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April 27, 2016

People : Delusion

One of my patients* went to see a specialist recently, who diagnosed him with "delusional parisitosis." She feels that the man's symptoms are inconsistent with actually having any stomach parasites, and that he believes in something that is not real. She also knows that the man had requested to see another specialist because he feels that he had bacteria in his blood, which he almost certainly does not have.  He has requested to see many different doctors for various infections, testing the patience of several providers usually well-known for their calm and composure.

I agreed that it's unlikely that the man has bacteria in his blood or parasites in his stomach.  But what the specialist doesn't know, and what I only learned very recently, is that the man has become homeless because his home has been overtaken by roaches, mold and bed bugs.  His landlord won't pay for any extermination, cleaning or repairs.  He needs a new scooter due to the old one being similarly infested--but the company won't replace it until they get the old one back, and they don't want to the old one back because it will contaminate their other supplies.  So the only space he can really occupy--his scooter--is infiltrated.

When the man told me that he had a specific bacterial infection in his blood, I told him that if he really had this infection he would be very sick, and unable to interact with me in his current manner.  He responded with quiet force: "But you don't understand--I am very sick."

It's a reminder that I see frequently, and in different forms, and yet remains easy to forget. That the people we see in our clinic rooms inhabit a very different space when they leave their interaction with us. That what we call "delusion" may just be someone else's framework for the very real things they experience, that we can't possibly experience.  That even though what a person is calling a parasite isn't what we medically define it to be, he still is in fact experiencing an invasion of the body and space he should be able to claim as his own.

Tyler State Park, Texas. September 2011.
For symptoms without obvious physical cause, I've tried to make it habitual practice to consider the source of these symptoms.  Sometimes we stop the investigation when we decide something is a "delusion," and therefore the source is the mind.  And because the mind isn't an organ--kind of the brain but definitively not--and we know much less of it than we like to declare, as doctors we leave that as the answer.  It's just not real.

But physical space is real, and the emotional and cognitive trauma that an inhuman circumstance triggers is real. I think that caring for people, and for ourselves in the process, means recognizing the nuanced malleability of our realities. Even, and especially if, they differ from person to person.



*To protect the privacy of  individuals no names are used and ALL identifying details have been changed. This post and website is HIPAA compliant. Please see disclaimers on homepage.


2 comments :

  1. Thank you for sharing. Your words are so beautiful. What other questions can physicians ask beyond their answer of it's not real? It would be great to hear a follow up. :)

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    Replies
    1. Thanks Vy! I think that asking about function is most important--how does whatever people are experiencing affect their day to day, and how can we affect that. I will definitely pu thoughts together for a follow-up!

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