TEMPORARY REVERSE DOMINANCE OF SOME BRAIN FUNCTIONS
IN A MAN AGED FORTY-SIX.

By Renato Cocchi, a neurologist and a medical psychologist.

(Italian translation)

Summary

The emerging of opposite behaviour in form of intractable crisis, in a man aged forty-six, is reported. His long-lasting psychoanalytic and psychiatric history never focused on this peculiar symptom, but mainly on the accompanying depression, which appears rather a following than a primary symptom. The major fields of opposition refer to emotions and self-esteem. This fact accounts for supposed temporary reversed half-brain dominance sometimes dealing with the emerging of opposite brain functions.

Key words: opposite feelings; emotions; self-esteem.

This is another case of temporary reverse dominance in some brain functions that went up in a man since his early adulthood. The trouble has quite special features and the patient had already had a long psychoanalytic and psychiatric history when he had his first consultation with me. I decided to report this case too and I asked the patient to write his history by himself. The cases I described are now four (Cocchi 1996; Cocchi 1998).

The case.

Male, 46 years at first consultation. So he wrote by summarizing his life for this report. "I was born in a hospital in Milan. My mother told me that delivery was long and difficult perhaps because I weighted about 4000 gr. The use of the forceps seems denied, but I have a dislocation in my right ribs. Skull X-rays revealed forehead marks possibly due to the obstetrician's fingers pressing during that delivery. Our home was in the centre of Milan until I was six. My sister is two years older than I and, differently from what I did, attended the kindergarten.

My parents tried to send me there too, but it did not run: I was presenting foods' vomit and continuously quarreling with the other children. So I was staying at home with my maternal grandmother. At that time my sister had a great jealousy versus me and she often beat me when the adults were not watching. It happened a peculiar episode when I was two, as my parents told me. I wanted the candies my sister owned but she gave my some psychodrugs my grandmother used to take. Nobody could exactly remember which kind of psychodrug I had eaten but I fell deeply asleep. The asked physician said that it did not seem something of serious, but I was sleeping for three days.

Then my parents used to quarrel very much and, besides abusing my mother, my father was doing the same with my sister and me. After I was six we move in a new peripheral neighbourhood where I could go out to play. I had many friends and then I did never like coming home and doing my homework. The family atmosphere became worse. When previously my father had the habit of going out nearly every evening, now often used to stay at home, so the quarreling and the abusing greatly grew. In the elementary school I had about sufficient notes, with scarce interest in studying and much more in playing.

Mainly in the first years I had grammatical difficulties, by omitting double consonants and leaving some words incomplete or mismatched. Even in Milan I attended the first two years of the junior high school where I got sufficient notes but the maximum in mathematics.  When I was twelve we move to Pesaro, since my father liked to live close to Mercatello sul Matauro, his place of origin. My impact with the life of a provincial town was rather troublesome.

First I did not want to go out, and I started to develop inferiority feelings versus my classmates and the social reality. The last year of the junior's I had to take two subjects again but I was successful in September. I attended the scientific high school in Pesaro and in the second year of it I had my sister as classmate, since she failed twice. Studying was not my best aim, but I was always successful in June.

Then I played a transgressing and clownish behaviour, but quite secretly I was feeling greatly distressed as for prominent reality and related attitudes. Those last ones appeared to me as owning magical but mocking features. My trials of imitating them somehow did not reach any result and I used to disguise everything by my cheerful and couldn't-care-less behaviour. When I attended the second year (or, in the third) of this scientific high school, a special event happened.

At school, in the morning, I drank an iced coke on an empty stomach. I partly lost my sight and I was unable to see anything but the centre of my visual field. A delirium took possession of mine and I cannot coordinate my thoughts with my speech. When I wanted to say that I was feeling sick I said wrong words instead of the right ones, even dirty words instead of plain words. Hardly I could inform my teacher that I was feeling sick since I was afraid of insulting her. I had the permission of leaving the school by myself and I cannot say how I came back home.

