Monday, December 11, 2006

Sex With Fish

Great title, eh? I started out with "My Favorite Delusions" but I just had to change it based on a case I heard about today. Face it, one of the reasons we go into psychiatry is because our patients can be fascinating. Or more specifically, their delusions can be fascinating. At times it can be tough to sort out non-bizarre delusions from reality, but the truly bizarre ones can be very complex and interesting.

In prison the most common isolated delusion I see is the contamination delusion. An inmate will believe that people are putting something into his food. He will go into great detail to point out something about the food that doesn't look or smell right, or will have some type of somatic symptom that he believes is proof that something has been done to him. In addition to giving medication, you can temporarily relieve anxiety by giving the inmate only food in unopened packages and this can help while you're waiting for the medication to kick in.

Being close to our nation's capitol we also sometimes get folks with politician-related delusions. They get arrested while travelling to Washington to confront the "devil-worshippers" controlling the government, or to get in touch with their "relatives" who happen to live in the White House. (Bush and Clinton would be surprised to learn how many patients they've fathered.) Presidential threateners are rare, but do show up occasionally. I understand the Secret Service even has a team that functions as something of an assertive community outreach program to ensure that threateners get their medications in the community.

But in addition to that, I've got a few other favorites:

Olfactory reference syndrome

This is the belief that one has a foul body odor. It's not a true hallucination in the sense that it is a smell that is associated with an idea, rather than just a perception. People will associate the smell with a body part which can lead them to excessive or repetitive washing or bathing. People with this delusion sometimes feel compelled to isolate themselves from others or to repeatedly apologize to others for their smell.

Capras syndrome

Also called imposter's syndrome, it's the belief that familiar acquaintances have been replaced by imposters. Think "Invasion of the Body Snatchers".

Fregoli syndrome

This is the inverse of the Capgras delusion. With Fregoli syndrome people believe they are being followed or stalked by someone who changes shape or form to look like others. If any of you have seen the Denzel Washington movie "Fallen" you can get an idea of what Fregoli syndrome would be like.

Koro

This is the belief that one's penis is disappearing or shrinking into one's body. This is not to be confused with kuru, a degenerative neurological disease caused by prions transmitted by cannibalism.

So what got me on this delusional theme today? I heard about a case of someone who believed he was having sex with fish. I will never look at the Little Mermaid in quite the same way again. I can only hope he's practicing safe sushi.

25 comments:

Jennifer said...

Ahhh...good old delusions. I have a family full of delusional people (strangely enough it is only the girls). hmmmm....

It amazes me how complex and detailed a person's delusions can be. Most of the delusional people in my family have delusions involving the government...and I'm not talking your typical government conspiracy delusion. Then I have another aunt who at one point (not sure if she still believes this) was convinced that my family was a cult and my grandfather was the leader of the cult. When I was a kid, we randomly got a 15 page letter in the mail from her about it after my dad called just to say "hello". She wanted my family to escape from the cult and was trying to convince us how blind we were to it all.

It sometimes scares me the genes that I have. haha! But I can say for certain that no one in my family has had sex with a fish (or at least believes that they have). haha! :-)

SEAMONKEY said...

This is more or less non-sequitur, but your mention of body-snatchers brought it to mind. The Cordyceps genus of fungi includes species which specialize in the parasitization of certain insects. The fungus changes the insect's behaviour, causing it to seek a place favourable to the fruiting body. It's sort of like toxoplasmosis in mice. There's a great and creepy video here:
http://www.videosift.com/story.php?id=23191

More to the topic: those delusions you mentioned aren't all that shockingly weird, are they? Isn't the olfactory thing a lot like OCD? Aren't the Capras and Fregoli syndromes sort of extensions of the depersonalization we all occasionally experience? Don't prisoners have good reasons to be paranoid about poisoning? Don't men sometimes look down and worry that their penis is shrinking or could shrink? And doesn't sex have a slippery, scaly, underwater dimension? (Okay, that last one is pushing it...)

jw said...

You reminded me of Tammy W. when she was doing in-the-water Dolphin shows at Marineland in Niagara Falls, Ontario. One of the dolphins got ... uhm ... interested in her. REALLY interested! A few times she had to pick the seat of her swim suit out of her butt.

