Delusions

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She smelled of rust and old blood.

Both arms and legs were freshly bandaged, but the red was still visible on the surface seeping through the soft, white gauze. The misery that rose up out of her was pervasive, filling up the exam room.

“What on earth happened to you?”

“Doc.” She paused for a deep breath. “I have worms.” I could see the fear. Even if they were not real, they were real to her and that was all that mattered. “They are crawling under my skin and I don’t know how to make them stop. I try to catch them with tweezers but no matter how fast I am or how deep I dig, I just can’t reach them.”

She was on blood thinners for her heart, which made this worse.

“I saw this thing on the news about Morgellons Disease. I think that is what I have.” Sure enough, it had been all over the news. Doctors everywhere were upset as people flocked to the office worried that any itch or burn or skin lesion was this mysterious disease.

“Wait. Did this start before of after the news story?”

“After.”

“Why do you think you have it?”

“I see these fibers inside the sores…”

“Wait. Did you have these sores or did you make them with the tweezers?”

She looked embarrassed. “I made them.”

“Do you have some of these fibers so I can look at them?”

“Welllllll…. No. But I see them all the time. I bet there are some right now.”

We unwrapped her arms and legs and did a thorough search for the fibers. Nothing.

“I just don’t understand why we can’t find any…” She was very distressed.

I told her not to worry, she could save some for me and bring them to her follow up visit in a few days. We talked about wound care. I gave her an antibiotic for the infection that was starting and a steroid for the itching, hoping that would take care of it but knowing that it probably wouldn’t.

Long story short, she never could bring any fibers and she never got better. She could not stop picking, even when her family took away the tweezers. We had months of this. She and her family got more and more frantic. She became anemic. She lost weight.

Several dermatology consults turned up nothing. Nothing except delusions of parasitosis…

In these kinds of situations you cannot just tell someone it is all in their head.

“I have a medication that can help with that itching.”

“No way am I going to take that, doc. It’s for crazy people!”

How does a nice, reasonable woman with no prior psychiatric history have this happen? How does that switch get flipped?

Eventually she did agree to take the medication. The switch flipped off. Just when everything was almost healed, she decided to stop it. It came roaring, raging back and she was bandaged up all over again.

This became a battle that persisted for several years until she eventually died (from other causes). It would go away when she was on the antipsychotic drug and return when she was off of it.

It is so easy to discount people as “crazy”, to put them into a box and close the lid, but delusions and psychosis are still real and are responsible for very real suffering. Remember your compassion.

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90 thoughts on “Delusions

  1. Another one that is hard to “like.” What a sad story. We all live with delusions, and often our own delusions are evident to others but not ourselves. Sometimes our delusions are shared and encouraged by a large portion of society, but they are still delusions. Sometimes our delusions are more obvious (to others) and physically harmful, like this poor woman’s. Differently manifested, she is us.

    Liked by 11 people

  2. Oh God what a terribly tragic story. It is heart-breaking to hear of someone in such a dreadful state because of something that is so real to her but no-one else. How frustrating it must have been for you too, trying to help her; seeing her get better, then a downward turn, and the cycle starting up all overr again. So sad.

    Liked by 3 people

  3. The like is for you, It is sad to read a story as this. I knew a co-worker who had a member of the family who was a cutter *as they described her* they never understood she was suffering inside to stop the emotional she created the phisycal.

    Liked by 2 people

  4. I had to ‘like’ this post as it resonated so much with something that is happening at the moment; my friend has just discovered her daughter, age twelve, self harms. She’s says,her daughter tells her it;’s to get the ‘bad’ out. This child is one of the most gentle girls I know – yet still it happens. My friend has turned to specialists for help. I hope they can.

    Liked by 1 person

  5. Amazing how what we believe can have such an impact. I worked in psychiatry for seven years and saw some crazy stuff and I’ve had some of my own crazy stuff to deal with. I like your reminder to consider compassion and thank you so much for trying to help this woman.

