Extraordinary Disorders of Human Behavior

320 Pages·1982·5.83 MB·English

by  Robert A. Faguet, Kay F. Faguet (auth.), Claude T. H. Friedmann M. D., Robert A. Faguet M. D. (eds.)

Extraordinary
Disorders of
Human Behavior
CRITICAL ISSUES IN PSYCHIATRY
An Educational Series for Residents and Clinicians
Series Editor: Sherwyn M. Woods, MD., PhD.
Universiryl of SOli them Cnlifomin School of Medicine
Los Angeles, Cnlifomin
A RESIDENT'S GUIDE TO PSYCHIATRIC EDUCATION
Edited by Michael G. G. Thompson, MD.
STATES OF MIND: Analysis of Change in Psychotherapy
Mardi J. Horowitz, MD.
DRUG AND ALCOHOL ABUSE: A Clinical Guide to
Diagnosis and Treatment
Marc A. Schuckit, MD.
THE INTERFACE BETWEEN THE PSYCHODYNAMIC AND
BEHAVIORAL THERAPIES
Edited by Judd Marmor, MD., and Sherwyn M. Woods, MD., Ph.D.
LAW IN THE PRACTICE OF PSYCHIATRY
Seymour L. Halleck, MD.
NEUROPSYCHIATRIC FEATURES OF MEDICAL DISORDERS
James W. Jefferson, MD., and John R. Marshall, MD.
ADULT DEVELOPMENT: A New Dimension in Psychodynamic Theory
and Pradice
Calvin A. Colarusso, M.D., and Robert A. Nemiroff, M.D.
SCHIZOPHRENIA
John S. Strauss, MD., and William T. Carpenter, Jr., MD.
EXTRAORDINARY DISORDERS OF HUMAN BEHAVIOR
Edited by Claude T. H. Friedmann, MD., and Robert A. Faguet, MD.
MARITAL THERAPY: A Combined Psychodynamic-Behavioral Approach
Edited by R. Taylor Segraves, MD.
TREATMENT INTERVENTIONS IN HUMAN SEXUALITY
Edited by Carol C. Nadelson, MD., and David B. Marcotte, MD.
A Continuation Order Plan is available for this series. A continuation order will bring
delivery of each new volume immediately upon publication. Volumes are billed only
upon actual shipment. For further information please contact the publisher.
Extraordinary
Disorders of
Human Behavior
Edited by
CLAUDE T. H. FRIEDMANN, M. D.
University of California at Irvine
Medical Center
Orange, California
and
ROBERT A. FAGUET, M. D.
Universihj of California III Los Angeles School of Medicine
Los Angeles, Califonzia
PLENUM PRESS . NEW YORK AND LONDON
Library of Congress Cataloging in Publication Data
Main entry under title:
Extraordinary disorders of human behavior.
(Critical issues in psychiatry)
Bibliography: p.
Includes index.
1. Psychology, Pathological-Addresses, essays, lectures. I. Friedmann,
Claude T. H. II. Faguet, Robert Andrew. III. Series. [DNLM: 1. Mental disorders.