My symptoms did not stop there and a consulted neurologist said that I could have suffered from a vascular spasm of the brain. The oculist I consulted too spoke about a pain of retinal vessels, but I do not remember which therapy he prescribed. When the high school ended, my family moved to Urbino and I started the Medical School in Perugia.

On the contrary of the high school, I was immediately and deeply involved in it. During my first three years I took nearly all my examinations and I had got high notes. The task of studying had my mind opened as for my fears and distress. So I did not use to live my inferiority feelings and "magical powers" other people owned in a such insuperable way. This change paralleled my relationship with groups of leftist persons. According to deep meditation I could relate my major affective troubles to something linked to my relationship with my mother.

In my infancy I could not have overcome her imagine of an almighty person. I was twenty-tree when I passed through a big crisis. I lost my fundamentals within few days and I was fully unable of going on. My thoughts swirled my mind without any possibility of having a resting point. What I was reading had completely become without any sense, but to do it became a kind of mental drug I could not stop. The present had been transformed into something that was burning and I felt my link with the past overturned. Any current action of mine was relating to the past and I could not sustain the idea of its relating to the present or the future.

The negative counterpart of my positive proposals made me unable to do otherwise and I had my identity reversed. There was a kind of malignant presence in my mind that forced me to live as somebody condemned to find the true origin of everything. Then, as the mythical Tantalus, I immediately needed to redo anything from the beginning. My life entered a kind of almighty delusion that was opposing the even only possibility of standing emotional events. So anything became equal to pure thinking. I lost the way of spontaneously referring what it happened to me because every thought did never overlap the meaning I wanted to word.

To consider myself as a human being, I should have to discover a perfect speech not to be criticizable by other people. In that time my father became seriously ill, following a heart infarct and a severe form of rheumatoid arthritis. My mother fully went in for him, and I developed tremendous hate feelings against her. But, at the same time, I wanted to impose on her to accept me without any condition and to look after me as for this almighty delusion. So I exactly did the opposite of what I had intended about my life and my values. In fact my parents considered what happened to me as something to have to hide. They scolded me with "my no will," without any proposal of searching an external help.

I had a hopefully but wrong thought about the psychoanalysis and I moved to Bologna with many efforts. Since there I did not find any therapist to have me as a patient, I start a Junghian therapy in Parma, with twice a week attendance. The female therapist paid near only attention to my dreams, and did not appreciate when I tried to refer to many other things.

I was having my head full of whirling thoughts and I would like more speaking. Things did wrong and perhaps I was getting worse, but I did not want to interrupt the analysis lest she should have charged me with therapy resistance. Eventually I was zero value and I decided to change the type of my psychotherapy. I came back to Dr. Z., of Bologna and by his advice I met a Freudian female therapist in that town. Meanwhile, I slowly did exams since I trusted I should have got maximum notes according to this rather perfect thinking I reached in past, although now definitely missed.

However I could not understand what my study object signified and illnesses were like something wrong according to my frames. I attended this new therapy twice a week again and I did not lie in the bed, but I had a face-to-face relationship. The therapist had the habit to let me speak with few interventions even if she first said she did not understand why I was getting bad, apart from tears. Thus I long told about my father and his authoritarian and violent temper.

She did not target the problem in another way too. So I did really forget my mother's role even if I were living that morbid relationship I referred above, with her and my sister. This therapy made me improved and I became quieter. I started then to work as an educator, even if I often thought to my medical studies that now were without any result. During the third year of this therapy I suffered from a heavy crisis so my therapist advised me to ask Dr. Z. for hospitalisation.

All went out in short time, without the need to enter a hospital. Then I was taking chlorimipramine and prazepam Dr Z. prescribed me. Only after drugs stopped, during a short relapse following my attempt to resume studies, the therapist defined my distress as dependant on an early relationship with my mother. She added that my mental structure was now consolidated, so the better thing to do was to let my distress pass and reach a certain balance.