    Liked by 2 people

  6. I think we have spent too much time trying to separate the physical and the mental. I am not a psychologist but I am sure that they are one and the same. This example is clearly the mind have a physical reaction.
    Would a placebo medication have worked?

    Liked by 2 people

  7. Remember your compassion is right.

    Close friends have a son who became dilution all in his second year of college. My heart goes out to them and anybody else having or helping with mental health issues.

    Liked by 1 person

  8. Gee that is a sad case. I know about delusions. Worked in psychiatry. That was my “area.” Loved my work but it was exhausting mentally and emotionally.
    it is so challenging when you have the combination of mental and physical. Some nurses could not understand and determine that a patient also was physically ill ever after doing as assessment. Fortunately most of the doctors could.

    Liked by 1 person

  9. I’m thinking people thinking they have worms is way common. Remembering your other story about the man with worms in his butt that was toilet paper. It was hard for me not to comment that when I was a kid I read about worms that lived in your intestines and came out of your butt at night. I also read that you could “test” to see if you had said worms by putting a piece of tape over your anus… now, I make no comments about any follow up on that test or what I read 😉

    Liked by 2 people

  10. Wow, Victo, I didn’t know that you did psych care too – that must be so difficult (from an emotional perspective). I don’t know about the States, but here in Canada, psychiatric care is seriously lacking. Acute care is fine, the problem is that many, like your patient, cannot care for them selves and will stop medicating or precipitate situations that enable their issues. Far too little is done to help such patients with long term problems. And it keeps getting swept under the rug. The gov’t has closed many facilities where the challanged could live in assisted care situations, and have dumped those patients on the street. When you speak to any service providers like police, social workers, psychiatrists and psychologists, among others, the story is the same: Those with mental health issues are ending up in jails and emergency wards and situations where they are not understood or even helped. They just progress until their problem becomes acute , then they are institutionalized and “repaired” and put back on the street, to do it all over again. It is a bad situation, this elephant under the table, and it is getting worse. When the public sees an apparently “normal”,person standing at the bus stop with them, we don’t “see” the problems under the surface. It is far easier to get empathy or funding for someone with their arm in a cast than it is to help those who need psychiatric help.

    Anyway, i write too much. Thank you for the caring and help that you offer those who are in need Victo. Please remember that it is not, and should not be, your responsibility to provide the long term care that some need. There there be dragons.

    Liked by 2 people

    • Because there is such a shortage of psychiatric care, particularly good psychiatric care and particularly for older patients in Medicare, primary care physicians find themselves managing quite a bit on their own.

      Like

    • I completely agree Paul. I also think of the lack of funding there is within the social welfare system to assist families whose children should be diagnosed with mental disorders and personality disorders. I know that personality disorders are generally not diagnosed in young children as a result of their continuing development, and that mental disorders tend to be diagnosed when children are around 9 years old (there are always exceptions). The cost to have psychoeducational assessments by psychiatrists is $2000 or more. Although Child and Family Services does it best to assist families who cannot afford to have these assessments done, and school boards are only given a certain amount of funding for assessments, many many many children end up falling through the cracks of the system. It is these children who later on develop into adults with more severe symptoms and go undiagnosed.

      My grandmother, who died yesterday at the age of 91, is such a person. By the time she was diagnosed with anxiety and a personality disorder, she had already destroyed key relationships in her life. Then toss in the stigma of mental health, and the story does not end well.

      Like

      • Hi TPDP! My condolences on the passing of your Grandmother. She would have been in grade school in the late 1920’s and early 1930’s – there wasn’t much help then. A lot of the asessment process is started at the county level – and there is very little continuity across the counties. I have a cousin – Teri – who does exacly that for a county outside Ottawa. She is one of a team of three and they try to intevene at the pre-K level. You are exactly right when you say funding is an issue. Teri spends a lot of her time working with the poor and disenfranchised to try and get their children services. She tells stories that will twist up your mind – where a child is firmly diagnosed and eveyone agrees they need treatment and there are no funds. She has a whole warchest of possible fuding programs from various sources and she tries very hard o get the child into the most helpful program. She is not above doing end runs around the programs – such as getting a child enrolled in one prgram so they can have a professional evaluation, and then. using that eval to get the child into another more appropriate program that didn’t have the funds for an eval. The whole thing is so hit and miss though because it has to be initialized on the observations of child care and pre-K teachers. They are good, but they are not trained in asessment. My Mum taught Child care as a Social Worker at UBC. She did her PhD late in life on that topic. There was a great deal of dinner table conversation about the issues.

