown very fond of purple. He had "a beautiful 
dream of a castle all purple against a blue sky. That was happi- 
ness." 



CASE HISTORIES 1 7 

His mother and little brother were angels, and his sister was 
Jewish and owned Jerusalem. Often he grabbed his nose to feel 
of it, saying it felt as if it were being drawn into a Jewish shape. 
He strongly resisted divulging what significance Jews had for 
him. All I could learn was that one of the men in the office in 
which he first worked was a Jew and told many smutty stories. 

General observations: In the first interview it was apparent 
that he was trying to fight off unpleasant ideas. The subjects 
that seemed to excite and upset him most were sex, his boyhood, 
the Maker, and his little brother. He said he loved his little 
brother, that the little fellow was sad and he wanted to comfort 
him, then he got very excited and rushed to look out a window. 

He talked much about not wanting to hurt people's feelings 
and said perhaps he had done so but not enough to kill them 
outright. He was excessively polite and anxious not to give 
offense, and went about the ward shaking hands with each patient. 
He said he didn't want hard feelings with anybody and that he 
always tried to make up. 

He had partial insight into his condition. He considered he 
had just passed through a " period " between youth and man- 
hood, and was now safely through it and should be discharged. 
He refused to be treated by any physician but would talk with 
the analyst because "we're friendly." He was well and ought 
not to be locked up like a criminal, especially after all his services 
to his country (much emotion). He described the horrors of the 
front, the noise, the maiming, the blood, and the danger of death. 
Noises bothered him greatly now because they recalled the 
sounds of the front. He hoped some day he would be able to 
think of these experiences without pain. The horrible sights had 
changed him. He used to be effeminate and sensitive but the war 
had made a man of him. It was the strain of life at the front 
that had made him " unnatural," and he had remained that way 
until he became natural in the receiving ward a few weeks previ- 
ous. It was not his being in the hospital that had made him 
natural. It would have happened anywhere for the period was 
over, that was all. He felt very bitter at the doctors for 
refusing to allow him to go home. It was just awful for people 
to oppose his will. 



1 8 CASE HISTORIES 

He was reticent about making me his confidant, saying it took 
him a long time to decide who was a friend, but that once 
accepted as a friend, always a friend. He told about his family 
and how united they were. If he should marry he would bring 
his wife to his parents' home, he couldn't be separated from them. 
Or better still, her parents would come also, and they would all 
live together. He called his parents daddy and mama. In the 
army he learned to call them father and mother, but now he 
preferred to use the old names again. I told him the story of 
Oedipus, and he was intensely interested, but when I went on to 
narcissism, bisexuality and homosexuality he jumped to his feet, 
and said he must leave the office, he wanted to lie down and sleep. 
This was his usual reaction to any attempt to discuss these pain- 
ful subjects. 

He behaved so well that he was given parole of the grounds. One 
day, however, he demanded to see the superintendent about being 
discharged, and when told the latter was not in his office he be- 
came excited and created something of a scene in the administra- 
tion building. His physician took away his parole, and he became 
very despondent. " My confidence has been broken by being 
kept here like in prison. I don't want to spend my life here. It*s 
a shame. I give up now. After what I did for my country this 
is the treatment I get." He grew rather careless in dress and left 
off his collar. He was warned that his physician would regard un- 
tidiness as a sign he was getting sicker, and he put the collar 
back on. 

Through promise of good behavior his parole was restored. 
He said if he should go home now he would go out in the woods 
and die. The hobo life attracted him. He hadn't known the 
world could be so harsh and cruel. He refused to acknowledge 
he was sick and would not become reconciled to waiting until the 
physicians considered him cured. He began to withdraw more 
into himself. The night nurse reported he cried a good deal in 
bed. He refused to join in the occupational work any longer, 
and said the doctors didn't know anything. One evening he 
broke parole and went to town. He had no money but got a 
night's lodging in a mission and saw the sights of the city the 



CASE HISTORIES 1 9 

next day. Then he asked a policeman to help him get to Chicago, 
but instead the policeman helped him back to St. Elizabeths. His 
parole was again taken up and he was transferred to a less 
desirable ward. While out walking with his new wardmates he 
made a dash to get away but was captured by an attendant. 

Once I succeeded in getting him to tell of his experiences in 
France, which he remembered and related well, but when I began 
talking about psychology and mental conflicts he got resistive and 
distrait and demanded to go. 

He resisted the sugar tolerance test because it smacked of 
medical treatment, and he was maintaining that he was perfectly 
well and was being unjustly deprived of his liberty. The venal 
puncture so unnerved him that he nearly fainted. He resented the 
removal of blood from his body because that weakened it. He 
disapproved of all killing and would eat nothing that had been 
killed. This was a result of his horror of war. As a consequence 
his diet was much restricted and he complained of not getting 
enough to eat. He nearly cut out milk also, but fortunately it 
was possible to convince him that it was kinder to milk a cow 
than to leave her unmilked. 

Although he was friendly towards me and said he felt better 
after talking things over with me, he would not face his conflicts 
and discuss them. 

During the examination after his arrival at the hospital it was 
noticed that when painful subjects were touched on he moved 
his lips and ran his tongue around behind them. In my office 
his hands were held pressed over his genitals much of the time. 

Occupational therapy: It was difficult to hold his interest. 
He got discouraged at the least obstacle and quit, saying he didn't 
feel well or didn't like to work. He never finished anything. 

Physical examination: Small type of skeleton. Skin poorly 
nourished with several scaly lesions on face, neck and back. 
Slight amount of hair in mid-sternal region, and submasculine 
type in genital region. Genitalia normal. Heart rapid. Ex- 
tremities cold and cyanotic. Reflexes sluggish. Slight tremor of 
hands. 

Endocrine diagnosis: Submyxedema. 



20 CASE HISTORIES 

Glandular therapy: None. He refused to take anything re- 
sembling medicine. Coaxing and argument were in vain. He 
would not take medicine because he was not sick. 

Four months later: I found him sitting alone in a washroom. 
He remembered me at once, called me by name and seemed 
friendly. He was much more introverted and was lost in his 
own thoughts most of the time I tried to talk with him. He 
showed none of the former desire to get out of the hospital and 
no longer wrote home. The records stated he said he liked the 
hospital and was not anxious to leave. No mental conflict was in 
evidence, he seemed just calmly lost in thought. 

Mental diagnosis: Schizophrenia with projection. His mind 
was split, part of it living in fantasy. He consciously resisted 
homosexual cravings and also projected them unconsciously, as 
shown by his saying that fear came from what other people 
thought of him and wanted to do to him. 

In his regression he returned to his boyhood habit of imagin- 
ing and called his parents by the names of childhood. He found 
reality too harsh and cruel. The fact that he was held virtually 
a prisoner in the hospital he found too painful to face, so he re- 
pressed this knowledge, considered himself a voluntary guest and 
repeatedly asked for a ring of keys. Reiterated explanations why 
a patient could not have keys made no impression whatever, and 
within a few minutes he would courteously ask for them again 
with calm assurance. 

The sister incest wish was conscious. If there were mother 
incest wishes also, he either hid them or repressed them. Prob- 
ably it was resistance to incest that rendered him impotent in his 
attempts at heterosexual intercourse. The idea of reentering the 
mother to be reborn is connected with the idea of incestuous 
intercourse. His resistance was shown in his asking the Maker 
to grant him manhood and stop the rebirths. 

The snakes which bit him and pistols which shot him near 
the genital region were penis symbols in his projection of the 
impulse to take the feminine role in homosexual acts. He 
often showed great excitement when these ideas forced their way 
into consciousness and he would not discuss them with me. Any 



CASE HISTORIES 21 

approach I made towards them resulted in mental panic and 
flight. Consequently psychoanalytic treatment was powerless 
to help him. At first I had had hopes of a cure. Perhaps if he 
had consented to taking desiccated thyroid it would have stim- 
ulated him to such a degree that he could have suppressed the 
perverse cravings sufficiently to be willing to recognize them and 
talk of them, and then psychoanalysis could have been used. 

He is now introverting more and more. Already the realm 
of fantasy has so far displaced reality that he is largely indifferent 
to whether he remains in the hospital or not. 

Dixon 

History: He was a tall, thin, weak-looking fellow with a 
long, very narrow head and a high-arched palate. His age was 
twenty-nine, and he was the youngest of four children. The 
father died of pulmonary tuberculosis when the patient was seven 
years old. He surmised there hadn't been much love between 
the parents. The father criticized the mother for being too 
affectionate towards the oldest son. This older brother used to 
beat the patient a great deal. 

He went to school until fourteen but had reached only the 
fourth grade. He had difficulty in applying himself to his studies. 
He didn't care much for rough and tumble games with other boys. 
For two years after leaving school he worked as a tabulator of 
weights in a coal yard but wasn't successful. At sixteen he 
entered the army, didn't like it and bought a discharge. Next 
he tried the marine corps and was given a medical discharge 
after three months' service. 

From seventeen to twenty-six years of age he led a roving, 
unsuccessful life, wandering from job to job over all the eastern 
portion of the country from Chicago and New York to Florida. 
He worked usually as waiter or dishwasher in cheap restaurants 
or in the galley of ocean ships for single voyages. 

Early in the war he was drafted, and within two months was 
in France and served as a cook in a camp far from the front. 
Less than three months later he was in hospital on suspicion of 
appendicitis (these pains in the abdomen have persisted and may 



22 CASE HISTORIES 

be connected with the idea of pregnancy). No operation was 
performed and he was returned to the United States as a psycho- 
pathic patient. Four months after his entering the hospital in 
France he was discharged from Saint Elizabeths as recovered 
from an undifferentiated psychosis. 

He went home and tried one job after another but could not 
give satisfaction. He lost them all and became very much wor- 
ried. He was returned unprotesting to this hospital after only 
ten months' liberty. 

On readmission he complained of fatigue and said he felt 
weak and nervous and that his mind was weak and he couldn't 
concentrate on anything. He heard voices and felt he was being 
imposed upon but that there was nothing much the matter with 
him personally. He was fully oriented, his memory was good, 
and he did fairly well in the intelligence tests. 

Sex life: He remembered, when he was eight years old, see- 
ing boys at school masturbate behind their desks and after- 
wards smell their hands. At ten he started the practice himself 
and indulged almost daily although he considered it immoral. 
After puberty he began having intercourse with prostitutes and 
liked this better than masturbation. Sometimes he could not 
get an erection and the girls laughed at him. He noticed that 
he nearly always was impotent if he tried to have intercourse 
twice with the same girl. He had to seek a new one. To over- 
come his impotence he once bought an expensive "vitality belt." 
He felt bashful with girls. 

He denied having committed any perversions and felt disgust 
for them. He could hardly believe a person could so lower him- 
self, yet twice men had offered him money to be allowed to com- 
mit fellatio on him. "I refused. It was an awful risk. I 
feared their teeth. It may have been done to me in my sleep 
but never to my knowledge. I really am afraid to go asleep and 
I try to keep one eye open." On shipboard erotic members of 
the crew had grabbed him and hugged him but he had fought 
them off. Often he had dieted and taken medicine to reduce his 
sexual cravings. 

" I object to hugging and kissing for it may stir up my body, 
my passion. I don't like my mother or sister to kiss me. Mother 



CASE HISTORIES 



23 



kisses me on the cheek. It makes her sick when I go home, she 
worries over me. She isn't good to me. She told me once she 
wished I was dead. I wouldn't care to live with Mother unless 
I was married. I wouldn't sleep with my wife if I had one. It 
would tempt us to do it too often. The body ought to rest. My 
sister's husband forbid me to come to their house unless he was 
there, but I never thought of her body. I let her kiss me but I 
don't believe in it." 

For four years he had had no coitus and since being in the 
hospital no erections. There were occasional night orgasms but 
'he could recall no accompanying dreams. He had felt no sexual 
passion, and tried to keep his thoughts off such subjects. 

Fantasies: His first complaint was that people paid too much 
attention to him. They thought the same things he did. While 
he was reading he could hear a voice in his right ear saying the 
words out loud. Probably it was somebody in another room read- 
ing through his eyes. He couldn't keep any secrets. Other 
people were reading his mind always, everywhere. This " influ- 
ence " was always working on him, something like hypnotizing. 
He was never free from it. He resisted it, but he was forced to 
give an account of everything he did, where he did it, and when. 
Nothing could be hidden. He had to commune to some power 
everything he had done. Something was sucking his mind, it 
wandered off and he couldn't concentrate. 

" It seems as if I was an old whore. They can see through 
my eyes. My soul is so weak that it is exposed. A whore's soul 
IS exposed. After taking a walk I think it over three or four 
times and see it again, not of my own free will but because I am 
forced to. If I hear anyone giggle or laugh I think it is at me." 

Voices talked to him of taking both the male and female 
roles in fellatio, pederasty and coitus inter femora and of cutting 
off his penis. They both urged him to ask other people to commit 
perversions with him and accused him of having committed them. 
" When the nurse comes near me the voice tells me to order her 
to commit fellatio on me. I've heard a voice commanding me 
to say that three times since I've been talking to you. When 
you approached me a voice urged me to say, 'Doctor, you look 



24 CASE HISTORIES 

good to me.' (" Have you ever realized that these voices might 
be your own thoughts?") No, I never think such things or pay 
attention to people's bodies. It seems very degrading and immoral 
to me, like the firemen hugging me on board ship. Just now the 
voice tried to get me to call you a f ellationist. It says I'm guilty 
of fellatio, and yet I haven't really done it. 

"That fellow, Carhart, seems to influence me to ask some 
fellow to commit pederasty on me. I'm afraid to go to sleep 
for fear someone might do it to me. My abdomen feels dead and 
it pains and is all swollen. I suspect three or four men, the 
attendant and Garland and Mathews. (He told another patient 
that I had told him he had a baby inside him. This may explain 
the pains that were first diagnosed as appendicitis in France.) 
They try to make my left eye bigger than my right. The voices 
sometimes tell me not to eat anything, and then if I do start 
eating my mind goes blank (emotional blocking from resistance 
to fellatio ideas?). I'm a light eater, chiefly bread and coffee. 
I vomit fish and greasy things. (Recall Carhart's aversion to 
fish.) 

" I've had wet dreams of seeing dogs at intercourse. (" Male 
or female?") Well, perhaps two males, just like you see in the 
street when they jump each other. You seldom see a male and fe- 
male doing it, it's usually two males. Yesterday when I was walk- 
ing near the edge of the grounds a negro grabbed me fearing I was 
trying to escape. My first thought was that he was a f ellationist. 
I dreamed recently of being at an auction sale of bunches of green 
bananas. Mother seemed to be there to buy them, though I 
couldn't see her. 

" My mind can't be at rest. The patients are too near me. 
They have sucked everything I know out of my mind, all I've 
been through in my younger days and recently, and now I'm 
at their mercy. It seems as if other fellows make me a scapegoat 
for their wrong deeds. They run their minds on me, put ideas 
into my head like hypnotists. On the Red Cross excursion I was 
embarrassed and had to hold my head down. I can't keep my 
mind on anything, but just sit and play like a child." 

General observations : The constant intrusion of unwelcome 
sexual thoughts kept him worried and unhappy. His face was 



CASE HISTORIES 2$ 

puckered and furrowed with anxiety on account of this con- 
tinual " influence." He was irritable and unsocial and didn't like 
to work. Most of his time was spent in wandering miserably 
around the institution. He couldn't enjoy himself in the Red 
Cross recreation rooms because the other patients kept digging 
into his mind. 

I often attempted to explain to him mental mechanisms such 
as repression and projection, but he vigorously rejected the ex- 
planation that his woes might come from his own unconscious 
mind. My talks made not the slightest impression on him. 

He said he often found his hands crossed over his genitals or 
his thumb or finger in his mouth, but of course it was " influence " 
that made him do this. 

Occupational therapy: He took to the work without urging, 
did fairly well and seemed to enjoy it, then got more worried 
and resistive and refused to work saying, " I can't do it, I don't 
feel well," and making other excuses. He had parole of the 
grounds and preferred to go outdoors rather than do handiwork 
in the ward. 

Physical examination: Tall, slender type of skeleton. Head 
elongated. Slight amount of hair over body. Genital hair and 
genitalia normal. Perspires easily. Heart normal. Moderate 
tremor of fingers. Reflexes sluggish. Pulmonary tuberculosis is 
suspected. 

Endocrine diagnosis: Submyxedema. 

Glandular therapy: Thyroid was first given and seemed to 
make him very irritable. He had been peaceable previously, but 
now he quarreled with the attendant and complained of him for 
being noisy and bossy. " It's been harder to keep my mind on 
things today. I feel like throwing my food on the floor. I don't 
enjoy nothing." The nurse reported him as restless and more 
talkative than usual. The thyroid stimulation seemed only to 
increase his difficulties. 

A combination of thyroid and orchic was next tried and proved 
beneficial. He lost the " influence " for half an hour at a time, and 
during these welcome interludes his mind felt free of all outside 
control. He said he felt better physically, and his appetite im* 

3 



26 CASE HISTORIES 

proved. He voluntarily joined in the work of the ward and soon 
was making all the beds. His facial expression looked somewhat 
less worried. 

Four months later: I found him lying on his face on the 
corridor floor. When I roused him he recognized me at once. 
He said he was much bothered in mind. He had given up going 
to town on theater parties for he couldn^t keep his mind on the 
play, nor could he concentrate enough to do occupational work. 

Mental diagnosis: Schizophrenia with projection. All his 
improper sexual cravings were projected onto other people or on 
voices. He had no insight whatever and resisted any explanation. 
His resistance to kissing his mother and sister clearly indicated 
incestuous impulses as did also the dream connecting his mother 
with green bananas (immature or stiff penises?). Probably this 
incest resistance was what rendered him impotent towards a 
woman after once he had intercourse with her and she had be- 
come familiar. Being thus hindered in getting his libido over to 
the other sex, his homosexual cravings became very strong. He 
did not succumb to them but protected himself through disgust. 
Not being able to repress the cravings and too horrified to recog- 
nize them as his own, he was forced to project them. His recent 
sexual impotence was probably a defense against the perverse 
cravings. At night he still had orgasms but the dreams were 
repressed. In the former wet dreams of the two playing dogs 
the real meaning was sufficiently disguised. Now the meaning 
of his wet dreams was probably too apparent to allow them to be 
recalled. He accepted dreams as products of his own mind and 
did not blame them on outside influence. 

The continual influence came of course from his unconscious. 
During glandular feeding he was able to completely repress his 
unconscious thinking for brief periods, but with total lack of 
insight. After the feeding was stopped the repressed thinking 
became too strong once more. Except for his inability to repress 
the obnoxious cravings and the splitting of consciousness which 
resulted, his mind did not seem deteriorated. He was perfectly 
oriented, his memory was good, and he could talk intelligently. 



case histories 27 

Engel 

History: He was a man thirty-nine years old and mentally 
deteriorated. It was difficult to get him to tell of his past life, 
and the medical records were brief. His boyhood and youth were 
spent in a great city, where he received a fair education. After 
leaving school at fifteen he loafed at home for several years and 
then worked in a tailor shop and a piano factory. At the age of 
twenty-two he entered the army and was an officer in the Philip- 
pine Guards when taken sick ten years later. He married at 
twenty-nine but had no children. His father died of alcoholism 
and his mother of tuberculosis. He himself never drank to 
excess. 

His wife said he overworked in the Philippines and had a 
breakdown lasting a month during which he had fearful dreams, 
one being that he had killed her. Two years after this illness he 
grew depressed and anxious and felt unworthy. One day at 
table he rushed out of the dining room greatly excited, saying he 
was choking and and his throat felt sticky. He was afraid she 
had left him and married another man. Voices accused him of 
disgracing himself and called him a thief and coward and other 
bad names. He feared he might die or be killed, and made one 
half-hearted attempt at suicide. 

After reaching St. Elizabeths he was suspicious and had un- 
systematized delusions of persecution. A twitching tic of the 
mouth was noticed, and sometimes he kept his tongue protruding. 
He said he was bad and had wronged his wife, and the police 
were after him. He stuffed his ears so as not to hear the per- 
secuting voices, and complained of peculiar sensations in his head 
and of frontal headaches after the sticky feeling in his throat 
and the resultant choking. 

Sex life: In answer to my question what was his chief pleas- 
ure as a boy he said, " Playing with myself, jerking of¥." He 
added that when he was twelve or thirteen years old a servant girl 
of thirty-five gave him all the coitus he wanted. After her he 
had relations " with a lady, nice and clean." No further informa- 
tion could be obtained. 

Fantasies: He had a great habit of scolding at nobody in 
particular. During one of these tirades I asked what bothered 



28 CASE HISTORIES 

him. He answered, " A man wanted to marry me. He called 
me good looking. He was stronger that I. You look like the 
man who wanted to marry me." 

On another occasion he indignantly complained that these 
pimps around here called him a fellationist. A fellow patient 
told me he sometimes acted as if someone were after him and 
exclaimed, " I don't care for any old man or anybody who 
bothers me and does things of that kind." 

He said he either dreamed of nasty sexual acts or of money 
with which he would buy lots of clothes and things. 

General observations: His most striking feature was a 
strange, persistent smile, mostly in the eyes, as perplexing as that 
of Monna Lisa. It could change very quickly into an expression 
of frank hostility, and at first I was careful when near him, but 
he never offered violence to anybody. I believe the smile denoted 
uncertainty and suspicion of other people and an attempt to 
discern their sentiments. 

A conversation with him was next to impossible. He looked 
at one most of the time with this impenetrable smile, and though 
he started many sentences seldom finished one; they usually 
stopped part way before the meaning became evident. One 
day I felt that he was trying to divulge something important 
and was on the edge of doing so several times but couldn't quite 
decide to take the plunge. He had used the phrase "nice and 
clean " again and again, " live nice and clean," etc. I suddenly 
asked, "What about dirty?" "That's all the trouble," be re- 
plied, " I don't think I ought to live on. I've been sort of 
married to everybody. I felt dopy and sleepy in the Philippines. 
Now I feel that way too, sometimes. Nice and clean, independ- 
ent, nothing annoys me much, live on nice and clean. I get along 
pretty well." He was very careless of his clothes and often went 
about with fly unbuttoned and genitals half visible. ( " Why do you 
do that?") "They ought to look at it." He said fellatio, ped- 
erasty and masturbation were all dirty, but heterosexual inter- 
course was clean. This information was slowly and laboriously 
extracted from him in piecemeal fashion. 



CASE HISTORIES 29 

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 



30 CASE HISTORIES 

keep nice and clean and be respectable. He explained that normal 
coitus was clean and perversions and masturbation dirty. Prob- 
ably he had committed fellatio in the past and this was why his 
throat felt sticky. His strong homosexual cravings were vigor- 
ously resisted, and the fight still goes on. The feeling of sexual 
unworthiness probably antedated such delusions as being a thief 
and deserter. 

Foster 

History: He was a deteriorated patient who had been in the 
hospital nine years. His age was thirty-five. There was no 
history of nervous or mental disorders in the family except that 
two paternal cousins were insane. His father was of " primitive 
mentality." The patient was the youngest of seven children and 
was considered delicate and backward as a boy. He didn't do 
well in school and had to be forced to attend. He was always 
seclusive and quiet and disliked games and amusements. He 
showed such aversion to girls that he was teased about it. After 
leaving school he worked as delivery boy in his father's grocery, 
for which he received five dollars a week and maintenance. 

Some weeks previous to his commitment he had complained 
of severe headache with loss of appetite and vomiting, and later 
became retarded and stopped work. He acted frightened, wept, 
said he was " full of electricity " and blamed himself as " the 
cause of it all." In the hospital he continued to show fear and to 
blame himself, and remained in a semi-stupor. He would eat 
only when threatened with tube- feeding. One day after a bath 
he had a clonic convulsion lasting several minutes. He made 
several attacks on other patients " because they called him bad 
names." He was confused and weepy for three years, then be- 
came oriented for place and person and emotionally indifferent. 
He talked to voices, but said they didn't bother him. He never 
associated with other patients and never worked. 