Was she ever annoyed! She wasn't fired for punching him in the nose as local gossip has it. I won't get into THAT story.

ClinkShrink said...

It is interesting to see how culture influences the content of delusions. Back in the 1980's at the beginning of the AIDS epidemic there were a number of case reports about patients incorporating AIDS into their delusions. Now that's not exactly case report-worthy. There probably weren't too many delusions about satellites prior to Sputnik.

Personally I'm waiting for the first report of an iPod-related delusion. You can't walk down the street and see all those white earbuds sticking out of people's heads without starting to wonder...

Patient Anonymous said...

Sex with fish...haven't yet heard of that one. Thankfully, I have not (yet? haha) reached a delusional state. I probably won't if I haven't yet. Although never say never, right *wink*

My mother? Garden variety "Second Coming of Christ" sort of thing. You may find it boring but it was rather torturous growing up (and still is...)

Turboglacier said...

Clink, I too am interested in the cultural/historical context of delusions. Some people, who I call "early adopters", seem right up-to-the-moment with their paranoia, while others lag years or decades behind the times. I have one frequent visitor who rants and rails to no end about the "commies" and their plots in his neighborhood. Sometimes I want to shake him by the shoulders and say "Terrorists! It's terrorists now, man! The commies are SO twentieth-century!"

Also, re: clients who whose suspicion of poisoning is overcome by use of sealed meals-- we see this frequently at my hospital. But for some reason, all that is usually necessary for reassurance is to wrap the plate in Saran wrap. This baffles and amuses me. I almost want to say to the patient, "Look-- that does nothing for you. Jessica the Kitchen Lady could easily poison your food just before she puts the plastic wrap on it..." But somehow, it's all in the symbolism.

ClinkShrink said...

Seamonkey: I just watched the fungus video. Eyeww, creepy but fascinating. In people we had to worry about ergot poisoning once, and more recently I blogged about the Pfiesteria outbreak we saw here. Amazing how little life forms like that can change the brain.

Turbo: I'm wondering, if you wrap the food in aluminum foil maybe you can take care of both the poisoning and the satellite delusions.

Jennifer & PA: I imagine that after years of dealing with delusional relatives you are experts at being patient and tolerant. Good qualities to have these days.

healthpsych said...

There is a actually a kind of iPod delusion reported here.

It relates to the shuffle function. Recently there's been a number of reports that people feel the shuffle function is giving them messages ie. the song randomly selected is telling them what to do eg. the Bob Marley song 'stand up for your rights' (?) advised someone just about to cave into workplace bullying to fight on.

HP

Dinah said...

I've found that one has to be pretty careful when screening for delusions, or else I end up looking like a rather narrow-visioned, dumb shrink.

Culturally, everyone in Baltimore periodically hears a dead relative call their name. In the absence of any other pressing signs of psychosis,this is simply a local phenomena, I don't know what it means-- if it means anything-- and it's not a true hallucination or an indicator of psychopathology.

In screening for Ideas of Reference from the Media (does the TV talk to you?), one also has to be careful. People often have the sense that something is 'meant' for them-- but not as an individual, isolated thing, more that what the speaker has to say is relevant to their lives, but they do get the "He's talking about MY problem!" sense...this is also not a psychiatric symptom.

IPOD shuffles? People often have the sense that random events happen for a reason, again not a symptom. I suppose, as with all these things, it depends on exactly what meaning you're getting from the event. So if hearing a specific song at a specific time is absolute confirmation that you should have sex with a given fish who has already been poisoned......

Turboglacier said...

Dinah-- I make the definitive call on television IOR when the person has come to the point of throwing an object through the picture tube to "make it stop".

Clink-- You can't put foil over the food. That traps the microwaves in, you know...

Patient Anonymous said...

Re: the iPod...now I can see this happening. One man's meat is another man's poison? I love my shuffle feature because it's the ultimate ADD toy. Don't like that one? skip...skip...skip...

But sometimes I do wonder why it keeps playing the same song/artist repeatedly when I have over 2000 songs on it!

Now my rational mind says that this is either chance or a technical glitch. If I were delusional or prone to having delusions...I might be in trouble.

ClinkShrink said...

