Self-Consciousness and Optic Imagination in a Case of Depression

The twenty-one-year-old medical student, Albert S., complains, “I can't talk in the past year, I do not think to say what I think. Thought and speech are not correlated. There is always something stiff in me when I talk with people. I must put them ill at ease. Most of the time nothing goes through my mind. There is only a mental activity without direction. I am manufacturing things in my mind. I often said things for saying them. I am afraid I shall not remember everything.”

He continually complains that he has lost his power of imagining the anatomical relations. He is compelled to try again and again whether he can imagine anatomy. He has particular difficulties in imagining the anatomy of the pelvic region. When he finally succeeds to imagine the pelvis, it turns around and is distorted. But he has also difficulties in imagining the topical relations between stomach and liver. It is so as if he would try to pull up the liver so that he could look into the deeper parts. (The mother had a gall bladder operation about a year ago.) “In my thinking, I think seventy per cent about the pelvis and thirty per cent about stomach and liver.”

“I feel blank-everything is futile, I never could do anything without thinking of myself. I always try to think what I am thinking. The knowledge I had was temporary. I have never had lasting knowledge.”

These are his complaints which come out gradually in the first two weeks of the analysis. This state had developed gradually in the course of the last four months. It had become so severe that he didn't dare to go any more to medical school and to face his colleagues. He felt that everything was futile and he laughed at the idea that he would ever recover. He sat at home in despair, moaning and groaning. He said, “I felt I would like to be a dog! I like to be a robot or mechanical thing.”

The patient is the oldest son. He has one sister two years younger