WM 100 E965j
RC454.4.E925 1982 616.89 82-12286
ISBN-13: 978-1-4615-9253-2 e-ISBN-13: 978-1-4615-9251-8
DOl: 10.1 007/978-1-4615-9251-8
© 1982 Plenum Press, New York
Softcover reprint of the hardcover 1s t edition 1982
A Division of Plenum Publishing Corporation
233 Spring Street, New York, N.Y. 10013
All rights reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted
in any form or by any means, electronic, mechanical, photocopying, microfilming,
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Contributors
FARUK S. ABUZZAHAB, SR., M.D., Ph.D. • Associate Clinical Professor of
Psychiatry, University of Minnesota, 606 South 24th Avenue, #818,
Minneapolis MN 55454
RANSOM J. ARTHUR, M.D .• Dean, School of Medicine, The Oregon Health
Sciences University 3181 S.W. Sam Jackson Park Road, Portland,
OR 97201
DANIEL B. AUERBACH, M.D .• Adjunct Assistant Professor of Psychiatry,
University of California at Los Angeles, 15760 Ventura Boulevard,
#1929, Encino CA 91436
BURTON G. BURTON-BRADLEY, M.D .• Honorary Professor of Psychiatry,
University of New Zealand; Mental Health Services, P.O. Box
1239, Boroko, Papua New Guinea
HARRY D. EASTWELL, M.D .• Senior Lecturer in Psychiatry, Royal
Brisbane Hospital, Brisbane, Queensland 4029, Australia
KAY F. FAGUET, Ph.D. • Assistant Clinical Professor of Psychiatry
(Psychology), University of California at Los Angeles,
Neuropsychiatric Institute, 760 Westwood Plaza, Los Angeles CA
90024
ROBERT A. FAGUET, M.D .• Assistant Clinical Professor of Psychiatry,
University of California at Los Angeles, 11665 W. Olympic
Boulevard, Suite 410, Los Angeles, CA 90064
CHARLES V. FORD, M.D .• Professor of Psychiatry, Vanderbilt University
School of Medicine, Nashville TN 37232
CLAUDE T. H. FRIEDMANN, M.D .• Assistant Professor of Psychiatry,
University of California at Irvine, 101 City Drive South, Orange,
CA 92668
v
vi CONTRIBUTORS
JAMES S. GROTSTEIN, M.D .• Clinical Professor of Psychiatry, University
of California at Los Angeles, 9777 Wilshire Boulevard, Los Angeles
CA 90212
KAY REDFIELD JAMISON, Ph.D. • Assistant Professor of Psychiatry
(Psychology) and Director, University of California at Los Angeles,
Affective Disorders Clinic, Los Angeles CA 90024
IRA M. LESSER, M.D .• Assistant Professor of Psychiatry, University of
California at Los Angeles, Harbor General-UCLA Medical Center,
Building D-5, Psychiatry, 1000 West Carson Street, Torrance CA
90509
E. MANSELL PATTISON, M.D .• Chairman and Professor, Department of
Psychiatry and Health Behavior, Medical College of Georgia,
Augusta, GA 30901
ROBERT F. REBAL, JR., M.D .• Assistant Professor of Psychiatry,
University of Southern California School of Medicine, 1934
Hospital Place, Los Angeles CA 90033
ROBERT T. RUBIN, M.D., Ph.D. • Professor of Psychiatry, University of
California at Los Angeles, Harbor General-UCLA Medical Center,
Building B-4, 1000 West Carson Street, Torrance CA 90509
DAVID RUDNICK, M.D., Ph.D. • Assistant Clinical Professor of
Psychiatry, University of California at Los Angeles-
Neuropsychiatric Institute, 19144-9 Hamlin Street, Reseda CA
91335
JOSEPH WESTERMEYER, M.D., Ph.D. • Professor of Psychiatry, University
of Minnesota, Department of Psychiatry, University Hospitals, Box
393, Mayo Memorial Building, Minneapolis, MN 55455
SHERWYN WOODS, M.D., Ph.D. • Professor of Psychiatry, University of
Southern California, 1934 Hospital Place, Los Angeles CA 90033
Foreword
Clinicians have long been fascinated by the rare and exotic in med-
icine. Similarly, psychiatrists and mental health professionals have been
intrigued by the uncommon and extraordinary syndromes which,
despite their rarity, have much to teach us about the limitless forms of
human adaptation. Of particular interest is the fact that fragments and
partial expressions of these rare disorders are often encountered in the
dreams and fantasies of the "ordinary" patient. For this reason, the
understanding and insights collected in this volume are likely to have
clinical usefulness far beyond those rare occasions when we encounter
the exotic in its fully developed form.
These disorders demonstrate the complex interplay between intra-
psychic dynamic forces and the cultural influences which act to shape
overt symptomatology. The section on extraordinary syndromes from
non-Western cultures demonstrates the universality of the psychody-
namic roots of human suffering, despite the seemingly strange furms in
which this suffering is expressed. As clinicians we are too often restricted
by ethnocentric attitudes and culturally determined stereotypes. This
volume provides a stimulating and enjoyable opportunity to reach
beyond those limitations.
