Delusional Self-Portrait

“That’s me,” he said when we asked him about the figure he showed us on the cover of his diary. “That’s what I’m like inside—all made of metal.” Mr. A., a 32-year-old Caucasian man, consulted us after arriving at an emergency room, asking to have some wires that stopped him from sleeping removed from his leg. He said there were many more wires inside his body that he had discovered after experiencing that “a magnetism of storms” produced multiple internal sensations in the form of erratic contractions and “electric currents,” which he tried to alleviate by sticking needles into himself so as to “discharge the current by touching the wires with a metallic object.” These experiences were unusual and difficult to describe in words, so he decided to express them artistically.

Mr. A had no idea why all of those wires were inside his body. Someone somehow had inserted them and made them move and discharge when there was a problem. He also told us that when he was riding his motorbike with his helmet on, he loudly and clearly heard a voice asking him, “What do you want?” He was so amazed that he had to stop and look around.

This case fits in with what Huber (1) called cenesthetic schizophrenia, considered a specific subtype, characterized not only by cenesthetic hallucinations but also by a relatively benign course, a peculiar conservation of affectivity, and an infrequent occurrence of first-rank symptoms, with the result that these patients are not usually diagnosed as having schizophrenia. Leonhard (2), in his personal nosology of psychoses, reached a similar conclusion, calling the disorder hypochondriacal paraphrenia.

Worried and surprised by his experiences, Mr. A asked if anyone else had had the same experiences. We recommended that he read El licenciado Vidriera, a tale by Cervantes (3, 4) about a man who felt his body change into glass. It made the following impression on him: