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The case to be presented is one in which organic brain disease could be detected on psychological grounds at a time when the diagnosis had not yet been made by neurological examination. Because the patient was an unusually perceptive boy, the case afforded a striking opportunity to distinguish between organic and psychological factors in the disturbance. Hugh's temporal lobe symptoms, as they were gradually identified in treatment, could be separated from his psychological problems and identified by the patient as the work of "Mr. 'Cephalitis," his name for the organic lesion. The ways in which the patient handled his organic damage and the body-image problems related to it could be distinguished from the symptoms he developed and the defenses he used with respect to his secondary psychological problems.
The parents of a six-year-old boy asked for a consultation, saying "Ever since Hugh was nine months old he had what people call emotional disturbances … They call them temper tantrums but they aren't." These eruptions, Hugh's "mads," consisted of frequent, unpredictable, apparently unmotivated aggressive outbursts of murderous intensity in which the boy attacked anyone near him, striking, biting, scratching, kicking, and screaming. His father was the only family member strong enough to restrain him. Until recently, if he had been ignored in an attack, Hugh had followed family members around the house, striking them.
The explosive outbursts were the parents' chief concern; the mother feared Hugh was psychotic. However, the patient also had many other difficulties. He was bound up in extensive compulsive