THE FEAR STRANGLING HIS CHILD IN
A MAN OF 27 YEARS AS SYMPTOM OF A PHOBIC-OBSESSIVE-COMPULSIVE TROUBLE, WITH
INTRUSIVE THINKING AND ALTERATIONS OF THE HALF-BRAIN DOMINANCE. RESULTS OF THE
ANTIDEPRESSANT AND ANTISTRESS DRUG THERAPY.
Renato COCCHI, a neurologtist and a medical
psychologist.
Abstract.
In a man of 27 years, it happened the obsessive taught
onset of strangling his two-year-old son. This kind of negative thought had
reference to troubles of the half-brain dominance, with an emergency of
"bad" contents. The need of putting his hands around his son's neck,
as for becoming convinced he could avoid going further, it is a compulsive
aspect with a rationalized explanation.
Similar cases had their literature, and classification
in the DSM-IV as (300.3) within obsessive-compulsive disorders. But this
trouble seems to have some autonomy, at least for its content, which it uses
only stimuli of an internal genesis. The phobic face is much visible, and it
seems nearly exclusively a secondary trait to the feeling of personal
extraneousness. It could be a signal of much difficulty in the rational control
of the situation.
The extended text reports the positive results after 8 months of
antidepressant and antistress drug
therapy.
Key Words: Stress-cocchi, disorder, obsessive,
compulsive, thought, strangulation, son, infant, fear, depression, stress,
half-brain, dominance, inversion, emotions, memory, negative, rationality,
control.
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The fear of killing a son is a not infrequently
psychopathologic condition and sometime it had a punctual description as so. In
past, when phobic aspects prevailed, it took place within the phobic-obsessive
troubles. Now, when instead obsessive-compulsive aspects prevail, it is
classified as obsessive-compulsive disturbs. (See: DSM-IV, 300.3, where the
idea to attack a child has its room among "aggressive or terrifying
impulses").
It is probable
that our subdivisions are always inaccurate and only the fruit of a
classification need, while instead we might have a continuum. I shall describe
here a case where are phobic, obsessive and even compulsive symptoms. Moreover,
as for me, there were some signs of troubled half-brain dominance, which,
perhaps, was the starting point of the whole morbid frame (Cocchi, 1994).
The case history.
A young man 27 years old, married, with a son of two years.
He ended the junior high school and he currently works in the housebuilding.
Second ten days of December 2006: He came to
consultation enough upset and terrified. He fears of strangling his son, is
afraid of dying, has some suicide ideas, and fears of becoming crazy.
As for his son, to the father occurs the thought to
strangle the child. Consequently he needs to put his hands around his son's
neck, as for strangulating him, but without touching his skin. He says he does
so, to prove to himself that he never would act such an action, since he may
maintain his self-control.
He needs frequently to do it to reassure himself. His
wife, even attending the consultation, confirms this [compulsive] behaviour,
but she inclines to minimize it, probably to avoid her husband to have still
more fear. When he gets this bad thought against his son, and the child is not
there, he does difficulty to send it away.
This trouble started about two years ago and since
over a year he is taking a drug therapy, currently with lorazepam, mirtazapine,
sertraline, and pregabalin, without any sensible result. With the same
psychiatrist ha runs psychotherapy, once a week, which seem to give him some
relief lasting two-three hours, then all returns as first.
Stress symptoms: He has sudden asthenias, for
no reason. There is greediness for sweet foods, in particular for the
chocolate. Usually, he has normal liking for the meat broth or the cube
bouillon, and normal too for milk and dairy. Some days, he wakes up tired, but
usually he is feeling better when he is waking up. In the morning, he has an
abundant breakfast at once. The warm and the cool let him indifferently. Now,
he doesn't bear the noise and the derangement.
He plays
football, and when he plays it too much, then his head clears away. Nighttime
bruxism does not occur, neither daily dental shut. There are frequent colic and
diarrheas. He has fainting feelings, but not feelings of disbandment. Hands'
oversweating is happening. He does not suffer from dyslalia. Fat hair is reported.
Trouble of the half-brain dominance: To the test
"Which is the opposite of the colour Red", he answers: Black [a
typical depressive answer (Cocchi, 2002; Cocchi, 2004; Cocchi, 2005 )]. He has
intrusive thinking, with fluctuating thoughts, mixed with the emergency of
negative thoughts. How he said at the beginning of his reported history, it
comes the impulse of strangling his son. He is afraid of dying, has some
suicide ideas, and fears of becoming crazy.
When he is going to bed, he is happy, because so he
stops thinking. At school, he did better mathematics.
Depressive symptoms: He has a depressive face,
and tight, with spots but he doesn't cry. To fall asleep, sometimes he needs to
have a sexual intercourse with his wife. Tachycardia is present. In past, he
had mediastinal oppression, a lump in the throat and air hunger. His willing is
scarce. The sexual activity decreased [as a side-effect of the drugs?] To the
test "Which is the opposite of the colour Red?" he gives the typical
depressive response of Black.