        Liked by 2 people

  11. Its Sad when People stop taking their medication because it is working. It’s not lawn fertilizer that you can put down once and get a result, it’s a shame people don’t always get the concept of long term therapy.

    Liked by 2 people

    • Part of the problem is the illness itself. With the meds they can function better but they still are ill. The other issue is with the meds themselves. They have unpleasant side effects, like terrible weight gain and sedation and fogginess that are difficult to live with.

      Liked by 1 person

  12. It’s just too sad, too common, and too true. Unfortunately, the area of the city in which I live is the area where all the facilities for people with these sorts of problems exist. This tends to concentrate all the people in need in this one area, and that makes it just too easy for the rest of the city to pretend this area, and its residents, don’t even exist. I’ve always wondered if the same situation could be found in other major cities, and if so, then just how common the practice actually is.

    Liked by 1 person

  13. Sad story. Dealing with a version of this now.

    A client of 8 yrs is more like family now since we know so much about each other. He has been in therapy for 7 plus yrs but seems to be stuck in a very bad cycle of reliving the past and desolving into a huge pool of depression a few times a year.

    After a stint in rehab last year he started seeing a new therapist who managed to equip him with better coping tools and meds for chemical imbalance in the brain. His outlook on life improved, his mood was excellent and he reclaimed his life. We were all relieved and so excited to see him happy again.

    Sadly, according to his spouse, he has managed to replace one addiction (pot) for another (alcohol). We are now back to the horrible place where he spends days in bed reliving the past, crying uncontrollably, and I assume secretly not taking his meds.

    We are all worried all over again.

    Liked by 1 person

  14. What makes this especially tragic is that the she had internalized the stigma against mental illness and it prevented her from seeing the medication as egosyntonic

    People will do anything to avoid becoming the “other”–especially after they have.

    People with psychotic and delusional disorders also tend to lack insight as a symptom of the disorder…
    It’s important to remember this the next time some politician justifies homelessness by saying people
    choose it.

    Liked by 2 people

  15. Thank you for sharing this woman’s narrative, Victo. You have given her a voice in death, that although she could not hear in life, continues to resonate with those of us who understand mental illness.

    Liked by 2 people

  16. Pingback: My Article Read (2-7-2015) | My Daily Musing

  17. It’s hard to even begin to imagine the non-stop hell and horror she was living. It’s interesting how drugs always seem to help the patient at first and then some other belief/sensation usurps the need for medicine.

    Liked by 1 person

  18. This story really hit home with me. The Compassion/Pain I feel in my Heart right now is from being immersed with family who I haven’t seen in many years. Shock waves coursed through me as I observed how some of my siblings are so deep in delusion, that nothing I said or did, could convince them otherwise. To see someone I Love slowly being drained of all potential of what Life could give them, is extremely difficult. This past week I’ve made the agonizing decision to keep my distance for whenever I am involved with these siblings, the pain arises. Acceptance that what they have chosen as reality I have made, yet, I have chosen as well, to keep a safe distance to protect myself. How sad it is to know that delusions are so real that they can actually destroy a Life. How sad.