Sherwyn M. Woods
Series Editor
vii
Preface
Human personality, the most complex organization known, has evolved
a staggering variety of adaptive mechanisms. Its plasticity is described by
Kolb (1977):
Since adaptation is the very essence of life, it is not strange that man, the
most highly developed species, has evolved not only anatomical adjust-
ments, which protect him structurally or physiologically in respect to his
environment, but also psychological devices, which assist him in dealing
with emotional needs and stresses. These devices help meet the needs for
affection, personal security, personal significance, and defense against per-
turbing affects. (p. 11)
There are a number of disorders, however, that represent atypical
adaptations in that they do not easily conform to standard diagnostic
frameworks (neither in Kraepelin's time nor in the modern era of DSM-
III). These entities have usually been termed uncommon, rare, exotic,
esoteric, extraordinary, and unclassifiable.
These "fragments," as Lehmann (1975) calls them, are scattered
widely over the literature. We have attempted to contemporize and
update them in one clinically relevant volume. It is our impression that
even though the general psychiatrist may encounter only one or two
such disorders in his lifetime, he will most certainly see their innumer-
able partial and fragmentary expressions in his patients' dreams, fanta-
sies, and behaviors. An interest in, and familiarity with, these syndromes
will therefore assist him, we hope, in understanding and treating his
patients.
We hope, too, that new interest will be stimulated in these disorders;
not only do we find them individually fascinating but we recognize that
the study of unusual syndromes often helps elucidate the more common
disorders.
Finally, in accordance with the current trend in American psychia-
try to revise diagnostic criteria and improve the reliability of diagnostic
judgments (Spitzer, 1978), we wonder: Will these syndromes continue to
stand apart as ungrouped entities or will they be seen in the future as
"typical" variants of the more common psychiatric disorders?
In addition to the sections on rare syndromes and extraordinary pre-
ix
x PREFACE
sentations of common syndromes, we are including a section on extraor-
dinary syndromes from non-Western cultures. These entities are further
illustrations of the extraordinary evolution of psychological self-preser-
vation and underscore the notion that what is extraordinary in one cul-
ture may not be so in another. Human behavior is in part culturally
determined and must always be judged in context.
C.T.H.F.
R.A.F.
REFERENCES
Kolb, 1. c., 1977, "Modern Clinical Psychiatry," W. B. Saunders, Philadelphia.
Lehmann, H. E., 1975, Unusual psychiatric disorders and atypical psychoses, in "Compre-
hensive Textbook of Psychiatry II" (A. Freedman, H. Kaplan, and B. Sadock, eds.), pp.
1724-1736, Williams and Wilkins, Baltimore.
Spitzer, R. 1., 1978, Foreword, in "DSM-II1: Diagnostic Criteria Draft," Task Force on
Nomenclature and Statistics, American Psychiatric Association.
Contents
1 La Folie a Deux . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Robert A. Faguet and Kay F. Faguet
Case Examples. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Epidemiology ..................................... 6
Subtypes of Folie a Deux ........................... 8
Etiology. . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . 8
Differential Diagnosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
2 Munchausen Syndrome. . . . . . . . . . . . . . . . . . . . . . . 15
Charles V. Ford
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Historical Origins of the Munchausen Stories . . . . . . . . . 15
Case Reports. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Phenomenology of the Syndrome ................... 17
Etiologic Hypotheses of the Syndrome. . . . . . . . . . . . . . . 20
Treatment and Management . . . . . . . . . . . . . . . . . . . . . . . . 23
Conclusions and Summary. . . . . . . . . . . . . . . . . . . . . . . . . . 25
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
3 The Ganser Syndrome 29
Daniel B. Auerbach
The Symptom of Approximate Answers. . . . . . . . . . . . . . 31
What is the True Syndrome? A Review of Cases in the
Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
xi