A bizarre psychiatric consequence of mammalian anatomy and physiology.

We were all taught in my medical school that patients may take our measure for a visit or two before divulging their chief complaint. Here is an example where I needed a similar measure of my patient before I could have given him the simple reassurance that his “problem!” required. What follows is the account of such a mutual measure taking with a man who became a long-term patient. My recollection begins with the visit in which he “dropped the bomb”.

“Doc. I think I am a pervert,” he began and went on to describe how he really liked to have his nipples manipulated and he considered this a serious perversion. Apparently I did not instantly seem totally convinced that this represented a perversion, so he added further emphatic detail to his concern. My response was, “Let us talk this over to see if we can figure out how your problem came to be.”

I started with an explanation of “witch’s milk” where newborn infants of either sex may have a serous (clear amber) discharge from the nipples due to exposure to the hormones that are preparing the mother for lactation. Women have the same discharge at roughly the same time (but more consistently than the infants). The technical name for this initial milk is Colostrum. The reason that boy babies also have this is that the original equipment in the chest wall is identical in infants of both sexes. An inevitable consequence is that that the nerves to the nipple are also identical. A rather obvious reason for these nerves is that pleasant sensations associated with breast feeding for infant and mother alike are bound to be beneficial to the entire mammalian lineage—so he and all mammalian males have had these nerve endings in their nipples throughout their lives through no fault of their own. It is scarcely fair to fault nature for taking the easy way out in making the chest walls of both sexes initially similar.

It is obvious why my patient needed time to get acquainted with me (and my possible biases). In retrospect I now realize that I equally needed my measure of him, especially intellectual ability and creationist biases, before I could have successfully led our discussion so promptly to the positive conclusion—he instantly became, according to his own criteria, a normal human being; and I became his trusted physician.

This episode from decades ago really occurred more or less as described. I remember especially the sudden favorable conclusion no doubt enhanced by my hobby of evolutionary biology since high school days. For more about this hobby see: Medicine’s Integrating Insights for Medical Science on www.frantzmd.info.

Soon after writing this I read an article about the history (only a few decades) of cognitive behavioral therapy, now a worthy replacement for psychoanalysis. The article was in The American Scholar for autumn 2009 and titled The Doctor is In by David B. Smith (page 20). On its last page the article very strongly implied, but did not quite explicitly state, that cognitive behavior therapy is like Socrates practicing modern psychotherapy. I was gratified to learn that I had occasionally achieved something similar in my 60 years of general medical practice by questioning patients in such a way that they learned to deal with their problems by their own insight rather than from external authority—the essence of cognitive behavioral therapy and the Socratic method.

John A. Frantz, MD

October 5, 2009