Type 2 Somatoform example

8/19/2019 Type 2 Somatoform example

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The Case for Jim Henson

What if one day Jim Henson walked into the doctors oce

complaining that, every time he takes o Kermit the frog, he cant move

his hand. Jim Henson, the famous puppeteer from Hollywood, at age 5

is having pro!lems understanding why his hand is not responding to his

thoughts. "ven though this case is complete #ction, $ still #nd it

interesting to wonder how his !rain worked. %r. Henson, apart from

oo&ing with creativity, was

diagnosed with a highly

functional autistic syndrome.

'his %aster of entertainment

left such a legacy that inspired

the writing of () dierent

!iographical !ooks, yet non of

them talk a!out his crisis,

out!reaks or symptoms with

autism.

*utistic people see the world in a dierent way, compared to thenormal human+ then again no two humans are eual either. %ay!e the

autistic !rain has a propensity to e-perience and interpret stimulus at a

dierent level than the normal !rain.

$f you were to ask Jim Henson /What !rings you to the psychiatric

clinic today01 he would pro!a!ly give you a complaint like the one that

follows. Jim would start

/$ can2t recogni&e my arm anymore. $ was at my workshop,

improving my Kermit puppet, when $ accidentally cut my

#nger. 'he cut wasn2t deep or wide. $t was a !a!y cut, and $

didn2t even !leed. 'hat2s when $ saw it. %y right arm was sti

as a !oard, and weird looking. 3omparing !oth hands, side

!y side, showed a discrepancy in color, si&e, temperature


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and smell. $t 4ust wasn2t right. $ washed my !leeding #nger,

!ut it still didn2t move. $ couldn2t control my arm+ couldn2t

clench my #st or even simply move a #nger. $ did feel pain

were the cut was, and $ could also feel the hot water pouring

over my cut #nger. $ have !een in the !usiness of

entertainment for as long as $ can remem!er and this has

never happened to me. octor, $ tried massaging it,

showering it with sunlight, even electric shock. $ sat down in

front o the computer to see if movement would return

spontaneously, !ut nothing happened. $2m very scared of

this+ $ have a show coming up. $2ve !een dreaming a!out this

performance for the last 5 years, there2s a lot of pressure for

it to !e perfect.

'he neurologist told me to rela-, !ecause there was

nothing wrong with my nerves. 'he nuts and !olts in my

!rain were spectacularly #ne.

"very night $2ve !een having nightmares a!out

puppets. $ see Kermit the frog placed on my hand, making it

a part of him. $ saw myself in the dark, fro&en and mute, withno control over the puppet or me. Kermit was using my hand

to move and talk to the other puppets. $ tried screaming for

help, !ut $ couldn2t even hear my voice. 'hen $ woke up,

looked at my arm, unsure of what to e-pect+ my arm was still

not moving when $ wanted it to.

'he day of my #nal rehearsal night came a!out. $t was

a very stressing moment !ecause my hand is a very

e-clusive tool, and it wasn2t working6 $2ll !e !ankrupt !efore

you know it oc. %y life will !e over. *s $ was thinking a!out

my demise $ tried Kermit2s puppet on my hand, and that2s

when it happened. %y hand started working again. $ couldn2t

!elieve it. 'his de#es all the rules of science. $s this thing


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going to get worse0 Will it spread to all my !ody0 Will $ wake

up one day completely sti and locked inside my !ody like $

saw in my nightmare0 'hese %uppets are controlling my

life61

$f we evaluate his statement, we2d !e a!le to !uild a case in favor

of diagnosing a somatoform disorder that developed as a protective

mechanism. We get the idea that %r. Henson2s hands are the !asis for

his great success and fortune in the !usiness. He is a very creative

individual with an autistic diagnosis, which makes him an interesting

character. His hand dysfunction started the day he cut his #nger on the

workshop+ meaning that his mind was protecting his moneymaking

e-tremity from getting hurt any further. *s Jim started comparing his

hands side !y side he could tell his right arm was o in color,

temperature, si&e and even smell. 7nderstanding that %r. Henson was

very accustomed to having a puppet on his hand all the time, we could

conclude that his !rain adapted to it like a foot to his sock. 'he previous

story tells of dysfunction with only one hand. 8ne could argue that, the

left arm was always in charge of trivial roles+ moving the small arms of

Kermit the frog. %ay!e it wasn2t enough to create a noticea!ledysfunction on the left hand.

Why the morphological dierence !etween hands0 His right arm is

the dominant one. He used it regularly, so much that with time it

!ecame thinner due to the glove9like #t of the puppet2s construction.

'he temperature and smell, then followed that, would digress

aesthetically from his left arm. $t would always smell like cotton fa!ric. $t

must have !een a shocker when he e-perienced all these factors

together. 'he o!vious somatic dierences made it easy for his !rain to

re4ect his hand as a part of the !ody, that his hand was somehow in

danger or that, it originated from an odd sensation of something

missing. 'his process might have strengthened the psychogenic origin of

his disa!ility.. *!out his nightmares, he might have e-acer!ated his


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dreams every time he went to sleep without thoroughly washing his

hands. $t would stink like puppet fa!ric all night. 'he smell might have

inspired his dreams and increase the awareness of his paralysis.

$t might have !een a defense mechanism e-posing something

wrong in his hand. $t2s the same way the !ody elicits pain and

in:ammation to inform the !ody that something anomalous is

developing+ something potentially dangerous that would aect the

normal function of the hand if left to move without restrictions. $t follows

that his arm would return to normal once a puppet, of green fa!ric,

would endow his hand.

;omatoform disorders develop without knowing its e-act etiology.

*fter ruling out any neurological origin, general medical conditions or

attri!uta!le to any other mental disorder, one can consider a

somatoform dierential diagnosis. ierential diagnosis *n-iety attack,

factitious disorder, malingering, conversion disorder, !ody9dysmorphic

disorder or induced !y su!stance a!use.

*n an-iety attack could !e a triggering factor that provoked a

somatoform event. He did present an acute stressor !efore the event,

while also, e-pressing the high value his hands represents in his life. *chronic stressor could have !een the rehearsal for the show, and an

acute factor would have !een the #nger cut.


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remem!ering he had a highly functional autism, his desire for social

interaction wasn2t a priority. 'he many people that know %r. H, could

easily satisfy his desire for attention. 'he conversion disorder seems to

!e the #nal diagnosis to consider. 'here is a clear loss of motor

movement alone, without any organic cause. =atient denies urinary

retention, >$ distur!ance, vertigo, tinnitus, ata-ia, syncope, hearing loss,

dou!le vision or convulsions or head trauma. /%r. Henson you have a

condition known as conversion disorder where, in this case, you lost

motor control of your right arm. We will proceed to physical therapy and

evaluate if there is improvement. ;ometimes, pharmacotherapy is

warranted. $n this case $ will make an appointment in two weeks and

we2ll talk a!out what2s to happen ne-t. o you have any uestions01

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Type 2 Somatoform example