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Wechsler, I.S. (1927). Delusional Projection Mechanism in a Case of Paralysis Agitans. Int. J. Psycho-Anal., 8:523-524.

(1927). International Journal of Psycho-Analysis, 8:523-524

Delusional Projection Mechanism in a Case of Paralysis Agitans

I. S. Wechsler

The following case is worthy of report, I believe, because it illustrates an exquisite projection mechanism in a patient who was suffering from an organic disease of the nervous system. It deals with a delusion of infidelity in a man otherwise mentally normal, the delusion occurring on the basis of impotence, waning or disappearing with the return of potency and recurring with successive waves of impotence which were invariably accompanied by excessive sexual desire.

A. B., a man of thirty-five, married and a father of three children, came to the neurological clinic with the complaint that he was impotent. He had been getting weak gradually for about a year and was altogether unable to perform the sexual act for six months prior to his coming to the clinic. He had always been perfectly well, except for a light attack of the grippe some two years before. There was apparently nothing in his personal, family or marital history to throw any light on his complaint. He was devoted to his wife and perfectly happy with her and the children.

Neurological examination revealed nothing except some poverty of the associated movements of the arms in walking. On the basis of this I ventured the diagnosis of incipient paralysis agitans, the result in all probability of an attack of epidemic encephalitis which was passed off as the 'grippe'. I prescribed hyoscin hydrobromid, a drug commonly given in Parkinson's disease, and kept the patient ignorant of my opinion, though I did not fail to communicate it to his wife. One week later the patient returned with the information that his facultas coeundi had returned and that for the first time in six months he had been able to have satisfactory intercourse. I advised him to continue taking the hyoscin and to report to the clinic from time to time.

Several months later he began to complain that the tablets no longer had any effect and that he was impotent once more. In addition, he felt that his gait and all other normal movements were slowed up and that his hands were beginning to tremble. It was now perfectly evident that he was rapidly developing the classical syndrome of paralysis agitans. While still bemoaning the fact of his impotence, the patient was more alarmed about his physical condition; but the wife complained that for the first time in his life he accused her of infidelity.

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