Sex life: All that the records stated was that he disliked girls. 

Fantasies: He frequently laughed and, when asked why, 
answered that some certain person in the environment was the 
funniest looking one he ever saw. The individuals he pointed 
out had nothing unusual about them. It was evident that these 



CASE HISTORIES 3 1 

replies were only excuses to hide the real cause of his pleasure. 

General observations: He was untidy and tore his clothes. 
He would not wear suspenders and had to hold up his trousers 
with one hand when walking. He never spoke unless spoken to, 
and would if possible move away without answering. He whistled 
a good deal, learning the latest airs from the graphophone, and 
he liked to look at pictures, but never read. 

The attendant noticed that when out walking he would 
respond to greetings from a distance but as soon as a person 
approached him he became uncomfortable, looked in another di- 
rection and tried to get away. 

Occupational therapy: He turned his back on the instructor 
and paid no attention to her efforts to interest him. 

Physical examination: Skeleton out of proportion with small 
pelvis and heavy upper extremities. Skin dry and covered with 
scabs. Hair dry and scaly and very fragile. Beard scanty. 
Genital hair normal. Genitalia normal. Heart slow. Circula- 
tion sluggish. Extremities cold and cyanotic. Patellar reflexes 
exaggerated. Gait shambling. 

Endocrine diagnosis: Submyxedema. 

Glandular therapy: The thyroid test caused him to become 
considerably more extroverted. He answered more readily when 
spoken to, didn't try to get away as much as formerly, noticed 
other patients, put on a bizarre skull cap belonging to the at- 
tendant and joined heartily in the resultant laughter, complained 
of pains and aches while formerly he never mentioned how he 
felt, and even consented after some urging to try basket-weaving. 
He also became tidier with his clothes. 

Later a combination of thyroid and suprarenal was given him. 
The improvement was maintained. 

Four months later: He seemed to have returned to his condi- 
tion previous to glandular stimulation. 

Mental diagnosis: Schizophrenia, with projection in the be- 
ginning at least. The meager records of his disease tally in the 
main points with the usual schizophrenia. He never got his libido 
over to the opposite sex, and he had a sense of unworthiness and 
sin due, no doubt, to perverse cravings. Perhaps at first he had 
insight, for he claimed he was to blame for it all. After three 



32 CASE HISTORIES 

years he apparently ceased the struggle against his unworthy 
tendencies and began to indulge them in fantasy, for the voices 
no longer annoyed him and he became contented. His laughter 
was probably over his formerly resisted fancies now freely in- 
dulged and not at the unlikely external objects he cited in excuse. 

Garland 

History: He was so deteriorated that he could not give any 
of his history. The following facts were selected from the hos- 
pital records. The family history was negative. He attended 
school till he was fourteen, and failed towards the end in the 
sixth and seventh grades. His longest job was in an optical shop 
where he ground lenses for seven years at low wages. At the 
age of twenty-four he married. He was extremely jealous and 
suspicious of his wife, and finally began accusing her of having 
sexual relations with almost every man in the neigborhood. He 
lost his job in the optical shop because he continually quit work 
early to spy on her. He heard voices call him vile names and 
feared his brother-in-law wanted to kill him. After losing the 
optical job he worked as elevator man and park laborer until 
he was committed at the age of twenty-nine. His wife had not 
lived with him for two years previous. 

The above information came from the family. His own 
version at the time of commitment was that noises, like buzzing 
bugs or jumbled voices as if several people were speaking at 
once, annoyed him and kept him awake. Sometimes he could 
distinguish what they said, and it was both pleasant and un- 
pleasant. Some told him to do right and others called him bad 
names. He could carry on conversations with them. He had 
seen unnatural things, but wouldn^t say what. He believed his 
wife's mother poisoned his food. He felt discontented and was 
easily angered, but didn't understand why he was sent to an 
insane hospital, for he wasn't insane. The examiner commented 
that he was much absorbed in his own thoughts, and was rest- 
less and suspicious. He had no insight. 

During his nine-year stay in the hospital he had gradually 
deteriorated. He didn't associate with other patients but had no 



CASE HISTORIES 33 

difficulties with them. The voices kept bothering him, however, 
and he often answered them angrily and was "profane and 
vulgar." Shortly before entering our ward he complained that 
magnetic power was being used on him. 

Sex life: The record stated nothing beyond that he was 
married, suspected his wife of infidelity, and denied venereal 
disease and perversions. 

Fantasies: In our very first talk he brought up the subject 
that troubled him most. " A man isn't responsible when influence 
is used on him. I don't see why they use influence on me. I see 
myself turned over and shot upside down out the window and 
then come back again into the room, and yet I'm standing still in 
one place all the time. All day long they turn me over. They've 
no right to. It's an offense to the law to turn a man over. And 
Fm a married man. Action on the human body is an offense. 
They shouldn't go beyond the limit, beyond the law." This was 
his greatest annoyance, and his good days were those in which 
he said he was not turned over so much. 

"Voices say things, thousands of them. I understand them, 

but I don't know where they come from. I can't use influence 

back again but I can answer. I enjoy their talks. ("Do they 

jiver jay:_bad_names ? " He frowns angrily.) I don't approve 

of that." ^ 

He had many face and head tics. He nodded his head 
violently up and down, his eyelids winked, and his lips smacked 
loudly. Often in place of smacking he would roll out a long 
neologism, " glahba-glahba-glahba-glah." He indulged in these 
simultaneous tics and exclamations only when angry and dis- 
turbed by his hallucinations and delusions. When they were 
agreeable he laughed in glee. The laughter occurred mostly 
when looking at pictures of women. This was one of his chief 
delights. He poured over Sunday supplements and magazines, 
cut out such pictures, carried them around with him, kissed them 
and took them to bed with him. The attendant once had to 
rescue his photograph of his fiancee. The patient said, " Pictures 
talk to me like any human being, not out loud, but influence. 
Not as plain as a voice like you, but still I understand what they 



34 CASE HISTORIES 

say. No particular subjects, just matters of friendship and love." 
(Blushes — emotion.) 

One night he took to bed a newspaper photograph of a noted 
prima donna who was suing for divorce. The following morning 
he told me she had spent the night with him in sexual intercourse, 
that she was going to settle a hundred thousand dollars on him, 
and he would marry her as the Earl of Wellington. On another 
occasion the attendant, out of curiosity to see his reaction, offered 
to bring a real woman to him. He became panic stricken at once 
and angrily forbade the attendant to do so. 

At night he was very disturbed and often had regular battles 
with imaginary antagonists. I sometimes came into the ward 
quietly and listened to him without his knowing it. He seemed 
usually to be fighting off another person or resisting masturba- 
tion. At intervals he exclaimed, " No, don't do that. Put your 
hand down. A nice young man like you," and his voice broke as 
if weeping. A " glahba-glah " would be interjected from time 
to time. After an hour's conflict he gave in and masturbated 
angrily, then became quiet. Patients in neighboring beds told 
me that during these struggles he talked of coitus, bestiality, 
cunnilingus and analingus. He would shout, " Take that man out 
of here. I don't want you. Come back in here." Then he'd leap 
out of bed and fight the air with his fists. The struggles ended 
in angry masturbation. Once he pounded his jaw as if angry at 
himself. 

He complained somewhat of trees, saying that trees and cars 
did it, made the offense (turning him over), and that plants and 
trees annoyed him by talking to him, and he could feel their talk 
tap him on the abdomen like a person's finger (homosexual 
assault?). 

" That gets me," he exclaimed indignantly, " I get the boys 
all the time and I want the girls sometimes." 

General observations: He was a pleasant, friendly fellow 
quite willing to talk unless too badly annoyed by his hallucina- 
tions, but it was often hard to understand him, for he had given 
meanings of his own to familiar words and thus invented almost 
another language. For instance he would rub a forefinger in the 
palm of the other hand and talk about " material " and " ingredi- 



CASE HISTORIES 35 

ents." This was constantly repeated, but I could never discover 
the hidden meaning. 

The following is a typical conversation: ("What made you 
sick in the first place?") "It might have been actual sexual 
intercourse at a distance. It might be action. A married man. 
Sexual intercourse at a distance. I can't state just the reasons 
for it. I never had difficulties at a distance. It seemed to be 
action, that's all. Action is movement. From a distance to my 
penis. I never had any difficulties. While I was at work elderly 
men more than young men bothered me. An affliction. If he 
wasn't married, it wouldn't be action against him." 

When not constantly stimulated by other people he was liable 
to go off into his fantasies, which were usually unpleasant, and 
then begin his violent tics and glahba-glah-ing or smacking. He 
could play casino but went into these tics while waiting his turn 
to play. He liked to join the other patients in playing catch 
with a baseball, and was quick and skilful, but lapsed into his 
mannerisms if the ball were not thrown to him frequently enough. 
When the others heard him begin to glahba-glah they threw a 
basket ball at his head, and he would laugh and join the game 
again. 

A few times he made sexual advances to the nurses. But his 
great preoccupation was masturbating. Several times a day he 
would retire into the watercloset and indulge in it in spite of 
attendants and fellow patients. 

Occupational therapy: He could not learn the simplest weave 
in basket making and spent fruitless weeks on a stocking cap. 
He would continually lapse into fantasy and weave blindly. 
Every day the instructor made him do some simple task such as 
marking holes on tray bottoms. He could play a game of cards 
because the other players continually called him out of his 
fantasy. 

Physical examination: Slender type of skeleton, well nour- 
ished and muscled. Skin presents slight actiniform lesion. Beard 
slight, small amount of hair over abdomen. Genital hair normal. 
Very large genitalia. Extremities cold and cyanotic with derma- 
tographism present. Heart normal. Extensive reflex excursions. 

Endocrine diagnosis: Submyxedema. 



36 CASE HISTORIES 

Glandular therapy: During the thyroid feeding he seemed to 
improve. He grew quieter because not so much bothered by his 
hallucinations. The masturbating nearly ceased. His mother 
visited him and thought him improved both mentally and phys- 
ically. 

Four months later: He knew me at once. His condition 
seemed the same as before thyroid feeding was begun. 

Mental diagnosis: Schizophrenia with projection. His 
struggle against his perverse cravings was plain to see. Ap- 
parently they were all projected and he was not consciously 
tempted. At night, however, in a hypnogogic state, they some- 
times broke through, and he cried that he would not do these 
things but wished he could. 

His extreme jealousy of his wife indicates that he must have 
been impotent. The obsession of being turned over is probably a 
passive pederasty fantasy. Unlike some of the other patients he 
has not given in and secured peace by indulging the perverse 
cravings, but still fights them as vigorously as in the beginning. 

Halsted 

History: He was a clumsy, strong-bodied boy of twenty-one. 
His parents and four brothers were living. He was the youngest 
of the family and had been much petted. The father was 
psychopathic and there had been much family discord. He com- 
plained that his wife cared more for her sons than for him, and 
when he got excited was severe with the boys. While they 
lived in the country he used to wake as early as 3 or 4 A.M., get 
up, and wander for hours through the fields and woods. At 
present he got angry whenever the mother, a timid weak little 
woman, saw another man, and the situation was getting so 
intolerable for her that the sons were contemplating taking her 
with them and abandoning him. None of the sons would remain 
at home. The second son had spasms until he was five. The 
mother described the third as nervous and impatient and intol- 
erant of noises, and the fourth as over-active. With the excep- 
tion of the patient the sons were able to make their way in the 
world. 



CASE HISTORIES 37 

He attended school from five to eighteen, graduating from 
the eighth grade after repeating it. School was too hard for him 
he said, and he used to play truant a good deal, going off in the 
woods with his dog, gun and fishpole. He was always reticent 
and a great home boy, and didn't play with other boys much 
when his brothers were away. 

Until his next older brother and he were ten and eight 
respectively their mother slept between them in the same bed, 
and she remembered that they used to be jealous and each one 
wanted her to face him and turn her back on the other. The 
brother then slept apart, but the patient slept with her until well 
after puberty. It was noticed that he became more bashful and 
shy after puberty. He sucked his fingers till he was twelve. 

The excitable father scolded the mother a good deal and this 
upset the boy who made faces at the father behind his back. 
The father said his other sons used to oppose his will at times, 
but that the patient rarely stood up for himself. Once, however, 
he refused to hitch up a team when ordered to, and the father 
chased him off the place with a revolver. He was slow and 
awkward, and the brothers nicknamed him "clum," short for 
clumsy. They had been forced to go to work about the age of 
fifteen and felt bitter over their limited education. They insisted 
that the patient be given a better chance and advised him not to 
go to work till he was twenty-one. 

The brothers were very affectionate among themselves. One 
of the older ones took the patient as his buddy, gave him candy 
and other preseii'ts, and looked after him in general. He used 
to caress this brother's head and hair. All of them kissed each 
other even yet. When one of them visited him in this hospital 
he called him Honey and kissed him. The father said the boys 
were fond of wrestling with each other on a bed and the victor 
kissed the vanquished one repeatedly. 

After quitting school at eighteen he went to the city and lived 
with one of his brothers, and got a job in a parcel check room, 
studying stenography at night school. He lost that job soon, and 
then got one as telegraph messenger boy but gave that up because 
it was too hard. One night he implored his brother to protect 



38 CASE HISTORIES 

him, saying people wanted to shoot and kill him. He was sent 
home, and arrived there in great terror. They soon took him to 
a state hospital, where he remained for a couple of years during 
which he made long visits home but could not adequately adjust. 

He had some delusions about his eyes, and hung up a picture 
of a skull on the wall with eyes punched out and strings running 
from the holes to all parts of the room. A photograph of his 
father he called the devil, one of his mother was God, and one 
of himself was Christ. He said he could turn anything into 
stone. He got careless of his personal appearance, slept on the 
floor, and ate with his fingers. The family noticed that he 
didn't like to be kissed by his mother, aunt, and brothers, and 
his attitude toward his mother alternated between strong affec- 
tion and angry aversion. He would spend two hours in the tub 
and lay with his head also under water. Several times he ran 
away from home and came back a day or two later disheveled 
and famished. He never would give any adequate explanation 
of his behavior. They tried him on farm work as a last resort, 
but he could not keep his mind on his work. He would stop and 
laugh to himself. When asked what he was laughing at, he 
would say at the dog or give some other transparent excuse. He 
was finally brought to St. Elizabeths. 

Sex life: He had no intention of giving out any information 
he could possibly hide, and probably feared that he might divulge 
something that would prove he was sick. He insisted he was all 
right and ought to be let out. I managed to draw out that he had 
masturbated about once a month (he told a brother he had done it 
as often as two or three times a day), and that he had tried 
heterosexual intercourse at twelve. That was the only attempt, 
he hadn't much desire later and he felt bashful with girls. 
Perversions he denied. 

Fantasies: He denied all hallucinations and delusions and 
gave no outward sign of any. I told him the story of (Edipus, 
and at the mention of mother incest dreams he broke into a 
sudden knowing smile. ("Did you ever have one?") "Not 
often, not for a long time." When I pushed the question, he 
denied he had ever had one. 



CASE HISTORIES 39 

He denied wet dreams, nightmares, or dreams of coitus, but 
said he had day-dreamed of sexual intercourse. He said his 
dreams were of finding money on trees and bushes, and of going 
fishing. He also used to imagine himself the boy characters in 
the Horatio Alger books of which he was very fond. 

General observations: He was a clumsy boy, walking in a 
rolling, loose jointed manner that had grown much worse in the 
last two years. His one main idea was to get out of the hospital. 
He insisted he was all right, there was nothing the matter with 
him, and if his family cared anything for him, they would come 
and take him home. It was noticeable that he preferred to see 
his father rather than his mother in spite of childhood love for 
her and fear of the father. (Another case, an eighteen-year-old 
boy, whose mother incest desires broke into full consciousness, 
used to greet his father cordially and rebuff his mother, even 
striking her and shouting, "Take this woman away, I've never 
seen her before.") He begged money and candy from them like 
a child. 

He had never confided in anyone and was unwilling to do so 
now. At every opportunity he would run away, even when the 
father was taking him for a walk about the grounds. He was 
deceitful and lied up and down, denying the information given me 
by other members of the family. He feared the doctors were 
going to hurt him in some way. He disliked being looked at, 
and during interviews with me picked nervously at his finger 
nails. He said that when he lost his jobs his brothers scolded 
him and he was afraid they might put him in prison for it, so he 
was anxious to get away from them and did not object to going to 
the first hospital. 

Since he would not talk freely I used the association word 
test in an effort to discover his complexes, but it accomplished 
very little because he would not give many free associations 
afterwards. I made three tests, embodying in the second and 
third tests the words which aroused emotion in the first. By the 
time we reached the third test he had learned to give stereotyped 
responses to nearly all the former complex-indicators. 

Eye, lips, mouth, tongue, suck, sucker and swallow were 
associated together and aroused much emotion and resistance. 



40 CASE HISTORIES 

They made one suspect fellatio. Woods and hushes were linked 
and brought back memories of playing hookey and hiding there 
from his father with another boy with whom he swam in the 
brook and also masturbated. Dirty, slimy, and dog made him 
think of dirty dog. Enjoy made him think of having all he 
wanted of candy, money, and clothes. Dreams: "Come true, 
we wish they would." Observe: "Observer, one who looks. 
People looking at you, I don't like to be looked at. (The pre- 
occupation with eye may have some connection with this. He 
exclaimed once, "When you say eye, I just can't help thinking 
of lips.") Voices: "I couldn't think of a word for voices so I 
had to think up some other. Insane people hear voices. No, 
I don't." Jealous, hate, kill, murder, die were connected. Hate: 
"Hateful, they won't do nothing for you, they're mean. To 
hate anybody is to kill them." Die: "Dead, they're gone." 
Lazy, work, forget, failure, and pity recalled how hard his family 
had been on him because of his forgetfulness and poor work. 
Love, kiss, had, prick, and cock brought evasive responses after 
delay. Father, mother, and brother also caused delayed re- 
sponses. Secret caused a blocking of half a minute, and the 
response was "secretly." But the longest delay, forty-five sec- 
onds, followed spit: "Whistle, Papa spits tobacco." He would 
say nothing more, and it was impossible to tell whether the 
emotion aroused by spit was connected with the suck-and-swallow 
complex or his father-hate. 

He escaped from the hospital numerous times and went home. 
The family often allowed him to remain there a while, but he 
could not accommodate himself to their life and they were forced 
to bring him back. After each escape he begged his doctor to 
give him another chance in the open endocrine ward and promised 
faithfully never to run away again, and then escaped again at 
the first opportunity. 

Occupational therapy: He was shy and lazy and did not do 
good work. He worked only part time and sat around a great 
deal in idleness. 

Physical examination: Skeleton normal. Skin well nour- 
ished. Good muscular development. Genital hair distribution 
normal. Small amount of hair around mid-sternal region and 



CASE HISTORIES 4 1 

nipples. Axillary hair very scanty. Genitalia normal. Ex- 
tremities rather cold. Type of movement slow and deliberate. 
Heart rate accelerated. Reflexes hyperactive. 

Endocrine diagnosis: Submyxedema. 

Glandular therapy: He was given thyroid. Treatment was 
much interrupted by his frequent escapes. No change was seen. 

Four months later: During the summer he escaped again and 
was allowed to stay home for a month until he attacked one of 
his brothers for refusing to give him money. He had also bull- 
dozed his mother when his father was at work. The attendants 
reported he was masturbating frequently. No one had seen him 
do this in the endocrine ward. He seemed worse ; more self-con- 
tained, introverted, and on the defensive. 

Mental diagnosis: Schizophrenia with projection. He had 
had considerable experience with insane hospitals and in his 
partially recovered condition was smart enough to hide the symp- 
toms he knew doctors were looking for. He claimed he was all 
right and wanted to go home, so of course he wished to hide 
any symptom that he had seen was considered bad. Thus, while 
he resolutely denied hearing voices in the hospital, on one of his 
escapes he told his cousin he was going to Union Station to find 
out about the voices. A stereotyped hospital question is, " Do you 
hear voices ? " As far as could be seen he had no delusions or 
hallucinations except the vague fear that someone might hurt 
him. He would rather sit or lie down than work. One never 
saw him smile or give any indication of enjoying his thoughts 
particularly. 

He had much autoeroticism. The staying in the bath showed 
skin eroticism, and the association test disclosed oral eroticism 
if not actual fellatio. It will be remembered that he sucked his 
fingers for many years. 

Signs of his struggle against incestuous and homosexual 
impulses were his resistance to his mother and brothers kissing 
him and his alternating affection and aversion for his mother. 
The flights from home were an attempt at emancipation from the 
family, but he was not strong enough to stand alone and had 
to return beaten. His childish relation to his mother and his shy- 

4 



42* CASE HISTORIES 

ness and fear of girls prevented his outgrowing the bisexual 
stage. His extreme reserve rejected all outside help and his only 
hope of cure was to work out the problem by himself unaided. 
This he did not seem able to do. 

Irgocz 

History: He was an Austrian Pole twenty-seven years old. 
There was no mental or nervous disease in his family with the 
exception of a paternal uncle who drank and later committed 
suicide. The patient was the first born and was sickly and 
delicate as a child. At five he had typhus fever. He attended 
school from seven to ten and liked it but had to go to work on a 
farm because they were poor. From sixteen to eighteen he was 
a laborer and then he emigrated to the United States. 

He worked in foundries and factories for rather low wages 
but got on all right except in the last place. It was too hot, 
and he noticed the other men were jealous of him because of 
his good work. They tried to make him mad and looked sus- 
piciously at him. He also believed that the food at his boarding 
house had been poisoned and complained of it to the police. To 
escape from the unpleasant situation he enlisted in the army at 
the outbreak of the world war. 

Two months later he was removed from a transport ready to 
sail for Europe, and put in hospital. His comrades had reported 
him to be making silly grimaces and talking to himself. His 
version was that everything was all mixed up and the men cursed 
him. He was transferred at once to St. Elizabeths. 

At first he was tidy and fully oriented and cooperated in his 
examination. He said he could think and remember as well as 
ever, while in reality his memory for recent events was badly 
impaired. Voices called him bad names. Later he went into 
a catatonic stupor and had to be tube-fed for a while. During 
the following two years he had become disoriented and untidy, 
and complained that magnetism was being used on him. 

Sex life: According to his statements two years ago he had 
never masturbated or committed perversions. He preferred girls 
to boys but seldom associated with them. At twenty he had his 



CASE HISTORIES 43 

first heterosexual intercourse, and stopped after four or five ex- 
periences. He was much afraid of venereal disease. 

Fantasies: On his admission he said he dreamed of being 
home in Poland and of working in the factory. Now he was 
absolutely inaccessible, spending all his time in his own thoughts. 
They must have been pleasant for he disliked any interruption 
and gave no signs of conflict or distress. 

General observations: He was absolutely indifferent to the 
external world. When standing, his arms were thrust down 
inside his trousers though not touching his genitals, and he 
walked with eyes downcast or stood staring by a window. In 
cold weather he huddled over a radiator, hands clasped over the 
nape of his neck. For hours he crouched in a heap in a corner, 
eyes shut and fingers stuck into his ears. He seemed to want to 
turn in on himself physically as well as mentally. But when the 
pantry door opened at meal time he was usually the first to reach 
it in spite of his apparent isolation. As he carried his tray to 
a table his grin of satisfaction was almost animal-like. 

When one forced oneself on his attention he sometimes struck 
out in annoyance, and then mumbled an unintelligible mixture of 
Polish, German and English punctuated with guffaws of laughter. 
I once distinguished the German vulgar term for feces and the 
ever-present son-of-a-bitch preceded by profanity. He repeated 
this phrase several times with delighted laughter and then pointed 
to his teeth. He pressed his lips tight together and pouted them 
forward and back a great deal. A Polish-born nurse spoke to 
him in his own tongue, but he rebuffed her like the rest. 

