NEW YORK THE CONCURRENCE of mental illness in two or more members of the same family has long posed a problem of concern to psychiatry. In an older era, this problem was investigated almost exclusively from the point of view of the psychoses. Studies of heredity and of folie \ l =a`\deux best exemplify this older vantage point. More recently, the intrafamily conflicts giving birth to the psychoneuroses have emerged into the sunlight of objective inquiry. Psychoses and psychoneuroses have rarely been considered together, however. This paper reports a family of which at least 4, and perhaps 6, members were psychotic and stresses the effect of this knowledge in causing a psychoneurosis in another sibling, a soldier. The relation of psychoses and psychoneuroses is discussed from the standpoint of nomenclature, traditions and basic conceptions.
REPORT OF A CASEA soldier aged 28 was admitted to the psychiatric division of a convalescent hospital in April 1946, complaining of headaches and easy fatigability. The family history was notable in that the paternal grandmother died in a psychiatric hospital. The diagnosis was probably senile dementia, since the patient remembered that she had first been hospitalized in her eighties. A paternal uncle was also mentally ill for many years, was hospitalized several times and was described by the patient as "very wild-he was always escaping from institutions." The mother and father were described as nervous but otherwise well; apparently, the father, a shipyard worker, was able to maintain the family at a marginal or somewhat better economic level. The patient stated that his father had always seemed more antagonistic toward him than toward the other children, and he recalled a dramatic incident when he was 10 or 12 in which he knocked his father down and out.He described his father as a steady worker, but "a man whose temper seems to dominate him. I think he's a sick man, too." The relationship to the mother, a somewhat passive woman, was apparently not close. The parents were frequently in conflict, but never to the point of separation. The patient recalled frequent quarrels in the home and much protecting of the children on the part of the mother against the temper tantrums of the father. On the whole, he remembered the home as one in which some degree of affection was manifested by both parents toward all the children during their formative years.The patient had 11 siblings, 5 brothers and 6 sisters. Three sisters and 1 brother had been hospitalized with verified diagnoses of schizophrenia. One pair of twin sisters were hospitalized within six months of each other, at the age of 19; they were interned for a period of six months, in 1 case, and of twelve months, Formerly Captain Medical Corps, Army of the United States. Downloaded From: http://archneurpsyc.jamanetwork.com/ by a Monash University Library User on 06/04/2015