The Psycho-Somatic Syndrome of Spurious Pregnancy After the Menopause
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J Neurol Psychiatry: first published as 10.1136/jnnp.6.1-2.17 on 1 January 1943. Downloaded from THE PSYCHO-SOMATIC SYNDROME OF SPURIOUS PREGNANCY AFTER THE MENOPAUSE BY BETTY JACOBS Assistant Physician, Royal Edinburgh Hospitalfor Mental Disorders (RECEIVED 23RD OCTOBER, 1942) Spurious pregnancy (false pregnancy or pseudo- satisfied in attributing it to wish fulfilment. The cyesis) constitutes a subject of considerable practical discrepancy, however, between the number of cases importance not only for the general practitioner and with a strong desire for pregnancy and those actually obstetrician but also for the psychiatrist, as it pre- presenting signs of pseudocyesis makes it clear that sents one of the most impressive examples of the wish fulfilment can result in the production of this influence of emotional mechanisms on physical particular psycho-somatic syndrome only under processes. certain conditions, still to be defined. The occurrence of this condition in humans and The following case represents a contribution to the animals has attracted attention throughout the ages, understanding of some of those conditions. one of the earliest descriptions being found in the writings of Hippocrates. Paddock, who in 1928 made Mrs. E. S. aet. 53 was admitted on 24th September a the 1941. Family history: The mother, to whom the patient survey of literature on that subject viewed from was unduly attached, is described as a quiet, sympathetic the obstetric aspect, quotes various authors, among woman with a deeply religious outlook. She was a mid- them James Y. Simpson and wife of repute. The father, who was 13 years older than Montgomery (1863). copyright. The psychological significance of the syndrome, how- his wife, died when the patient was 7 years of age. No nervous or mental illness has been reported in the family. ever, has not received adequate attention. While Personal history: The patient was the only child. She some authors maintain that pseudocyesis is found describes her early childhood as happy; but she was mainly in women of the 25-35 age period, Simpson always solitary and introspective. So strong was her and Montgomery emphasize its more attachment to her mother that she disliked leaving home frequent to go to school. She recalls scenes when she wept at the association with the climacteric period. Paddock very thought of leaving her mother and she found it maintains that most of the cases reported were young difficult to mix with other children, her contact with her women. He regards false pregnancy at the climac- schoolmates being entirely superficial. Occasionally teric as part of the general she suffered from " bilious turns," during which she http://jnnp.bmj.com/ menopausal syndrome. enjoyed a sense of pleasure and satisfaction because she Maranon (1929) supports Simpson and Montgomery could remain beside her mother and have her special in their view that the frequency of the condition is care and attention. She was obsessed with the idea that highest at the climacteric and classifies the condi- she was different from her friends and became progress- tion as a metabolic ively more dependent on her mother, the only person in disturbance originating from whom she could confide and from whom she could emotional causes. " In women whose desire to derive comfort and encouragement. The menarche remain young makes them forget how old they are occurred at the age of 131; menstruation was irregular . .it is striking to note how the suppression of the until the age of 18 when a normal cycle was established. menses coincides with a general increase in According to herself, she was small and under-developed on September 29, 2021 by guest. Protected the size until the age of 18, when she began to develop normally of the abdomen." He states that the condition may and her outlook became less solitary and dependent. be due to an unfulfilled desire to have children or to At the age of 191 she married, her husband being an effort at self-deception that sexual power may not 12 years older then herself. She says that because of his yet be lost. Schwarz age she was less afraid of him than of most other men and (1933) states that pseudocyesis that he gave her a feeling of protection akin to that tends to occur mainly in women with a premature which she had come to associate only with her mother. menopause. From the psychiatric point of view, That feeling of dependence remained a prominent feature Kehrer (1928) has recently surveyed the literature of her relationship to him. Her attitude towards the and reported on his own physical side of marriage was always immature * she was observations. He says that frigid and constantly harboured a fear of becoming preg- the supposition ofpregnancy may be the