A CASE
OF HALF-BRAIN UNSTABLE DOMINANCE, WITH CONTINUOUS FLUCTUATION OF THE OPPOSITE
CONTENT ON EMOTIONAL BASE, AND CONSEQUENT MAKING IMPOSSIBLE OF TAKING ANY
DECISIONS. A DESCRIPTION OF THIS SYMPTOM IN A 33-YEAR-OLD MAN, WITHOUT EVIDENT
OBSESSIVE-COMPULSIVE DISORDER OR A MAJOR DEPRESSIVE EPISODE.
Renato
COCCHI, a neurologist and a medical psychologist.
Summary.
It is
reported a clinical case of pathological inability to take decisions, in a
university student of 33 years. The features, probably, makes it as a primary
form. There appear poor relationships with the Major Depressive Episode, or an
Obsessive-Compulsive Disorder of Personality, as described in the DSM-IV
(1995).
An
other interesting element is that such inability disappears, when it deals to
decide things that refer to third persons or they are without any personal
emotional implication.
Of
fact, he might have a situation of unstable half-brain dominance, with opposite
continuous fluctuation on emotional base, and consequent making impossible to
take decisions on own really behaviour. By differing to what written on the
DSM-IV, here this symptom seems seen as isolated, and could be a particular
response of stress.
Key Words: reversebrain,stress, inability, take decisions, hlf-brain dominance, fluctiation,
Major Depressive Episode, Obsessive-Compulsive Disturb, drug therapy, trial.
Theoretical bases
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A
university student of 33 years, listed in Jurisprudence, reports difficulty in
his studies, not succeeding to sustain more than an examination per year. His
problem is not a lack of concentration, but a continuous indecisiveness that
drives him to abandon immediately the study, because he is never sure on the
right method to do it.
Of facts,
we might be in presence of unstable half-brain dominance, with continuous
fluctuation to the opposite on an emotional base. Consequent it makes
impossibly to taking any decisions. This indecisiveness doesn't come out when
he has to decide things related to third persons or without any emotional
implication of himself.
The
symptom of indecisiveness was reported in the DSM-IV either in the Major
Depressive Episode and in the Obsessive-Compulsive Disorder of Personality.
Both diagnoses are unfit to this patient.
Differently
to what reported on the DSM-IV, here this symptom seems present itself as
alone, and could be a particular response of stress.
Recently
a man of 33 years, who had already introduced himself by an e-mail, came to my
observation. He was a subject with inability to take important decisions for
his own life, because any intention of doing a choice, becomes at once
frustrated by the thought that alternative one would be more convenient.
However
even the possible alternative meets immediately the same difficulty. It is
always the other choice to be thought the right one. In this way, he cannot do
any behaviour, with time wasting and consequent psychological dissatisfaction.
I have to
say that this person was only partly aware about this cognitive feature, and
for which he thought as primary the difficulty of studying, which instead
appears clearly as a secondary one.
His
conviction deceived also me, and inclined me to believe of dealing with a
concentration trouble, as in the other cases I reported. I think instead I
found an enough known symptom (Cocchi 1996; 1998;
2002; 2003a; 2003c; 2993d; 2007a; 2007b), but it may be interpretable in a
completely new way, when observed by the perspective of the troubles of the
half-brain dominance.
The case history.
This was
the first contact by email.
. . .
I am a student of jurisprudence in the university of ****, aged 33. Casually, I
got knowledge of yours articles regarding the concentration troubles, following
a search on internet on problems and methodology of studying.
I find
a great deal of my troubles in the histories you reported, which pollute my
work on the books since much time.
To
tell the truth, many intrusive thoughts and difficulties I have in the study
even influence other spheres of my life, from that affective to that of
relationships of friendship, of work, but straight even the simplest decisions
(EG. To decide to go to a place, to buy something, etc.) It will be already
much if I will succeed to end writing this email to you, without throwing it
out and to leave all as it is.
Since
many years I am consulting every kind of specialist (psychologists,
psychiatrists, psychotherapists who practise hypnosis, . . . ) but till now the
results seem poor, at least as for the study.
Now I
am under treatment with a psychotherapist whose name I had by the psychiatrist
of the Local Health Unit of ** [A Tuscan town] where I am living. This
specialist should give me behavioural strategies, but they do not appear to
have any results, as for studying.
He
should give me behavioural strategies, that yet to the aim of the study not
seem to give me any results.
I am
inclined to doubt on every thing and I am aware that this represents a
pathological aspect of mine, but what I can say after having I entrusted to the
suggestions of many doctors and then non-being arrived to any ( or nearly any )
result?
