SEPTAL STIMULATION FOR THE INITIATION OF HETEROSEXUAL BEHAVIOR 25experience pleasure, where he states that he isbored by everything and left constantly blasr.Having initially turned to alcohol, drugs andsexual acting out for pleasure and stimulation,drugs no longer produce a high or euphoria andhe gets no "kick" out ofsex--"not even mastur-bation". He does have a three-year history of drugabuse, which ran a course punctuated by alcohol,amphetamines, barbiturates, major and minortranquilizers, the sniffing of chemical agents andsolvents, marijuana, and nutmeg. Addictionand preference were for amphetamines, whichgave him a "lift", confidence, energy andelation. With continued usage, however, alcoholand drugs, even in greater frequncy and dosage,failed to produce the desired effects and resultedin severe depression and a state he referred to as"brain pollution".For the past 5 years he has exhibited fixed,overt homosexual behavior but has never in hislife experienced heterosexual relations of anykind. He prefers to be the dominant individualin anal intercourse, with fellatio being toleratedbut not necessarily sought. He is most attractedto and jealous of handsome, well-built and-dressed, intelligent and masculine men; though,he is far more comfortable when lovemaking iswith effeminate males. Those with whom hehas had sexual relations over any consistentperiod of time have been several years olderthan he and characteristically of marginalemotional stability. He describes himself ashaving been "sexually precocious", experi-encing erotic feelings toward his sister whenbathed together as children, having begun "wetdreams" at age 5 or 6 (which he elaborates as asense of pleasurable relief when he wet the bed),and having very actively indulged in masturba-tion since age 12 (still a preferred behavior).Homosexual encounters began at this time, aswell as wide reading in the area of sexualdeviations and perversions. There has neverbeen an active interest in females, though headmits that he is somewhat aroused by picturesof women in various degrading and pitiablepositions. In no way does the patient himselfphysically manifest effeminate mannerisms,gestures or movements.
Hospitalizations, Evaluations and Examina-tions.
Following two previous psychiatrichospitalizations of approximately 5 monthseach and initiated by suicidal depressions,
B-19
was examined and admitted to the TulaneService of the Department of Psychiatry ofCharity Hospital of New Orleans. Physical andneurological examinations were within normallimits, as were the results of urinalyses and bloodchemical determinations. Psychological evalua-tion indicated bright normal intellectual func-tioning (WAIS Verbal Score 118, PerformanceScore 104, Full Scale Score 113) and an unusuallyhypersensitive and obessive-compulsive indi-vidual who experiences chronic depression of adegree which leaves him functionally dis-organized, confused, discontent and bitter. Histolerance for frustration is extremely low, andhe responds quickly with suspicion, anger,impatience, querulousness and vindictiveness.Psychiatric examination indicated that thesymptom complex exhibited by the patient wasconsistent with temporal lobe epilepsy. Con-ventional scalp EEGs showed an abnormalitycharacterized by bitemporal slow-wave activity,maximal on the left. Paroxysmal delta activityalso appeared over the right temporal region,with Chlorolose activation. Pneumoencephalo-gram was normal.TECHNICAL PROCEDURE ANDAPPARATUSOperative procedure and stereotaxic implanta-tion of electrodes followed techniques previouslydescribed (Heath
et al.,
1968). The patient wasunder general anesthesia, with visualization ofthe ventricular system by air and pantopaque.Stainless steel Teflon-insulated electrodes 0.003in. diameter, each with three to six leadsseparated by 2 ram, were implanted into thefollowing brain regions: right mid septal, righthippocampus, left and right amygdalae, rightanterior hypothalamus, right posterior ventrallateral thalamus, left caudate nucleus, and attwo subcortical sites within the left lobe of the
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