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Enoch, 2005, Case Reports [a defense of, in The British Journal of Psychiatry]


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Case reports
M. D. Enoch
The British Journal of Psychiatry Jan 2005, 186 (2) 169; DOI: 10.1192/bjp.186.2.169

Dr Williams courageously urges the Editor to think again regarding his predecessor's joy at hastening the demise of the case report . [That's Wilkinson, 2003, which like Williams 2004 is free, full text, and short.]

Medicine generally is being dehumanised; if psychiatry follows suit, then we cannot complain that the masses are deserting us for alternative medicine. The bias of the Journal towards so-called ‘pure science’ while discarding the whole-person approach will accelerate the dehumanising process. Following the massive development of drug therapy from the mid-1950s there was a golden era when the so-called controlled experiments supported what we clinicians found in practice - that people improved with antidepressants and anxiolytics.

For the past 40 years or so the Journal has been full of further ‘ research’ papers which have added little of note to our psychiatric knowledge. At the same time much fruitful research has occurred in the clinical field through the analysis of narrative and transference and the study of case reports.

Uncommon Psychiatric Syndromes (Enoch & Ball, 2001), described by Littlewood (2004) as a pioneering book, now in its fourth edition and translated into several languages, arose from one case report, albeit followed by a further 35 years' (continuing) research.

The pioneer Dr Rolf Strom Olsen, Superintendent of Runwell Hospital, encouraged every clinician to be a researcher; to think and to contribute to the advancement of our subject. Following one ward round he informed a young senior registrar that the case report that he had just presented was an example of the rare ‘delusion of doubles’ and insisted that the world literature be scanned for other examples. Little did we think at that time that the Capgras syndrome would become such a prominent condition throughout clinical psychiatry during the next 40 years. The same can be said for de Clérambault syndrome, now the explanation for about 50% of stalkers (the fashion disorder of the age), and folie à deux, which explains much of the mass phenomena of the past half century.

Peter Hobson psychiatrist, experimental psychologist and psychoanalyst, protests effectively that successive editors rejected his papers on dynamic psychopathology as not being scientific enough. Hobson illustrates ‘how easy it is for the science to squeeze out the subjective, personal dimension of life in the quest for objectivity...’ (Hobson, 2002).

The case history reminds us that the person is not merely a statistic but comprises body, mind and soul and that each must be taken into consideration for complete healing to occur.

  • © 2005 Royal College of Psychiatrists
    Enoch, D. & Ball, H. (2001) Uncommon Psychiatric Syndromes. London: Arnold.
    Hobson, P. (2002) The Cradle of Thought. London: Macmillan.
    Littlewood, R. (2004) Book review. Unusual Psychiatric Syndromes. Psychiatry31-2.
    Williams, D. D. R. (2004) In defence of the case report (letter). British Journal of Psychiatry18484.


2009: Cancer hospital said I had adjustment disorder because I thought they were doing it wrong. Their headshrinker prescribed Effexor, and my life set on a new course. I didn't know what was ahead, like a passenger on Disneyland's Matterhorn, smiling and waving as it climbs...clink, clink, clink.

2010: Post surgical accidental Effexor discontinuation by nurses, masked by intravenous Dilaudid. (The car is balanced at the top of the track.) I get home, pop a Vicodin, and ...

Whooosh...down, down, down, down, down...goes the trajectory of my life, up goes my mood and tendency to think everything is a good idea.
2012: After the bipolar jig was up, now a walking bag of unrelated symptoms, I went crazy on Daytrana (the Ritalin skin patch by Noven), because ADHD was a perfect fit for a bag of unrelated symptoms. I was prescribed Effexor for the nervousness of it, and things got neurological. An EEG showed enough activity to warrant an epilepsy diagnosis rather than non-epileptic ("psychogenic") seizures.

:o 2013-2014: Quit everything and got worse. I probably went through DAWS: dopamine agonist withdrawal syndrome. I drank to not feel, but I felt a lot: dread, fear, regret, grief: an utter sense of total loss of everything worth breathing about, for almost two years.

I was not suicidal but I wanted to be dead, at least dead to the experience of my own brain and body.

2015: I  began to recover after adding virgin coconut oil and organic grass-fed fed butter to a cup of instant coffee in the morning.

I did it hoping for mental acuity and better memory. After ten days of that, I was much better, mood-wise. Approximately neutral.

And, I experienced drowsiness. I could sleep. Not exactly happy, I did 30 days on Wellbutrin, because it had done me no harm in the past. 

I don't have the DAWS mood or state of mind. It never feel like doing anything if it means standing up.

In fact, I don't especially like moving. I'm a brain with a beanbag body.   :unsure:

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Thank you for using the proper format for posts in Journals.

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