The Year's Best Science Fiction 11

TITLE: A SINGULAR CASE OF EXTREME ELECTROLYTE BALANCE ASSOCIATED WITH FOLIE A DEUX

[Reproduced from Worm Runner’s Digest, 1965, VII, 2 (78-79).]

AUTHOR: ROBERT D. TSCHIRGI

University Dean of Academic Planning University of California, Berkeley, California

The Case of L. W.

Chief Complaint (obtained from husband): Sudden collapse during cross-country hike.

Present Illness: This approximately forty-year-old, well-developed, well-nourished Caucasian female, a refugee housewife of Mediterranean extraction, was D.O.A., accompanied by her husband and two daughters aged twenty and twenty-one. The patient’s history was obtained from her husband, who was somewhat incoherent and appeared to be a latent schizophrenic with delusions of grandeur.

The family had been moderately successful sheepherders along the eastern Mediterranean seaboard, and no previous history of electrolyte balance could be elicited. However, descriptions of strange nocturnal behavior by the uncle-in-law of the deceased might represent a tendency toward mental instability in the husband’s family. During a sheep drive several weeks before the patient’s death, her husband and his uncle quarreled over the disposition of some of the sheep, and they separated with the husband apparently harboring paranoid delusions.

The acute onset of the patient’s terminal disease was inextricably woven into a bizarre hallucinatory episode of her husband, during which he described voices and visions warning him of impending disaster. His behavior during this episode was sufficiently irrational to arouse the neighbors, who attempted to calm the disturbed man by humoring him and offering to dispose of the visions by forcibly ejecting them from his house. Rather than allaying his fears, this served only to aggravate his paranoia, and he forced his wife and two daughters to leave their home and accompany him in a rigorous cross-country flight, during which the patient developed the acute and fatal episode of her disease.

The patient had delivered two normal pregnancies at home, with no history of edema or toxicity. She had at no time complained of excessive thirst, and was apparently free of symptoms until the fatal, fulminating attack. Very little family history was obtainable, but no similar condition was known on either her paternal or maternal side.

Psychologically, the patient appears to have been completely dominated by her husband and his uncle, and to have become so submerged in her husband’s mental aberrations that she began to share his hallucinations and delusions. This transference to her husband of an unresolved Electra complex may well have been the psychosomatic basis for the altered adrenocortical physiology which seems to have been responsible for her terminal disease. We cannot, of course, eliminate the possibility of a libidinous attraction towards her uncle-in-law, who, no doubt, represented the more masculine father figure. This multifaceted ambivalence and superego-id conflict resulted in schizoid withdrawal and an attachment to mysticism centered around her husband’s psychotic manifestations. Indeed, the subsequent history of her two daughters who were seen in their third trimester, having become pregnant incestuously, indicates the pervasive and malignant nature of this psychiatric problem.

At autopsy, the primary findings were those characteristic of right heart success, recently described by Assali as “tissue drought,” and attributed by him to vagus imbalance causing the heart to beat counter-clockwise. The tissues were dehydrated and friable, and the sodium and chloride content of the body fluids was extremely elevated. The adrenal glands were hypertrophied bilaterally, and histologic examination revealed marked hyperplasia of cortical cells.

Final Diagnosis: This is believed to be a unique case of acute, fulminating salt-saving syndrome resulting from a primary hypertrophy of the adrenal cortices. There can be little doubt that chronic psychosomatic forces interacted with a genetic predisposition to generate the constellation of pathologic factors involved in this remarkable case. The suddenness of onset of the final illness, the rapidly downward and fatal course, and the absence of previous symptoms lead one to suspect that the emotional shock to the patient of seeing her home destroyed minutes after her escape with her family produced an overwhelming hyper-adrenalcorticism.

Then the Lord caused to rain upon Sodom and upon Gomorrah brimstone and fire from the Lord out of heaven; and He overthrew those cities, and all the Plain, and all the inhabitants of the cities, and that which grew upon the ground. But Lot’s wife behind him looked back, and she became a pillar of salt.—Genesis XIX, 24-26.

I am pleased to report, Dr. Tschirgi’s note concludes, that I was laughed off the podium.