罪悪感が関与したと思われる心因性全身痙攣の1例
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A case of psychogenic generalized convulsion, which was considered to be related to the sense of guilt, is reported in this paper. The patient was a 48 year old female, when she was first seen by the therapist. About a half year before the initial interview, she began to have the attacks of convulsion. These attacks went through 3 stages as follows ; (1) generalized convulsion for about 3 minutes, (2) confused state for about 15 minutes, (3) sleeping for about l-2 hours. On awakening, she had no memories of the attacks. She was admitted to our hospital (department of internal medicine), with the tentative diagnosis epilepsy. But no abnormality was found on EEG (done 2 times) and brain CT. She complained of insomnia and psychological difficulty, and was referred to our department for psychiatric interview. At the initial interview, she spontaneously talked about her unhappy life history and the sense of guilt concerning her recent situation. These can be summarized as follows ; She was born in a very poor family, father being an alcoholic, and there being incessant parental quarrels. She married when she was 21 years old, with the hope of getting a better family. But her husband was a terrible man, with the tendency of excessive gambling and extra-marital relationships, making a lot of debt, and beating her frequently. She finally left her husband when she was 46 years old. Then she began to live with 'the uncle', who helped her when she was at a loss. 'The uncle' had a wife, who was bedridden due to apoplexy. The patient was to take care of this woman, but she couldn't, because her physical condition began to deteriorate when she tried to do this. 'The uncle' put his wife into hospital, where she died about 3 months before the initial interview. The actual relationship between the patient and 'the uncle' was that of lovers. The patient felt strong sense of guilt toward his wife, especially because she did not take care of this woman. She also talked about the dream. In this dream, 2 red eye-balls flew in the air, attacking her. She recognized these eye-balls to be the wife of 'the uncle', and declared to the eye-balls that from then on the patient would take care of 'the uncle'. On hearing this, the eye-balls came just in front of her, and crushed themselves. After hearig these, the therapist assured the patient that she had done nothing wrong, and had the every right to her own happiness. There were no more attacks observed after this interview. In this case, the sense of guilt was considered to be the main causative factor of her conversion hysteria. It was possible to interpret it in the Oedipal context, 'the uncle' being father, and his wife being mother in her fantasy. But the therapist tried to alleviate this sense of guilt by means of supportive psychotherapy and prescribing anti-anxiety agents, with the result of good and stable recovery.
- 日本心身医学会の論文
- 1993-06-01
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