An Unusual Neurcsis Following Head Injury1

It is now generally agreed that the majority of symptoms typical of the chronic post-concussional syndrome are psychogenic in origin. Although a good deal of work has been done in relating these symptoms both to previous personality and to current conflict, there is not much analytic literature with regard to deeper psychopathology. Not only is the occurrence of cerebral damage sufficient to cause a lapse of consciousness of vital significance in itself, but also the psychological effects of organic cerebral impairment present an important field for psycho-analytic investigation, particularly at this time, when artificial methods of damaging the brain are playing such a large part in the treatment of mental disease.

A.B., the patient to be discussed in this paper, suffered a serious head injury in December, 1940. For two years after his discharge from hospital in March, 1941, he suffered from the symptoms typical of the post-concussional syndrome, namely, headaches, giddiness, irritability and difficulty in concentration. He also suffered from double vision which appears to have been physically determined at the outset. In 1943, however, his symptoms suddenly altered; he developed a severe pruritus ani—the main symptom for which he sought psychological treatment. His double vision which had previously been improving has also shown marked variation parallel to the state of his anal irritation.

HISTORY. A.B., aged 26, is the younger son by nine years of neurotic, somewhat elderly parents. His brother, aged 35, is probably a chronic schizophrenic. Although his parents are happily married, the home atmosphere has never been very happy or contented and there has been constant pre-occupation with physical illness and financial worries. A.B. appears to have been a nervous timid child, who from an early age was severely bullied by his elder brother. Although he was a good student, particularly in subjects requiring verbal facility, he lacked confidence and initiati