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Psychosomatic Medicine 4:319-323 (1942)
© 1942 American Psychosomatic Society

An Analysis of a Somatic Delusion

A Case Report

HERMAN WORTIS M.D. and BERNHARD DATTNER M.D.1

1 Medical Service of the Psychiatric Division, Bellevue Hospital New York City Departments of Psychiatry and Neurology, New York University College of Medicine

A case of delusion of absence of an extremity caused by thrombosis of a branch of the right middle or posterior cerebral artery is presented. Another limb with certain characteristics of a phantom has taken its place. The pathological and psychological differences between anosognosia and delusion of absence of an extremity (autotopognosia) are presented. In cases of anosognosia the lesion, according to available pathologic material, must either affect the thalamus directly or separate it from the cortex. Here the abnormal sensations which should mean to the patient that his limbs are paralyzed are conveyed as far as the thalamus, but fail to reach the cortex. Psychologically, these individuals tend to ignore their body defect and thus maintain their pre-disease body image. With lesions of the thalamo-parietal peduncle or supramarginal gyrus, the ability to properly synthesize these impulses is lost, and a normal tendency to ignore the left side of the body is reinforced. Such a disturbance is rarely seen with lesions of the major hemisphere, but it must be emphasized that most right-sided lesions are complicated by aphasia. In addition, there are rare reports of anosognosia and autotopognosia with lesions of the major hemisphere (11).

These studies are of importance in that they emphasize: 1) the neurological basis of certain somatic delusions. This is not meant to imply that these phenomena are understandable on purely "organic" grounds. The lesion tends to produce a specific psychological attitude on the part of the patient, which usually enhances and emphasizes certain normal physiological and psychological drives. 2) the phenomena of phantom limbs, anosognosia, and delusion of absence of an extremity are discussed in relationship to the body image scheme.

Note:
Presented at a Meeting of the New York Society for Clinical Psychiatry, Bellevue Hospital, New York City, November 13, 1941






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Copyright © 1942 by the American Psychosomatic Society