Ah PA, what a great observation and example. Indeed, many people have commented on the apparent non-randomness of the iPod shuffle. A blogging math wonk actually did the experiment and the calculations to figure this out (scroll to bottom for the formula). His conclusion:

"It's simply the mind's tendency to find a pattern that makes you think iTunes has a preference."

It's that same "pattern-seeking tendency" that finds connections between stars to form constellations. To form the pattern you have to be able to ignore or reject the elements that don't fit. When the piece-rejecting process goes awry, unrelated elements get connected to form ideas of reference.

That's how I picture it anyway.

Patient Anonymous said...

hi clickshrink, very interesting.

You know, I'm not surprised that someone didn't come up with some sort of experiment like that. My math skills are non-existent so my eyes basically glazed over the entire thing but I think I get the general concept. It's sort of based on statistics and random probability--kind of like pulling lottery numbers but with the added variability of "tagging" them with favourable properties...which apparently in the experiment didn't turn out to be so favourable. Okay, I'd better stop before I make a total fool out of myself for being the non-math person that I really am.

But I understand what you are saying about the pattern recognition process and connecting related and unrelated elements. I like that sort of basis of understanding with regard to one's surroundings in order to make sense of "real"ity.

That's an interesting explanation.

Patient Anonymous said...

hi clickshrink, very interesting.

You know, I'm not surprised that someone didn't come up with some sort of experiment like that. My math skills are non-existent so my eyes basically glazed over the entire thing but I think I get the general concept. It's sort of based on statistics and random probability--kind of like pulling lottery numbers but with the added variability of "tagging" them with favourable properties...which apparently in the experiment didn't turn out to be so favourable. Okay, I'd better stop before I make a total fool out of myself for being the non-math person that I really am.

But I understand what you are saying about the pattern recognition process and connecting related and unrelated elements. I like that sort of basis of understanding with regard to one's surroundings in order to make sense of "real"ity.

That's an interesting explanation.

Patient Anonymous said...

hi clickshrink, very interesting.

You know, I'm not surprised that someone came up with some sort of experiment like that. My math skills are non-existent so my eyes basically glazed over the entire thing but I think I get the general concept. It's sort of based on statistics and random probability--kind of like pulling lottery numbers but with the added variability of "tagging" them with favourable properties...which apparently in the experiment didn't turn out to be so favourable. Okay, I'd better stop before I make a total fool out of myself for being the non-math person that I really am.

But I understand what you are saying about the pattern recognition process and connecting related and unrelated elements. I like that sort of basis of understanding with regard to one's surroundings in order to make sense of "real"ity.

That's an interesting explanation.

Patient Anonymous said...

hi clickshrink, very interesting.

You know, I'm not surprised that someone didn't come up with some sort of experiment like that. My math skills are non-existent so my eyes basically glazed over the entire thing but I think I get the general concept. It's sort of based on statistics and random probability--kind of like pulling lottery numbers but with the added variability of "tagging" them with favourable properties...which apparently in the experiment didn't turn out to be so favourable. Okay, I'd better stop before I make a total fool out of myself for being the non-math person that I really am.

But I understand what you are saying about the pattern recognition process and connecting related and unrelated elements. I like that sort of basis of understanding with regard to one's surroundings in order to make sense of "real"ity.

That's an interesting explanation.

Patient Anonymous said...

hi clickshrink, very interesting.

You know, I'm not surprised that someone came up with some sort of experiment like that. My math skills are non-existent so my eyes basically glazed over the entire thing but I think I get the general concept. It's sort of based on statistics and random probability--kind of like pulling lottery numbers but with the added variability of "tagging" them with favourable properties...which apparently in the experiment didn't turn out to be so favourable. Okay, I'd better stop before I make a total fool out of myself for being the non-math person that I really am.

But I understand what you are saying about the pattern recognition process and connecting related and unrelated elements. I like that sort of basis of understanding with regard to one's surroundings in order to make sense of "real"ity.

That's an interesting explanation.

ClinkShrink said...

Hmm...I'm seeing a pattern here.

Roy said...

LOL.

And I really digged that iTunes shuffle link, Clink. A very clever way to come up with empirical data.

SEAMONKEY said...

