Case 194. (Laignel-Lavastine and Courbon, July, 1917.)
A twenty-year old engineering student of high grade and without hereditary taint, a scientific and non-introspective man of a brilliant and gay disposition, not very religious, without special sexual abnormality, was mobilized in class 1914, was put into the artillery, and was soon appointed maréchal des logis. He left for the front April, 1915, yet had to be evacuated in November. One afternoon, at the end of a bombardment, he rose from a recumbent attitude and immediately felt a dreamy, bizarre feeling, as if a fog lay between him and his surroundings. Next day, after a good night, he woke in the same state. Everything was bizarre and novel despite the fact that he recognized men and things. A physician ordered rest and after a few days evacuated him.
He was cared for in various hospitals, but the psychasthenia increased. He felt a terrible and causeless anguish, with precordial constriction. He felt as if he were about to be executed. His fears appeared after seeing some turning object, such as a wheel or a cane twirling. Gradually this fear was transformed into a genital excitation, though lascivious pictures did not excite him. Seeing anything turning gave him a voluptuous feeling in proportion to the speed of the rotation. It seems that all sexual interest had been at a standstill for several months in the early part of his disease, when suddenly this new aberration appeared. It seems that a portion of the man’s work in the artillery caused him to use screws and cogwheels every day. Attacks of vertigo occurred, with the appearance of an infinity of small, colorless spheres turning over one another, the whole forming a sort of animated system of rotation. In the night this system was luminous and somewhat like what one feels on compressing the globes of the eye. There was a retraction of the visual field. The man would be found in the dream state, especially after waking in the morning or when some novel kind of act was being performed. He got somewhat better and did not wish to go on leave, because he feared the recurrence of these psychasthenic paroxysms. However, he took a leave July 14th. In the first part of his journey he had some vertigo and some of the voluptuous sensations, but in the next two days he was much better. He returned to hospital without trouble.
The authors somewhat doubtfully term this case one of a quiet psychasthenia, but in discussion still further talk arose as to the diagnosis.
Re psychasthenics, Lépine notes that the lack of any out-standing symptoms in many psychasthenics allows them to stay in the army longer than would epileptics or hysterics of the same degree of disease. The line officers tend to consider them exaggerators or simulators. The fact that they besiege the line officers and the physicians with their troubles may add to the impression of falsification. The basis of the psychasthenia is often also, genuinely enough, a fear. Lépine divides the military cases into anxiety neuroses and hypochondrias. The anxiety cases are hypotensive and given to tachycardia. They have very labile vasomotors. When it comes to the necessary exclusion of malingering, it is the history, with its hereditary and collateral taint, that tells the tale. A history in the patient himself of alcoholism, typhoid fever, syphilis, or especially cranial trauma may play a part. An agoraphobic may actually be in general a courageous man except for his crises of anxiety about open spaces.
As to the hypochondriacs, fear of syphilis must be noted. Akin to the syphilophobics are a group of pseudo genitourinary cases that fear effects of an old gonorrhoea. See [Case 195] (Colin and Lautier) below.
Gonorrhoea: NOSOPHOBIA, depression, suicidal attempt. Recovery, thirteen months.
Case 195. (Colin and Lautier, July, 1917.)
A munition worker came to Villejuif, December 6, 1915, with cord marks on his neck and conjunctival ecchymoses. He had tried to hang himself.