Dr. Z. then confirmed it too. Close to the end of my therapy I met a German young woman voluntarily working where I had my job. I had a ten-years relationship with her. First anything seemed going well, but the lamb asks for the wolf. In first years I was very concerned so that our relationship went well, but she had a highly despotic temper, and tried to leave me no escape. Thus I swallowed very much during years and when we decided to move to Germany everything again turned over in my mind. I convinced myself I had to follow her even if now I am aware I did want it, so I fell in my deeper relapse. My psychiatrist found a support for me by a German psychoanalyst. In Germany I began working in a restaurant but I was going worse and worse as for the therapy.

At home I did not give any support to my wife that had become a malignant and almighty person. Seven or eight months later I started having a persecution complex so I entered a psychiatric clinic. First they treated me with neuroleptics and lorazepam. They did not reach a definite diagnosis other than autistic psychosis and borderline state. I attempted suicide with the aim of dying, and I am alive only because the rope I hung with, got broken. This happened when they gave me the permission of leaving the clinic for the weekend.

Then they stopped neuroleptics and prescribed only lorazepam, if in need. I underwent an EEG and a brain CAT both referred as normal. When I was in my worst state, I again went in touch with my mother and my sister. Thus I decided to come back to Italy even if I considered both them as prosecuting persons as well. When in Italy I met again the Bolognese psychiatrist I had seen off and on, who prescribed lorazepam and a low doses compound of perphenazine + amitriptyline.

I felt every consultation as a nightmare so I consulted a chief neurologist of Ancona who diagnosed me a profound depression. For three years and half he cured me with many different antidepressant drugs. Some improvements appeared but the basic situation did remain unchanged. Following the advice of my current wife I consulted prof. R. of Pesaro. He tried to help me with high doses of chlorimipramine, delorazepam, and perphenazine + amitriptyline then he sent me to you [the present author]."

The 1^st visit took place on 1st September 2000. He reported severe distress and anxiety. The last psychiatrist he consulted prescribed him 150 mg chlorimipramine, 12 mg perphenazine + 75 mg amitriptyline, and 6 mg delorazepam (daily doses). His job is in a social cooperative dealing with old people. His anxiety distress does not arise in particular moments of the day, while he feels worse on Springtime and Autumn. Many intrusive thoughts have maximal room in his mind. His crisis last days or even weeks. During them he appears changed, and considers himself a superhuman being and the others as very poor people.

Normally he is exactly feeling the opposite. The opposite of all things seems to attract him very much, but he denies it as a choice. When asked to answer without any hesitation and to say the opposite of the colour Red, he replays White. (Cocchi, 1994). With apparently no reason he feels anger or bad against beloved persons. Since some years he prefers sweet things, but does not taste meat bouillon. He does not like hot or even warm temperature. During the night, when sleeping, he does not suffer from cramps, as he did in past, but he has several starts. He does not report any night drooling; as soon as he woke up, he needs having breakfast; no intolerance for light, noise or din reported. His hair is fatty, his speak sometimes dyslalic and he shows a very evident depressed mood.

A QEEG asked by the present author had the following result. "There is an asymmetric distribution of the alpha power, with dexteral prevalence and decreasing of the normal occipital stress on the left half-brain. Pathologically doubtful. A poorly active and slightly unstable trend."

Discussion.

The patient has problems of brain dominance that becomes sometimes reversed for some functions. He is aware that something is going wrong and it names it "to have a crisis." Lacking a coherent frame of reference, he described it in his history with a great approximation. This made him unable to be understood by professionals not acquainted with this very complex mental state. When revised under a suitable light, his written history becomes more interesting and significant. There are probable perinatal risk factors.

"... My mother told me that delivery was long and difficult perhaps because I weighted about 4000 gr. The use of the forceps seems denied, but I have a dislocation in my right ribs. Skull X-rays revealed forehead marks possibly due to the obstetrician's fingers pressing during that delivery . . .". During childhood he had a sort of "kindergarten phobia", with psychological and somatic symptoms, which required to send not him to kindergarten.

