The Case of Paul Schreber

The Case of Paul Schreber

Robin Childers Professor Dewey Balsley PSYC 205 Abnormal Psychology July 12, 2010

The Case of Paul Schreber

Summary of Case History Daniel Paul Schreber was born in 1842 on July 25th. He was one of five children born to Dr. Schreber, a well know physician. While it is not known the conditions in which Paul Schreber grew up in; His father took pride in the fact that he used his questionable child raising methods he wrote about on his own children. At age 42, he suffered his first mental breakdown shortly after losing a race for political office. Schreber started having hypochondriacal delusions. He believed he was being emaciated and that he was going to die of a heart attack. His first hospital stay lasted six months. During that stay he was highly emotional, he was hypersensitive to noise, he had speech impediments, and two suicide attempts. After being released, he spent 8 years with his wife and excelled in his career. Immediately before he was appointed to the countys highest court, he started dreaming his mental illness was returning. He contacted his psychiatrist when his insomnia and anxiety increased. This time he was committed and spent the next eight years hospitalized. During this stay he had delusions of persecution and had fears that he was soon going to die. He also believed his penis had been twisted off with a nerve probe and he believed that he was being transformed into a woman. He was constantly

The Case of Paul Schreber

having visual and auditory hallucinations. He thought he was being tortured to death; also that god openly spoke to him. He continued to be preoccupied with the process of being transformed into a woman. He believed his psychiatrist started this process in order to turn him into a prostitute. He eventually agreed to become a woman. This was to ensure his survival. He said that his ultimate goal was to become pregnant by god. Salient Symptoms Seven years after Paul Schrebers bother committed suicide and shortly after being defeated in a race for political office, Schreber started believing he was emaciated and that he was going to die of a heart attack. These hypochondriacal delusions are what led to his first hospital stay. During that stay it is noted that he was highly emotional, had speech impediments, and was hypersensitive to noise. He also reportedly attempted two suicide attempts. Even after his release from his six month hospital stay he believed he had lost 30 pounds. He actually had gained two pounds. Immediately before Schreber reached the top of his profession, he started dreaming that his illness had returned. One morning after one of these dreams Schreber (1903) reports having the idea that it really must be pleasant to be a woman succumbing to intercourse (p. 46). He later believed that some external influences were at work to implant this idea on him (Schreber, 1903).

The Case of Paul Schreber

His second illness did return beginning with torturous insomnia (Freud, 1911). Freud (1911) says that he complained that he was suffering from softening of the brain and also believed he had the plague and that he would soon die. He also had sensory delusions and considerable sensitivity to light and noise. It was also reported that he would sit for hours rigidly in a hallucinatory stupor (Freud, 1911). Paul Schreber had delusions; he believed he was being turned into a woman for the purpose of sexual abuse and that his penis had been twisted off with a nerve probe. He was preoccupied with sexual thought and spent a lot of his time with ribbons over his naked body. He believed he was missing many organs including his stomach and intestines and that his spinal cord had been pumped out of his body through little men in his feet (Freud, 1911) On top of the delusions he suffered from auditory and visual hallucinations. He thought he was being tortured to death and that god spoke to him. Possible Diagnosis The first possible diagnosis I thought of for Schreber is hypochondriasis. This is a persistent preoccupation with ones health and physical condition, despite negative findings. As I mentioned earlier Paul Schreber had the beliefs that his brain was softening and he had the plague. Also, him thinking he was being emaciated, when he had actually gained weight, fits this diagnosis.