    Liked by 1 person

      • Doc, what I haven’t experienced lately …. LONG post coming soon in which I show all of you some of the emotions that have had me spinning. I am on firmer ground right now, because of the choices I have made to do so. To know I have free will in allowing who I wish to be in my Life, is a Gift, a huge one. Just because it is family, does not mean by a long shot, you must have those people in your Life. FYI …. In order for me to be able to live by example and to say what I do over at Petals, believe me, I do tend to have a challenging Life. Yet, out of those very challenges, those very things bring to me, my Greatest Gifts, that I share with those who view my work. (((HUGS))) Amy

        Liked by 1 person

      • That is the power of art of any kind… words, photography, painting, drawing, anything really… it turns the evil, hurtful things in life into something beautiful. You have done that wonderfully through your blog. I have distanced myself from my family, too. I don’t like the person I am when I am around them. It was such a relief to give myself permission to do that. Keep shining your light! 🙂

        Liked by 1 person

      • Aw, Doc, you’ve got the tear ducts active again. Thank you. I really have worked hard to create my Life the way it is now, and not even family will disturb my little sanctuary I have made. Bless you for understanding. Much Love, Amy

        Liked by 1 person

  19. I just finished a bio on Vivien Leigh (Scarlett O’Hara). One of the greatest beauties in the world, she was bipolar, though the field of psychiatry had yet to come up with the term. I’ve been thinking about her a lot. She was a deeply passionate (and with that, COMpassionate) soul with many gifts who coped with issues of fear and abandonment very well (or so it seemed). Her mother dropped her (only child) off at a convent school in England when V was 7 and took the boat back to India. Your patient had deep, deep issues (likely from childhood) that medicine consumptive or topical could not reach or was relevant to, obviously. There are also nutritional deficiencies mentally ill people have (like copper) that MDs are just not aware of. I enjoy reading you. If I, HOLISTIC momma who steers clear of the medical establishmt, thinks you’re a wonderful doctor, you’re doing something right.

    Liked by 1 person

    • Hmmmmm. You are not someone I would put into a whiner class, truthfully. But it is good to be reminded periodically that there is always a lot more suffering to be had in this life, given the “right” combination of circumstances.

      Like

  20. Again, you and your compassion and you taking the time and putting this story in to our awareness. Thank you. I think it’s so difficult for people to grasp that mental illness, psychosis, “crazy” is as much an infliction to a persons health as a broken bone. A cancer. They need help and treatment.

    Liked by 1 person

  21. I agree paranoia can be sparked by media stories and the situation you describe is tragic. However there is another side where people think “it couldn’t happen to me” and avoid going for medical check ups. For example there is concern in the UK about increasing numbers of people having unprotected sex with strangers predicated on the belief that they won’t get AIDS/HIV as this happens to others but not them. So there are undoubtedly paranoid people out there but you also get the opposite type who go through life thinking that “it couldn’t possibly happen to me” and avoid seeking medical attention. Of course you get the opposite paranoid response (those who think they are likely to pick up a sexually transmitted disease from a toilet seat or from sharing a glass). Sorry if I have gone off topic here. Kevin

    Liked by 1 person

  22. That’s so sad (and gross). I, as an autistic person, tend to “pick” sores (that are already there) because they feel “funny” since they don’t belong there (and I’m hypersensitive to the awkward feeling they cause). And because of my experiences with MRSA, I know how horrible it is to pick, but sometimes I even do it subconsciously in my sleep. And I know several autistic people with this “symptom.” But I never imagined there was an actual mental illness that caused picking! 😦

    Liked by 1 person

  23. Rereading your post I am reminded of the following incident. Being blind I often accept the assistance of people when crossing roads particularly in unfamiliar surroundings. Some time ago, as I stood at a busy crossing a man said that he would tell me when it was safe to cross. I thanked him and asked whether I could take his arm (this is the best way to guide a blind person, to let them take your arm, just above the elbow). He replied that he “didn’t like being touched”. Alarm bells went off in my head – this guy obviously had problems and was, perhaps paranoid. Possibly he had suffered childhood abuse but, whatever the cause of his dislike of being touched the whole incident was bizarre.

    Liked by 1 person

  24. Wow. What a coincidence. I saw a patient with Morgellons syndrome this week. In fact I was going to put her in my blog when I find time. My patient is unfortunately psychotic. Accused me of being Satan, and many other things….

    Liked by 1 person

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