I have
suffered from depression and this occurred in several moments. I think that I
have even some genetic predisposition since my mother too had suffered from it
and recently also my sister.
I
would have many things to say, but already the fact that I do not succeed to
put them into an Order, elicits my anxiety, then I limit me to what I have
already written.
Thanking
for consideration, I would like to get some suggestion to such intention . . .
This is
the second email following my answer.
I
thank you for you had me answered. I want me to excuse for the hasty way with
which I ended my precedent email, a fact due, as I mentioned, more from the
frenzy and anxiety that come out when I risk speaking about my feelings and
disturbs.
I
surely did not look for any consultations via internet, but I liked to know if
in my case (so a few and badly described) you might help me.
Such
help I have always sought by the doctors, in certain moments perhaps in a
little obsessive way, but this is always better than leave gone himself or
undertake many worse roads.
Yet, I
think I did never find the chance of a right therapy. Some of your colleagues
said that my problem was a problem where it doesn't need the use of drugs.
I
presume that there are various opinions about such task. Nevertheless, I ask
you as for the disorientation where a patient may be in front of as many ideas.
I would
like to know how can I take a reservation and how I can reach your clinic.
This is
the report of the first consultation, based on the card written in that
occasion.
The
second ten days of September 2007, the first consultation. He works as clerk in
a hotel, during the weekends.
He has
difficulties in studying, as enrolled in jurisprudence. Now, he acts less than
an examination
per year.
Intrusive thinking is continuously. With no trust in himself, he is always
undecided, but only for the choices that concern himself.
To the
test "Which is the opposite of the colour Red?", he answers:
"Green". Usually he does not bear the heat. He has normal greediness
to feed sweet things, and normal like for the meat or cube broth. The milk
disturbs him, since he is suffering from ulcerous colitis. Stomach ache occurs,
and he is inclined to the diarrhea. His hair is often
fat.
Frightful
dreams do not happen. In past he woke up tired. Also in past he had feelings of
dizziness, and of faint. He bears badly the noise. During the day, he has the
dental shut. No losing of saliva occurs during the sleep. In the evening he is
better. He has days of pallor with the eye sockets. In past he has suffered
from a stiff neck. Usually he doesn't get up with sex erection.
He has
emotional axillary perspiration. Someday dyslalia occurs. It happens to him of not recalling the
names of persons whom he knows well. Sudden asthenias without reason occur, and
he feels some pain into the calves. He has musical tunes (songs) as intrusive.
His dry
birth was a risk factor. In childhood, he was shy and a little solitary. At
school I did better in Italian.
I
prescribed a trial therapy, at low dosing, with glutamine,
pyridoxine, carbamazepine, bromazepam
and chlomipramine.
I
proposed an appointment for the checkup after one
month and half, or two months.
The first
email, five days after the consultation.
"I
am writing to give a report about these first days, after taking the treatment
you prescribed to me. I began it the evening of the same day of the
consultation and I followed it according to the directions you gave me.
To
tell the truth, I did not find any change of my psychological conditions of
uneasiness. Of course, I realize it was a short time.
To
descend into details, as for the study, I feel always usual uncertainty and
insecurity about the method of studying (What, how, and the way of studying).
I find
myself unable to know as I can manage the long time lasting till next
examination sessions, starting on December. I would like to use better this
time for succeeding to prepare me in suitable way ( unfortunately for me that
means to be ready in nearly perfect way . . . )
I have
an important and enough big subject as for its contents, which needs revision,
then I would like to prepare at least an other subject. I feel as unable of
programming my studies.
Unlike
you feared as possible, the chlomipramine does not
affect my sleep.
So in
the night I am sleeping without problems.
In
case, I feel some drowsiness mainly in the early afternoon, and I need a nap.
Besides,
I want to inform you that I was assuming glutamine joined to an integrating
protein, about 150mg per day, just before your prescription.
I am
awaiting your reply.
After 18
days from the beginning of the therapy I got this email:
. . . With
this email I wish updating you on the evolution of my psychophysical conditions
following
the treatment you prescribed, which I started, nearly three weeks ago.
As for
the study, I did not get any positive result in improving my concentration and
attention on what I am doing; On the contrary, to tell the truth, what I try to
do is enough little.
The
uncertainties on the method to adopting are going on and they quickly lead me
to abdicate to develop any task.
But
worries, doubts and uncertainties even torment other plains of my life, in my
relationships with the others, in the little choices of every day.