" My sister ... differently from what I did, attended the kindergarten. My parents tried to send me there too, but it did not run: I was presenting foods' vomit and continuously quarreling with the other children. So I was staying at home with my maternal grandmother." In elementary school the physiological (dyslexic)-dysorthographic period seems to have lasted longer than usual. We know that this fact can refer to early difficulties of synchronizing some functioning of the two brain hemispheres. "Mainly in the first years I had grammatical difficulties, by omitting double consonants and leaving some words incomplete or mismatched."

Another fact probably linked to an absolute or relative overrunning of the right half-brain is the ability in mathematics. "Even in Milan I attended the first two years of the junior high school where I got sufficient notes but the maximum in mathematics." I noted this feature in dropouts high-school or college students and in college students who entered a psychosis (Cocchi, 1994; Cocchi 1995). Some feelings of derealization appear at the time of the senior high school. " ... but quite secretly I was feeling greatly distressed as for prominent reality and related attitudes. Those last appeared to me as owning magical but mocking features."

A stress reaction following a cold stress (iced coke) elicited both neurological (tunnel vision) and neuropsychological symptoms (impaired coordination of thoughts with speech, and the emerging of opposite words). "At school, in the morning, I drank an iced coke on an empty stomach. I partly lost my sight and I was unable to see anything but the centre of my visual field. A delirium took possession of mine and I cannot coordinate my thoughts with my speech. When I wanted to say that I was feeling sick I said wrong words instead of the right ones, even dirty words instead of plain words. Hardly I could inform my teacher that I was feeling sick since I was afraid of insulting her."

Instead of polite words used in that social situation, the opposite (unpolite or "dirty words") took the priority in his mind. The emotional connotation of words runs on the contrary. Two professionals agreed that the episode came out from neurological and neuro-vascular impairments. " . . . a consulted neurologist said that I could have suffered from a vascular spasm of the brain. The oculist I consulted too spoke about a pain of retinal vessels, . . . ". This could be high speculation, but the patient seems to have done better when he was involved in opposition political groups. Is this compensatory behaviour? (Cocchi, 1994).

"This change paralleled my relationship with groups of leftist persons." When he suffered from his big crisis, he was unable to control his thoughts and left the ability to make any sense of what he was reading. Besides it, he was forced to read since this action worked like another compensatory mechanism. "My thoughts swirled my mind without any possibility of having a resting point. What I was reading had completely become without any sense, but to do it became a kind of mental drug I could not stop." He was fully unable to master the mental opposition "past-present/future", a fact that could relate to a reverse brain prevalence for some functions. "The present had been transformed into something that was burning and I felt my link with the past overturned. Any current action of mine was relating to the past and I could not sustain the idea of its relating to the present or the future."

The following is a clear confirmation of so reverse mental running that is so strongly acting to prevent him from doing otherwise. "The negative counterpart of my positive proposals made me unable to do otherwise and I had my identity reversed." The semantic field of his language appears impaired. "I lost the way of spontaneously referring what it happened to me because every thought did never overlap the meaning I wanted to word. To consider myself as a human being, I should have to discover a perfect speech not to be criticizable by other people." Opposite behaviour arose because this mental state. "So I exactly did the opposite of what I had intended about my life and my values." The first psychoanalytic attempt did not work, but it had some efficacy as a compensatory behaviour against whirling thoughts. "I was having my head full of whirling thoughts and I would like more speaking.

Things did wrong and perhaps I was getting worse, but I did not want to interrupt the analysis lest she should have charged me with therapy resistance." The new psychotherapy of Freudian type was better accepted. " I attended this new therapy twice a week again and I did not lie in the bed, but I had a face to face relationship. The therapist had the habit to let me speak with few interventions . . . " " This therapy made me improved and I became more quiet." In this occasion too I have doubts that the psychotherapy had more worked as a compensation mechanism than a true psychological intervention. I think so because both the probable bases of soft neurology and a relapse during psychotherapy. Eventually, despite a correct diagnosis of depression the patient had in Bologna, Ancona and Pesaro, and many antidepressant regimens, he poorly improved.

