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Other Symptoms And Symptom Complexes

Obsessive-Compulsive Patterns

There were seven men and twelve women diagnosed as psychoneuroses of the obsessive-compulsive type. Of these patients, two men and five women met the classically described combination of repetitive behavior and recurrent ruminative, indecisive and circuitous thoughts. They exhibited the well-known hand-washing, germ- dust phobia, rituals of cleanliness and food preparation and the endless self-debates and tenacious preoccupation with certain numbers, letters, words or ideas.

Phobic Phenomena

The patients who were diagnosed as cases of “phobic reaction” were those who were either in a “phobic stare,” generally fearful of everything with continuous shifting fears, or who presented “true” phobias. The latter, complaining of one or more specific phobia, came for help only because the dreaded object or situation could no longer be avoided.

Phobias and phobic states were numerous in both groups. The phobic state pertained more to a generalized fear of venturing into certain situations while the phobias singled out certain specific objects or situations as evocative of great fear. Phobic states rode on waves of anxiety attacks. One observed, however, that even after the acute phase of the illness has passed (with the patient declaring himself “well”) one or two phobias continued to persist. It turned out that these remaining phobias had been there long before the illness but had never been an object of concern to the patient. Other phobias were mentioned accidentally or casually during treatment, causing hardly any discomfort and, at most, only a bit of embarrassment or amusement.

Depressive Phenomena

In addition to the 17 males and 38 females diagnosed as reactive depressions, significant depressive features were also found in a large percentage of the rest of the patients. Anxiety reactions alternated with depression. Obsessive-compulsive mechanisms were desperate struggles against being overrun with depression. About a third of the psychophysiologic reactions in each group of men and women were body expressions of a depression so severe that I often wondered if the body were not being used as a safety valve to stave off a more malignant psychological process.

Many of those diagnosed as adjustment reactions of adolescents and adults revealed difficult situations which were gradually bringing the patient, had resolution not been reached, towards a depression. Because depression is a subjective symptom, the burden of proof rests on whoever declares its presence. This task proves difficult in patients whose type of depression is of non-psychotic proportions. Psychotic depression, with its classical signs and symptoms, is unmistakable anywhere. Reactive depression, which finds the patient still reality-oriented, with some capacity left to react, communicate, and function even if to a greatly reduced degree, is more difficult to detect.

Difficulty In Mastery Of Aggressive Impulses

Although both sexes expressed and demonstrated great strain in attempting to contain aggressive impulses, particularly anger, they had different ways of coping with the problem. The difficulty in mastery of aggressive impulses therefore assumed different clinical forms, and they will be discussed separately in the two groups.

Men

In at least 50% of the male patients, the fear of losing control of oneself was expressed clearly, directly, and early in the psychiatric encounter. The patient’s statement or first association with loss of control was that of “doing something terrible” or “hurting somebody,” or “running amok” or “going crazy, shooting people.” Beyond these statements was a blank wall, the patient having no idea whatsoever, in his conscious mind, of who would his prospective target be and why. Many times, the patient expressed regret at having even admitted the problem. He would then start to backtrack with a laugh and, in a joking tone, would make a quick denial of any serious intent—”Of course, I would never do anything like that.”

Conversions

Conversion patterns showed further differences between male and female groups. More examples of a particular pattern among women may be a result of the greater number of women in the study rather than a reflection of true incidence.

In the patients from this sample, the conversion reactions were not entirely devoid of concomitant or appropriate concern about the disability. The classic “la belle indifference” was not encountered. This may be related to the fact that these conversions were of fairly recent duration. There was no case with any tell-tale signs of chronicity. In contrast to this, patients at the Philippine General Hospital OPD psychiatry clinic tend to demonstrate much more the classic indifference; furthermore, some conversion symptoms described by female patients in the PGH group levels little doubt that it is an orgiastic equivalent. Such frank degree of sexual symbolism was not encountered in any patient in this study.

 

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