Unus_Munus_Sunhill_Asylum_Void_Case_Note_Nine-shea

Jack Vallis. A case of climacteric transsexual melancholia with delusions of grandeur and persecution. A history of self-indulgence and sexual vice. Hallucinations of bodily dysmorphia and accusation. Partial recovery. Monday, December 3rd 1956.

The patient is convinced of his own sanity, and remains opposed to psychoanalytic treatment. He is not satisfied with the reasons for his detention, and demands release on compassionate grounds, claiming his condition cannot be cured, except by angels.

During his catatonic state, his superego functions were destroyed, and his current remission might be ascribed to decreased superego and increased ego strength. As to his mental state, his mania has become chronic, with recurrences of acute exacerbations. He is remarkably lucid and coherent within the sphere of his own psychopathy, but has very little patience for any suggestions that conflict with his delusions.

Superficially, he is a marked neuropath, morbidly religious, who suffers from a Christ complex. However, his psycho-sexual make-up combines infantilist female traits, together with fetishistic aberrations. The conflict between these two poles is the root of his hysteria. Indeed, his fetishism can be regarded as a religion in its own right. His psychopathy is complicated by a residuum of prepubertal impressions, from a time when his perceived girlhood was unpolluted by testosterone. He labours under the false belief that he is not only in the wrong body, but the wrong world.

Like all fetishists, he is a fantasist, and his psycho-sexual infantilism takes place in the twilight realm of dreams. As his psychosis deepens, the real world – the exterior world beyond the asylum gates – is a world that is forever shrinking in his mind. He is now under the delusion that nothing exists beyond Sunhill at all – nothing except mist and eternal darkness, or rather, the chaotic void of his own psychosis. His compulsion to change sex is represented by a symbol — ‘The Sparkling Orb of Divine Humanity’, which lies across the abyss. He believes possession of this orb will finally set him free, and is a salve, not only for himself but all Mankind… His transmutation in ‘The Garden of Earthly Delights’ is a delusion of the miraculous, par excellence, and one that reminds me of a passage by Stekel:

“What a beautiful idea! Delusion is a wish-fulfilment exactly as the dream is. The mad-house is the paradise of thoughts, the heaven in which wishes meet with unlimited fulfilment. And human beings sicken so often, and madness increases with such uncanny rapidity, because our most secret wishes are never gratified, because in these dull times the miraculous has died, and because life demands so much renunciation and yields so little happiness.” [i]

With regard to his physical health, there is no marked disturbance of digestion, and his stools remain normal, but there are pronounced dermic changes – peeling, whitlows and boils. He remains in denial of his catatonic spell, and insists he was “away with the faeries” in a literal sense, believing he was transported bodily to another realm. Like all demi-gods, he desires to be respected, held in high regard, and taken seriously at all times. He is armed with a barrage of quotations, and reels off passages from Plato, Socrates and Virgil, to make others feel small. Rather than recognise his delusions, he compensates for his inferiority complex by telling me to “wake up.” When I refuse to adopt his point of view, he resorts to obscene verse and mockery.

He has accused me of spying on him, both in the asylum Post Office and the Lady Chapel. In point of fact, he is correct: I was indeed at both locations, making clinical observations of the patient. How he managed to spot me in the Post Office I don’t know, as I had secreted myself behind a rack of postcards. But such acute awareness of surroundings is typical of paranoiacs. He told me that his visits to the Lady Chapel also have an aesthetic value, as he likes to meditate upon the stained glass windows. But he refuses to attend Sunday mass because the priest is an agent of Satan. He claims the Virgin is the only one who understands his earthly condition.