I am
feeling the usual inadequacy in daily matters and situations
days,
so fearing of being wrong and not doing the "right thing", a fact that
elicits uneasiness and
nervousness
(however, now this last appears a little calmed ).
I am
saying all that not because I wish a psychoanalytic session by internet but to
make a clear picture of "manias" that afflict me the day long.
Have
not either the pretension that your treatment have immediate effectiveness, but
only to give an updating, an aim, to say the truth,
I do
not know whenever I may do it.
After 27
days from the beginning of the therapy I received this email:
". .
. A week ago you said me that within not much I should come back for the checkup. So, by considering even that, to your saying, the
treatment not has had any effectiveness in more than three weeks from the
beginning of the therapy. [In facts, he always
said it, while I heard only his complaining].
I
would know when exactly I have to take the appointment. Lately, my things do
not improve, the study doesn't go on at all and I am not doing anything for
whole days."
Meanwhile
I have collected in a unique text all his emails, and I understood that his
difficulty is not "to study" but "to decide to study." The
critical point is in taking a decision and pursuing it, a fact that doesn't
concern only studying.
The third
week of the October 2007, the first checkup, after 42
days of drug therapy.
As he
wrote in his emails, he did not resume to study because he did not know to
decide which is the better method of studying.
His
ulcerous colitis did not improve and the same for his stomachache.
In this period he did not suffer from any diarrhea.
His hair is fat as before the treatment.
The noise
is troubling him always. More days of pallor with the eye sockets occurred.
It seems
he lowered the axillary emotional perspiration. The
amount of dyslalias did not decrease while he
remembers better the names of the persons.
Sudden
asthenias did not happen anymore, as the pain in the calves too.
The
intrusive musical tunes (short songs) reduced. He feels more
"supported" [ie. He is stronger, in a
psychophysical meaning]. Recently, he had an bad dream.
He
confirms my interpretation, that at the base of his troubles there is mainly
the inability to decide. This happens when there is a personal emotional
involvement.
Nevertheless,
he is doing better, and he feels more "adjusted", even if he has had
not, or, has not still had, any result on studying. In fact, he did not get
improvement on his continuous indecision that prevents him, among the other
things, of applying to studying, which he thinks his main problem.
Therapeutic
variation: Reinforced the antistress drug therapy.
Discussion.
The
symptom of the lack of the ability to decide is enough known but perhaps have
had the attention that deserved. In this patient, this incapability doesn't
exist, if he needs to take decisions that not emotionally involve him, either
personal or regarding other people. In this person the symptom is practically
isolated, though inside to general modest discomfort with both depressive and
obsessive traits.
In the DSM-IV
(1995), the inability to decide can be found again in the range of the Major
Depressive Episode, where it is said that many individuals report a compromission of the ability to think, to pay concentration
or to take decisions (A8 criterion).
More clear
too is what described in the Obsessive-Compulsive Disorder of Personality
(DSM-IV, 1995). Among the symptoms and disturbs associated, we find writtten: When the rules and the programs don't get a
correct response, the take decisions can become an expensive, often painful
process in terms of time. The individuals with Obsessive-Compulsive disturb of
Personality may have such a difficulty to decide which are priority tasks, or
which is the better way to develop a particular action, that their can never succeed
to begin something.
Abraham
and Shirley, 2006, add the inability to decide among the depressive symptoms
together to the concentration lack of.
However,
the datum that such inability to decide may be found even within the Major
Depressive Episode, may mean two things. 1. It is a not specific symptom. 2.
Between the Major Depressive Episode and the Obsessive-Compulsive Disturb of
Personality there is, at least in part, a continuum that may explain the
presence of some common symptoms.
In this
patient's case history has been reported some depressive and some obsessive
traits, but that is rather little to do a diagnosis of Major Depressive Episode
or Obsessive-Compulsive Disturb of Personality.
The
problem of the difficulty to decide had an intuition, and I already reported it
as having something to do with the half-brain dominance, two previous articles.
The first one concerned a child of eight years with opposition and destructive
behaviour (Cocchi, 2002)
"The
negative safety of the child, as the ground of his behavioural opposition,
transformed into insecurity, at least at school. Even when doing well, the
child asks the teacher, about continuous confirmations of not being wrong. At
home he has the habit of the obstacle elusion (So, for not has to choose?)
A
possible interpretation of this new behaviour is that currently the child bears
in mind both the engrams, either the positive and
negative one, but is not still sure that the choice of the positive engram is that right".
