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Ideas of changing sex, and the doubt about sexual identity which these ideas imply, are considered to be “invariable” and “pathognomonic” features of schizophrenia by Macalpine and Hunter (1955). The authors quote, in a footnote, a personal communication from Manfred Bleuler dated 1953 which states that Eugen Bleuler would have agreed that “schizophrenics are almost invariably, if not indeed invariably, in doubt about the sex to which they belong”. Planansky and Johnston (1962), in an uncontrolled study of 150 male schizophrenics, found that only 15 per cent. (22 cases) exhibited “direct expression of confusion of sex identity” and only 4·7 per cent. (7 cases) had clear delusions of having changed into a woman. Jackson (1960), Weckowicz and Sommer (1960), and Skottowe (1964) state merely that these ideas occur, or occur frequently. A check of the standard English language teaching texts reveals that Allen (1962), Bleuler (1911), Mayer-Gross et al. (1960), Noyes and Kolb (1963) and Sim (1963) make only oblique references to ideas of changing sex, whilst Anderson (1964), Arieti (1959), Bellak and Benedict (1958), Curran and Partridge (1963), Fish (1962 and 1964), Freeman et al. (1958), Henderson and Batchelor (1962), Merskey and Tonge (1965), and Stafford-Clark (1964) make no reference at all. In their study of schizophrenic delusions Lucas et al. (1962) similarly do not mention change of sex. They state simply that (in males) 30 per cent. had a sexual content.
A previous study of the incidence of subjective ideas of sexual change in male schizophrenics has briefly noted the lack of precise quantified data in the literature and the standard English language teaching texts (Gittleson and Levine, 1966). There are no controlled studies of these ideas in female schizophrenics. The studies of Klaf and Davis (1960), Planansky and Johnston (1962) and Lukianowicz (1963) refer only to males.
SummaryOne-hundred female nurses at a psychiatric hospital were interviewed in an attempt to assess the overall frequency of having been the victim of indecent exposure and to describe it as experienced by the victim.Forty-four of the subjects had been victims of indecent exposure, one-third of these on two or more occasions.The attitudes of those who had been victims were no different from the attitudes of those who had not. One-third of all incidents had not been disclosed to anyone. In over one-fifth of the episodes the reaction of the family and friends in whom the victim confided had been more distressing to the victim than the episode itself.
Obsessions may appear for the first time during the course of a depression without having been present before the onset of the depression. Such cases (hereinafter called “Gainers”) have been noted by Esquirol (1827), Prichard (1835), Marc (1840), Schüle (1886), Gordon (1925), Saunders (1932), Lewis (1934), Woolley (1937), Muncie and White (1937), Lion (1942), Stengel (1948), Terhune (1949), Sargant and Slater (1950), Pollitt (1956), Reda and Paretti (1958), and Skoog (1959). The frequency of this phenomenon, however, remains uncertain. Heilbronner (1912) described 22 cases of melancholia with obsessions of whom 18 were “Gainers”. Vurpas and Corman (1933) described 27 cases of depression with obsessions (two organically based) of whom 24 were “Gainers”.
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