Sleep: At night he is sleeping. He talks when
sleeping. At the morning, he doesn't remember what he had dreamt. No nighttime
muscular cramps occur as well as drooling in his sleep.
Possible risk factors or antecedents: He had been born
from a caesarian section. Now, he does not know if he had symptoms or behaviour
signalling a previous brain suffering, in his first year of life. It seems he
was a calm child. As a child, he was a little timid, with some difficulty to do
friendships.
Other: When he does not work, he feels better.
Third
ten days of January 2007: The first check-up, after 50 days of drug
therapy. He is doing decidedly better,
and he has fewer impulses to strangle
his child. He thinks, the lowering is as 50%.
Already
to the third day of therapy he felt a real benefit, being true that he telephoned his wife, during the work, to say
that he did better. His wife,
attending his check-up too, says that she was very frightened, because
her husband did never phone at home during his work, and first she feared a
misfortune.
He
still fears of dieing, an idea usually instigated him when he ears to speak about death or corpses.
As
previously, he feels better in the mornings and when he doesn't go to work. He
says that he is seeking the chocolate as first, but, as for his wife, he eats
it of less. Now, he remembers better the dreams, and he gets up always well.
The sudden asthenias reduced. The intrusive thinking lowered too, but now it is
no more fluctuating, but focussed, mainly on death thoughts. Ideas of suicide
were missed. He not more had feelings of
fainting, and the tachycardia is not more shrewd.
Poor
tolerance rests to the noise and to confusion. At night he continues to speak,
even if he feels to sleep better. Colic and the diarrheas went out and the hand oversweating reduced.
He is less lazy. His face is more relaxed with missing nearly at all of the
spots. The hairs are still fat. The sexual activity improved and is more frequent, as reported even by his wife.
He resumed playing better to football, as confirmed by his trainer. Now, he has
less fear of dieing. In the evening he feels quite tight, even in the muscles.
Therapeutic
variations (daily dose, by the oral
via): Hanging Bromazepam, it was substituted by Diazepam 2mg; Carbamazepine
200mg.
First
ten days of April 2007, the second check-up. Of facts, he sustains that he did not improve, but
being questioned in a more exact way, he
admits that the episodes are less frequent in comparison with the preceding
checkup, even if they have the same intensity.
His wife, who attended the examination, says, as
for her, he much improved, a fact even
confirmed by his parents. When however has a critical episode, he forgets
totally the gotten improvements, which are as erased, or cannot be recalled. In
these moments to remember him the days of comfort doesn't serve to
anything.
It is as if the situation of discomfort would eliminate totally the possibility to
think the opposite datum. After having discussed this controversial phenomenon during the
examination, eventually he said of being aware that it happened exactly so.
First ten days
of July 2007, the third control. He is going much better in comparison
with the preceding months. His depression decreased and he has less intrusive
thinking.
Actually,
he is more active and more prone to play with his child, he is more calm and
does not speak anymore during the sleep. His diet is now in a more regulated
way.
When he
ears bad news he takes it amiss, but
less than in past. By working of less (9 hours per day) he feels better. For
this reason, he stopped going to work on Saturday.
His asthenia decreased. He has become more
sociable and more participating. Now, he considers himself as 50% improved.
Currently, he succeeds to stay with the children. When he ears bad news, it comes to him to think for 4-5 days about. His job is running
better. Some days he is irritable and reactive. He has gotten greater critical
ability [Has he a better control of the left half-brain?] Now it happen he used
to smile.
Current
therapy(daily doses, by the oral via): Carbamazepine 300mg; Pyridoxine 75mg;
Glutamine 250mg: Fluoxetine 20mg, 5-hydroxytriptophan 50mg; Amitriptyline 10mg
+ perphenazine 2mg; diazepam 4mg.
Discussion.
As I said in the introduction, the phenomenon is not
rare. In my nearly psychiatric practice lasting about 40 years, it seems to me
I met, in all, four cases, this inclusive. I must say that the other three were
women. The fact that they come always in the same way, is a possible sign of
their specificity and, perhaps, of their psychopathological autonomy.
Surely there is a phobic aspect here, but surely also
the fear does not concern an external object, as usually it happens. Here it
concerns an internal object that gets up from one's own "bad"
thinking. Of fact, if not entirely, this phobia is mainly secondary. It ties up
to coming out of particular contents of many thoughts. So it occurs even the
related fear of doing not succeed to dominate these thoughts or even only to
send away them from own mind.
These negative contents of the thought are not
continuous, but alternating. So, it seems to have something of similar to
switch off (or to switch on) of an interrupter. I ask you your consent about
doing this some coarsen simile.
In the reasons that have pushed this young man to ask
for a consultation (He fears of strangling his son, is afraid of dying, has
some suicide ideas, and fears of becoming crazy") two of them are possible
eventualities ( " . . . (he) is afraid of dying, . . . and fears of
becoming crazy "). The remaining two ("He fears of strangling his
son", . . . has some suicide ideas") implicate a distortion of his
real will, which could bring him to act against his current convictions.