Occupational therapy: He remained entirely inaccessible. 

Physical examination: Medium type of skeleton. Skin pale. 
Entire chest and abdomen covered with long, thick hair. Gen- 
italia normal. Abdomen protuberant. Heart weak and irregular. 
Pupils pinpoint. Reflexes sluggish. 

Endocrine diagnosis: Submyxedema. 

Glandular therapy: Thyroid was given. The stimulation 
seemed to force him to extrovert in spite of himself. He dropped 
his hands from his ears from time to time and looked about him 
in half surprise as if wondering where he was. He paced rest- 



44 CASE HISTORIES 

lessly a good deal and didn't stay crouched in corners so much. 
The extroversion increased and he was soon pushing a floor 
polisher and was even induced to do a little basket weaving. 
The attendant reported that in taking a bath he soaped, scrubbed 
and wiped himself well. On previous occasions he had made a 
few passes and tried to get out of the tub and dress while still 
wet. 

Four months later: During the summer nurses reported he 
had seemed brighter and more alert. He would obey orders and 
even made beds. He no longer closed his eyes and ears, hung 
his head, or crouched in fixed positions. He became oriented 
for place and asked why he was there. 

I found him still lost in his thoughts though his eyes and ears 
were open. His lips were pressed tight together and protruded 
as before. Instead of looking happy or at least contented he now 
had a slightly troubled expression. 

Mental diagnosis: Schizophrenia with projection. In the 
beginning at least he projected his difficulties, and believed other 
men persecuted him, and he heard accusing voices. As the 
disease progressed he appeared to give in and to indulge in his 
dirty fancies. He showed a bit of waxy flexibility which is a 
sign of submission. The lip tic indicated oral eroticism. He 
tried to avoid all external stimuli by closing his eyes and ears 
and striking off anyone who touched him. 

The thyroid feeding seemed to force him out of his comfortable 
fantasy life somewhat into the world of reality. The troubled 
expression may indicate that the increased pressure of reality 
has stirred up some resistance to his fantasies, and conflict has 
again ensued. 

Jackson 

History: He was an enormously fat man with a huge paunch 
and a voracious appetite. His age was forty and the last eight 
years had been spent in the hospital. He knew very little about 
his family. His father drank periodically and he himself had 
drunk too much he said. An uncle had died insane. 

The patient was born in Ireland and came to this country 
when five years old. He attended school irregularly until he was 



CASE HISTORIES 45 

fifteen, by which time he had reached the fifth grade. He worked 
in a printery, a machine shop and a theater, never earning enough 
money to live the way he wanted. Most of his jobs were as 
hostler for wealthy families who let him go when they left for 
their summer vacations. When motor cars began displacing 
horses he should have learned the automobile business, he said, 
but something in him didn't want to. 

At the outbreak of the Spanish War he enlisted in the army 
because he wanted to see the world. After three years he was 
honorably discharged. There followed a series of enlistments in 
the army and navy with dishonorable discharges and prisort 
sentences for fraudulent enlistment, drunkenness and stealing- 
He finally became upset and believed people were reading his 
mind and hypnotizing him and forcing him to say and do things 
he didn't intend to. He became terrified because he was sure 
some people were going to kill him. 

In the hospital he refused to work, did not associate with 
other patients, and was certain he was to be killed. Voices, 
accused him of vile practices, and God gave him instructions^ 
about his eating. He became somewhat grandiose and decorated' 
his clothes bizarrely. 

Sex life: He preferred to keep off this subject. With blush- 
ing and shame he said that he considered masturbation harmful" 
and had never done it much. The record states he had been 
caught at it. When he was eighteen a married woman, separated' 
from her husband, had picked him up and he had gone with her 
for two or three years. He disliked even to admit having had 
heterosexual intercourse. It was not possible to marry on less 
than a hundred dollars a month he said, and he had never earned 
that much. At mention of perversions he was instantly on the 
defensive, "Better not talk of that." 

Fantasies: Voices used to insult him and call him a fella- 
tionist, and he would retort. His brain told him that another 
man, Satan perhaps, was trying to control him. The tempter 
agreed that you could do anything you pleased if only you 
confessed it afterward to a priest ; that cleared it all up, but he 
insisted no, it couldn't be as simple and easy as that, for you 
would get sent to prison for fifteen years just as some men had 



46 CASE HISTORIES 

been sent to Portsmouth for committing perversions. His brain 
was deadening the other man's brain and keeping it down, so he 
was winning out (an ingenious dramatization of the conflict with 
perverse impulses, into which the fear of consequences was 
injected). 

" Before I came here, there was a mindreader who used to 
say what I thought before I could say it myself. That happens 
often now too. I believe there are people all around here who 
can do that. 

" Voices talk a lot about the Lord. They say the Lord was 
assassinated before the birth of Christ. Then the Holy Ghost 
went to Bethlehem and had a child by Mary Magdalen, which 
was Jesus Christ." This peculiar jumble seemed to be the old 
CEdipus complex in a religious disguise. The father was killed 
off in favor of the son, and Mary Magdalen symbolized the 
soiled mother. The composite Holy Ghost and Christ stood for 
both husband and son. 

General observations: When he first entered the ward he did 
nothing but sit in a chair, frequently wearing his coat over his 
head. Gradually he began to extrovert, first singing out of a 
book, then pushing the floor polisher and finally joining in 
basket weaving. He didn't mix much with the other patients 
but seemed to feel no antagonism towards them. 

He said that after soldiering three years he thought it was 
the place of the army to look after him and not try to get rid of 
him for little offenses. He believed he could earn his living out- 
side now if the work wasn't too hard. However, he was satisfied 
to be kept and cared for. That was all there was in the world 
for him. Outside he would have to work for his living, and he 
was as well off in here as a working man outside with pick and 
shovel. " I think there are lots of people in freedom who if they 
were put in here like us couldn't get out again." 

Occupational therapy: When the instructor first came to our 
ward, he sat all day with a coat over his head. In three days 
she had succeeded in getting him to do basket weaving and he 
worked every day, improving steadily in ability. He made many 
mistakes at first and was impatient of instruction. He would 
willingly work all the time if she could furnish him sufficient 



CASE HISTORIES 47 

material. His general mental condition seemed to improve also. 

Physical examination: Heavy type of skeleton with general- 
ized adiposity, which is exaggerated on shoulders and abdomen. 
Weighs 248. Skin smooth and almost hairless, though there is 
a slight beard and some scanty hair about the mammary glands 
which are enlarged, being filled up with adipose tissue. Fingers 
are short, stubby and without tremors. Breathing is shallow 
and emphysematous in character. Penis very small, genital hair 
normal. Heart rapid. Reflexes normal. 

Endocrine diagnosis: Submyxedema. 

Glandular therapy: He had been steadily improving for a 
long time before taking desiccated thyroid gland. But with the 
first large doses he grew more active, talkative, industrious and 
complaining, and talked about getting out of the hospital in a 
few months. 

Four months later: After occupational therapy had been 
discontinued in the ward he began working in the pantry and kept 
it up industriously. Perhaps the opportunity to get extra help- 
ings of food had something to do with his willingness to wash 
dishes. The attendants said he had no sleepy spells and was 
fairly energetic. His mental condition showed no particular 
change. 

Mental diagnosis: Schizophrenia with projection. His diffi- 
culties tallied with those of the majority, that is, he had little 
interest in women and he was struggling against homosexual 
cravings. His description of the wicked brain trying to control 
him but losing the fight was an admirable one. He really had 
gotten sufficient control of his unpermissible cravings to make a 
happy adjustment to institution life. 

KiMMEL 

History: He was a deteriorated patient forty-eight years old 
who had been in the institution nine years. He had a wife and 
five children. His mother's father had died of senile dementia 
and her sister was insane. One of his own sisters had suffered 
from a nervous affection since she was eight years of age. The 
others were healthy. 



48 CASE HISTORIES 

As a child he was considered normal, but at fourteen a horse 
kicked him in the head, lacerating the scalp. His father believed 
the patient's attitude toward him changed after this experience 
(presumably for the worse though the record failed to specify), 
and ascribed it to the kick. He left school at seventeen having 
completed one year of high school. He worked at farming and 
in his father's store and as a laborer. Around the age of twenty 
he drank considerably. After marriage he stopped drinking but 
he was irritable and excitable. He was serving a second enlist- 
ment in the navy when he got sick. He complained he had been 
unable to sleep for many nights and had hard headaches. He 
was quite weak. Before reaching this hospital he developed 
hallucinations and delusions of persecution and had a severe 
epileptiform seizure lasting five minutes. 

The hospital record mentioned no more epileptiform seizures. 
He had had hallucinaHons of all senses and delusions of persecu- 
tion which made him talk in a homicidal manner. Voices insulted 
him. At times he was so unruly he had to be confined in the 
worst ward. He complained of pain in the upper left arm and 
right leg where he said his mother had cut him. No scars were 
visible. The right side of his face was somewhat paralyzed. He 
said other patients talked about him and cut his abdomen. That 
his head felt bound up and he couldn't think well, and electricity 
was used on him. 

Sex life: During the four months he was under special 
observation no one heard him mention any sexual matter. He 
ignored questions on sex subjects. The records gave no infor- 
mation. 

Fantasies: The only audible indications of his fantasies 
were his angry arguments with imaginary people who thought 
they did better work than he and depreciated his accomplish- 
ments. 

General observations: He was an ugly-tempered, unkempt 
man usually quite lost in his own thoughts and oblivious to the 
environment. Though once or twice I saw him go into laughing 
fits he generally sat quiet with head hanging or scolding loudly in 
great anger. This scolding was almost exclusively about what 
blockheads and poor workers other men were and how well he 



CASE HISTORIES 49 

himself did things though always criticized and never appreciated. 
Once in a while he scolded about his food. These tirades oc- 
curred during the night as well as the day, and in them he 
articulated with difficulty, making extreme grimaces in which he 
drew his mouth way over to the left. 

Occupational therapy: He was very resistive to the instruc- 
tor's efforts to interest him but finally consented to try basket 
weaving and managed to complete two pieces. Every morning 
he had to be taught all over again as if he had never seen a 
basket before. Some days he angrily refused to work telling the 
instructor to do it herself. At any time he was liable to stop 
work and go into one of his tirades. 

Physical examination: Slender type of skeleton. Skin pre- 
sents a few brown pigmentations, particularly over shoulders. 
Considerable hair over upper chest and about neck. Genital hair 
and genitalia normal. Face asymmetrical, elongated on right 
side. He has generalized arteriosclerosis and there is an occa- 
sional stereotyped choreiform movement of the left side of the 
face. Considerable photophobia. Reflexes hyperactive. 

Endocrine diagnosis: Submyxedema. 

Glandular therapy: The three day test of tolerance for des- 
iccated thyroid gland had a bad effect on him. His pulse became 
very irregular and rapid and he showed other signs of intolerance. 
He grew much noisier. Afterwards he became quiet and somno- 
lent again but seemed to have a little more initiative. For 
instance, he soaped and scrubbed himself in the bath which 
previously the attendant had been obliged to do. Because of his 
advanced chronic heart disease no glandular treatment could be 
given. 

Four monthrS later: His condition was unchanged. 

Mental diagnosis: Schizophrenia with projection. His con- 
tinual scoldings disclosed an inferior, inefficient man magnifying 
his own abilities and accomplishments and decrying other men 
who imagined themselves superior to him and failed to appreciate 
his true worth. If he had a sexual conflict too, it was now 
buried out of the sight of the onlooker, but his history gave 
hints that the usual erotic difficulties had once been present. 



50 CASE HISTORIES 

His change of attitude towards his father at puberty, his 
failure to adjust to his home relations so that he left wife and 
children and served two enlistments at sea, and the voices in- 
sulting him were quite in line with the other schizophrenic cases. 
He probably did not develop a psychosis merely because other 
people didn't like his work. 

Lefferts 

History: He was a thin, delicate fellow twenty-nine years 
old. His father was born in Germany and his mother in Ireland. 
Most of his family had died of pneumonia. His mother remar- 
ried after his father's death, and the stepfather abused him 
when drunk. She died when the boy was sixteen. He went to 
school until he was fourteen, at which time he was in the fifth 
grade. He didn't have much ambition in school and sometimes 
failed to pass. His first job was in a florist's shop, and he 
changed jobs a good deal until he was twenty-one, when he 
became a department store delivery boy. After three years he 
got typhoid fever and lost the position. He also had had pneu- 
monia and pleurisy. For a year and a half he worked in a 
boiler factory, and then for a half year as a church sexton until 
he enlisted in the army at the outbreak of the war with Germany. 
Of his army service of two years, a year and a half were 
spent in Panama. He had malaria there, and felt sickly and 
without ambition. He was brought back to the United States 
and discharged in April, 1919. For two months he worked in a 
shipyard, then one night in June he felt as if in a trance, as 
if electricity filled his body. He saw strange visions and heard 
loud noises. His head and stomach swelled up, and something 
in his left side swelled up and burst like a balloon, it was a 
ball of heathen idolaters and other wicked people. There was a 
swelling in his right side too, but it was good and didn't burst, 
and his mother's voice from it said, "This is my son," and that 
pleased him. His eyes felt as if changed, big, hard, and with 
eyelids wide open. Venus, Mercury, and Jupiter were inside him 
and talked. The first two were female and didn't insult him, 
but Jupiter, a male, called him a son-of-a-bitch. The first two 



CASE HISTORIES 5 1 

said he was overloaded with responsibility and that if anything 
happened to him the world would go to destruction. While going 
through the backyard to the privy he heard two voices disputing. 
One said, " Grab him," but the other said, " You can't touch 
him." He often heard these two voices disputing afterwards. 
For a week he tried to keep on working, though pestered by 
visions and voices, then had to quit. He reached St. Elizabeths 
in August. 

Sex life: He began masturbating at eight, and at one time 
did it daily, but realized it was bad for him and gradually 
stopped it altogether. He believed he sometimes thought of 
girls while doing it. He was bashful with girls and seldom went 
with them, preferring the company of boys. He never had a 
best girl, and was afraid of rivalry with other fellows over a 
girl. Sexual intercourse was not much of a temptation. He 
feared making a girl pregnant for he hadn't enough money to 
marry. He was very much afraid of venereal disease. 

At Panama, when he was twenty-six, he had his only hetero- 
sexual experiences, a half dozen in all, but got very little enjoy- 
ment or feeling out of them. " Something ran through my 
mind." He soon tired of it, and the fear of disease was ever 
present. His night orgasms were infrequent and when there 
was any dream at all in connection with them it was of normal 
coitus. He had never committed perversions. 

Fantasies: The kernel of his trouble, he declared, was that 
there was something in him that if taken out might do great 
damage, and only the devil knew what that something was (per- 
verse impulses?). 

He dramatized a struggle between two forces, good and evil 
like the two disputing voices. He himself was good, backed by 
visions of saints in white, crosses in the sky, and a full regalia of 
crowns, balls, candlesticks, and moons such as decorated his home 
church. A grandiose element entered in also, he was head of the 
Catholic, Jewish, and Turkish religions, higher than the pope, in 
fact he was too good for this earth and was expected to rise 
to heaven. He had been the sun, Moses, and St. Patrick, and 
had been crucified several times. When he was killed in ancient 
times, the world came to an end. 



52 CASE HISTORIES 

Opposed to these good Catholic forces were the Masons and 
other wicked secret orders, backed up by various devils and ac- 
companied by visions of carpenter squares, scimitars and other 
fraternal symbols. Voices accused him of having founded these 
orders long ago, and their members came to his bedside at night 
and tried to get him to join the orders and to indulge in their 
orgies of fellatio and cunnilingus, but he resolutely refused. 
Gradually the orders developed into three ; the first was of earth 
and pretty good, the second was of the devil and belonged in 
hell fire, the third was his own order, not hostile to the 
Catholics, and belonged in heaven. He had no visions in the 
day time, but at night he had them frequently. One night when I 
entered the ward in the dark he saw horns on my head, and when 
Vincent was having an epileptic fit he saw little devils jump out 
of his mouth. " The devil shan't get into me," he exclaimed, 
" I could catch him from some other fellow, but I fight tempta- 
tion." 

He was sure his eyes and testicles were removed during his 
sleep and others inserted and that the same thing had been done 
to his father. He had a fantasy that he had been in Germany, 
and they had tried to operate on him there and take out his 
testicles to put them in some one else's scrotum, but they all 
dropt dead and lost their own power instead (struggle of father 
and son to castrate each other. His father had been born in 
Germany). 

He had many physical delusions ; he was drawn along by the 
head as if by a magnet, he grew small and then stretched out to 
normal size accordeon-like, he was done up in a ball, and he felt 
something go down from his head and out near the pubic region, 
and something else rise to take its place. (During this period 
he lost his potency and had no erections and had only one night 
orgasm for six months. Voices told him he would never have 
children.) Something had been taken out of him, and no one had 
a right to do it. He had Adam and Eve balls, the right testicle 
came from Adam, and the left one from Eve. His testicles had 
sprouted like growing beans. 

There was often a buzzing like a dynamo in his ears, and he 
heard many voices. They called him good and bad names. 



CASE HISTORIES 53 

threatened to kill him, said the devil must keep away from him, 
ordered him to commit fellatio and cunnilingus and submit to 
fellatio, and compared a mouth to a vulva and wanted mouths 
and vulvas to kiss one another. They never mentioned pederasty. 

He dreamed of his parents as he remembered seeing them at 
the time of their death, on bed and in casket, and it made him 
feel badly, for if they had lived he would have had more advan- 
tages and not been forced to go to work too young. 

General observations : He was a thin nervous fellow, awk- 
ward, restless, and emotional, and with protruding eyes. His 
behavior was unvaryingly good, but he said he often felt very 
irritable and just like springing at people and walloping them. 
He had no insight into his psychosis and insisted that he really 
did see and hear these things. If other people couldn't, they 
were the ones that were crazy, not he. He was very stubborn 
and obstinate in clinging to his delusions and did not want to 
listen to any psychological explanations, but interrupted constantly 
to give the true version, namely his. He was, nevertheless, 
always courteous, friendly and humorous. 

After working for two months I had made no progress what- 
ever with him. Then he pricked his thumb and got a severe 
infection of his whole left hand and wrist during which part of 
the thumb had to be amputated. He was sick for a month 
and meanwhile his psychosis evaporated. " The voices and all 
are dying away, and I see no more visions. The voices told me 
those strange things. Perhaps they were fakers and didn't tell 
the truth. I don't believe them now. Once in a great while I 
hear a voice but I pay no attention to it. I had a mental disease, 
I guess. After they put me under ether to cut off my thumb the 
visions began leaving. There was something inside me, talking 
to me and trying to control me. It sets your brain on fire. You 
don't know what you are doing. You might go out of your 
head completely. I wouldn't give in, I fought it. The voices 
asked if I did fellatio and cunnilingus as if they wanted me 
to start doing them." 

During the month following this explanation he gained phys- 
ically and in emotional control, and then gave this version, "There 
was a struggle on all the time, some force trying to get control 



54 CASE HISTORIES 

of me. I fought it all the time and finally won out, and now it's 
gone. ("What would have happened if you had given in?") 
Why, something awful. I probably would have gone and done 
those bad things they wanted to make me do." He believed he 
had cured himself unaided by anything or anybody and resisted 
my explanation of the phenomena just as obstinately as during 
the psychosis. He much preferred to regard it as supernatural. 
When I called his attention to Garland reacting angrily to his 
hallucinations, he replied, " He has the power to see things that 
you and I can't." 

I tried very hard to give him some insight into the delusions 
he had suffered, but in vain. His superstitions were sufficient 
to explain everything satisfactorily, and it was undoubtedly much 
pleasanter to believe he had triumphed over a vile external foe 
than to recognize that the tempters were his own repressed 
desires. He hung on grimly to the belief that these hellish and 
heavenly visitors had been real and he just knew that such things 
could happen. 

After six weeks I was startled to discover that the delusions 
had returned. There was a woman inside him, and "they" 
were accusing him of being a Protestant. Devils sported around, 
and something inside him was trying to drive him wild. The 
nights were full of demons, bats, angels and all. The delusions 
were not systematized again however, and no Masons tempted 
him to commit perversions. 

It was useless to argue with him or to recall the interlude of 
the infection. These spirits had departed at that time and now 
they had returned, that was all. His conduct remained good and 
he still used his parole of the grounds. He didn't do much but 
sit around indifferently. 

Occupational therapy: He was interested from the begin- 
ning and very anxious to work, but was nervous, obstinate and 
wilful, refusing instruction, saying he knew how and then blund- 
ering ahead with many mistakes. Once when he got all tangled 
up in mistakes he burst into tears. Gradually he became less 
nervous and more careful. His infected hand put an early stop 
to his work. 



CASE HISTORIES 55 

Physical examination: Skeleton slender. Dome-shaped pal- 
ate. Perspires easily. Radial arteriosclerotic pulse under tension 
and rapid. Hair, normal male distribution. Genitalia normal. 
Thyroid gland, both lobes enlarged about one third and isthmus 
is hypertrophied. A noticeable exophthalmos with eye globes 
under tension. Fine toxic tremor of fingers. All reflexes ex- 
tremely exaggerated. 

Endocrine diagnosis: Hyperthyroidism. 

Glandular therapy: None. Even the thyroid tolerance test 
had to be stopped on the second day because of his excessive 
reaction to it. 

Four months later: He still had parole and his behavior was 
exemplary. The hallucinations and delusions persisted, but were 
not yet well systematized again. He said there were men and 
women inside him, and they put things in and took things out 
of his body, particularly his eyeballs. The symbolism was as 
rich as ever with Scottish rites, Satan and the rest. 

Mental diagnosis: Schizophrenia with projection. His own 
explanation of his psychosis at the time of the infection was very 
accurate except he would not admit that the " force '* came from 
within rather than from without himself. The coincidence of the 
disappearance of the perverse cravings with the height of the 
infection makes one presume a connection between the two 
phenomena, particularly since there are records of many similar 
cases in which severe infections apparently cured psychoses. 

During the dominance of the perverse tendencies his sexual 
power was lost, probably a suppressive act of self-defense. I 
have found this phenomenon in many similar cases. When the 
improper impulses are again well repressed, potency returns 
as it did with this patient. It will be recalled that he stated some- 
thing had been taken away from him, that his testes and eyes had 
been removed (since some eyes and testes were there, he had to 
invent the theory of substitution), and that voices told him he 
would never have children. His delayed sexual development 
was shown by his timidity with girls, his fear of fighting 
another male for the girl he might want, and his lack of satis- 
faction in coitus. 



56 CASE HISTORIES 

His gradual alteration of the, at first, totally bad fraternal 
orders was interesting. They became three in number: one, a 
male symbol, was " pretty good ; " two, symbol of the female 
genitalia, was bad and belonged in hell fire ; while three, symbol 
of the male genitalia, and normal coitus, was his own and be- 
longed in heaven, that is, his male cravings were triumphing 
over his female cravings and repressing them. 

Mathews 

History: He was a jack of all trades who had been in the 
hospital twelve years. His age was thirty-four. The family 
history was negative. The father had been a peddling butcher 
in a country town. He drank heavily and one cold night fell out 
of his cart and died from exposure. The patient was then seven 
years old. The mother was nervous and excitable. She had 
twelve chidren ; six by her first husband ; five by her second hus- 
band, the patient's father; and one by her third husband, whom 
she later divorced. 

After his father's death the patient quit attending school 
regularly and went to live on a relative's farm where he was 
allowed to attend school winters until he was twelve, at which 
time he had reached the fourth grade. During the rest of the 
year he did farm work. His stepfather didn't care for him, and 
the boy didn't want to stay home. After his mother's divorce 
he returned to her and helped her keep a country store winters, 
and worked on farms summers until he was fifteen, when he went 
to the city. When he was seventeen she died of hernia. 

