MANIFESTATIONS OF NEUROTIC CONFLICT IN HUNTINGTONʼS CHOREA

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Abstract
Huntington''s chorea is a hereditary disease with prominent psychological symptoms. A detailed case report of a patient with Huntington''s chorea is presented. Her mother and maternal grandfather had the illness. Her older brother also developed the illness. A younger sister remains free of symptoms. The patient''s mother developed the illness during the patient''s childhood and died when she was an adolescent. Her father provided much of her care. The patient developed an interest in religious matters after her mother''s death that led her to a graduate degree in theology. When her brother was diagnosed as having the illness, the patient and her sister vowed celibacy. Both recanted and eventually married. The patient developed psychological symptoms around the time of her marriage, before the onset of physical symptoms. Her husband, a minister, had major troubles in caring for her and had a period of psychosis requiring hospltalizatlon. The patient was hospitalized several times before institutionalizatlon was accepted by the husband as the only alternative. She had no children. Prior to the illness, the patient had significant neurotic conflicts. She was unable to express dependency needs, had much sublimated aggression and had a poorly formed sexual tdentity. With illness, a hostile, dependent personality emerged with no interest in sexual matters. The loss of cognitive abilities had special significance to this gifted woman. The case demonstrates how the psychological symptoms in this illness are predicated on premorbid personality. The importance of separating reactive elements of the illness is emphasized. A definition of the premorbid personality was essential to treatments It was possible to make the patient more comfortable and less depressed by allowing her to express her dependency needs and by encouraging her continued involvement in her surroundings.

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