Friday, February 12, 2010
I guess there are a lot of theories about psychosis. Does it stem from psychodynamic conflict? Is it purely biologic? Is it a combination of factors? I am in a more biologic training program, but a case I saw this week shows you where there is at least a gray area.
Mid-20s male comes into clinic after recent discharge from psych unit (first hospitalization). The guy has had 3 big psychotic breaks in the past few years, all of them related to his current girlfriend. With his first girlfriend, he began to think she was cheating on him. He got really paranoid and eventually attacked her. Admittedly, this alone is not enough to say he's psychotic-maybe she really was unfaithful.
Second girlfriend he dated, everything was going okay until he started to believe she was someone different. Not only that, he believed that she had undergone a sex change. She left before much more happened.
Now he comes to clinic with 3rd girlfriend (also with his sister in tow, which was awkward). The guy had begun to believe that when his GF was washing dishes or touching any long, cylindrical object, she was making a subliminal comment to him about his masculinity. He described how his girlfriend denigrates him by reaching for the cookie jar. He demonstrated this in my office by grabbing my canister of disinfectant antibacterial wipes and stroking it off. Even if his girlfriend touches an oven pan, that somehow sets him off.
He told me, "I even went and had sex with a few strippers. I asked them if I was big enough, and they said it was. I don't know why, but I have too much anxiety about my small penis." He later admitted that he is paranoid around pretty much everyone, and stays at home and to himself. It seems that when he gets into an intimate relationship, he can't escape his self-doubt and it escalates to a psychosis. The guy does no drugs, confirmed by drug screen and all family members present.
At some point, I think every guy not named John Holmes went through some period where he questioned whether or not he was properly equipped. But this is too much.
Freud woulda loved this guy. Next time I'm gonna ask him about his momma.
Posted by SerenityNow at 9:30 PM