From fifteen to twenty years of age he had a long series of 
changing jobs, lasting from one day to a year and a half (on a 
farm), and including such varied occupations as riveter in bridge 
works, store clerk, miller, teamster, shoveler, carpenter, and 
physician's man of all work. Sometimes the work was too hard, 
other times the pay was not big enough. If he got tired he'd 
move on, and he wouldn't wait to be fired when people didn't 
like him, he'd get out. Finally, out of work and tired, he 
enlisted in the Marines for a secure and steady life and within 
two weeks was in this hospital, diagnosed dementia precox. 



CASE HISTORIES 57 

At first he was restless, incoherent, irrelevant, sometimes 
abusive and threatening, and always complaining. He didn't 
want to stay and demanded his release, but never seemed put out 
when his many requests were refused. He also had quiet, stupid 
periods which lasted for months. His own present version of 
his psychosis was that he had been very nervous and restless, 
and his mind wandered. A thousand different things would 
come into it during a day, including bad thoughts that weren't 
really so. He feared the attendants wanted tO' kill him, and be- 
lieved other people called him vulgar names, and his conscience 
bothered him. He would try to choke himself with a towel, 
and beat his head and elbows against the wall. His clothes 
burned his skin, so he took them off, tore them up and threw 
them out the window. In the fourth year he asked to have his 
throat operated on (it was thought because of tonsilitis). In the 
eighth year he was reported to be more interested and extro- 
verted. He was neater, tidier, began to work, and gave no trouble. 
In the ninth year it was noticed that his thyroid was enlarged. 
This was followed by protruding eyeballs, tonsilitis, and acute 
articular rheumatism, and he complained of perfectly sound 
teeth. His mental condition cleared simultaneously, and remained 
clear. The exophthalmic goiter remained, the other maladies 
disappearing. 

He said when a boy his neck bothered and hurt him, es- 
pecially the '' left muscle," and he noticed it most when running. 
He also remembered stories of sheep and heifers escaping from 
his father's knife and running wildly with bleeding throats. 

Sex life: At eight he committed mutual fellatio with a gypsy 
boy. Soon afterwards he began masturbation. Then he attempted 
coitus with his sister, who was one year older. He used a heifer 
at ten. He got his first orgasm at eleven or twelve, and was 
wearing long pants at the time (date probably not accurate; he 
said his memory had never been good). He used to have mas- 
turbation races with a negro boy. After puberty he had several 
coiti interrupti with his sister. Wet dreams frightened him. He 
believed it was injurious to let semen remain in the body, for it 
might corrupt the body. The semen ought to be got rid of. He 

5 



58 CASE HISTORIES 

masturbated excessively. At sixteen piles became more or less 
chronic. At seventeen, when he moved to the city, he had coitus 
with a prostitute. He had had five or six in all, and once was 
impotent, but on returning home he masturbated and obtained 
an orgasm. Coitus was unnecessary he explained, because he 
could masturbate at home, which he did nearly every night. He 
had felt "good, hearty, healthy and enjoyed life." At that time 
he used cows and mares. 

In the hospital he continued the masturbation and committed 
fellatio with other patients a few times. He consented once to 
allow pederasty, but it hurt so much that he made the other man 
stop. He also masturbated on the bodies of other patients. He 
remarked with wonder on the hardness of other patients' penises 
and said his own was half flabby. These incidents he related 
with some shame, but said he had repented and felt forgiven. 
He had rationalized masturbation as being necessary ("a man 
must do enough to live"), and there was no mental conflict in 
connection with it. Day masturbation he had given up, but if he 
couldn't go to sleep at night he masturbated and then slept well. 
This occurred on the average of every other night. He had 
had only two night orgasms in his life, one without a dream ; in 
the other he dreamed of heterosexual intercourse and awoke to 
find himself in the sexual position on the farmhand he was sleep- 
ing with. 

Fantasies: The only waking fantasies he had were of hetero- 
sexual intercourse while masturbating. As a boy he dreamt of 
being chased and caught by the police, and waked up out of 
breath ; of building a fire ; and of seeing his father butcher a 
cow upstairs and hang up the quarters. The quarters frightened 
him very much. He had always been timid at night. 

More recent dreams were of being home again ; of seeing the 
face of a handsome negro girl who worked in the hospital 
kitchen ; of a nurse who sat down on his bed and, when he put 
his arms around her, fainted; and of his half-brother hacking 
at his goiter with a knife. This last was " terrible." 

General observations: Physically he was a thin, nervous, 
quick-moving man with large goiter and protruding eyes. Ex- 



CASE HISTORIES 59 

ercise tired him very much and he seldom went on walks, prefer- 
ring to remain in the ward and work on raffia baskets. The ward 
attendant made an assistant of him; he helped serve meals and 
look after and govern the retarded and deteriorated patients. 

He dated his mental recovery from the onset of the goiter 
and said he didn't tire as easily and felt in better health than 
before the goiter appeared. His memory for events during the 
psychosis was not as good as for events of his life previous to 
it. He took an intelligent interest in everything and was of 
assistance to me in reporting the behavior of other patients. 

Occupational therapy: No urging was necessary to get him 
to begin work; he was only too glad to find something to do 
and kept at it incessantly. After learning how to weave a raffia 
basket he was satisfied to make one after another in the same 
pattern, and his weaving was always slack and loose. He hated 
to try a new pattern and did so only under compulsion. The 
same old way was easiest, and he had no desire to change it. 
His baskets sold readily and brought him in quite a little pocket 
money. 

Physical examination: Medium type of skeleton. Skin nor- 
mal in color. Pubic hair normal, but hair absent from rest of 
body with exception of slight beard. Genitalia well developed. 
Perspires easily and profusely with skin always damp and 
clammy. Superficial reflexes hyperactive. Deep reflexes nor- 
mal. Pulse 96, full and bounding. Thyroid region is bilaterally 
greatly enlarged with prominent superficial veins and bruits 
which may be heard by stethoscope on both sides from the bases 
of the ears to the clavicles. There is a striking exophthalmos 
with several of the eye signs of exophthalmic goiter in evidence. 

Endocrine diagnosis: Compensatory hyperthyroidism. 

Glandular therapy: A successful thyroidectomy was per- 
formed, about half of the goiter being removed. 

Four months later: He had entirely recovered from the 
operation and felt stronger and better. The annoying pulsation 
in his neck was gone, and he no longer woke up at night out of 
breath. His mind was as clear as before the operation. 

Mental diagnosis: Schizophrenia with projection. The incest, 
bestiality and homosexuality in this case were out in the open. 



60 CASE HISTORIES 

The usual resultant impotence was present also. During his 
psychosis he projected his improper desires into voices, felt sin- 
ful, and punished himself physically. At times he gave in to his 
perverse cravings. Coincident with the development of his goiter 
these mental symptoms disappeared. He spoke of his past trans- 
gressions with embarrassment but felt that they were forgiven. 
He had adjusted himself well to hospital conditions, having re- 
duced his sexual activities to masturbation and rationalized 
that as necessary and so permissible, and was contented. 

His mind seemed perfectly clear and his judgment fair. He 
lacked self-confidence and initiative but that can hardly cause 
surprise in a man who had spent thirteen years in an institution. 
If he could be cured of his hyperthyroidism, he thought he might 
adjust to life outside and earn his own living as a farm laborer. 

Since the advent of the goiter was coincident with the fading 
of the psychosis, it could be regarded as a compensation for the 
latter. In that case a removal of the goiter might be followed by 
renewed psychotic symptoms. Perhaps not enough was removed 
to have any such effect, but certainly the patient's mental condi- 
tion became no worse. 

Nolan 

History: He was a fat, childish-looking moron of twenty 
years. His mother was very nervous and had spells during which 
she " sat down and took things easy." One sister had hysterical 
spells after which she was confined to bed for a week or so. He 
was the youngest of the family and his mother's pet. He attended 
school until fourteen and reached the fifth grade. Then he 
worked as grocery boy, teamster, and expressman for various 
employers, staying from two to six months in a place and leaving 
for higher pay. He claimed he never was fired. 

He enlisted in the navy in June and went to sea on a 
battleship in August. The other sailors teased him, probably on 
account of his boob looks and slow mind. They hid his hammock 
and blankets (he could not tell of this without -weeping) , and 
said he ought to make a lot of money with his fat rear, but he 
*' sassed them back." 



CASE HISTORIES 6l 

After two months at sea he became nervous and unable to 
concentrate, disobeyed orders, and got into trouble with the 
officers. He was put in the brig, which broke him up completely, 
and was transferred to a hospital when the ship reached port. 
He had an obsession that he had been forced to commit some 
act that was wrong, and he heard voices saying that on account 
of what he had done he would be buried in a Protestant burying 
ground instead of in a Catholic cemetery. The voices were some- 
times pleasant and sometimes accusatory. He was emotionally 
unstable, varying from cheerful talkative periods to fits of 
weeping. 

Sex life: He had masturbated two or three times a week. 
His first heterosexual experience was at seventeen, and he had 
had many since. He had never committed perversions, but had 
felt tempted to allow pederasty on the battleship, and had about 
decided to submit if solicited any more. 

Fantasies: By the time I saw him he had recovered from all 
but sexual hallucinations and delusions. When first taken sick 
he thought he had syphilis because he saw a man write four X's 
on a bottle. He saw various visions : his mother's smiling face 
in the clouds surrounded by red, white and blue, a little garden 
of angels, and a red devil on a blue ball between two lights. He 
had been very homesick and used to hear " spoken letters," that 
is, the voices of his family and friends saying to him just the 
things they would write in a letter. He thought some one had 
doped him in the nose. Around Christmas time he said to himself 
that he ** must stop this stuff, this talking and thinking, that that 
was being sick," and from then on he had no more visions and 
heard no more voices. 

One night in January the night nurse saw him get out of bed 
and with a shoe start beating little O'Neil who was sound asleep 
in the next bed. My inquiries as to the reason for this attack 
brought to light some sexual delusions. While in bed just after 
his being sent to hospital he complained of a pain in his abdomen. 
A sissified male attendant felt of it, and then remarked to some 
others that "it was tight." He took the remark to mean that 
the attendant had committed pederasty on him during his sleep 



62 CASE HISTORIES 

and found his anus tight. He. heard the doctors tell his mother 
he was in no condition to go home, and he interpreted that as 
meaning he had been raped in pederasty. He began to fear he 
might become pregnant and have a baby in his rectum. His 
relief was great when I assured that it was impossible for a male 
to become pregnant and that no one could assault him without 
waking him up. 

The reason he attacked O'Neil was because in his sleep it 
had felt as if his thighs and abdomen were being licked and then 
his penis sucked. When he woke he suspected O'Neil had been 
doing it, but had already discovered the latter was fast asleep 
before the nurse interfered. He was not convinced by my ex- 
planation that it was only a dream. It seemed too real for that. 
A fellow sailor had told him about this fancy method of fellatio 
and he had thought it must be very pleasant, but he roused him- 
self from sleep because he didn't want an orgasm, for that would 
sap his strength. 

Now he had delusions of reference. If other patients moved 
their lips and tongues, his penis felt as if it were being sucked. 
He complained that they looked at him and made him uncom- 
fortable, that they ought not to grin at him, and that they seemed 
to be making signals to him. Finally he struck Dixon in the 
head, and only the timely arrival of the attendant prevented a 
fight. My attempts to explain projection to him made no im- 
pression and I had to merely order him to pay no attention to 
the others and, when they annoyed him, to go some other place. 
He was very indignant and looked like a thundercloud for a week, 
then became very happy. (''You were cross a few days ago.") 
" You can't be happy all the time. I had a little headache and 
didn't feel very good. I don't know why I thought other fellows 
were making signals to me, and thinking dirty thoughts. Now I 
don't feel that way at all." He told me also that his ears used to 
itch and then he thought spirits or something were reading his 
mind. 

In March after hearing Carhart's diatribes about being locked 
up he " almost heard " voices say he would never get out of here, 
and he anxiously asked me the truth about it. This was the dying 



CASE HISTORIES 63 

gasp of the psychosis. He came to look on it all as imagination. 

General observations: He was a big, fat boy with a boob 
face, and his behavior was what might be expected in a child of 
his mental age, nine years. At first he was much worried over 
his body and always had a new pain or ache or funny feeling. 
He examined his phlegm and feces to see if any nerves had come 
out in them, and took great satisfaction in an enema. He was 
emotional and wept on any provocation, particularly at mention of 
home and mother. He said she loved him most of any of her 
children, and he felt he ought to behave well to please her, and 
explained what a good boy he had been at home, coming in after 
a ten-hour work day and chopping wood for an hour so his father 
wouldn't have to. 

He was exceedingly lazy, sitting or lying down most of the 
day, and refusing to aid in the ward work. When reproved by 
a Red Cross girl and told she would give him no more gum and 
candy if he didn't work, he got very busy until she was out of 
sight. The nurses tried in vain to get him to help in the pantry 
until they offered him extra food. After that he was most faith- 
ful. When forced to go without breakfast on the day of his 
sugar tolerance test, he was deeply grieved and turned his face to 
the wall because he could not bear to see the other men eat. His 
appetite was enormous. 

It was evident he had been teased and ostracized on account 
of his childish appearance and dull wits, and he had kept to 
himself largely through fear of rebuff and ridicule if he made 
friendly advances. The vocabularly test in the Stanford Revision 
intelligence test proved to be a good complex-indicator for he 
invented meanings for every word he didn't know, and many 
of these definitions showed a desire for friends and the feeling 
that other people didn't want him around and took advantage of 
him. Examples: mosaic, to mose around with someone who 
doesn't want you ; tolerate, to tantalize one who is under you 
and can't protect himself ; brunette, to be brewed with someone, 
to be needy, to nag someone; ochre, to be an ochre with some- 
one, to have friends, be chums ; achromatic, to be very achro- 
matic with someone, to be friends and chum with ; outward, to be 



64 CASE HISTORIES 

outward with someone, to be awkward; civil, to be civilization 
with everyone, correspond with them, enjoy their company, be 
kiddish ; piscatorial, pispatorial, have a steady leak out of a vein 
or something; sudorific, to be satisfied, don't let them leave the 
store till they are well satisfied ; lotus, you have a low test in ex- 
amination in school. 

Occupational therapy: For the first two days he v/as induced 
to cut a few basket spokes, but after that he quit absolutely and 
just sat and lay around. 

Physical examination: Weighs 173. Tall, undeveloped type 
of skeleton. Protuberant abdomen and general obesity of whole 
body. Skin smooth, pink, and hairless except in genital region, 
in which hair is scanty and of feminine type. Genitalia normal. 
General behavior sluggish. Facial expression that of a young 
child with small, fat rounded cheeks and pale blue eyes. Heart 
normal. Reflexes normal. 

Endocrine diagnosis: Hypothyroidism and infantilism. 

Glandular therapy: Desiccated thyroid gland worked a veri- 
table transformation on this boy in the three-day test. From 
a lazy listless lump he suddenly became active, industrious, worked 
all day long on basket weaving and planned the next day's work 
ahead. Like a different fellow, wonderful change, shows so much 
constructive intelligence, were the comments made by attendants 
and occupational therapist. The improvement continued after 
the conclusion of the thyroid test. The first Stanford Revision 
test, in January during his listless period, gave a mental age of 
eight years and seven months and an intelligence quotient of 
54 per cent. The test just after the thyroid feeding, in March, 
gave a mental age of eight years and nine months and an intelli- 
gence quotient of 55 per cent. Later on, a moderate dose of 
thyroid was given him daily, and he improved steadily. In 
May, his mental age had risen to nine years and eleven months 
and his intelligence quotient to 62 per cent. Soon afterwards he 
was discharged as recovered. 

Mental diagnosis: Schizophrenia with projection, in a moron. 
His homosexual cravings were evident, sometimes becoming a 
conscious temptation, but usually being projected. His moral 



CASE HISTORIES 65 

self had a feeling of sin and resisted the cravings, which were 
repressed without insight before glandular therapy was begun. 
The latter treatment made him more alert and energetic, and 
speeded his recovery. 

O'Neil 

History: He was a sturdy little fellow twenty-one years old, 
and had always lived on his father's farm until he was drafted 
into the army. He got on all right on the farm but was never 
bright at school. He claimed he reached the eighth grade when 
he was eighteen. The Terman intelligence test proved him to be 
a moron. 

He found it difficult to adjust to the new conditions in the 
army, and it was very hard to have to leave home and mother. 
He had no complaints to make. He denied with some heat a 
question whether the other boys ever made fun of him. " What 
right had they to?" 

He had always drunk in moderation. In France he was sent 
to a hospital because he was resistive, depressed, and worried 
over the '* recent death of his mother from pellagra," and feared 
he was going to get it and die too. He became more depressed 
and emotional, and declared the Germans had won the war 
because he hadn't taken baths regularly. In tears he begged not 
to be put into a machine and ground to pieces. He refused food 
and said he was going to die. 

On admission to this hospital he was disoriented, preoccupied, 
resistive, could not remember well, and denied hallucinations 
though he appeared to be hearing voices. He stood at a window 
for hours. 

Sex life: He admitted having masturbated two or three 
times a week at one time, but he did it no longer. His first 
heterosexual experience was at eighteen. He had had several, 
always with prostitutes. He denied any knowledge of perver- 
sions with every sign of sincerity. 

Fantasies: He had a great habit of snickering and laughing 
to himself, which at first I suspected might be due to fantasy but 
after further study of him decided was in response to external 
stimulus. He watched everything and everybody and broke into 



66 CASE HISTORIES 

frequent gleeful chuckling whether their actions seemed amusing 
or not. He never would tell what he found so funny in all about 
him. "It*s better to laugh than to cry. It doesn't do to tell 
everything you know, does it ? " 

Of the fantasies reported in his record he denied any recol- 
lection whatever. " I never told them nothing of that. I never 
thought it." He said his mother had had pellagra before he 
entered the army but recovered and was now living. He had 
never believed she was dead. He denied hallucinations and delu- 
sions, but said he had been nervous in France and had shaking spells 
that lasted for an hour during which he felt cold. He denied he 
was afraid of anything. Now his nervousness had disappeared 
and he felt as well as he ever did. His amnesia for the psychosis 
seemed sincere. His memory for recent events was excellent. 
If I chanced to ask him a question I had asked even three months 
before, he would retort, "I told you that once." ("Do you 
remember everything you tell me?") "Certainly." 

General observations: At first he stood all day by a window 
reading. Any book would do. I couldn't ascertain whether he 
comprehended what he read or not, for in answer to any questions 
he would push the book towards me, saying, "There it is, can't 
you read?" This resistive attitude he displayed towards every- 
body, and seemed perfectly satisfied if left alone. He never 
gave any trouble. 

I tried the Stanford Revision intelligence test on him in 
January and found his mental age to be just eight years, intelli- 
gence quotient 50 per cent., the borderline between a moron and 
an imbecile. His negativism I considered to be partly a defense 
reaction against revealing his low intelligence, for he seemed to 
have no unfriendly feelings towards other people. For a month 
he would do nothing but read, but on offering extra food the 
nurses got him to help in the pantry and he continued to do 
steady, efficient work there. About two weeks after beginning 
dishwashing the occupational therapist induced him to try wood 
carving, and he soon did very well. During a physical examina- 
tion he was very nervous, giggling hysterically, and responding 
exaggeratedly in all reflexes, but insisted he was not afraid. 



CASE HISTORIES 67 

He improved slowly and steadily, and was granted parole of 
the grounds in April. It was not possible to ascribe his improve- 
ment to any particular factor. He saw he was in friendly hands 
and so began to lose his apprehension, he liked the wood carving, 
and he seemed pleased to be given glandular therapy. That was 
medicine, the kind of treatment he was familiar with for sick 
people. None of these factors seemed to alter the steady course 
of his recovery. 

In May his behavior had become fairly normal, and the silly 
giggling had almost ceased. The intelligence test now showed a 
mental age of nine years and three months and an intelligence 
quotient of 58 per cent., a gain of fifteen months and eight points 
in five months* time. His father came to town to attend a conven- 
tion and made him a visit. After he left, the boy came to my 
office of his own accord, the first time he had sought anyone^s 
company since he entered the hospital. He had received a great 
shock and wanted sympathy. His eyes were wet with tears, and 
he showed the emotion natural under the circumstances with 
none of the old aloofness. He had asked after his mother and 
was told that she was dead. She had died while he was in 
France in the army, and his father said they had written him 
the news at the time. The discovery was a severe blow, for he 
had felt sure she was alive and that the records were wrong in 
stating she was dead. 

'* I was a great mother boy, and home won't be the same now 
without her. It was hard to leave her and home, and go to war. 
I unloaded cars in France and sometimes had tO' work till late at 
night. I got very tired. The first I noticed of the sickness was 
that my hands and face got numb like going to sleep, and my feet 
got cold. These spells lasted from an hour and a half to two 
hours, and my mind was clear during them. I felt smothered, 
I couldn't get my breath, I felt as if I would die. I couldn't lie 
down, I must have air. Every bone in my body ached. Between 
spells I felt all right. These spells lasted nearly up to the time I 
reached this hospital. Now I understand about the letter telling 
of my mother's death. It must have come after I got sick, and 
the doctors were afraid to give it to me, so they just put it in 
the records. 



68 CASE HISTORIES 

" I felt strange here. Nobody was introduced to me. I didn't 
know the names of the nurses and attendants. I felt lazy and 
wanted to be left alone. It's hard to talk to strangers. I don't 
know what to say. You weren't friendly enough at first, you 
didn't smile at me. Now I feel better and I want to get to work. 
I feel better than I did at home before I was drafted, and I 
weigh twenty pounds more." 

About sex matters he said he had heard of bestiality at home, 
but he had never seen it done nor done it himself. He had always 
tried to keep nice and clean. In camp in France he had heard 
of pederasty but had never been solicited; he would have told 
them where to get off. It was dirty and probably painful. He 
had never had any ideas or fears about such things when he 
was sick, though he realized that other fellows did (this knowl- 
edge and the phrase "nice and clean" may have been acquired 
in the endocrine ward). 

His father took him home. 

Occupational therapy: For a long time he refused to try 
any handicraft, but two weeks after he began dishwashing in the 
pantry he reluctantly consented to mark holes on a tray bottom. 
In spite of his " I can't do it " the instructor led him into wood 
carving which he soon did very well. She thought his resistance 
was due solely to fear of failure. As soon as he saw he could 
carve well, he stopped his reading completely and carved steadily 
until he got parole of the grounds. 

Physical examination: Short, heavy-set, pink-skinned. Ple- 
thoric-appearing face. Hairless over abdomen and chest, but 
with male type of genital hair distribution, though somewhat 
limited. Genitalia somewhat flabby. Body in general excellently 
nourished. Heart beats regular but very fast. Shows very rapid 
carbohydrate metabolism. All deep reflexes extremely hyper- 
active. 

Endocrine diagnosis: Submyxedema with hypoadrenia. 

Glandular therapy: Desiccated suprarenal gland was given 
for three or four weeks. No sudden change in behavior was 
noted. His steady improvement continued with no apparent 
acceleration. 



CASE HISTORIES 69 

Mental diagnosis: Schizophrenia with projection, in a 
moron. He seemed perfectly sincere in his amnesia for all the 
mental manifestations of his psychosis. All he remembered was 
that he had felt cold, nervous, and breathless, and trembled a lot. 
Finding it very difficult to adjust to the strange new conditions, 
the news of his mother's death was too much to bear, and he 
sought refuge in a psychosis. His apparently ridiculous state- 
ment that the Germans had won the war because he hadn't bathed 
regularly becomes intelligible if interpreted as a symbolic way of 
saying that he was dirty (mentally) and the enemy (improper 
impulses) was therefore getting control of him. The usual 
depression and sense of unworthiness with fear of punishment 
and death followed. His catatonia was a form of self-protection 
against assault. 

