xxviii Preface
disorder (Case 7.2) in Chapter 7, transvestic fetishism in Chapter 11 (Case 11.6),
and separation anxiety disorder (Case 14.8) in Chapter 14. Often several From the
Outsidecases are included in a chapter; for instance, in Chapter 8 , we include From
the Outside cases on dissociative amnesia (Case 8.1), dissociative fugue (Case 8.2),
depersonalization disorder (Case 8.3), somatization disorder (Case 8.5), and body
dysmorphic disorder (Case 8.8).From the Inside
In every chapter in which we address a disorder in depth, we present at least one fi rst-
person account of what it is like to live with that disorder or particular symptoms of
it. In addition to providing high-interest personal narratives, these From the Inside
cases help students to consolidate memory of the material (because they mention
the symptoms the individual experienced), provide additional retrieval cues, and
are another way to link the descriptions of disorders and research fi ndings with real
people’s experiences.TheFrom the Inside cases illuminate what it is like to live with disorders such as
agoraphobia (Case 7.3), obsessive-compulsive disorder (Case 7.6), hypochondriasis
(Case 8.7), alcohol dependence (Case 9.5), gender identity disorder (Case 11.1),
schizophrenia (Case 12.2), attention-defi cit/hyperactivity disorder (Case 14.7), and
dementia (Case 15.4), among others.CASE 12.1 • FROM THE OUTSIDE: Disorganized Schizophrenia
Emilio is a 40-year-old man who looks 10 years younger. He is brought to the hospital, his
twelfth hospitalization, by his mother because she is afraid of him. He is dressed in a ragged
overcoat, bedroom slippers, and a baseball cap and wears several medals around his neck.
His affect ranges from anger at his mother (“She feeds me shit... what comes out of other
people’s rectums”) to a giggling, obsequious seductiveness toward the interviewer. His
speech and manner have a childlike quality, and he walks with a mincing step and exagger-
ated hip movements. His mother reports that he stopped taking his medication about a month
ago and has since begun to hear voices and to look and act more bizarrely. When asked what
he has been doing, he says, “eating wires and lighting fi res.” His spontaneous speech is often
incoherent and marked by frequent rhyming and clang associations (speech in which sounds,
rather than meaningful relationships, govern word choice).
Emilio’s fi rst hospitalization occurred after he dropped out of school at age 16, and since
that time he has never been able to attend school or hold a job He has been treated with neu-CASE 6.1 • FROM THE INSIDE: Major Depressive Episode
Another experience of depression was captured by the writer William Styron in his
memoir, Darkness Visible.
In depression this faith in deliverance, in ultimate restoration, is absent. The pain is unre-
lenting, and what makes the condition intolerable is the foreknowledge that no remedy will
come—not in a day, an hour, a month, or a minute. If there is mild relief, one knows that it is
only temporary; more pain will follow. It is hopelessness even more than pain that crushes the
soul. So the decision-making of daily life involves not, as in normal affairs, shifting from one
annoying situation to another less annoying—or from discomfort to relative comfort, or from
boredom to activity—but moving from pain to pain. One does not abandon, even briefl y, one’s
bed of nails, but is attached to it wherever one goes.
(Styron, 1990, p. 62)