Perhaps it went so because depression could be the secondary symptom of very discomforted mental impairment. During the first consultation with me he spoke about a reversal of his self-esteem, when in crisis. " ... he appears changed, and considers himself a superhuman being and the others as very poor people. Normally he is exactly feeling the opposite." He confirmed this strange phenomenon. " The opposite of all things seems to attract him very much, but he denies it as a choice." The test Name the Opposite Colour of Red usually elicits "Black" as the opposite answer depressed people does. Instead of "Black" so typical of depressed persons, he said the opposite "White". " When asked to answer without any hesitation and to say the opposite of the colour Red, he replays White." Long lasting and strong positive feelings appear reversed (Sackeim et al., 1982; Coffey, 1987; Davidson and Tomarken, 1989; Witting and Roschnman, 1993; Schiff and Gagliese, 1994; Schiff and lamon, 1994). " With apparently no reason he feels anger or bad against beloved persons."

The QEEG could confirm what he reported about the EEG made in Germany. I cannot use this alpha power prevalence in the dexteral half-brain as a significant datum because that QEEG is the only one I have got in people like this patient. I prescribed a drug therapy with the aim of stabilizing the normal sinistral half-brain dominance, and he had less crisis till now. Of course I left a low doses antidepressant therapy. It is too early for reporting these results since such therapy is still a work in progress.

Conclusion.

This new case of temporarily reversed half-brain dominance for some function is highly suggesting this kind of trouble. Larger casuistry will only let of giving a coherent description of what I think a poorly understood psychiatric syndrome.

References.

Cocchi R.: Problems of attention and concentration leading to interruption of studying by high school and university students: A report of 4 typical cases. It. J. Intellect. Impair. 1994, 7: 29-38.

Cocchi R.: Scientific college dropouts and the risk for psychotic outcome: Four male cases. It. J. Intellect. Impair. 1995, 8: 37-43.

Cocchi R.: Defective hemispheric dominance and cognitive behaviour: Speculative considerations. lt. J. lntellect. lmpair. 1994, 7: 19-27.

Cocchi R.: lntrusive opposite emotional thinking in a chronic "schizoid-affective" woman. A stabilízed ínverse half-brain dominance of a specific function? lt. J. lntellect. lmpair. 1996, 9: 163-168.

Cocchi R. Opposite half-brain dominance of specific functions? Another case in a Down child under drug therapy. It. J. lntelled. lmpair. 1998. ll: 151-156.

Coffey C.E.: Cerebral laterality and emotion: The neurology of depression. Comprehens, Psychiatry 1987, 28: 197-219.

Davidson R.J., Tomarken A.J.: Laterality and emotion: An electrophysiological approach. In: Boller F., Grafman J. (Eds): Handbook of neuropsychology. Voi. 3. Elsevier, Amsterdam 1989: 419-441.

Sackeim A., Greenberg M.S., Weiman L., Gur R.C., Hengerbuhler J.P., Geshwind N.: Emispheríc asymmetry in the expression of positive and negative emotions. Arch. Neurol. 1982, 39: 210-218.

Schiff B.B., Gagliese L.: The consequences of experimentally induced and chronic unilateral pain: Reflections of hemispheric lateralisation of emotion. Cortex 1994, 30: 255-267.

Schiff B.B., Lamon M.: lnducing emotion by unilateral contraction of hand muscles. Cortex 1994, 30: 247-254.

Wittling W., Roschmann R.: Emotion-related hemisphere asymmetry: Subjective emotional responses to laterally presented films. Cortex 1993, 29: 431-448.

First published on Internet: February 2001. Copyright by Renato Cocchi, 2001.

Author's address: dr Renato COCCHI, via Rabbeno, 3
42100 Reggio Emilia (Italy)
renatococchi@libero.it

Italian translation

Theoretical bases

Clinical cases

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