As he recovered he developed complete amnesia for the 
mental content of the psychosis including his mother's death. 
Along with the repressed perverse cravings went the memory 
of any previous knowledge of such matters, and he was quite 
honest in declaring he had never heard of them. After his re- 
covery he regained the memory of sexual ideas that he had held 
previous to the psychosis, but he still had amnesia for his mother's 
death and had to suffer the agony of her loss a second time. But 
the war was over now and home was in sight, and he could 
endure the shock. 

PURDY 

History: He was a slender, serious-looking man with iron 
gray hair. His age was forty-two, and he had been in this hos- 
pital once before. He denied that there was any mental disease 
in the family but his parents had both drunk. He was the oldest 
of six sons. He reached only the third grade in school. When 
six years old he was struck by a train he said, and remained 
unconscious for three days. 

He had been a wild boy and liked to be a leader in mischief 
and daredeviltry. He stole papers from news stands and coal 
from railroad cars, jumped trains and threw bricks at trainmen 
from bridges, and tried to excel in stone throwing and high div- 
ing. Sometimes he'd stay away from home for a night or two. 



70 CASE HISTORIES 

These escapades infuriated his father who punished him brutally. 
He was tied up by the thumbs naked and beaten with straps, and 
chained in the attic and fed only bread and water. The boy 
would loose himself and escape by climbing down the water 
spouts. When his father was drunk he was knocked and kicked 
about. The mother tried to protect him and even stepped between 
them, receiving the blows herself. The next brother two years 
younger, was a pet and didn't get such abuse, so the patient felt 
jealous and used to beat him up himself, though he would not 
allow the other boys to do it. 

When he was seventeen he was framed up on a charge of 
stealing coal from cars, while all he had really done, he claimed, 
was to pick it from the tracks. He was sentenced to reform 
school for a year, and this injustice started his tendency to be 
suspicious. He was unruly in the school and was frequently 
punished. This lengthened his term from one year to three. 
From his associates he received a thorough schooling in crime 
which he never put into practice however. 

Before his term was up, his father was accidentally electro- 
cuted, and he was pardoned. He realized now that he ought to 
take his father's place in the family, but he lacked self-confidence 
and felt unworthy and unequal to the task. He noticed that his 
affection for his mother seemed to change over to the memory 
of his father. He wanted him back and cooled down towards 
her. 

The Spanish War broke out a few months later and he en- 
listed gladly as a means of escape. On his return from Porto 
Rico he had fever and was depressed. He felt that humanity 
was cruel and that life was a fight. He was not skilled in any 
trade and had trouble in getting work. The next youngest brother 
was away at work and the other boys were in charity institutions, 
so he and his mother lived alone. When she got drunk she 
had spells of raving during which he held her on the floor. This 
made him feel very badly. He had contracted gonorrhea in the 
army and began to worry over whether he might infect her with 
it. When I asked him just how he feared he might infect her, he 
said through using the same towels. Finally he abandoned her in 



CASE HISTORIES 7 1 

poverty. She died soon afterward, and his treatment of her 
caused him much remorse. 

At twenty-five he married and had two children. One died 
in infancy but the other, a boy, was still living. He was not 
successful as a worker and did not provide well for his family. 
In hard times his wife took the boy and went to live with her 
mother, and then she got the habit and left him when he didn*t 
consider it necessary. Finally she left him altogether and de- 
manded alimony. He became worried and was committed to this 
hospital. 

His disease was diagnosed hebephrenic dementia precox. The 
records state that he had felt badly for three years and had had 
delusions that his employers persecuted him. He greatly feared 
impotence and believed he. had syphilis. He had strayed away 
from his church and joined a fraternity which now prevented 
his becoming a Knight of Columbus, and all these things had 
worried him. His wife said that their married life was very 
unhappy. He gambled and drank to excess, though seldom getting 
drunk, and refused to support her. He accused her of infidelity, 
called her a prostitute and swore the boy wasn't his. He accused 
her also of all sorts of immoral practices. One night he had 
stolen into her room and tried to strangle her, but the child's 
screams frightened him away. 

In the hospital he was depressed and sure he was doomed to 
die. He nearly succeeded in committing suicide by hanging. He 
dreamed he was to be the mother of fifteen little devils, and he 
felt that a good and bad spirit had possession of him at different 
times. The delusions were fairly fixed in character but his belief 
in their reality was inconstant. Following an operation for vari- 
cocele, which he held largely responsible for his impotence, he 
improved rapidly and was discharged as a social recovery thirteen 
months after he entered the hospital. 

For the next three years he led an easy life as electrician in a 
soldiers' home. When the United States entered the Great War, 
he became restless, feeling he should do his bit, and left the home 
to work in camp construction. He tried to get in touch with his 
wife and child, but the grandmother would not let him see the 



72 CASE HISTORIES 

boy and said his wife was dead. After the armistice he went back 
to work for the same contractors whom he had suspected of 
^- persecuting him before by giving him all the hardest jobs. Soon 

the other men began to kid him and say, " Own up, Purdy, that 
you're a f ellationist," and that " broke him all up." He became 
much upset, and was brought here a second time. 

Sex life' When about ten years old he was sleeping with his 
mother's sister and rolled against her in bed. He had an erection 
and was making copulative movements in his sleep when she 
waked him by pushing him away. He masturbated once or 
twice a week throughout adolescence and then slowed down, but 
revived it again in the army. In the reform school he committed 
pederasty once and allowed fellatio. An older fellow offered him 
some much coveted tobacco if he would allow pederasty. He re- 
fused but consented to allow coitus inter femora from behind. 
They were caught and accused of pederasty, and this lengthened 
his term. 

A few weeks after he was pardoned at the time of his father's 
death his mother sent him to have an interview with her con- 
fessor, a man she respected greatly, in hope that the priest would 
exert a good influence on her wayward boy. But the priest after 
praying with him took him to a bedroom and began to play with 
him sexually. He was unable to accomplish pederasty but did 
coitus inter femora. The shock to the boy was extreme. He 
knew such things occurred in penal institutions, but to find that 
a priest of the church did them was a blow. He reasoned that 
if this respected man did them, so must the rest of the clergy. 
All priests and preachers were hypocrites, and the church which 
to him had been the holiest thing in life now became despicable. 
He pictured the poor " with their noses to the grindstone to earn 
money to support the gold cross whose priests were rotten. And 
if the priest would seduce me under the cloak of religion, 
wouldn't he try to seduce my mother also?" (He showed great 
emotion in recalling these memories.) After this experience he 
never felt the same again either towards the priest or his mother. 
He was disgusted with him and her and himself, with his 
brothers, with everything and everybody. It was in this state 



CASE HISTORIES 73' 

of mind that he had his first heterosexual experience. After it he 
actually hated the prostitute. He gladly went away to war. 

He usually did feel hate for a prostitute after coitus and 
sometimes said he never enjoyed intercourse with women as much 
as with men. At other times he claimed he preferred normal 
coitus, but was much afraid of venereal disease after once having 
contracted gonorrhea, and that he committed pederasty on both 
sexes and allowed fellatio merely because they entailed no danger 
of disease. He indulged in active homosexual acts about once a 
week. If his companion refused intercourse, he masturbated 
against him. Once he had trouble in arousing sexual feeling in 
a boy and to stimulate him started fellatio on him, but had a 
revulsion of feeling and quit. This attempt at fellatio had 
bothered his conscience a great deal. With that exception he had 
never taken the female role in homosexual intercourse. Taking 
the male role he considered permissible and he felt no remorse. 

He had relations with his wife before they were married, and 
she became pregnant. She threatened suicide, and he married 
her out of pity to protect her good name. Another man, a lawyer 
whom he regarded as a better man than he, had also been paying 
her attention and he reasoned that since she had ceded readily 
to him she might have also to this superior man. Three months 
after the wedding a boy was born. The child resembled Purdy. 

He had only one real " love '* coitus with his wife he said, 
the others were nothing more than relief of passion. Once he 
committed cunnilingus on her, and she committed much fellatio 
on him but refused to allow pederasty. When he got to feeling 
that his employer was giving him all the hardest jobs and he 
needed all his strength to make a living, he stopped sexual inter- 
course altogether. Then he began to suspect his wife of getting 
it elsewhere. He was sure his employer had relations with her 
and suspected him of sending a young man to board next door 
just to win his friendship and thus get the freedom of his home 
and opportunity to seduce his wife. And this young man he had 
considered his bosom friend. He wanted to murder all three of 
them, his wife and the two men. Doubts whether he was really 
the father of the boy haunted him again. 

6 



74 CASE HISTORIES 

He attributed his failing vitality to overwork, but one thing 
restored his self-confidence and made him feel equal to anything. 
Like Columbus, who discovered a new world, he also had the 
courage to do the im.possible in that he succeeded in committing 
fellatio on himself. After that his spirits revived and he found 
he could do things in his work that he had previously thought 
impossible. (With every evidence of sincerity he insisted this 
incident was true.) 

About a year before the present commitment he found a 
boarding place in the home of a poor widow with several children. 
She was " as homely as sin," but was a devoted mother to her 
children, and that aroused his sympathies. He felt like helping 
and protecting her as he should have done but did not do for 
his own mother when she was in identical circumstances. His 
interest in her began to arouse comment, and he hotly resented 
suspicions that he had sexual relations with her. Finally, how- 
ever, his feelings toward her became erotic and he tried hard to 
seduce her. She refused even marriage because her children 
didn't like him, but she allowed him to caress and handle her. 
After many futile attempts he succeeding in making her erotic, 
and she hugged him and sniffed in her emotion. He realized 
she would not now resist him, and just at this moment of success 
he found himself absolutely impotent. " It was an awful blow. 
It showed up my weakness. I just went out of my head and 
raved. 

" Afterwards I tried to reason out why I couldn't get an 
erection and I remembered how she had sniffed in her excitement. 
I decided that was what had sucked my strength. Then a 
neighbor came in to see me and urged me to go to a hospital. 
I recalled that his wife was sickly and so was a young man who 
boarded with them, and then I suddenly saw through it all, that 
he had been sniffing their strength away." In righteous indigna- 
tion he beat the man up, and then felt so strong and elated 
in his victory that he got an erection. This was an opportunity 
to prove his masculinity to the widow and he attempted inter- 
course whether she would or no, but she was not in the mood this 
time. The police were called in, and he was taken to a psycho- 
pathic hospital. 



CASE HISTORIES 75 

Fantasies: He had the usual delusions and hallucinations. 
"Other minds were influencing me. Some superior power was 
working on me and pushing me to do things against my will. The 
Catholics used influence on me to my hurt, they used witchcraft. 
That influence was beyond my control. When I was first brought 
to the hospital I ate my feces and drank my urine to prove I was 
brave and that I would not practice Catholicism. I'm a Jew." 
(Here he showed the common symbolization of the conflict of 
impulses as Catholics versus their religious opponents. Which 
party is the wicked one depends on the patient's own religious 
convictions. This man was further influenced by his unfortunate 
experience with his mother's confessor. Loyal Catholics like 
Lefferts make the Masons the devilish tempters who use influence 
on them to make them commit sexual perversions.) In addition 
people had tried to poison him, and he had felt electricity surge 
through him from his feet upwards, and his hair was pulled up. 
Another patient had put cocaine up his nose during his sleep and 
influenced him, and that had driven him insane. 

He had been used as a tool for other people's purposes, they 
had hypnotized him and driven him insane and had him brought 
here to get evidence on him, for they wanted a scapegoat. He 
saw secret service agents in disguise all around him and suspected 
me of being one also, though at times he believed I was as I said 
a psychologist trying to help him. Once he told me he didn't want 
to talk with me, for he feared I would destroy his belief in his 
delusions and he preferred to keep them. 

" The kernel of my trouble is that my strength and sex power 
have been sapped and it is something outside me that has done it." 
He was very busy trying to reason out just what had sucked his 
strength. One theory was that when struck by the train in his 
boyhood he "lost some of what a male is entitled to. I'm not 
the man my father was." But the sniffing seemed the likeliest 
method. The ward physician had a habit of sniffing and, being 
ignorant of the delusion, was much startled when one day the 
patient without warning spat copiously in his face. The doctor 
thought he had filled his mouth with water at the tap, but he 
reassured him later that it was only saliva. He realized now that 



76 CASE HISTORIES 

people had been sniffing his strength away for a long time, but he 
had hit on a method of self-defense. If he sniffed back again, 
there was an interchange of strength, the balance of power re- 
maining as before. After this discovery his conduct became more 
agreeable, for he could hold his own and consequently had nothing 
to fear. 

He thought of his mother a good deal and wondered if she 
could have been raped when as a sixteen-year-old girl she had 
crossed the sea from Ireland to America. He remembered hold- 
ing her down during her raving spells, and thought what a bad 
effect they would have on an embryo. Was it possible that he had 
been thus injured before birth? 

" When I looked at a man who had a hypnotic eye I felt an 
erection and orgasm, but I had no idea of letting him go down on 
me. When he looked at me I said to myself I won't take it (the 
hypnotism), I won't swallow it (the host or saliva). I resisted, 
and he swallowed his host instead. When I see men swallow, 
I know they're afraid of what they see in other men's eyes. I 
can stare a person in the eye till they swallow their host, or saliva ; 
that's their weakness. It seems that I force them to." These 
fantasies disclose very obviously his resistance to fellatio, par- 
ticularly towards taking the female role. 

He suffered a good deal from headache. In a dream the pain 
was relieved by a man's committing fellatio on him. *' The man 
said he was drawing it out of my brain. I felt a great relief in 
my forehead, then it went down my body and out my penis. I 
woke up and found I had an erection but no orgasm." A number 
of times he dreamed that both men and women masturbated him 
and committed fellatio on him. 

A very vivid dream was of a horsehead on the end of a 
derrick. " The horse snuffed up oats and blew them into a box 
car for chickens to eat. Then I said to myself, ' Now I see 
through it all.' I felt an erection and orgasm and woke up 
blowing my breath out." This dream symbolizes his conscious 
fantasy that he could sniff up sex power (oats, seed, semen) from 
others to use in sexual intercourse. Horsehead and derrick 
represent his own head, penis and libido; box is the female 



CASE HISTORIES 77 

genitals, and chicken is a slang term for a young woman. Both 
normal coitus and fellatio ideas are present in the dream. 

Just before he was arrested and taken to hospital he used to 
sit a great deal on a magnifying lens, but though he puzzled 
over it he could not now remember why he did it. " That*s where 
the insanity comes in; I can't recall the reason." (Protection 
against pederasty?) 

General observations: He often had insight into mental con- 
dition and spoke of his strange sensations. " My mind wavers, 
and jumps from one subject to another. I remember having 
three ideas in it all at once. It seems like a piano board, the 
thoughts chase through it so much. I have trouble articulating. 
I'm like a ship without a rudder. I must be a nut. Sometimes I 
get into delusions. In the second talk with you I began to be able 
to follow one line of thought steadily. Before that my thoughts 
were all mixed up. I believe I am coming out of it. I can re- 
member back pretty far now." Sometimes his memory became 
clouded. 

His attitude toward me was variable. I told him he was 
mentally sick and that I was trying to help him get well. He 
responded at first, but in our fourth talk he said, " The first time 
I saw you, I felt I might confide in you. Now I'm getting sus- 
picious of you." A month later he said, " I'll confess to you, a 
secret service man, an intelligence man, but I won't confess to 
a priest. I like your countenance, whoever you are." And 
again, " I've been kidded so much, fooled so much, that I feel 
fortunate to have someone like you to talk with and rely on in re- 
gard to my mental condition." These confidential moods alter- 
nated with periods of suspicion in which he began to see me 
about the grounds disguised in the garb of both sexes. '* You're 
a slick one. Doc, you're a secret service man disguised. I'm well 
and I want to get out of here." 

Occasionally he felt he was misunderstood and became very 
depressed and weepy. The paranoid traits appeared at such 
times. " When I get out of here, I'll be a bad man, I'll fight for 
my rights. People have used me as a tool, a stepping stone." 
Once he started to go to his old employers in town to demand an 



78 CASE HISTORIES 

explanation of "what this is all about." His parole had to be 
taken back, and he was confined to a ward. 

The masculine protest was shown by his letting his beard 
grow and wearing an army uniform. " Tm a man, I'm no molly- 
coddle, and I want to prove it." He demanded that I afford him 
opportunity for heterosexual intercourse, and when I refused, 
escaped to town in search of it, but was recaptured. 

The greatest temptations of his life had been to murder his 
wife and the men he believed she had relations with, and to com- 
mit fellatio and cunnilingus. His greatest regrets were that he 
had not been able to have coitus with the widow when she was 
willing, and that he had done cunnilingus on his wife, and had 
once begun fellatio on a boy. 

One day when he showed resistance toward me he said, " I 
keep things back from you because I don't want my belief in 
these things destroyed. I prefer my delusions. ("What is a 
delusion?") A false belief. They aren't false to me. I have 
faith in them. ("Why call them false then?") Because I was 
called insane. I've been driven insane by other people. They 
sent me here to get evidence on me, that's all. I don't know what 
they expect to find. They must have a fall guy, a goat. I don't 
want to get sane. I fear my son is not really mine, and the 
widow I was so fond of has negro blood because her son's arms 
are so very long." He became despondent and quarrelsome and 
got into fights with other patients, thinking they were women or 
myself in disguise. 

In a fortnight he improved once more and his parole was re- 
stored. " I'm working my way out of this tangle, out of my 
delusions and hallucinations. It's as you say, it is real to the 
man himself, but it's all in his own mind just the same. I'm 
satisfied my trouble is all in my head and I feel I'm straightening 
it out. I feel I can find interesting work and earn my living. At 
first I couldn't believe you when you said the mind could get sick, 
I didn't realize it could. It seemed some phenomena superior to 
man. Now I see it's all in the mind. A man can be anything he 
has a desire to be, provided he has will power to back it up." 

In another month he seemed fairly normal to his physician, 
and the latter allowed him to go on a Red Cross party to town. 



CASE HISTORIES 79 

He slipped away from the guards in a theater and escaped. 
Months later a brother wrote to the hospital that the patient was 
getting along all right in freedom and requested that his name 
be stricken from the roll. 

Occupational therapy^: He consented at once to try bead 
work, but though interested was rather careless. He seemed to 
be more interested in having the instructor sit by him than in 
the work itself. He got more indifferent and as soon as parole of 
the grounds was granted him, stopped work altogether. 

Physical examination: Medium type of skeleton with well 
developed muscles. Skin well nourished, perspires easily. 
Brown pigmentation on back. Hair of head gray and scanty. 
Body hair scanty. Genital hair normal in amount but submas- 
culine in type. Genitalia normal. Heart regular but rapid. Ex- 
tremities cold and slightly blue. Eyes protrude. Reflexes nor- 
mal. Thyroid gland slightly palpable. 

Endocrine diagnosis: Hyperthyroidism. 

Glandular therapy: He went through the tests which es- 
tablished the endocrine diagnosis, but escaped before any real 
glandular therapy was begun. 

Mental diagnosis: Schizophrenia paranoid. Not only were 
his improper sexual impulses projected onto other people but, as 
the years went on, he built up a somewhat systematized structure 
of persecution in other matters besides sexual. The delusions 
themselves did not change so much as did his belief in their 
reality. At times he had considerable insight as shown by such 
a remark as, " I realize I was nutty, and I may be yet at periods." 

it is easy to trace the effect that his mother incest impulse had 
on his life. His father's brutal punishments and his mother's 
attempt to shield him probably helped to fix his libido on her in 
the first place. He felt resistance toward taking his father's 
place in the family after the latter's death, and had a revulsion 
of feeling toward her, seeming to prefer the father image. His 
suffering when during her raving spells he had to hold her on the 
floor was perhaps not entirely due to her unlovely condition. He 
was quite ready to suspect her of illicit relations with the priest. 
His fear of infecting her with gonorrhea was hardly justified. 
His incest fears drove him to abandon her even though he knew 



8o CASE HISTORIES 

it was an unworthy thing to do, and his remorse over this act 
followed him all his life. An exaggerated recoil from incest can 
cause a certain amount of resistance toward the whole sex, and he 
found little satisfaction in heterosexual intercourse, usually pre- 
ferring males, though he rationalized this tendency as due to fear 
of venereal disease. In marriage he had little pleasure, and said 
there had been only one real "love" coitus. Something spoiled 
the others. Finally he became somewhat impotent and stopped 
relations entirely. The widow attracted him in spite of being 
"homely as sin," because she was a devoted mother, and he 
likened her to his own mother and resented insinuations that 
there was anything erotic in their companionship. Later when he 
gave way to his erotic impulses he found himself suddenly im- 
potent at the moment of opportunity. In the hospital he had 
fantasies of his mother's having been raped while emigrating to 
America. 

In homosexual matters he rationalized the male role as per- 
missible. His cravings to take the female role were sometimes 
recognized and resisted, and sometimes repressed and projected. 

QUITNER 

History: He was a petty officer in the navy thirty-eight 
years old, and was serving his fourth enlistment when sent to 
hospital. He was one of eight children and was born in Hungary. 
When still a little child the family emigrated to America, and 
he spent his boyhood and youth in a great city. He attended 
school from the ages of six to eleven and reached only the fourth 
grade. He didn't do well in his studies and felt humiliated when 
other children surpassed him. He nearly cried with shame. Not 
only in mind but also in body he felt inferior and was much 
ashamed of his small frame and delicate bones. 

After leaving school he worked for two years as a cash boy 
in a big store, but quit because people teased him. Other jobs 
didn't last long. He couldn't adjust and gave them up. He tried 
night school but couldn't get on there either. At nineteen he left 
home and wandered west to see the world. After he tired of a 
job or a city he moved on to another. He reached San Francisco 



CASE HISTORIES 8 1 

when he was twenty-two and enlisted in the navy. Between 
enHstments he roamed about on land from job to job. 

He got on all right in the navy until the fourth enlistment, 
when it was noticed he was queer, but he still did his work satis- 
factorily. He talked much about religion and spiritualism and 
knelt like a fire worshiper making obeisance to the sun or to 
lighted cigarets. He said he heard voices as if coming from a 
telephone receiver, and believed that God spoke through him. 
Finally he received an order from God via his mother that the 
ship should change its course, and without securing permission 
he invaded the captain's cabin and delivered the message to him. 
To his great indignation he was arrested and sent to hospital. 

He was perfectly oriented and could remember well. He 
declared he wasn't crazy and that he could think even better than 
formerly. He had hallucinations and delusions of persecution, 
was very suspicious, and had no insight whatever. He was tense 
and emotional and very talkative. 

His suspicious antagonism to the doctors was so keen that he 
could not be admitted to the endocrine ward for nearly eight 
months. By that time he had quieted down very much, and 
while still insisting that he had not been insane and that it was 
a dirty trick to shut him up, he behaved well and was willing to 
talk courteously with anyone. 

Sex life: He made no mention of masturbation. When ten 
years old he had been warned to beware of men who might try to 
commit pederasty on him, and he saw two negro boys in the act. 
At twelve he had his first heterosexual experience. When 
eighteen he fell in love with a girl, but his sense of inferiority 
caused him to step aside to allow her to get some superior fellow 
with better prospects. Then he began his wanderings. 

Later in life he had relations with a widow and helped to 
clothe her child. The act of coitus he had reduced to a fine art. 
Perversions he denied. 

Fantasies: He began hearing voices about a year before the 
incident with the captain, and at first they were insulting. They 
were like spirits and they knew all his past, all his sins. Finally 
he made peace with them by confessing and acknowledging his 
sins to them, and then they ceased bothering him an^ became 



82 CASE HISTORIES 

friendly. "If Garland and Engel would do this instead of fight- 
ing the spirits, they would be all right. The spirits are company. 
It's impossible to be lonely when you can talk with them. I 
answer them noiselessly by making silent movements in my throat 
and larynx. Like a medium I get messages from God as over a 
telephone. He is interested in me like a father in his son. Father, 
mother, son, that is religion. At first the voices were insulting 
and sounded as if coming from some distance outside me, but I 
coaxed them closer and closer till now they're inside my head 
completely. 