The Case of Paul Schreber

Posttraumatic stress disorder is characterized by anxiety, dissociative, and other symptoms that last more than one month and that occur as a result of extreme trauma. It is not known exactly how Paul Schreber and his siblings were raised, it had been said that he was a nervous child and that his father used his child care methods he wrote about on his children. On top of that, Schrebers brother committed suicide; it was after this that he had his first mental break. This is what leads me to believe he has Posttraumatic stress disorder. Major Depressive disorder seems like a likely diagnosis for Mr. Schreber. Depression is characterized by feelings of worthlessness and futility, intense sadness, and withdrawal from others. Schreber expressed thoughts of being left behind by everyone during his stay in the hospital, and was experiencing insomnia. Taking into consideration the number of suicide attempts made by Paul Schreber, this seems to fit. The last possible diagnosis I came up with is schizophrenia. This is a group of disorders characterized by severely impaired cognitive processes, personality disintegration, affective disturbances, and social withdrawal. To be more specific I believe Schreber could have paranoid schizophrenia. I think this is a possible diagnosis because of the preoccupation with his delusions and his hallucinations. Also, his high level of anxiety and stress over him believing he was being persecuted. He also had several paranoid features in his illness, such as; he believed his psychiatrist, Dr. Paul Flechsig,

The Case of Paul Schreber

was a soul murderer and had initiated the process of Schreber being transformed into a woman. Final Diagnosis I decided on my final diagnosis as paranoid schizophrenia and posttraumatic stress disorder. I felt as if there was more evidence pointing to these particular diagnoses. In coming to this conclusion I had to rule out my other possible diagnoses. First, I ruled out hypochondriasis. Although he did have symptoms pointing to this disorder, I felt as if these same symptoms could be contributed to the delusions he was having. The second diagnosis I ruled out was major depressive disorder. Although he was probably suffering from some level of depression, I feel that he did not have enough physiological and behavioral symptoms to justify this as his main diagnosis. This diagnosis also does not explain the delusions and hallucinations. This leaves me with my final Diagnoses. First I decided there was enough evidence from his symptoms to justify Posttraumatic stress disorder. First, he experienced a traumatic event when his brother committed suicide. There is no evidence that he ever sought treatment to deal with that event. I think that by thinking he was being turned into a woman he was showing dissociative symptoms and he also complained of sleep disturbances.

The Case of Paul Schreber

My other final diagnosis is paranoid schizophrenia. He has many symptoms that fit the criteria for this diagnosis. He had false beliefs about his psychiatrist. He also had delusions of persecution and the delusion believing that his penis had been removed and that he was being turned into a woman. Other symptom he has pointing to this diagnosis is auditory hallucination, where he believed god was speaking to him, and he also developed a speech impediment at one point. Finally, it seems that Paul Schreber functioned well before his first breakdown. He stated that before each breakdown he had been put under a great deal of stress. It is believed that a high amount of overwhelming stress can cause a normal person to have a schizophrenic breakdown. Treatment Options There are several treatment options available for both paranoid Schizophrenia and posttraumatic stress disorder. I am going to start with the treatment I have decided on for the posttraumatic stress disorder. To start off with, I would start him off on an SSRI antidepressant medication. This should help with some of the stress, anxiety, and depression he may feel from the traumatic events in his life. This has been a proven successful treatment for this disorder. I would also recommend he get some psychoeducation about posttraumatic stress disorder, stress management, and training in muscle

The Case of Paul Schreber

relaxation. Also, I think family therapy with his other siblings would be beneficial to help him to start to deal with his emotions about this tragic event. There are a few different things I recommend for the treatment of Mr. Schrebers Paranoid schizophrenia. First, I would start him on antipsychotic medications and monitor the dosage levels carefully. These medications can be beneficial because they reduce the severity of the symptoms, such as hallucinations, delusions, bizarre speech, and thought disorder. These medications can greatly improve Mr. Schrebers life, but will not cure the disease. Second, I would start him in cognitive behavioral therapy. This is to help reduce the frequency and severity of symptoms not helped by the medication. In this therapy the therapist would explain where some of the symptoms of schizophrenia come from and identify his beliefs. They then could come up with some strategies to help Mr. Schreber find ways to deal with and try to control his symptoms. Finally, I think that with a disease like this the whole family system needs to be addressed. In Schrebers case this would include his wife. This helps to educate family on how to deal with symptoms to make it easier for Mr. Schreber to return to his home. This has also shown to be beneficial in preventing relapse.

The Case of Paul Schreber

References Freud, S (1911) The Schreber Case. New York, NY: Penguin Group. Schreber, D.P. (1903) Memoirs of My Nervous Illness. New York, NY: The New York Review of Books.