Assessment and Diagnosis

Abstract

The young patient introduced in Chapter 1 has been sitting with an icy stare. The clinician feels uneasy as the stare becomes more hostile. A tense silence is broken by the patient declaring that he will resist all efforts to alter his sex. The clinician asks him to explain, but the patient wonders why the doctor is denying the obvious. Hesitantly at first, the patient proceeds to describe the vague somatic sensations experienced several months ago, sensations which he later realized were caused by drugs in his food. He noticed that his scrotum wrinkled after a cold shower— evidence of an assault on his sexual organs. Sexual thoughts began entering his mind, their source unknown. Last week circumstances converged, fortuitously permitting his sudden discovery of the source of his sexual change. During dinner at his aunt’s house, her daughter complained that the food tasted like plastic. His aunt was visibly disturbed but told her daughter that they would discuss it later. Since the aunt had thus unwittingly tipped her hand, it remained only for the patient to account for her motivation. She had always secretly resented the patient’s mother and now feared her own daughter’s sexual attraction toward the patient. The aunt feared the patient’s sexual power, believing he would reunite the family through coitus with her daughter.