" I've always been able to mimic girls and women. I've gone 
to fancy dress balls disguised as a girl and fooled everyone. 
(For my benefit he mimicked a woman very well, and it was 
evident that he enjoyed doing it immensely.) But it's dangerous 
to act ladylike, for some fellows jump to the conclusion that 
you're a pervert. In the navy I was always on guard against 
other men's suspecting me of being a pervert and for that reason 
I kept alone some. When a fellow feels lonely it's a comfort and a 
pleasure to hear his own thoughts as you call them, to hear these 
spirits. They talk to each other and I listen, or I join in and talk 
with them." 

When told these spirits were splits of his own mind and that 
he should try to reunite them, the prospect didn't attract him at 
all. **I prefer to keep them as they are, they're so comforting 
and interesting. I don't want any change. I have seven of these 
spirits inside me. They are like my children. I wouldn't 
want to lose them any more than a father would wish his children 
to die. Besides, I don't see how they can be splits of my own 
mind for sometimes I'm sure they tell me interesting things that 
I never knew before." 

General observations: The first day he entered my office he 
looked around suspiciously and admitted he feared a dictaphone 
was secreted somewhere. He began the talk by boasting of his 
adaptability, saying he could pass as tough or refined at will. He 
had always been much interested in religions and believed they 
originated in fear; fear first, then worship of the thing feared 
(recall his worship of the lighted cigaret, a frequent potent penis 
symbol). 



CASE HISTORIES 83 

In the following interviews he aired lengthy grievances about 
his detention and mistreatment. To contradict or reason with 
him led to an unending maze of argument in which he delighted. 
I finally stopped it short and said I was more interested in his 
own thoughts than in what otner people had done to him. He 
reproached me for not taking more interest in his grievances. 
" If I had been a pretty girl, you'd have waked up, straightened 
your back, and said, ' Miss Quitner, we'll look into this and see 
what can be done.' ("But you wouldn't want to be treated like 
a girl.") Yes I would. ("That would be favoritism, not jus- 
tice.") Then I want favoritism. I'm looking out for number 
one. I want sympathy. 

" In tough neighborhoods one has to be tough because if one 
is too pleasant and soft, they may take you for a fruiter (fella- 
tionist) or a bushwhacker (cunnilinguist). Such fellows are 
soft and easy and dreamy like Engel. I found out in the navy 
that there were two classes of men, those who stood up for their 
rights and those who gave in. (It was clear that he had trained 
himself to be touchy and instantly to resent with force any slight, 
an overcompensation for feelings of inferiority and fear of being 
considered a pervert. Ulster in his restlessness struck him one 
day, and he reacted exaggeratedly, attacking Ulster so violently 
that he broke one of his own fingers.) Middle-aged pederasts are 
called Turks. They go insane. They suffer from it more than 
the boy they do it to. It's dangerous on board ship for boys. I 
used to warn them of the danger, and the Turks in revenge made 
things disagreeable for me." 

He showed some antipathy to the women nurses and the 
occupational therapist, and was exceedingly conceited, believing 
he knew more than the physicians. This made psychoanalytic 
work with him difficult. He already was aware, however, that 
children had attributes of both sexes and must develop those of 
their own sex, neglecting those of the other sex. This he had 
striven to do. He was intelligent enough to grasp the conception 
of mental mechanisms well, but he felt reluctant to give up his 
dearly loved spirit voices. He even wrote a poem about them 
which he called Babies in Fairyland. 



84 CASE HISTORIES 

He said he wanted to go away off into the wilds after regain- 
ing his freedom, so that he wouldn't get locked up again. He 
came to see clearly that no one had interfered with him so long 
as his spirit beliefs hadn't affected his behavior or led him to do 
forbidden things like forcing himself on the captain. He had 
previously argued that if belief in spirit voices was sufficient 
grounds for incarceration in a hospital for the insane, why 
weren't Sir Oliver Lodge and other spiritualists locked up too. 
He learned to see that if he behaved in a manner acceptable to 
his f ellowmen and could do his work, no one would bother much 
about his beliefs. 

Occupational therapy: He was only mildly interested but 
could do good work. He preferred arguments to basket weaving. 

Physical examination: Slender type of skeleton. Skin 
smooth, dark brown over entire body. Hypertrichosis. Hyper- 
hidrosis. Extreme sensitivity to heat and electricity. Front 
teeth protrude outward from alveolar process. Reflexes hyper- 
active. Fine tremor of fingers. Eyes protrude, pupils dilated 
and active. Heart irregular. Thyroid gland slightly enlarged. 

Endocrine diagnosis: Hyperthyroidism with associated pitui- 
tary dysfunction. 

Glandular therapy: Thyroid rather increased his nervous- 
ness and argumentativeness. Suprarenal had a better effect. 

Four months later: A month previous to my return he had 
been discharged as a social recovery from dementia precox. The 
records stated that his physical health and his mood improved 
steadily. Finally no psychotic symptoms were seen. He said 
his behavior during his insanity had been like that of a drunken 
man, he wasn't responsible for his acts. 

Mental diagnosis: Schizophrenia paranoid. His long 
struggle with the feminine side of his nature is evident. The 
insulting voices were without doubt his projected perverse crav- 
ings. After he had confessed his sins, the voices lost their disturb- 
ing quality and became a means of recreation inside his own 
head, or in other words the perverse cravings were again re- 
pressed deeper into the unconscious. But the habit of projection 
kept alive a paranoid fear of hostility from mankind in general. 



CASE HISTORIES 85 

This had largely disappeared before he entered the endocrine 
ward. It is doubtful whether the schizophrenic habit did entirely 
cease, but he was at least cunning enough to conceal it from the 
physicians and obtain his discharge. 

RiEGEL 

History: He was a chunky, ill-proportioned sailor twenty- 
six years old. He denied there was any mental disease in his 
family, but said his mother was nervous and cranky and annoyed 
him a great deal. He went to school from eight to sixteen years 
of age and reached the eighth grade. He didn't get on well there ; 
the teachers were cranky and didn't want to teach him anything, 
and he had to learn all by himself. He didn't get on any better 
at home ; for everybody wanted to be the boss. He liked his 
father and brothers better than his mother and sisters. His 
mother was too cranky. She called him a lazy loafer and other 
worse names. 

After leaving school he worked in factories and machine 
shops, seldom staying long in one place. The other men wouldn't 
show him how, and then the foremen would fire him, or he would 
get into a fight with the other men or be laid off when work was 
slack. The poor workingman he declared, was oppressed by 
every class, by the farmers, the rich, the municipal employees, 
everybody. He had expected big jobs and big money and got 
only disappointment. The fault was always somebody else's. He 
felt everyone was against him. 

When in imminent danger of being drafted into the army he 
enlisted in the navy and he considered the war and the draft a 
fresh imposition. In the navy he had a terrible time trying to 
adjust. Eastern boys made fun of western boys like himself, 
they guyed him on his short stature and clumsiness and table 
manners. He felt helpless and inferior and that everyone was 
down on him, and he reacted with hate and anger. 

A year later he was removed from duty, as he was unable to 
carry out simple orders. He had been doing very unsatisfactory 
work as a messman. He was tense, nervous, and untidy, and 
defecated in his clothes. He thought the other fellows had it in 



86 CASE HISTORIES 

for him and were talking about him behind his back. He reached 
this hospital after some months and believed he had been sent 
here only for discharge. He saw nothing wrong with his mind, 
but sometimes it got sleepy, and his legs felt weak. 

Sex life: His attitude was very resistive, but I succeeded in 
getting some information. He admitted masturbation but 
wouldn't tell how often. He had always been bashful and un- 
successful with girls. He had never had a best girl, that was all 
damn foolishness. A wife was nothing but a moneysucker. He 
had never danced, he was too clumsy. He had never had hetero- 
sexual intercourse, nor committed perversions. 

His wet dreams were of accidents to which he was a spectator 
only. Wagons and automobiles ran away, tipped over, and broke 
the legs of the passengers who were always men. There was 
much blood. These dreams were not unpleasant. Another typ- 
ical dream was of work, work, working in the shop. He denied 
dreaming of women. 

He had not been able to get an orgasm since entering the 
hospital. 

Fantasies: He sometimes seemed lost in thought, and smiled 
or chuckled to himself, but he never would divulge what amused 
him. Often he looked furtively at other patients and then went 
off into silent glee as if ridiculing them. Any laughter he heard 
on the ward he immediately attributed to himself and swore furi- 
ously under his breath. The occupational therapist frequently 
heard him muttering to himself, and once he exclaimed angrily 
to her, "If you call me a fool, I'll be damned if I'll work for 
you," when she had said nothing at all. He went away scowling 
and would not work for a couple of days. 

In answer to questions he denied seeing visions or hearing 
voices or feeling that electricity or any outside force or influence 
was being used on him. ("Do you think other people are com- 
bining in a plan to hurt you?") "Yes, by talking about me. 
("What do they say?") Gee, I don't know myself!" 

General observations: He had a great sense of grievance 
and felt that other people were imposing on him. He was very 
self-conscious and constantly on the defensive, looking for slights. 
Any friendly advances were rudely rebuffed, for he suspected 



CASE HISTORIES 87 

some hostile motive or intention to ridicule, and muttered and 
glowered hatefully. I have never seen more hate in a human face 
than in his. 

'Tm not as strong as I used to be. My thoughts are getting 
slower. I don't feel like moving myself much. I can't think as 
fast as I used to. I've no appetite and I feel lazy. I don't like 
this climate. I can't get braced up. I worried myself out, work- 
ing in the machine shop. You get to be an old man in a short 
while. ("Why don't you mingle with the other patients?") 
They're from other cities, and I don't know what to say to them. 
They don't want me around. They go on their way, and I go on 
mine. You're from another state, and so you're not easy to talk 
to. 

" People don't care about me ; they have enough to do to take 
care of themselves. In the navy one fellow called me short, and 
the others laughed (intense emotion). I've always been guyed 
about being short. A navy chief had it in for me because I was 
from the west. He gave me extra work. They made fun of 
westerners, of our table manners and the way we looked. I felt 
the other fellows came from better families. Workmen like me 
have a hard time. When work is unsteady the money soon goes. 
Some people have money already and don't have to worry. Other 
people get better chances than I do. You can't help me, and / 
can't talk with you, because you're not a shop worker like me. 
You loaf around here and do no work. If I was as well fixed 
as you I'd feel good too. You're not in my class. I want to keep 
to my class. You like women, you're dressed that way, you're 
not a bad looking fellow." 

Quizzing him on his sex life drove him into such a fury of 
hate that I half expected him to leap at my throat. For a month 
I paid no attention to him, but every time I entered the ward he 
glared at me ferociously. However, he never actually offered 
physical violence to anybody. Through gifts of candy he became 
sufficiently mollified so that I attempted the Terman intelligence 
test. All went well until he began to fail on the harder questions 
and realized he was failing. He got so angry that he did poorly 
on some problems that I felt sure he could have solved if he had 



88 CASE HISTORIES 

not been so emotionally upset. Throughout life this has seemed 
to be his customary reaction to his failures, and he projected the 
blame on other people. His mental age was twelve years, in- 
telligence quotient 75 per cent., that is, low average intelligence, 
nearly a moron. 

Occupational therapy: He began without urging but was 
handicapped by his self-consciousness. He was shy about asking 
questions and when things went wrong went to pieces. His work 
showed no improvement but was of fair quality. Sometimes he 
was so ugly that the instructor left him alone. 

Physical examination: Short in stature, heavy type, large 
head and neck. Skin dry and covered with fine white scars and 
a papular eruption. Normal distribution of hair about genitals 
with moderate amount over chest. Beard heavy. Genitalia 
normal. Heart normal. Eyes very sensitive to light. Deep 
reflexes markedly hyperactive with wide extensions and rein- 
forcements. 

Endocrine diagnosis: Submyxedema. 

Glandular therapy: Thyroid made him somewhat more active 
physically. Nurses and attendants said he seemed pleasanter and 
more contented and didn't look so mean or mutter curses as 
before. One of them noticed he acted apprehensive and looked 
back over his shoulder, but he said people didn't bother him as 
much as they used to. Then he began to masturbate at every 
opportunity and became depressed. 

Four months later: He had been transferred to a state hos- 
pital nearer his home. The record stated he had improved 
remarkably. He stopped masturbation, lost his fearfulness, and 
became pleasant and courteous. His mind seemed clear, and he 
paid attention to his personal appearance. When asked why he 
was so much better humored he replied, " Nobody bothers me 
now. That's why I don't swear and curse as before." 

Mental diagnosis: Schizophrenia paranoid. He was too 
suspicious and resistant for one to learn much of his sexual diffi- 
culties, but since he projected his more apparent difficulties of 
every day life onto others, it is more than probable that he did 
the same with his deeper sexual troubles. That he had them 



CASE HISTORIES 89 

was shown by his ill success with girls and hatred of them and by 
his resistance towards his mother and sisters. No doubt he pro- 
jected hostile physical and sexual wishes onto the environment, for 
as he recovered he admitted that people didn't bother him so 
much and finally didn't bother him at all. The change was en- 
tirely within him, his environment was not altered. Anal erotic 
and sadistic cravings were clearly revealed by his pleasant wet 
dreams of accidents, broken legs and blood, in which he was an 
interested spectator. 

Sabin 

History: He was a man thirty-six years old, slow and quiet 
and well-behaved. He had lived an uneventful life on a southern 
farm, sometimes clerking in stores in the winter, until he was 
twenty-one. Then he enlisted in the army to see the world and 
spent his five-year enlistment in two barracks. He didn't leave 
one of them for six months and his comrades asked him why 
he didn't bring his coffin in. During the service he married, his 
wife remaining in her parents' home. They had one child, a son. 
Apparently he was already slow and retarded before his discharge 
from the army. He worked as a visiting nurse in Baltimore, 
catheterizing prostate cases, and then was employed as a chore- 
man in Shepherd and Enoch Pratt Hospital. After a month 
he was fired. He tried for one day to find another job and then, 
recalling how kindly the patients were treated at Pratt Hospital, 
decided the easiest thing to do was to enter an insane hospital for 
protection. He lost heart easily, he said. Accordingly he pre- 
sented himself at one of the Maryland state hospitals and re- 
quested that he be received. He screwed up his lip and stared 
into the distance in an attempt to look crazy. They told him 
they saw nothing the matter with him but would take him if he 
so desired. This account is the patient's own version. 

He was hazy whether he spent three or five years in that 
hospital. While there he worked on the farm. One day an 
attendant told him he saw no use in a man as young and as well 
as he staying there, and he ran away. At first he worked on a 
farm not many miles away, but fearing he might be discovered he 
left and came to Washington and hired out as a garbage wagoner. 

7 



90 CASE HISTORIES 

It seems that even this was too much for him to do without 
surveillance, for after seven months he was arrested and taken to 
a hospital with body and clothes in filthy condition, and physically 
much run down. He said he had worked long hours and cooked 
his own meals in a vacant lot. On admission to St. Elizabeths he 
showed considerable mental deterioration. 

Sex life: As a child he slept between his parents in the same 
bed, but had no recollections of having seen them in coitus. At 
puberty he got an erection on seeing his mother accidentally ex- 
pose her leg, and he hid and masturbated. She caught him at it 
and whipped him. The small negro boys of the vicinity per- 
formed perverse acts and offered themselves to the white boys 
for five or ten cents. His father had a negro boy working for 
him whom he had " bought out of jail " in which he had been 
incarcerated for attempting coitus on his mother (according to 
patient). The patient tried pederasty on this boy and, failing, 
had the boy commit fellatio on him. His father found them 
doing it and whipped them. Never again did he commit a per- 
version. 

His first coitus was at sixteen with a married second cousin 
who invited him. This happened several times. At nineteen he 
began going with prostitutes. At twenty he again saw his mother 
unwittingly expose herself and got an erection. Not long after, 
he returned one night unexpectedly and surprised his parents in 
intercourse. This seemed to have been a trauma. He felt that 
he didn't belong there any longer and never felt at home again. 
It was then he joined the army. He claimed not to have mastur- 
bated more than a dozen times in his life, but he had coitus about 
once a week when possible. While in the army he married, and 
enjoyed coitus with his wife until after the birth of their child. 
She was then apathetic, and he lost interest and left her. He 
denied ever having been impotent, but his fantasies were full of 
means to avoid becoming so. During the last few years spent in 
hospitals and garbage gathering he had had no intercourse, nor had 
he masturbated. There was no desire. His wet dreams were of 
heterosexual intercourse. 

He used to be pretty passionate he said, and lust and longing 
for masturbation made life a misery. Giving in to perversions 



CASE HISTORIES 9 1 

would only increase desire. He felt that way after fellatio with 
the negro boy, but he never succumbed again. 

Fantasies: The first intelligible fantasy he gave evidence of 
was concerning hair. To grow long hair and leave it uncut 
was necessary in order to excel in health and potency. If a man 
cut his hair while a woman let hers grow, she became the stronger 
and sucked his strength. He grew a beard in order to look like 
his father who had been a hairy man and had always worn a 
beard. 

Sometimes the voices mentioned birth, sucking a cow, fellatio, 
or son-of-a-bitch, and he thought persons left an influence behind 
in every place they had been. The influences left behind by old 
men bothered him particularly. 

When the attendant tried to get him to help in the ward work, 
the voices objected and said the attendant was supposed to do it 
himself. 

During a moderately dull period in the fourth month he 
suddenly divulged a mass of sexual fantasies, all of them con- 
cerned with the maintenance of potency. " If a father has coitus 
with the mother while he thinks of a living child, he takes strength 
out of the child and puts it into the mother. When the mother 
gets old and her sexual organs become flabby, that makes the son 
weak, for there is a sexual sympathy between mother and son. 
The son should then leave home. My father wanted me to get 
out. That was probably the reason. If parents still have inter- 
course after they have ceased to be able to beget children, it 
sucks the strength of their son. It was using up my manhood. 
Before I caught them at coitus I was sucking their strength. 
Afterwards I lost strength because they sucked mine. Probably 
a mother, when she and the father get old and sexually weak and 
their son is passionate and ready to go with girls, goes to the 
house of prostitution ahead of her son, disguises herself with 
paint and short dresses sO' he doesn't recognize her, and has inter- 
course with him, getting his passion to bolster up her own so she 
can use it with the father. My parents were reported dead and 
yet I saw my father off on the lawn a few days ago, so my 
mother is probably alive too. I have no doubt she has had 
intercourse with me to get my passion away. She pretended 



92 , CASE HISTORIES 

death just to fool me; I don't, understand it. If the father has 
intercourse with the mother and doesn't make her pregnant, it 
harms their living child, makes him weak, makes him want to go 
back into her sexual organs and be reborn. All children have 
sexual feelings towards their parents." 

"If in a group of thirteen men (like my little group in the 
army) only four indulge in coitus and the other nine go without, 
the four suck the strength of the nine. When I married, my 
comrades supported me with their strength and my wife's family 
supported her, but her sisters got fellows of their own and lost 
interest, and she got less passionate and didn't care whether she 
took me or not. I felt as if I were masturbating in her ; I might 
as well have done it out the window. Then I left her. It 
weakens a man if the woman doesn't respond and breed. When 
passion rises between buddies until one gets too strong, he seeks 
a girl and absorbs the other fellow's strength. If a man should 
receive another fellow in his mouth, his ear, his anus, or his fist, 
but people don't allow that, those parts of his body would feel 
like repeating the act at the same time the next week. That's 
the way I felt after the nigger committed fellatio on me, but I 
never did such a thing again." 

" Once I worked on the farm of a man who was absent. His 
wife was sexually old and worn out, and I got to feeling that way 
too. You see I was taking his place. I had to get out. You 
don*t want a woman whose strength has been used up by some 
other man, for it weakens you." 

When he was still duller, he talked of having recently had 
both active and passive pederasty hallucinations, of girls through 
intercourse turning into males, of mothers making penises out of 
their skin and flesh and using them for intercourse with their 
sons, of boys whose genitals were alternately male and female, 
of a man he saw naked in the hospital bathroom who had big 
teats and a little penis and claimed to have been his wife, and of 
tables without heads which grew hair. " I've a mind to get a gal 
and have intercourse with her till I turn her into a boy." 

General observations: On admission he wore long hair and 
a full beard, and objected to having the beard removed and his 
mustache and hair trimmed. He wanted all the hair possible^ 



CASE HISTORIES 93 

because it meant strength both physical and mental. His mind 
seemed deteriorated and much of his talk was unintelligible. He 
was quiet and apparently emotionless, sitting all day long in a 
chair. His expression was dull ; he spoke slowly and seemed to 
have difficulty in moving his jaw. A sample of his talk is, *' I'll 
say it's glass that wheels itself and begets itself and lets you hear 
and then collects itself back into line." 

To everyone's surprise his mind cleared after a few weeks and 
he seemed quite normal. He was interested in everything, was 
quick to join in any conversation and became facetious and witty 
in a country smart Alec way. When confronted with what he 
had said in the previous dull period, he exclaimed that it didn't 
make any sense. He said also that he no longer had any queer 
ideas. In three weeks he went into another depression, looked 
dull and apathetic, heard voices and talked nonsense. Any noise 
became a speaking voice to him, as the purr of a radiator, or 
squeaking footsteps, and he would report to me what they said. 
Sometimes voices shouted indistinctly in his ear. 

In two weeks he was alert again and said, " Those voices 
come when I feel sick, or bilious, or have indigestion, and leave 
when I feel good." These alert and dull periods lasting from two 
or three days to a week or two alternated continually. During 
the dull periods he could play a slow but good game of checkers 
and continue slowly his leather pressing occupational work. 
When dull he sometimes used clang associations, and he always 
had trouble moving his jaw to speak. He also complained of 
feeling weak and tired and not being able to remember well. 

Occupational therapy: After hesitating three days he began 
to work and continued it without interruption. In his depressed 
periods he did poorer work than in his normal ones. He pre- 
ferred leather pressing, showed good judgment and artistic feel- 
ing and improved steadily. He originated some of his designs. 

Physical examination: Large type of skeleton. Powerful 
muscular development. No deformities. Skin soft and pliable 
but shows localized hyperaemias or " flushings." Perspires very 
easily over hairy parts. Face is notably plethoric. Hair, normal 
distribution over chest and genital region. Genitalia normal. 



94 CASE HISTORIES 

Heart normal. Superficial reflexes all present. Deep reflexes 
slightly hyperactive. 

Endocrine diagnosis: Hypoadrenia. 

Glandular therapy: None. He was transferred to another 
hospital before treatment could be begun. 

Mental diagnosis: Schizophrenia with projection and fea- 
tures of circular insanity. 

One can see that this man had long had an incestuous love 
for his mother, when one considers his getting erections at seeing 
her legs as a boy and adolescent, his distress following his find- 
ing her in coitus with his father, his resistance towards his wife 
after she became the mother of a son, his present fantasies of 
incest and impotence and his attempt to look hairy and virile like 
his father. The long fear of impotence was probably caused by 
the realization that his cravings were directed toward a forbidden 
object. Homosexual cravings were also present. 

His alternating periods of happy normality and depressed 
dullness and confusion were like quick-changing circular insanity. 
His different levels of sexual thought are interesting. In his 
clear, alert periods his sex attitude seemed fairly normal, in 
moderate depressions he was in the CEdipus-homosexual stage, 
in deep depressions his thinking became archaic with bisexual 
monsters and metamorphoses. 

