picture of journal cover
The case report was published in The British Journal of Psychiatry, which is still published today

In 1907, Dr. M. J. Nolan published a case report about an obsessional patient who asked to be admitted to an asylum because she feared being responsible for harm to others. NOTE: The following is this website's synopsis, not a quotation.

SYNOPSIS: A woman who was about 50 years old and living on a farm in Ireland in 1906 was troubled by distressing thoughts. She knew the thoughts were silly but nonetheless was terribly bothered by them. She had tried various treatments including massage and electric baths, but those didn't seem to help. She was at her wit's end. She asked to be admitted to the asylum in Downpatrick. Maybe she could get some relief. She feared that "her miserable state of doubt and apprehension might lead her to do some undefined harm," as the asylum's medical superintendent Dr. M. J. Nolan described it.

"Walking on the road she wondered 'why?' the stones were left in heaps by the wayside; she feared they would cause a fatal accident; she was obliged to retrace her steps to see for herself what casualty might have resulted," Dr. Nolan explained. "Gradually these doubts increased as to the degree of her personal implication and responsibility in the misfortunes concerned—she feared she had caused, in some strange way, the death or illness of such children or persons as she had passed by." The doctor went on to note that "Water in quantity, whether brook, river, lakelet, or sea, at first suggested someone's death by drowning; later this water gave her the idea that, in a mysterious way incomprehensible to herself, she was the cause of the imagined death, and, where possible, she took steps to reassure herself that there was no visible corpse."

At her own request, she was admitted to the asylum as a paying patient in August 1906. She realized that she was not as badly off as the more acutely ill asylum patients and she was kind to them. Dr. Nolan treated her with tonics (generally, herbal concoctions) and apparently not much else. He believed the calming environment of the asylum would have a curative effect. At the time Dr. Nolan wrote his case report, the woman had been living at the asylum just three months and was feeling "a shade better," he reported. Dr. Nolan published his case report in The British Journal of Psychiatry in 1907.1

1M. J. Nolan, Study of a case of melancholic folie raisonnante, British Journal of Psychiatry, 1907, 53:615-626.


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