Descriptive Psychopathology: The Signs and Symptoms of ...

146 Section 3: Examination domainsSelf-decoration that includes tattoos, body piercing, make-up and clothing areacceptable adornments in moderation in Westerners raised after 1960. Whenexcessive and beginning early in life, these choices reflect personality deviation.When they occur for the first time after maturation and are strikingly differentfrom previous appearance, they indicate disease. For example,A Euro-American physician whose demeanor and appearance had always been that of thestereotypic middle-class Mid West suddenly let his hair grow long and dressed in loose-fittingclothes of African patterns. He lost substantial weight. A year latter his erratic behavior wasclearly evident and subsequently he was arrested for using and selling illicit drugs.Excessive self-decoration has been recognized since the nineteenth century inassociation with manic-depressive illness. Staid European women overwhelmed bymania are described wearing brightly colored turbans, drapery, beads, and feathers.Manic men are pictured wearing decorative flowers and military paraphernalia.Manic patients continue to excessively self-decorate. Patient 4.3 dressed as RobinHood is an example. The following vignettes also illustrate.A middle-aged manic man calling himself “a preacher” was hospitalized for loud publicorations and irritability during the height of the summer heat. He spoke rapidly, his wordsoverflowing each other. He was wearing 12 overcoats and several hats.A middle-aged manic-depressive man dressed himself in a paper suit and hat made from thecartoon section of a Sunday paper. In this garb he loudly and intrusively harangued passers-byin the street. In the hospital, he stood on a chair in the dayroom “addressing” other patients.An elderly, chronically ill manic-depressive man prowled the hospital grounds wearing araincoat, every inch of its surface covered with campaign and other novelty buttons. He clinkedas he walked and on fair days the sun reflected off his buttons as if they were electrified.A middle-aged manic-depressive man dressed entirely in black leather, including a black leatherhelmet, ran down Fifth Avenue in New York City with long kitchen knives attacking skyscrapers,mimicking Don Quixote attacking windmills.Sudden changes in culture-specific behaviors in émigrés that cannot be readilyexplained by efforts at acculturation may also reflect illness.A 46-year-old timid housewife from India who always spoke to her elder brother-in-law in asoft voice and with downcast eyes, and who covered her hair in deference, when manicabandoned the head cover and started calling her brother-in-law by his first name, a highlyunusual interaction for Indians. She also publicly blamed him for her marital failure.Manic patients often decorate their heads. Men shave one side of their headhair or beard. Women manic patients place their hair in exaggerate styles. They useelaborate make-up schemes with garish colors not typical of their euthymic taste.They wear bedsheets and towels as if togas, or scanty, sexually provocative clothing