Tocci 

History: He was a wiry, delicately built little Italian with 
almost feminine agility and grace, but surprisingly strong. His 
age was twenty-five. In Italy he had only three years of school- 
ing, after which he worked as a farm laborer, tailor and shoe- 
maker. At seventeen he came to America to see the world, and 
wandered from city to city working as a shoemaker. He went 
to night school to learn English but still spoke it so badly that he 
was very hard to understand. He felt lonely and unhappy in 
this country. " I was sorry to be alone, far away from my family, 
and disturbed not to see my people. They told me not to 
worry but I worried all the time. If I got sick, who would take 
care of me?" He suffered much from headaches. 



CASE HISTORIES 95 

He was probably drafted into the army. It was difficult for 
him to adjust to the new conditions. He deserted and was found 
wandering in a confused state of mind. He felt very tired after 
doing any work and was much worried over voices in his ear 
that sounded as if coming from a telephone receiver. They were 
from bad people and said bad things and called him insulting 
names. 

In this hospital he was catatonic and showed waxy flexibility. 
He complained that he couldn't think and that voices persecuted 
him. If not guided he bumped into objects when walking. In 
the fourth month he grew excited and went naked, then again 
became catatonic. From then on, depressions alternated with 
manic periods, and he often attacked other patients. He was 
grandiose at times and decorated himself. He had spent nearly 
two years in the hospital before entering the endocrine ward. 

Sex life: Another boy taught him how to masturbate, but 
he wouldn't say how much he had indulged. He said it was not 
good for one. He never had had heterosexual intercourse, be- 
cause he feared disease and if he got sick there was nobody to 
care for him or look after him, for he was all alone. He never 
had had girl friends. He intended to marry when he was old 
enough. When he was seventeen a widow wanted to marry him, 
but friends warned him he was too young. Wet dreams fright- 
ened him very much ; he had had them nearly every night at one 
time. A druggist, however, told him not to worry and said they 
wouldn't hurt him, and gave him some pills. In the hospital he 
had them about twice a week, but they didn't worry him. No 
dreams accompanied them. He denied perversions and showed 
disgust at the mention of them. 

Fantasies: At first the voices were obnoxious but later they 
were of good people and said good things. Usually he could 
make out no voices at all, only a faint ringing in his ears. He 
said he liked to think of good things, good people, good houses 
and good cities. 

Once he thought all his family were here in the hospital, and 
that he had seen his mother when he went to bed and she had 
talked with him. He had hoped he would see her again the 



96' CASE HISTORIES 

coming night. He called some of the middle-aged patients uncle 
and called younger men cousin. 

He dreamed of good years, good business, good people and of 
talking with them. One dream was of two brothers jealous of 
each other. Another was of one man against all of the family, 
and of a private in the army. Some dreams seemed to be remi- 
niscences of his past life, such as reading and writing in a library, 
visiting shoe shops, and planting grain. 

General observations: He said he didn't know why he was 
[I brought here, but perhaps it was because he was sick and cold. 

When he felt better, he was not so cold. He complained of 
sweaty hands and tied rings of string around his fingers and 
forearms to prevent the sweating. 

The most striking aspect of his behavior was his rapid swings 
from depression to elation. On an average the periods lasted only 
one day, though fairly frequently there was an intermediate 
period of one day in which he was quiet but worked steadily. 

In his depressions he usually sat motionless with eyes closed 
and refused to eat. Sometimes he huddled with a coat over his 
head, complaining that his head was cold. Often he stood in 
one place for hours. If asked how he felt he might answer, " All 
right," or " I don't feel good." 

In the intermediate stages he sat staring gloomily into space, 
or did occupational work without speaking to anyone. 

In his manic phrase he ranged from happy busyness to great 
elation when he wanted to have a finger in every pie and run 
everything and everybody. With peals of laughter he would slap 
me on the back or put his arm around my waist and whirl me 
down the room, or leap up like a cat to intercept the basketball 
in midair and scramble wildly after it when it rolled under the 
beds. He took the other patients' work away from them, stole 
their food, and refused to give up his tools when it was time to 
quit. The other patients stopped playing cards with him, for he 
insisted on taking every trick no matter what card he played. 

He was frugal and reiterated, " I must save." His clothes 
were so stuffed with trash he had saved that he often looked like 
a circus clown. He was affectionate and constantly insisted on 
shaking or kissing one's hand. But stubbornness and wilfulness 



CASE HISTORIES 97 

were his most prominent traits ; he wanted what he wanted when 
he wanted it, and nothing but superior force would make him 
desist. He seemed to have no conception of adjusting his wishes 
to those of others. 

One physical examination had to be given up because he was 
so excitable and afraid, and in the second attempt he showed 
much fear of the rubber hammer used to test reflexes, and re- 
acted exaggeratedly. 

Occupational therapy: He took hold of the work with alac- 
rity and quickly learned to do all branches of it well. His wil- 
fulness made him impatient of instruction and he went on accord- 
ing to his own ideas. In his elated periods he worked rapidly and 
even grabbed other patients' work away from them in order to 
" help " them. In his depressions he did no work at all. In the 
occasional intermediate periods he worked steadily and quietly. 

Physical examination: Slender type of skeleton, but well 
muscled. Skin normal. Small amount of hair on chest but 
normal in genital region. Genitalia normal. Heart rapid. Pupils 
dilated. Reflexes were active. Psychomotor activity pronounced 

Endocrine diagnosis: Hypoadrenia. 

Glandular therapy: He was fed suprarenal gland. At first 
he showed a marked improvement. Instead of having a depres- 
sion every day or so, he would remain elated for several days at a 
time. When the depressions recurred they lasted barely a half 
day and were not so deep but what he could work throughout 
them. The attendant said that during them his skin was cold 
and clammy, and immediately after them his face was pigmented 
brownish, and then the color gradually faded to normal. 

By the end of six weeks the good effects of glandular feeding 
had begun to wear off. The depressions grew somewhat more 
frequent and deeper, and he began once more to refuse food. 

Four months later: He seemed much the same. The de- 
pressions and elations now lasted about a fortnight each. When 
depressed he often became ugly and attacked other patients 
viciously, trying to choke them. He had to be confined in an 
undesirable ward. 

Mental diagnosis: Schizophrenia with projection and fea- 
tures of circular insanity. The projection of his bad impulses 



98 CASE HISTORIES 

into insulting voices was schizophrenia. He had partially suc- 
ceeded in repressing them for he seldom heard them any longer, 
but the schizophrenic habit persisted in his f antasying good people 
and good thoughts. Probably the depressions were due to the 
undesired unconscious cravings striving to gain control of his 
conscious thinking. At first the glandular feeding helped to 
prevent this unwelcome eruption, but the effects gradually wore 
off. 

He was clearly an undeveloped personality. The homesick- 
ness and lack of self-confidence and independence showed his 
fixation on the family. At seventeen he even considered marrying 
an older woman, a mother substitute. In his bedtime fantasies 
his mother came and talked to him. 

Ulster 

History: He was a restless, unkempt, unhappy fellow of 
twenty-three. A social worker visited his home and reported it 
as comfortable and decent, and that there seemed to be no abnor- 
mality, alcoholism or degeneracy in the family. His sister said he 
had been a normal boy, healthy, well-liked, athletic and got on 
well in school. His own version was that he had always been 
up against it, that he was bashful and couldn't get used to 
strangers, and preferred to stay at home rather than associate 
with other boys and girls. 

He said he attended school irregularly and finished the sixth 
grade. Then he worked in a shipyard and made good wages, 
paying his own board and saving money, though too fond of 
shooting craps. He was drafted into the army. 

His army record stated he was put in disgrace by his comrades 
and became listless and depressed. It was thought best to re- 
classify him in order to give him another chance in a new unit. 
But he grew worse and was put in hospital instead, and event- 
ually reached St. Elizabeths. 

Sex life: He talked incessantly in a disjointed manner dur- 
ing all his waking hours, and usually one could not break this 
stream of ideas and get him to answer a question unless one shook 
him by the shoulder or give him some other sharp stimulus. 



CASE HISTORIES 99 

Consequently it was difficult to get any information from him 
except by culling it out of his stream of talk, and one could not 
be certain what was fact and what was fantasy. Under this 
heading I have given only what I believed was fact. 

He had much sexual curiosity, but his bashfulness prevented 
him from seeking experience. In France he first tried hetero- 
sexual intercourse, but did not satisfy himself. " IVe never had 
a good coitus or seen a vulva. My penis slipped out. The girls 
said it was too small (his genitalia were normal). Boys said it 
was too small too." 

He submitted to pederasty by other soldiers, and that must 
have been the cause of his disgrace among his comrades. Once 
he said he had committed fellatio also, but denied it in the next 
breath. 

General observations: In our first talk I asked what he was 
here for. " Fm sick in the guts, in the stomach, and spine. (" Are 
you getting any better?") I don't think so. This is a state 
prison or a reformatory." (I explained it was a hospital for 
mental disease, and that he was being kept here only because his 
mind was sick. "Do you believe your mind is sick?") Yes, it 
always has been. This place is full of nuts. They fatten you up. 
He wants to get fat and go home and get an automobile. He 
was afraid he was going to get shot. He wants to get home. 
He's supposed to be a white rat. I heard that. He wants to 
borrow a couple of hundred dollars to get home with, this kid 
does. This world is coming to an end. I hear voices all the 
time. Catholics and Masons. He ought to fall under a train for 
being a Catholic. Fm a clean white kid, I never did anybody 
dirty. Father supposed to be a Catholic, mother too. I guess 
I'm only afraid to fight with bare fists. I fought in France with 
boxing gloves. I want to go home. Being afraid of people. 
This kid wants to be rich. They won't tell him nothing. He's 
against the Masons and Knights of Columbus and everybody. 
This kid would do anybody a favor. (He spies a calendar with 
a picture of a pretty girl.) Have coitus with her, with everybody 
in the world. I earned thirty dollars a week in the shipyard. 
He wants an automobile to ride around in. Spiteful devil, me. 



100 CASE HISTORIES 

He (indicating the analyst) says he likes you, and all he does is 
write. He won't lend you money or buy an automobile. I'd pay 
you back. No, just jump overboard." 

This talk was typical of those that followed except that later 
he spoke much more freely on sex subjects. The pleas for 
money, home and automobile, however, were never omitted in 
any interview. This first talk disclosed his main preoccupations. 
He had a feeling of sin and remorse and felt he ought to be 
punished for it or even commit suicide, and feared others would 
punish or kill him. He said that on the trip from France to St. 
Elizabeths he thought of throwing himself or being thrown under 
a train or into the sea. Then tearfully he protested his innocence 
and begged to be allowed to go home and to be given a motorcar 
to sport around in. His sense of guilt centered about sexual per- 
versions, deceitf ulness and cowardice. The conflict between good 
and bad impulses was dramatized as the familiar hostility be- 
tween Catholics and Masons. 

In later interviews he said, " These fellows pick on you. They 
pick out your tits. I've never seen a woman's genitals in my life. 
He wants to see a woman bare-naked. I never did see fellatio 
committed. The world would come to an end. They say it's 
coming to an end. Get rid of his dirty thoughts. His mother 
(she was dead) knows everything he does. Jerking ofif in the 
street. This kid knows he's a four-flusher, he wants to get 
washed out. My penis is burning up in my heart. The blood is 
being sucked out of his heart. (He looks at his face in a mirror 
and whimpers.) Dirt and filth. His tits, hearts, testes, eyes are 
picked out. Burn the tits right out of him. Do cunnilingus and 
allow fellatio. Put it in the paper (apropos of my steady writ- 
ing). The devil is female and gives dirty thoughts. The voices 
suck the blood out of you by talking to you. They tell me to 
commit fellatio. Masturbate your father. They're bleeding me 
to death. They have no right to. If anybody called him a rat or 
accused him of mother incest or fellatio, they'd cut his eyes out 
(symbolic castration). 

"Please don't suck his tits. ("I'm not doing it.") It feels 
that way. They burn. You ought not to suck his tits. You^re 



CASE HISTORIES lOI 

sucking my tits and my eyes. They burn. (He tries to force his 
left eye out of its socket with his finger. I expostulate and 
stop him.) He might as well help it along if they are going to 
suck his eyes out anyway. He wants the dirt cleaned out of his 
heart, whitewashed and go home. Whitewash tits, penis, vulva, 
anything in your body. Give him a new penis and testes and 
guts and kidneys. Wash out his kidneys. He wants to get rid 
of his dirty thoughts. He wants new genitals. He wants to get 
married. 

"He sucks tits, this kid does. No, you mustn't think that 
dirt. Jump overboard! jump overboard! (The revolt against 
the improper craving can be plainly seen here with the suicide or 
punishment wish immediately following.) A little pimp. He 
hates everybody in the world, because everybody hates him. He 
ain't got no friends. (This shows the germ of paranoia.) 

" Men and women talk to me. Some are good and some are 
bad. He hears the voices of fellows from between the walls. 
Let me do cunnilingus and you put it in the paper. Sisters — 
have coitus with them. Brothers and sisters having coitus around 
the corner. Do you want me to commit fellatio on you (hits me 
in genitals), do you want me to masturbate you for a dollar? 
He masturbated cops on the beach with his fist. 

" Stink. He smells bad smells sometimes. I'm Kaiser Wil- 
helm the Great, the Greatest. That's what they tell you. The 
Dutch fight for you. No they didn't. ("Why did you say so 
then?") Well, you have to make up things. Steal an auto 
but don't get caught. He's damaged goods, in his rectum, they 
broke it. I'm a Catholic god. Don't commit fellatio on me. This 
kid is nutty." 

He frustrated an attempt to make a spinal puncture believing 
it was a pederastic assault, " they pulled up my shirt and pulled 
down my drawers and did pederasty on me. They jabbed a 
needle into my back and set me on fire. This kid never had a 
friend and he hates all the world." When the physical examiner 
stripped him, he feared a sexual assault. " He wants to have 
intercourse with me, do fellatio on me, masturbate me." He 
tried to escape from the room, then recovered from his fear, be- 



102 CASE HISTORIES 

came erotic and began to masturbate. Sometimes he started to 
leave my office, saying he was going home, and I had to lead 
him back to his chair and sit him down in it. He usually mistook 
this for a homosexual assault, but made hardly any resistance. 

It was evident that he had burning sensations in many parts 
of his body, particularly the erogenous zones. He fingered his 
left nipple until it was big and stiff, and he occasionally mastur- 
bated. 

It was not possible to keep him in the fairly open endocrine 
ward, because he tried to escape and also made sexual advances 
to the occupational therapist and women nurses. 

Occupational therapy: His attempt to break out of our ward 
on the second day brought his short visit to an end. He was 
willing to try basket weaving but his diffuse energy prevented his 
concentrating on learning it. He continually dropped his work 
and wandered away, and failed to master the simplest weave. 

Physical examination: Tall, slender, showing pronounced 
psychomotor activity. Muscular development poor. Actiniform 
eruption present over back and neck which are much scarred 
from old acne infections. Skin in general very poorly nourished. 
Genital hair tends to masculine type. A little tuft of hair in 
mid-sternal region. Genitalia normal. Abdomen protuberant. 
Heart very rapid. Reflexes not reliable. 

Endocrine diagnosis: Hyperthyroidism. 

Glandular therapy: Suprarenal gland was fed him. No 
change was noticed in his behavior. 

Four months later: He was still talking steadily but in a 
very low tone of voice, and he was quieter physically. He was 
easier to control because he was much less restless. It was harder 
to talk with him however, for he seemed to be cut off more com- 
pletely from outside stimuli. In a low, dull voice he talked of 
the same subjects, hugging, kissing, getting new brains and teats, 
sucking eyes, and wanting an automobile, a gift of money, and 
to go home. 

Mental diagnosis: Manic depressive with schizophrenic 
features seems the best diagnosis for this unusual psychosis. 
After his disgrace in France he became " listless, depressed and 



CASE HISTORIES IO3 

melancholic," but later his behavior grew more manic in type, 
though he repeatedly whimpered and mourned throughout his 
restless activity. His actions were rather childish. Every few 
minutes he whooped like a boy at play, he noticed all the details 
of the environment and wanted to handle and examine every- 
thing, and occasionally he dived into a bed and kicked his heels 
in the air. The next moment he might be weeping at his face in 
the mirror and lamenting that he wanted to be washed clean. 
Often his emotion did not harmonize with the occasion. Like 
most of the schizophrenic cases he projected his difficulties and 
believed other men assaulted or wanted to assault him sexually, 
and he turned his perverse cravings into voices, yet throughout it 
all he had much insight and knew that if he could wash his mind 
clean he would be all right. 

His perverse impulses ran the whole gamut, with incest, male 
and female perversions, and even such an infantile act as sucking 
a nipple. His history disclosed his inability to direct his libido to 
the opposite sex, thus leaving him in the childish bi-sexual stage 
in which his female component strove towards other males. On 
this account he made the devil who tempted him, a female. There 
was much craving left in the secondary erogenous zones. 

Vincent 

History: He was an epileptic twenty-nine years old and was 
born defective. He could not coordinate well in any way. He 
enunciated with difficulty. He was badly crosseyed and could 
read only the big headlines of newspapers. All his movements 
were stiff and clumsy. 

The family history was negative. The father was a prominent 
professional man, and the younger brothers were normal. The 
family tried to protect him from teasing, and his mother devoted 
herself to him, even telling him she would rather lose any of her 
other sons than lose him. She taught him at home, and he 
learned to read a little. 

He had the first epileptic seizure at the age of nine. They 
became worse as he grew older. When he was twenty-seven he 
had a very severe one lasting over two hours. After it he was 



104 ^^^^ HISTORIES 

hallucinated and was removed to a hospital. He gradually 
emerged from the psychosis, but was left in this hospital. Half 
a year previous to his entering the endocrine ward his mother 
died. 

Sex life: When he was eleven a girl over twenty played with 
him sexually, and he tried to have coitus and pederasty with her, 
but did not know how. He never had another heterosexual experi- 
ence because he didn't care to. He was home most of the time 
and didn't get acquainted with girls and wasn't much interested 
in them. 

As a boy he felt that erection and masturbation pulled his 
brain. After circumcision at twelve, erections did not cause this 
sensation, but at the moment of orgasm he could feel a pull on 
the brain and the temples, and then some pain over the eyes. 
When he was twenty-four he played sexually with a brother of 
twenty years. They masturbated each other and tried pederasty. 
The passive role hurt the patient and he allowed only coitus inter 
femora, but he committed pederasty on the brother several times. 

For a year previous to his psychosis he had masturbated 
daily. He thought this was one of the causes of his breakdown, 
and stopped doing it oftener than once a month. During a visit 
away from the hospital he committed pederasty on a young boy. 

After his mother's death he became more interested in other 
women. An occupational therapist feeling pity for his afflictions 
was kind to him, and he fell in love with the young woman and 
dogged her footsteps. " I'm so fond of her I can't keep her off 
my mind. I can't keep away from her. Since Mother's death 
I've gone more with girls." He was blissfully unaware that his 
abnormalities prevented other people from ever feeling any emo- 
tion toward him warmer than pity. 

Fantasies: The severe seizure which preceded his psychosis 
he believed had been caused by his daily masturbation and his 
long worrying over his father's danger at the front in France. 
("What thoughts did you have about your father?" He 
flushes.) "Perhaps I can tell you better some other time. 
Father and Mother were devoted to each other and didn't like 
to be separated. (He quotes some Bible references about the 
Golden Rule.) I worried over whether I'd ever see him again. 



CASE HISTORIES 1 05 

I imagined his dead face in a box looking at me in his sleep. 
The household talked about the war till it got on my nerves. The 
spell lasted two and a half hours. I saw the Lord looking at me. 
He said I was one of his best sons, one of the best ever put out. 
Then he pulled me up into the sky. There was a multitude of 
angels. It was quite pleasant." 

While in the psychosis he dreamed several times that he was 
a female having intercourse with a male. In one of the dreams 
his male partner was the sun. Always he could feel the male's 
semen enter his body. He also had the fantasy that male and 
female were joined together in his body, making him a combina- 
tion of the two, and he drew a kind of swastika of four arms 
and legs united at one point which was his abdomen, and he 
named the four limbs north, east, south and west. North and 
east were above and to the right and were of heaven and good; 
south and west were below and to the left and were of hell and 
bad. To the right were five circles of stars and to the left one 
line of stars. This swastika became a nude man standing in a 
box with the pores of his skin as big as if punched by fingers, 
though which the devil tried in vain to inject evil into him. 

These fantasies show his bi-sexuality and his craving to take 
a female sexual role, and also his resistance to it. Representing 
resistance we see, standing in the female symbol of a box, a man 
full of vaginas through which the devil (perverse impulses) 
tries vainly to inject evil (semen). 

As he recovered he dreamed of being in a car crossing a 
burning bridge. It falls into the water and he cries for help. 
The Lord looks at him and gets three big locomotives to pull the 
car out. It then enters tunnels where he becomes master of all 
the world. He explained that fire stood for great fear. " When 
you disobey the Lord, you fear he will punish your spirit with 
fire." This dream seems to picture him falling through sin (fire) 
back into mother (water) and being rescued by three big loco- 
motives (male potency) so that he can enter tunnels (vaginas), 
or in other words he struggles out of his mother fixation and 
establishes his heterosexual potency. 

After his mother's death he had visions of seeing her stand- 
ing beside God and smiling happily at him. Once he heard a 

8 



I06 CASE HISTORIES 

voice which sounded like hers call out of the West, Oscar, come 
home, come," and he answered, " I'm coming as fast as I can." 
(" Do you have dreams or visions of your father? ") No, there's 
no call for one. I saw my mother's spirit standing beside my 
father — my heavenly father. Mother was pleased because I was 
one of the best sons ever put out. My father was pleased too. 
("Your father?") No, no, my heavenly father." 

It is true that since his mother's death he has succeeded in 
turning his libido more toward younger women, as evidenced by 
his infatuation for the occupational therapist. " I dreamed I 
was to marry her. Another night I dreamed I was dead and 
she was looking at me in sorrow, for I was her husband." He 
never had had a dream of normal heterosexual intercourse. 

General observations: Fortunately he seemed not to realize 
his defects, and was very happy and cheerful. He found some- 
thing humorous in all about him except in the realm of religion 
and morality. His Bible was always handy though he could not 
read it himself, and he appointed himself monitor of the conduct 
of other patients and even the attendants. He reproved swearing 
severely and attempted to prevent other patients masturbating 
in the toilet. Sometimes he got knocked down for his pains, but 
his missionary enthusiasm always revived. He followed one 
about like a curious child and butted into any conversation no 
matter how private, and always had an opinion to offer on 
every subject. In spite of his inability to read ordinary print he 
kept accurate track of the date. " I just keep dates in my mind." 

His spells came at irregular intervals and he had never noticed 
that they followed any particular emotion or state of mind. An 
aura always gave warning of their approach. " The nerves of my 
body go dead first — in my fingers and feet. There's a feeling in 
the left side of the brain, then over the forehead and eyes. The 
numbness creeps up my arms and legs. I see a buzzing of many 
lights, either all yellow or all white. They go around in a large 
circle like a pinwheel. My head buzzes and roars like a train of 
cars inside you. All the parts of my body get deader and deader, 
until it's all dead, and then I go unconscious. 

"The first spell I had was when we had been waiting five 
days for father. Word came that he wouldn't be home for six 



CASE HISTORIES IO7 

months. I said I was tired of waiting and fell in a fit. I was 
seven or eight years old then." The father had been absent 
a long time and the boy had meanwhile been the center of his 
mother's life. She had been awaiting the father's return with 
joyous anticipation. I asked the patient if he thought jealousy 
had played any part in the spell, and he broke into sudden loud 
laughter. " I wouldn't be a bit surprised if that was the founda- 
tion of the whole thing, of my having these spells. Mother 
would hold me down during them so I wouldn't move around 
much. I'd be weak after them and she'd pay a good deal of 
attention to me. I think pressure on the brain and jealousy may 
have caused these spells." It will be recalled that the severe 
seizure which ushered in his psychosis came at a time when he 
had worried over his father's danger in France and had had 
visions of his corpse in a coffin. His spells in the hospital no one 
was able to connect with any particular emotion or incident. 