There's a term for seeing patterns where none exist: apophenia.
http://en.wikipedia.org/wiki/Apophenia

NeoNurseChic said...

Delusions.....This is just almost too small to comment about, but I did have a couple of periods where I was truly delusional. I don't remember most of the 1st and all of the 2nd until I started to come out of it. During the 1st, however, I managed to be in the hospital and had my laptop. My IM messenger at the time logged all my conversations. I was with a real jerk of a boyfriend at the time, and after we broke up, I was reading back over some of our IM conversations. In truth, I was reading it to see if I was the one who had really screwed up. (This guy was extremely emotionally manipulative/abusive.....I had attempted to break up with him twice and yet still, I spent hours after we finally split up on his terms trying to determine where I went wrong....totally nuts in and of itself.) I found this IM conversation from when I was in delusion #1 from the anticholinergic toxicity. It was incredible. I saw where most of my delusional statements came from.

Then later, when I had delusional period #2.....I said things that made no sense at all, but much of which, I could figure out where it came from. I guess I gave away a few subliminal thoughts by constantly saying, "James...Kiss me!" (James was my best friend and ex boyfriend...and was present at the time - as were my parents), but what's more interesting was that when my mom was having me name people (she was totally freaked that I had some sort of psychotic break and was gone for good - especially since this was the 2nd time it happened....and wayyyy worse than the 1st time!) - I called my brother a green dog named Jake. We have a black lab named Jake, and my brother's favorite color when we were kids was green. It all makes sense. It's just that almost everything I said/wrote while delusional was just random things my brain was trying to connect together. Trying to find some sort of pattern in the random thoughts.

I found a paper of things I wrote. It did look a bit paranoid - I think I wrote how someone had stolen a paper of mine. I can't remember now because I later destroyed the "delusional" paper out of sheer embarrassment - but it was so weird to read it. The thoughts that came out of my subconscious that I'm really GLAD nobody could understand. Because if they had understood it, they would have seen something in my mind that I would have been very unhappy about. But to everyone else, it was a bunch of nonsensical jibberish. To me, I saw where a lot of the pieces and words came from. I saw inversions of things that I would think about.

As someone who went through 2 relatively very brief moments of delusion but actually has remaining written records (in the list and the IM convo) and verbal records (my parents and James telling me what I said), it has been very very very interesting to see what my mind did when I was out of the driver's seat. I imagine it was much more of "My Thoughts Uncensored" than anything I ever say while in full control of my thoughts/words. No psychiatrist could ever see those things the way I did because only I know what those words mean. It is a really strange perspective to go down that road and come out of it but yet be able to look back at the pieces.

I'm left to believe that sometimes delusions for some people might mean a lot more than they seem at face value - even if the two things don't connect... Most of my writings from that time showed that two things did not connect to one another. But they both had strong meaning. It was wild.....and I learned a lot!

Sorry to come late to the discussion!
Carrie :)

Patient Anonymous said...

clickshrink, it was Blogger, I swear! I'm not so egotistical and demanding that I post repeatedly *grin*

I was thinking about this (while listening to my iPod on the way home after commenting--not looking for patterns--haha) and was trying to somehow draw the distinction between being delusional and having feelings of grandiosity (don't know if you've checked me out but I have bipolar disorder for one.)

I was trying to apply the "pattern theory" to situations I've been in when I've had feelings of grandiosity (but have not been delusional.) It's been really hard, however, because I could not have separated myself from the moment and also, in looking back, I can't see what part of the pattern I was missing. Except for, perhaps, the blatant fact that certain things were just false. Depending on the particularly feelings of grandiosity, it's like, I'd "wake up" (or settle down) and it would be like...um, yeah...that just wasn't the case. I can actually see reality now.

It almost seems like euphoric grandiosity is a sort of mini delusional state? Gee, maybe I have been delusional after all, just on a small scale haha!

ClinkShrink said...

LOL Yes PA we've had a string of blogger-induced repetitive comments. I think it's a form of server tics. We need to put Blogger on mushrooms.

Patient Anonymous said...

I think Blogger already is on 'shrooms, (but not DrShroom hehe) that's the problem. Or maybe acid?

You're the doc...maybe you can prescribe something *wink*

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