Descriptive Psychopathology: The Signs and Symptoms of ...

343 Chapter 14: PersonalityIntersexPersons identified as “intersex” have ambiguous external sexual characteristics.The condition is defined as a “congenital anomaly of the reproductive and sexualsystem”. Intersex persons are born with external genitalia, internal reproductiveorgans, and endocrine systems that are deviant. There is no single intersexcondition, and the term includes a wide variety of degrees of abnormality.Intersex is not an identity condition and intersex persons are biologically maleor female and have a male or female identity. 59Normal personality under difficult circumstancesLife is not without difficulties. Death, separation, illness, social adversity, naturaldisasters are all stressful. Under stress, human behavior changes, sometimesdramatically. Dramatic changes under such circumstances, however, should notautomatically be interpreted as deviant or psychopathological. That determinationis made in the cultural context of the situation and the person’s previousexperience and circumstances. Patient 14.1 illustrates.Patient 14.1A psychiatry consult was requested by a surgical team to evaluate the capacityof a 56-year-old man to “refuse” care. The patient, a cancer survivor, wasre-hospitalized because of fever of unknown origin, and after several days ofextensive testing a complicated biopsy was recommended. The patient, demoralizedand fatigued by the days of fever and testing, initially agreed, but askedhis surgeons for a day or two advanced notification to “prepare” himself.On each of the previous three days when he asked if the biopsy was scheduled,he was told “not yet”. Then without notification, on a Monday morning, anaide with a stretcher came to the patient’s room to bring him to the biopsysuite. The patient, distraught and angry, refused. The psychiatric evaluationfound him to be behaviorally and cognitively normal.BereavementNormal bereavement and melancholia share some features (e.g. sadness, poorsleeping and appetite). Melancholia, however, is characterized by an abnormalemotional state that has a “life of its own” and a subjective quality that differsfrom the sadness following the death of a loved one. Motor, cognitive, andvegetative signs also define melancholia. Abnormal bereavement as defined inpresent classification is melancholic depression, transcends culture, and is a poorterm that confuses illness with normal mourning behavior.