outstanding nant. This fear was fostered by her mother who thought delusion in a psychosis and that in many instances childbirth undesirable for her daughter because of her mental phenomena may be present in a marked delicate childhood. Consequently the patient sub- degree even in the absence of mitted to intercourse only infrequently, and then only bodily changes. The when- coitus interruptus was practised. Only in the most recent review of the literature has been con- 13th year of their marriage did normal intercourse take tributed by Moulton (1942). place on a few occasions and it was then that she became Those authors who have stressed the psycho- pregnant. Even now she complains that her husband pathological implications of the took advantage of her and that the pregnancy should condition have been never have occurred. Throughout the pregnancy she C 17 18 BETTY JACOBS J Neurol Psychiatry: first published as 10.1136/jnnp.6.1-2.17 on 1 January 1943. Downloaded from was unhappy and fearful, she had persistent hyperemesis, about her "pregnancy" and kept on asking other lost her appetite and on several occasions during the latter patients whether she would be all right. 3 months visited her doctor in a state of extreme agita- Phy sical Examination. Her abdomen was distended tion because she had ceased to feel life. She kept saying and firm, the swelling reaching the level of the umbilicus. that something dreadful was going to happen. Her In shape it was broader than that found in pregnancy, no physical condition was poor at the time of delivery, foetal parts could be felt and no foetal heart could be labour lasted for 2 days and was preceeded by 3 panic located. She could simulate foetal movements by con- attacks, during which she was very agitated and main- tracting and relaxing the abdominal muscles. No dull- tained that labour had commenced. Inertia persisted ness could be elicited on percussion, the note being throughout the labour and the patient was quite unco- hypertympanitic all over, suggesting the condition of operative. A forceps delivery was performed and the meteorism. The breasts were full and enlarged and baby, a girl, was stillborn. The puerperium was cha- from the nipple a serous secretion could be expressed. racterized by apathy and lack of initiative and her Vaginal examination revealed no evidence of pregnancy. recovery was very gradual. Information received from a The cervix was elongated and lacerated, the scar causing friend suggests that she had a melancholic depression at marked puckering of the edges. There was some laxity this time. She became more shy and secretive and the of the pelvic floor and the perineum was deficient. The doctor advised the husband that the patient should have uterus, however, was in good position, quite mobile, and another child. She became pregnant 2 years later. of normal size. The appendages were palpable on both Though she had the same fears and apprehensions as in sides and the right ovary was very slightly enlarged. The the first pregnancy, her physical condition was satis- Aschheim-Zondek Reaction was performed and the factory and hyperemesis much less persistent. The result was weakly positive. Two weeks later this was labour, like the first, was complicated by inertia but repeated with a negative result. delivery was spontaneous and this child, a boy, was alive. At first, repeated reassurances that she was not preg- She made a good recovery, took an interest in the child nant did not have the slightest effect. She was treated by and became very devoted to him. She remained as psychotherapy and although she was very unco-operative reticent as ever with strangers, but in the home she was less in the initial stages, she was later more readily influenced. quiet and secretive. Her whole life had obviously been She began to talk more freely about herself, said she had made much happier by the arrival of the baby. Four wanted to have another child, that she had never got over years later, however, when her husband developed the disappointment of the stillbirth, and that even the phthisis, she reverted to her former anxious state with its birth of her son had not compensated her for the loss of inhibitions and feelings of inadequacy. After his death the daughter. About six weeks after admission, she 6 months later, she made her home with her mother as admitted that she was not pregnant, and her depression she had done before her marriage. She made a good gave way to a state of comparative contentment. Never- adjustment to this life and was contented and happy until theless, the physical signs simulating pregnancy per- the death of her mother 2 years prior to admission. She sisted; but a week later the abdomen " deflated " became very depressed and felt that a part of herself had overnight, the breast secretion ceased and the Aschheim- died with her mother.