More
clear this intuition in a university student with difficulty in studying,
problems of half-brain dominance and episodes of inability to decide (Cocchi, 2003a).
"In
this young person, the indecision seems to have its cause in an alternation of
the opposite images of the two half-brains. So, there is a difficulty of
choosing because he cannot succeed to stop the thought on what is the right
thing to think or to behave."
In the
here described subject there are problems of half-brain dominance. 1. Intrusive
thinking; 2. Response of Green to the test "Which is the opposite of the
colour Red (Cocchi, 2003b; 2004; 2005); 3. Intrusive
musical tunes (as short songs). 4. Probably even to do "not remember the
names in persons who I know well", as dysfunction of the left half-brain.
It is not
clear if the problem of the concentration lack, exists indeed or, following a
search on internet, it is the name given to the fact of not deciding to start
studying.
In his
first email he wrote that he did" a search on internet on problems and
methodology of studying", and not on the loss of the concentration.
Casually,
he found my articles on the lack of concentration and difficulty in studying or
dropping out.
Differently
to what reported on the DSM-IV (1995), here the symptom seems an isolated one,
and this would be a novelty because, in this form, I cannot find it described.
It is
possible that it works as a particular response of stress, and according to, I
set up the approach of the drug therapy.
PS.
After many months of different drug trials, I was unable of gaining any
improvement on it, and the patient stopped to come back for the checkup
Conclusions.
The
clinical case of pathological inability to take decisions, of a university
student of 33 years, listed in jurisprudence, introduced features that,
probably, make it as a primary form. There appear poor relationships with the
Major Depressive Episode, or an Obsessive-Compulsive Disorder of Personality,
as reported in the DSM-IV (1995).
An other
interesting element is that such inability disappears, when it deals to decide
things that refer to third persons or without any personal emotional
implication.
Of fact,
he might have a situation of unstable half-brain dominance, with opposite
continuous fluctuation on emotional base, and consequent making impossible to
take decisions on own really behaviour. By differing to what written on the
DSM-IV, here this symptom seems seen as isolated, and could be a particular
response of stress.
References.
Abraham
PF, Shirley, ER. (Letter to the Editor) New Mnemonic for Depressive Symptoms Am
J Psychiatry 2006, 163: 329-330..
American
Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders.
4th ed.
Cocchi R. Intrusive opposite emotional thinking in a chronic
"schizo-affective" woman. A stabilized
inverse half.-brain dominance of a specific function?
1996 Riv. It. Disturbo Intellet. 1996, 9: 231-237.
<www.reversebrain.net/Case1.htm>
Cocchi R. Opposite half-brain dominance
of specific functions? Another case in a Down child under drug therapy. . Riv. It. Disturbo Intellet. 1998, 11: 199-204.
<www.reversebrain.net/Case2.htm>
Cocchi R. A child of 8 years with probable problems of
inverse brain dominance. 2002, <www.reversebrain.net/Case6.htm>
Cocchi R. Troubles of the half-brain
dominance, in three dropout university students. <www.reversebrain.net/Case5.htm>.
Cocchi R. The test "which is the opposite of the Red colour"in 325 outpatient's subjects. 2003
<www.reversebrain.net/Domin11.htm>
Cocchi R. Temporary reverse dominance of some brain function
in a man aged forty-six , 2003c, <www.reversebrain.net/Case3.htm>.
Cocchi R. A girl aged ten with Smith-Magenis syndrome and possible reverse brain dominance of
some brain functions 2003d, <www.reversebrain.net/Case4.htm>.
Cocchi R. Short-lasting sudden episodes
of green colouration of the whole visual field, even persistent six months
after a cranial trauma. 2004, <www.reversebrain.net/Case10.htm>.
Cocchi R. The answer "White"
to the test "which is the opposite of the Red colour" and previous
behaviour of "The contrary Mary.": An investigation on clinical
reports of the years 2003-2004.,<www.reversebrain.net/Domin16.htm>.
Cocchi R. A new case of fluctuating half-brain dominance in
a young adult aged twenty-two <www.reversebrain.net/Case9.htm>
Cocchi R. The fear of strangling his son in a man of 27
years.. A phobic-obsessive-compulsive disorder with probable alteration of the
half-brain dominance. 2007b, <www.reversebrain.net/Case11.htm>
Posted on internet on 21 March, 2006. Copyright by Renato Cocchi, 2008
Author’s
address: dr Renato Cocchi
Via Rabbeno, 3 –
42100 Reggio Emilia
Email: renatococchi@libero.it
Theoretical
bases
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