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Disturbances of the body image caused by organic disease of the brain have been studied with especial interest in recent years. While the distortion of the body image might be an expected consequence of the dysfunction of brain tissue, illusional reduplication seems to be more difficult to explain. A paper by Brock and Merwarth, in which five cases are presented, prompts these comments.
The illusory reduplication of body parts in cerebral disease, since it seems to be limited to no single locus of damage, is probably the result of the action of a psychodynamic defense as Weinstein and his co-workers contend, and as Brock and Merwarth allow. Although the reduplication clearly serves to replace a defective or an absent structure, I believe that the specific nature of the defense can be delineated more precisely.
In his discussion of the psychodynamics of paranoid psychosis in 1911, Freud suggested that the primary psychic event was a breaking of psychic contact with the real world. The subsequent elaboration of a delusional cosmology, said Freud, is merely an effort to re-establish by projection the world which has ceased to exist for the patient. Nunberg, in his detailed observations of the psychic productions of schizophrenics, concluded that fantasies of the creation of children (impregnation, conception, pregnancy, birth) and individual fantasies of rebirth are prominent features of the manifest and latent content. He inferred that these fantasies were activated by the wish to repopulate the world which had disappeared. The form of these strivings is usually the fantasy of a number of small human or other animate organisms. Such observations are becoming commonplace as more and more schizophrenics are finding their way to analysis, especially with the assistance of tranquilizing drugs.
For patients who have illusory reduplication of body parts, a segment of the real world has ceased to exist for them or to function—namely, an important part of the body. Such