Occupational therapy: He had parole and didn't work in the 
ward but liked to visit the occupational carpenter shop occasion- 
ally where, on account of his poor eyesight and incoordinate 
movements, he did very poor jig sawing and broke many saws, 
but enjoyed it immensely. 

Physical examination: Slender type of skeleton. Oxycepha- 
lic skull. Arrest of development of lower jaw. Teeth irregular 
and notched. Hair distribution normal. Genitalia normal. Ab- 
domen protuberant. Heart irregular and rapid. Bilateral in- 
ternal strabismus. Chronic middle ear disease. Athetoid facial 
expressions. General incoordinations. Numerous tics and 
slightly hyperactive deep reflexes. Slurring speech defect which 
patient attributes to previous tongue adhesions. 

Endocrine diagnosis: Dyspituitarism. 

Glandular therapy: He was given desiccated pituitary 
(whole gland). Some observers thought his epileptic seizures 
occurred less often, but this was difficult to decide, for they had 
always been irregular. 

Four months later: He seemed a bit duller. 

Mental diagnosis: He was a defective and epileptic, who had 
recovered from a psychosis with schizophrenic features in which 



I08 CASE HISTORIES 

his wishes had been projected into visions and voices. He secured 
compensation for his actual sorry condition by causing the Lord 
to announce him as one of his finest creations, and after his 
mother's death he saw and heard her again. The usual perverse 
sexual cravings were also present. 

Now he is emerging from the mother-fixation bi-sexual stage 
and turning his love impulses toward a permissible object, the 
occupational therapist. 



CONCLUSIONS ON OCCUPATIONAL THERAPY 

With the exception of Irgocz, nearly every patient on the 
ward seemed to have improved to some extent before the begin- 
ning of glandular therapy. It is difficult to decide just what was 
responsible for this betterment. Probably it was a combination 
of things, the unusually cheerful ward with its sunny glassed-in 
piazza, the care of kindly and capable nurses and attendants, 
the encouraging presence of the occupational therapist with her 
pleasing personality, interesting work and play and more atten- 
tion all around than the average patient in the institution was 
receiving. 

Of the four patients who improved markedly before glandular 
therapy began, Lefferts and Nolan cannot be credited to occupa- 
tional work because they did not do enough of it. O'Neil and 
Jackson, however, seemed to be drawn out of themselves and 
aided by it. The active men who had no parole of the grounds 
found occupational work a pleasant way to pass the time. The 
worried and dreamy patients worked only when urged. With the 
exception of the badly introverted Abrams, every man who got 
parole of the grounds preferred freedom outdoors to work in- 
doors and dropped work partially or completely. 

The work and play undoubtedly made many of the patients 
happier, but I believe that only in the cases of Jackson and 
O'Neil did they lend any considerable aid towards improvement 
or cure. 

Occupational therapy however, is a most valuable indicator of 
a patient's condition. Any mental improvement or regression is 
quickly mirrored in his work. 



109 



CONCLUSIONS ON GLANDULAR THERAPY 

Feeding desiccated glands stimulated the patients in almost 
every case. In one or two instances this stimulation seemed to 
increase their troubles, and they became more irritable and upset, 
but as a rule it proved beneficial in varying degrees. Some gave 
the impression of being forced to extrovert and to notice the en- 
vironment in spite of themselves; others seemed to develop a 
spontaneous normal interest in their surroundings. 

The most spectacular change was in the convalescent Nolan, 
who out of abject laziness was suddenly transformed into a 
fairly energetic boy, interested in his daily work and even plan- 
ning it ahead. His improvement lasted throughout the few weeks 
until he was discharged. Dixon was enabled to repress his 
perverse cravings for half an hour at a time, and thus obtained 
periods of respite from the torturing " influence " used on him. 
Tocci's depressions, which had come regularly two or three times 
a week, now occurred much less frequently and were not so 
deep, but this improvement disappeared in a few weeks. O'Neil 
and Quitner continued their steady convalescence with no very 
apparent acceleration. But Riegel after a few weeks of glandu- 
lar therapy improved considerably. For many months his con- 
dition had remained stationary in spite of hospital protection and 
occupational therapy. 

At first the effects of gland feeding were so spectacular that 
we expected great benefit from it, but as time passed, the im- 
provement gradually faded even while treatment was still being 
given. After it was stopped, the patients returned practically to 
their former condition with the exception of those who had 
previously begun to convalesce. Riegel started to regress before 
he was transferred to another hospital. 

Although the effects of gland feeding seem to be temporary, 
this treatment may possibly be of great value in breaking into 
the so-called vicious cycle of mental disease, particularly in the 
early stages. A combination of thyroid stimulation and psycho- 
analysis might be an excellent method of attacking incipient 
schizophrenia. 

no 



CONCLUSIONS ON PSYCHOANALYTIC TREATMENT 

No cure or great improvement can be claimed as due mainly 
to psychoanalysis in these twenty-two cases. To be sure, my 
purpose was to study rather than treat the patients, but I did 
try to help six of them, Carhart, Dixon, Lefferts, Nolan, Purdy 
and Quitner. The old deteriorateds such as Engel, Foster, Gar- 
land, Irgocz, Jackson and Kimmel were beyond aid from this 
source, Mathews and Vincent had already recovered from their 
psychoses. Abrams, Bailey, Halsted. O'Neil and Riegel were 
too negative and resistant. Tocci was too inattentive in his 
elations, and inaccessible in his depressions, and the barrier of 
language separated us. Ulster had too much manic push to listen 
to anyone. Sabin in his depressed periods was very dull and his 
psychosis was of long standing. Unless a patient realizes he is 
sick and wishes to get well, the analyst has little chance to help 
him. 

Purdy, though often suspicious, had considerable confidence 
in me and talked freely of his troubles. He got insight into 
his improper impulses and their projection and improved con- 
siderably so that I felt much encouraged. Then the old paranoid 
ideas obtruded and proved too fixed to remove. His remark is 
illuminating, that he did not want to talk with me for fear I 
would destroy his belief in his delusions and that he preferred to 
keep them. But he recovered sufficiently to obtain his freedom. 

Lefferts wished to learn nothing new and would listen to no 
explanation. He knew all about it already and enjoyed many of 
his hallucinations. His stubborn conceit was probably an over- 
compensation for his inferior body and lack of physical courage. 
During his healthy interlude, coincident with the infection in his 
hand, I tried very hard to make him understand mental mechan- 
isms, but his obstinate ignorance was impregnable. He had 
witnessed supernatural phenomena then, and now he no longer 
did; this was sufficient explanation for him. Because he had 
gained no insight whatever, it was easy for him to slip back again 

III 



112 CONCLUSIONS ON PSYCHOANALYTIC TREATMENT 

into the psychosis after he had recovered from the infection. 

Nolan was of such limited intelligence and vocabulary that it 
was practically impossible to explain mental mechanisms to him. 
After his talks with me however, he lost his delusions and he 
was immensely relieved when I removed his fear of being preg- 
nant. His psychosis was gone before he began glandular treat- 
ment. 

Carhart was struggling desperately to suppress his unworthy 
cravings, but he could not overcome his resistance and make a 
clean breast of his troubles. I hoped to win his confidence 
enough to enable him to break down his reserve and talk freely 
with me, but I failed. 

Dixon was perfectly willing to talk freely, but he had de- 
veloped in self-defense such disgust for homosexual perversions 
that he could not face the possibility that cravings of this kind 
might originate in himself. Consequently he would not even 
consider the hypothesis of projection. He clung tenaciously to 
his belief in " influence " and gained no insight whatever. 

Quitner, as compensation for a sense of physical inferiority, 
had built up great conceit of intellect and believed he knew more 
than the doctors. This attitude made him resistant to psycho- 
analysis. Furthermore, after the unpleasant cravings had been 
once more repressed, he so enjoyed the now innocuous conversa- 
tion of his projected voices that he was reluctant to give them up. 
But he loved freedom even more, and when he saw that this 
schizophrenic habit stood between him and liberty he either 
concealed it or reasoned his way out of it. Probably psychoanaly- 
sis aided him in his recovery. 

Although psychoanalytic treatment showed no conspicuous 
results in this particular group of men, I have seen other psy- 
chotic patients in St. Elizabeths greatly benefited by its use. 



GENERAL CORRELATIONS 

The first two tables give the groups according to mental 
classification with the endocrine diagnosis following each name, 
and vice-versa the groups according to endocrine classification 



Mental Diagnosis. 



Endocrine Diagnosis. 



Abrams 

Bailey 

Carhart 

Dixon 

Engel 

Foster 

Garland 

Halsted 

Irgocz 

Jackson 

Kimmel 

Lefferts 

Mathews 

O'Neil } Morons { 

Purdy 

Quitner 

Riegel 

Sabin 

Tocci 

Ulster 

Vincent 



Schizophrenia no projection. 



Submyxedema. 



Schizophrenia with projection. 



Submyxedema. 



Hyperthyroidism. 
Hyperthyroidism, 

compensatory. 
Hypothyroidism, infantilism. 
Submyxedema with hypo- 

adrenia. 



paranoid. 



Hyperthyroidism. 
Hyperthyroidism, 
dyspituitarism. 
Submyxedema. 



circular. 



Hypoadrenia. 
Hypoadrenia. 



Manic depressive with schizo- 
phrenic features. 



Hyperthyroidism. 



Defective, epileptic with 
schizophrenic features. 



Dyspituitarism. 



with the mental diagnosis following each name, while the last 
table gives briefly the facts of each individual case. 

In order to see whether the percentage of each mental syn- 
drome among our patients corresponded with the percentage 



113 



114 



GENERAL CORRELATIONS 



among a large group of other psychotics, I took as control from 
a list of all the male first admissions in the New York State 
hospitals for the year ending June 30, 1917, those psychogenic 
types that corresponded roughly with our own. From the de- 
scription of their method of diagnosis I judged that our two cases 
of schizophrenia circular and one case of manic depressive with 



II 



Endocrine Diagnosis. 



Mental Diagnosis. 



Carhart . 
Dixon. . . 
Engel. . . 
Foster. . 
Garland . 
Halsted . 
Irgocz. . . 
Jackson . 
Kimmel . 
Abrams . 
Bailey. . 
Riegel. . . 
O'Neil. . 

Sabin . . . 
Tocci. . . 

Purdy. . , 
Ulster . . . 

Lefferts. 
Mathews 

Quitner . 
Nolan. . . 
Vincent. 



Submyxedema. 



Schizophrenia with projection. 



with hypo- 
adrenia 



no 



no 
paranoid, 
with projection, 



moron. 



Hypoadrenia. 



Schizophrenia circular. 



Hyperthyroidism. 



Hyperthyroidism, 
compensatory. 

Hyperthyroidism, 
dyspituitarism. 



Schizophrenia paranoid. 
Manic depressive schizo- 
phrenia. 
Schizophrenia with projection. 



Schizophrenia paranoid. 



Hypothyroidism, infantilism. 



with projection. 



moron. 



Dyspituitarism. 



Epilepsy, schizophrenic. 



schizophrenic features would in their diagnosis be called allied 
to manic depressive, that our schizophrenia with projection 
would be called dementia precox — hebephrenic or catatonic, and 
that our schizophrenia paranoid and simple schizophrenia with- 
out projection would be called dementia precox paranoid and 
dementia precox simple. Whether or not the New York state 
group contained endocrine disorders was not stated. 



GENERAL CORRELATIONS 



115 



III 



Abrams . 
Bailey. . 
Carhart . 
Dixon. . . 
Engel . . . 
Foster. . 
Garland . 
Halsted . 
Irgocz. . 
Jackson . 
Kimmel . 
Lefferts . . 
Mathews 
Nolan . . 
O'Neil . . 
Purdy. . 
Quitner . 
Riegel. . 
Sabin . . . 
Tocci. . . 

Ulster .. 
Vincent . 



*S 

<u 

si 
o, 
o 

N 

o 



Oh 



> a 
o o 

E a 



Effects of Glandular Therapy. 



Improved. 
Improved. 
No treatment. 
Considerably improved. 
More active and irritable. 
Improved. 
Improved. 
No effect. 
Improved. 
Improved. 
No treatment. 
No treatment. 
Improved. 

Remarkably improved. 
Recovery accelerated? 
No treatment. 
Recovery accelerated? 
Improved. 
No treatment. 

Marked temporary improve- 
ment. 
No effect. 
No effect. 



The following table gives the comparisons between our group 
and this large group: 



New York. 



Number 
of Cases. 



Percent- 
age. 



Endocrine. 



Number 
of Cases. 



Percent- 
age. 



Manic depressive 

Allied to manic depressive 

Symptomatic depressions 

Dementia precox: 

Paranoid 

Simple 

Hebephrenic and catatonic . . . . 

Allied to dementia precox 

Paranoia 

Epileptic 

Mental deficiency 

All dementia precox 

All dementia precox and paranoia 



281 

89 

9 

403 
95 
296 
121 
61 
74 
91 



18 
6 
I 

27 
6 

19 
8 

4 
5 
6 



o 

3 
o 

3 
2 
II 
o 
o 
I 

2 



O 

o 

14 

9 
SO 
o 
o 
4 
9 



1,520 

915 
976 



100 
60 
64 



22 
16 
16 



100 
73 
73 



Il6 GENERAL CORRELATIONS 

The comparison made above seems to indicate that the dis- 
tribution of cases, which had been selected primarily or exclu- 
sively for endocrine conditions, does not correspond with the 
distribution of cases of functional or so-called functional char- 
acter in the admissions intO' the New York state hospitals. 

The most striking difference is that half of our patients 
would be called hebephrenic or catatonic dementia precox, while 
only 19 per cent, of the New York state hospital patients are 
included in that group. 

On the other hand the New York paranoid precox group is 
2J per cent, of the the total while ours is only 14 per cent. 

Even were it true that in New York some of our hebephrenics 
and catatonics might be called paranoids, still they would largely 
exceed the percentage in New York. Our total percentage of 
schizophrenia is greater than their percentage of dementia pre- 
cox and paranoia combined. 

It is particularly interesting that we did not have one single 
case of pure manic depressive insanity although nearly 23 per 
cent, of our patients suffered from hyperthyroidism. We had 14 
per cent., however, which had some manic depressive symptoms, 
while in New York there are only 6 per cent, in this classification. 
But if we add together New York's manic depressive, allied to 
manic depressive, and symptomatic depressions, they outnumber 
ours 25 per cent, to 14 per cent. 

We had no case of pure manic depressive, paranoia or symp- 
tomatic depression. In simple dementia precox, epileptic psycho- 
ses, and psychoses with mental deficiency our percentages are 
approximately those of New York. 

Of course I realize that one case more or less in our group 
would change the percentages considerably, so that they cannot be 
taken as fully characteristic, with the exception of our schizo- 
phrenia with projection. They form a surprisingly large per- 
centage, nearly three times as great as the corresponding group 
in New York. 

It may be objected that a comparison with the New York 
state hospitals alone is not enough but I wish to call attention to 
the fact that the reports of various states in other years have 
shown very striking similarity in the percentages of distribution 



GENERAL CORRELATIONS II7 

in communities throughout the East and in other sections of the 
country where the conditions of Hving are practically the same, 
so I have considered myself justified in taking New York as 
typical of the more populated sections of the nation. The main 
reason for selecting New York was because of its excellent 
official reports wherein the statistics for all the state hospitals are 
combined and clear description is given of their methods of 
diagnosis. 



GENERAL CONCLUSIONS 

Every case was schizophrenia or had schizophrenic features. 

The two cases of simple schizophrenia, that is, in which the 
patients introverted without projecting their impulses, were both 
submyxedema. 

The two cases with features of circular insanity were both 
hypoadrenia. 

The hyperthyroids as a whole seemed to be more extroverted 
and to keep in closer contact with reality than the other types. 

The feeding of desiccated thyroid gland seemed to reduce 
introversion and to cause the patient to come into closer contact 
with the environment. 

Most of these patients showed or gave indications of the 
struggle with perverse impulses of the creative instinct, that is, 
the sexual conflict which the Freudian school believes to be the 
cause of psychogenic disorders. 



Il8 



DISCUSSION 

Although it has long been recognized that there are mental 
disturbances associated with endocrine changes such as menstrua- 
tion and the menopause, still very little has been done to find a 
definite correlation of special mental symptoms or groups of 
symptoms with the physical disorders of the ductless glands. 
So far as I am aware, this is the first serious attempt to psycho- 
analyze a group of psychopathic endocrine patients and thereby 
get a deeper insight into their mental condition than is ordinarily 
given in previous attempts at correlation of mental disturbances 
and endocrine disorders. While previous investigators have 
often given excellent reports in great detail on the condition and 
function of the ductless glands, their descriptions of mental symp- 
toms have usually been meager and superficial. 

Wechsler* has been one of the few who have given better 
pictures of the mental side, but even his article on the psycho- 
neuroses and the internal secretions is more of a suggestion than 
a thorough study. Barham^ has given a psychoanalysis of a single 
case of insanity with myxedema. After the myxedema had 
been cured, the mental disturbances broke out anew as soon as 
the patient returned to her former unfavorable environment. 

As a result of the present great interest in the endocrine 
glands and their relation to the various functions of the organism, 
they have been studied from many angles, and a number of 
investigators have touched more or less on our phase of the 
problem. Several of them have remarked that the adrenal and 
sometimes the thyroid glands weighed less among the insane. 
Mott^ found the adrenals atrophied in many post mortem ex- 
aminations but laid it to the physical disease that caused death 

* Wechsler, I. S., The Psychoneuroses and the Internal Secretions, 
Neurological Bulletin, vol. 2, number 199 (May, 1919). 

5 Barham, G. H., Insanity with Myxedema, Journal of Mental 
Science, vol. 58, numbef 226 (1912). 

« Mott, F. W., Suprarenal Glands in Nervous and Other Diseases, 
Archives of Neurology (London), vol. 3, p. 123 (1907). 

119 



120 DISCUSSION 

rather than to the mental disease. Kojima^ reported after a 
very detailed study of over one hundred cases that the thyroid 
weighed less among the insane. Of course, our classification 
according to endocrine dysfunction was not made from observa- 
tions on the morbid anatomy of the glands. 

Rossi^ found in nine cases of manic depressive insanity 
following influenza that there was marked adrenal insufficiency. 
In six other manic depressive cases uncomplicated with influenza 
there was similar adrenal insufficiency. The use of adrenalin had 
good results. Prior^ reported that among epileptics there was 
very frequently degeneration in the adrenal cortex. Phillips^^ 
connected sporadic goiter with hyperthyroidism, excitement, agi- 
tation, and manic depressive insanity, and connected endemic 
goiter with hypothyroidism, apathy, indifference and dementia 
precox. 

Laignel-Lavastine^^ draws correlations between abnormal 
mental states and endocrine disorders. With mania he connects 
disturbances of thyroid, adrenals, and ovaries. This quite tallies 
with our results, for our cases with manic features were hyper- 
thyroid and hypoadrenal. As our patients were all male, the 
ovaries did not figure. With dementia precox he connects tes- 
ticles, ovaries, and pituitary. Our experience is totally different, 
for our precox cases showed disorders of thyroid and adrenals. 
With epilepsy he associates thyroid, parathyroids, testicles and 
ovaries, while our one epileptic, Vincent, showed dyspituitarism. 
He cites genital perversions, not stating whether they are fan- 

'''Kojima, M., The Ductless Glands in no Cases of Insanity with 
Special Reference to Hypothyroidism. Studies on Endocrine Organs of 
Dementia Precox, Archives of Neurology (London), vol. 7 (1918). 

8 Rossi, S. C, Influenza, Suprarenal Insufficiency and Manic Depres- 
sive Psychoses, Anales de la Facultad de Medicina (Montevideo), vol. 
4, number 12, p. 801 (Dec, 1919). 

^ Prior, G. P. U., Mental Cases of Endocrine Considerations, Journal 
of Mental Science (London), vol. 66, number 272 (Jan., 1920). 

10 Phillips, N. R., Goiter and the Psychoses, Jourtial of Mental 
Science (London), vol. 65, p. 235 (Oct., 1919). 

11 Laignel-Lavastine, M., The Internal Secretions and the Nervous 
System, Nervous and Mental Disease Monograph Series No. 30, 1919, 
p. 32. 



DISCUSSION 121 

tasied or actual, and connects them with ovaries, testicles, pros- 
tate, and adrenals. Our cases who confessed to having committed 
perversions (excluding Sabin and his one unsuccessful attempt 
at puberty) had hyperthyroidism and dyspituitarism. If only 
fancied perversions are meant, probably every one of our cases 
would be included. 

Prior states that mentally deficient patients after being fed 
for several months on thyroid and pituitary extracts gained 
percentages in the Binet-Simon intelligence tests several years in 
advance of the grade they reached before treatment began. 

Of our two morons Nolan, who had already recovered from 
his psychosis, took desiccated thyroid and gained remarkably in 
energy and intelligence. His mental age, according to the 
Terman test, advanced from eight years seven months to nine 
years eleven months, and his intelligence quotient from 54 per 
cent, to 62 per cent. O'Neil was emerging from his psychosis 
before he began to take desiccated suprarenal, and the speed of 
his convalescence did not seem to change during the gland feeding. 
His gains in intelligence were practically the same as Nolan's ; 
eight years to nine years three months, and 50 per cent, to 58 
per cent. 

Cushing^^ draws attention to the close relation between the 
function of the anterior lobe of the pituitary and the gonads, since 
if one is hyper or hypoactive the other is also, and thinks the 
psychoanalytic school should take cognizance of this in their 
theories of infantile sexual complexes. He believes that sexual 
precocity or backwardness, due to disturbances of these glands, 
might well give rise to abnormal sexual mentality. 

Jelliffe deals with the same problem as follows : " Variations 
in the actual endocrine organs undoubtedly alter the reactivity of 
the individual, so that certain complexes, always difficult in them- 
selves even under the best of circumstances, are not as well dealt 
with by reason of this (for lack of a better term) what may be 
called ' sensitiveness.' We know the complexes are a necessary 
part of everyone's evolution. Why should fixation and regression 

12 Gushing, Harvey, Psychic Disturbances Associated with the Duct- 
less Glands, American Journal of Insanity, vol. 69, p. 965 (1913). 



122 DISCUSSION 

occur with greater intensity in some people than in others ? Does 
a defective hyper-thymus-gonadal group handle an incest complex 
more inadequately because of the early appearance of the crav- 
ing, thus forcing a repression before its time, with its consequent 
readjustment to a narcissistic libido fixation? What does a 
thyroidal-adrenal group do with the same situation? If the 
psychical factors, and the knowledge of the accidents, traumata, 
etc., can be integrated with the constitutional factors, I feel sure 
we will be on our road to a real psychiatry. 

'' For the present all we can hope for is to indicate the lines 
along which the correlations can be made. The real indices of 
endocrine adjustments are far from being well known. We 
have a few facts bearing on extremes, the means are in a jumble. 
Psychoanalysis also is in a similar situation. But it does deliver 
definite qualities — as for quantity, that is, the force behind the 
wish — ^that is still an important problem. Two patients may 
deliver us two similar incest dreams. On the face of them they 
have come through the censorship with quite similar distortions 
and displacements — yet they may have behind them dynamic 
intensities of great variation, so that one patient has awakened 
refreshed, shall we say satisfied, the other disturbed, diarrheal 
and all cramped up ; the dream has only partly satisfied the wish. 
Hence the quantitative factor is in great need of comprehension. 
This is a problem for the future." 

152 West 58th Street, 
New York, N. Y. 



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