He has no memory of jumping from the train or how he arrived at Sunhill, but his recollections of childhood are detailed and vivid, especially those of a transsexual aspect. His overriding wish is to surrender completely to his feminine tendencies, and so end the conflict in himself. At the same time, his religious sentiment considers this a blasphemy. His dreams are full of forbidden desires which he tries to suppress with fervent prayer. But despite his efforts, he cannot purge the transsexual impulse, which has tormented him since childhood. He freely confessed to attempting an orchidectomy [castration] on himself at the age of ten, which failed and resulted in a scolding from his mother. It is not clear if this damaged his erectile function, but he claims impotency during sexual arousal. He is repulsed by his genitalia and prefers to keep his member hidden, either under a girdle, or tucked away in oversized frilly knickers. His ideal female attire is that of Scarlet O’Hara in Gone With The Wind, but he also craves to dress as a sissy, in nappies and protective rubber pants. The constriction of his erotic horizon is probably due to infant trauma, and emotional displacement of a violent mother.

His waking hours are plagued by a storm of sensations and uncontrollable desires, predominantly to emasculate himself and appear female, and he remains angry with the staff for burning his corset. I am hopeful that my attempt to curb his perversions will ultimately prove successful, although Krafft-Ebing has shown that sexual abstinence can produce states of general nervous excitement. However, it is unclear if there is a sexual component to the patient’s cross-dressing, as with transvestic fetishism.

He has been administered six sessions of ECT, which have caused partial incontinence, and he now wears diapers at night. Despite sedation, he remains impatient and irritable, and at times becomes an ungovernable maniac. His pulse is intermittent but his general strength appears to be improving. Whilst he continues to be highly delusional, he can shift his fancies from one subject to another, and his train of thought makes sudden jumps in time, from one imaginary world to another. Until post-mortem, there is no way to determine if his infantile paraphilias, sensory paræsthesias and hallucinations are caused by actual lesions in the nerve mechanisms of the brain, or have a purely psychical origin.

The patient still has delusions of exalted rank, and refers to himself as The Parisian Lady in the Old World, or Gypsy Jill in the New. Whilst Gypsy Jill is a real stage persona, The Parisian Lady is a high-born damsel, who dwells is a sumptuous gothic bedchamber, furnished with velvet drapes. He describes her as dressed in a sky-blue bodice, with the most godly babe suckling her breast. Her closet is full of silken gowns, and from her lancet, she surveys the towers of Notre-Dame and the distant marshes of the Sens.

Before being put in isolation, Jack Vallis spent the majority of his time in the hair salon, where he gave psychic readings in exchange for lipstick and other cosmetics. These were hidden in an old biscuit tin under his bed. The tin was promptly confiscated, but he was still wearing mascara at his last session. This needs investigation; either he has another stash of cosmetics, or he continues to manipulate other females for his own gain.

His Cassandra complex continues to infect his consciousness with apocalyptic visions, and he is acutely paranoid of some demonic force, hell-bent on destroying the world. He regards his incarceration as a conspiracy of the Devil, of which I am unknowingly a part.

I am using the Dialectic Method, as formulated by Socrates, to penetrate the patient’s delusions. Briefly, this is divided into two parts, the negative and the positive. The former is known as Socratic Irony, whereby the psychiatrist takes the position that he is ignorant, and endeavours to show, by a process of reasoning, that the patient is irrational and in a state of confusion, so proving his delusions to be a source of inconsistencies and contradictions. In essence, the Socratic method presents two striking tendencies; one destructive, the other constructive. The former annihilates erroneous beliefs, and the latter aids the reconstruction of a healthy mental world, in which the patient may find a route to recovery. However, to my constant dismay, Jack Vallis is always one step ahead of the game. The other day he accused me of dabbling in “the so-called obstetrics or art of intellectual midwifery” and suggested I take a draught of hemlock instead. He has a very low opinion of doctors, and looks down on Freudians and atheists in general.

Dr. Robert Hardy. F.R.C. PL. D.S.O.

i. Wilhelm Stekel. ‘The Depths of The Soul’, Chapter 15. ‘Refuge in Disease’. (Kegan Paul, Trench, Trubner & Co., Ltd. London, 1921).

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