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Images in Psychiatry   |    
Delusional Self-Portrait
A.G. Alcántara, M.D.; L. García-Fernández, M.D.
Am J Psychiatry 2003;160:1251-1251. doi:10.1176/appi.ajp.160.7.1251

"That’s me," he said when we asked him about the F1 he showed us on the cover of his diary. "That’s what I’m like inside—all made of metal." Mr. A., a 32-year-old Caucasian man, consulted us after arriving at an emergency room, asking to have some wires that stopped him from sleeping removed from his leg. He said there were many more wires inside his body that he had discovered after experiencing that "a magnetism of storms" produced multiple internal sensations in the form of erratic contractions and "electric currents," which he tried to alleviate by sticking needles into himself so as to "discharge the current by touching the wires with a metallic object." These experiences were unusual and difficult to describe in words, so he decided to express them artistically.

Mr. A had no idea why all of those wires were inside his body. Someone somehow had inserted them and made them move and discharge when there was a problem. He also told us that when he was riding his motorbike with his helmet on, he loudly and clearly heard a voice asking him, "What do you want?" He was so amazed that he had to stop and look around.

This case fits in with what Huber (1) called cenesthetic schizophrenia, considered a specific subtype, characterized not only by cenesthetic hallucinations but also by a relatively benign course, a peculiar conservation of affectivity, and an infrequent occurrence of first-rank symptoms, with the result that these patients are not usually diagnosed as having schizophrenia. Leonhard (2), in his personal nosology of psychoses, reached a similar conclusion, calling the disorder hypochondriacal paraphrenia.

Worried and surprised by his experiences, Mr. A asked if anyone else had had the same experiences. We recommended that he read El licenciado Vidriera, a tale by Cervantes (3, 4) about a man who felt his body change into glass. It made the following impression on him:

When I read El licenciado Vidriera, I was relieved that somebody else had experienced the same as me, and I realized that reality is a very broad, diverse concept, not something unique and the same for everybody.

Address reprint requests to Dr. Alcántara, c/Floridablanca, 51, 1B, 30.002, Murcia, Spain; agal@mx3.redestb.es (e-mail).

 
Huber G: Die coenästhetischen Schizophrenie. Fortschr Neurol Psychiatr  1957; 25:491-520
[PubMed]
 
Leonhard K: Classification of Endogenous Psychoses and Their Differentiated Etiology. Heidelberg, Germany, Springer, 2000
 
Cervantes M: El licenciado Vidriera: Novelas ejemplares. Madrid, Taurus, 1983
 
Barcia D, Gayral L: Sobre la realidad clinica de "El licenciado Vidriera" de Miguel de Cervantes. Psicopatologia  1988; 8:237-245
 
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References

Huber G: Die coenästhetischen Schizophrenie. Fortschr Neurol Psychiatr  1957; 25:491-520
[PubMed]
 
Leonhard K: Classification of Endogenous Psychoses and Their Differentiated Etiology. Heidelberg, Germany, Springer, 2000
 
Cervantes M: El licenciado Vidriera: Novelas ejemplares. Madrid, Taurus, 1983
 
Barcia D, Gayral L: Sobre la realidad clinica de "El licenciado Vidriera" de Miguel de Cervantes. Psicopatologia  1988; 8:237-245
 
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