The obsessive aspect is give from the unintentional
and repeated onset of these "bad" thoughts, recognized as extraneous
to his own feeling. This is an upsetting onset because would bring presupposing
the coexistence of a double personality. The second one is "inviting"
to do to damage, to the little son or to his same.
Already in the attempt of a more suitable
comprehension of the "raptus", I wrote (Cocchi, 2003):
"Incomprehensible" murders and raptus find
increasing possibilities of explanation if to the usual interpretative lines of
the psychology and of the forensic psychiatry is adding the supplies of the
neuropsychopathology and of the neurochemistry related to the reactions of
stress, of the intrusive thinking, and of the reverse of half-brain dominance,
mainly in the emotional structures."
In my preceding article, faced to try an explanation
of the "evil" (Cocchi, 2005) I had stated also:
"Given that the evil exists, and that its
symbolic interpretation is not the task of this article, I can conclude:
- In condition of temporary prevalence of the opposite
half-brain dominance, it may occur the emergency of evil thought, felt as
extraneous, against beloved persons;
- About 20% people, who are seeing as half-empty the glass
filled to half, had a prevalence of the not dominant half-brain, at least for
some functions;
- external or internal stress can elicit troubles of
the half-brain dominance, even in persons who previously had a normal
half-brain dominance;
- To do evil could find in itself its justification as
a reward mechanism as it happens in several computer virus spammers;
- It is not sure that evil and troubles of the
half-brain dominance are always correlated. Certainly, they are so in several
cases;
- In sects of Satanist type the opposite, which seems
to have become an ideological choice, could own opposite half-brain dominance,
at least for some functions, to its ground.
To suggest a neuropsychological base in several forms
of evil, is only a partial attempt for its better understanding."
In the clinical history of this young man I found
symptoms of stress, depressive symptoms and possible symptoms of troubled
half-brain dominance, at least for some functions.
The idea of doing damages doesn't however approved,
but rejected, even if with some difficulty.
As for this topic, the compulsive aspect shows notable
interest. The need to put the hands around the neck of his son, it is only the
means to show to himself to have still the control of his will or it is such
where this function runs, but there is even something of different. It is not
easy to give a sure answer. The will, even when tried, works badly to suppress
the negative thoughts.
In facts, the patient seems not to have any choice: He
needs to pass through this gesture to have temporarily peace. If the son is not
present, and he cannot put in practice this gesture, he may erase the relative
intrusive thought with greater work.
In the previous history of this person there is a
birth following caesarian section, as a risk factor, and depressive-introvert
behaviour in childhood.
Another element to consider, even if by now it I do
not know which weigh it could have. It is the fact that he wakes up well and
becomes badly during the work. On Saturday and Sunday, days where he does not
work, he is less tormented by these "bad thoughts".
Being
lowered the amount of the working stress and elevated the threshold of tolerance to the stress, the
result seems already very positive. It is possible, however, that the current therapy is only a substituting therapy and non
curative one, if the fall to zero of the brain plasticity, at the pubertal
time, corresponds to a true datum.
Conclusions.
The obsessive onset of the taught of strangling his
two-year-old son in a man of 27 years, has been considered as connected to
troubles of the half-brain dominance, with an emergency of "bad"
contents. The need of putting his hands around his son's neck, as for becoming
convinced he could avoid going further, it is a compulsive aspect with a
rationalized explanation.
Similar cases had their literature, and classification
in the DSM-IV as 300.3 within obsessive-compulsive disorders. But this trouble
seems to have some autonomy, at least for its content, which it uses only
stimuli of an internal genesis.
The phobic face is much visible, and it seems nearly
exclusively a secondary trait to the feeling of personal extraneousness. It
could be a signal of much difficulty in the rational control of the situation.
A
better tailored drug intervention and the reduction of the daily and weekly
working time, 8 months after seem
have given both positive results
and confirmation of the psychopathological
hypotheses put forwards.
References.
Am. Psychiat. Ass. DSM-IV. Diagnostic and statistical
Manualof Mentali Disorders. APA, Washington DC, 1994.
Cocchi R. Defective hemispheric dominance and
cognitive behaviour: Speculative
onsiderations.<www.reversebrain.net/domin1.htm>
Cocchi R. "Name the opposite of the Red"
Test in drug addicts and in normal subjects
<www.reversebrain.net/domin5.htm>
Cocchi R. The test "Which is the opposite of the
Red colour" in 325 outpatient's subjects
<www.reversebrain.net/domin11.htm>
Cocchi R. From the "incomprehensible" murder
to the raptus: Mystery or incomplete frame of reference?
<www.reversebrain.net/domin15.htm>
Cocchi R. Short-lasting sudden episodes of green
colouration of the whole visual field, even persistent six months after a
cranial trauma. <www.reveresebrain.net/Case10.htm>
Cocchi R. Evil and the troubles of half-brain
dominance: Is there a relationship? <www.reversebrain.net/Domin18.htm>
Posted on internet on 14 March 2007; Copyright by
Renato Cocchi, 2007.
42100 Reggio
Emilia (Italy).
renatococchi@libero.it
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