Like a Train Wreck

Studying psychosis is a little like looking at a train wreck -- as much as you might be shocked and horrified, you are also deeply curious, perhaps even morbidly so. All those parts bent, twisted, mangled and strewn about. Utter chaos. You look at the pictures over and over again, knowing something pretty bad happened, and hoping something in the photo will help you figure out exactly what.

Here's the really fascinating part: We all read newspapers and watch TV, so we know that those guys at the NTSB can sift through a tangled wreck of a train and catagorize an amazing amount of detail. Every wreck is different, but also the same. What looks like chaos to you and me actually follows a pattern. Steel bends and twists in certain ways. Glass cracks and shatters in its way. Insulation bubbles and melts in the way that it does, fire follows its own rules. And so on.

And like a train wreck, psychosis. Most people have some idea of what a psychotic person sounds or acts like. But when you sit yourself down with a psychopathology textbook, you are utterly amazed that people who have studied these things have an dizzying array of ways to describe when someone doesn't make sense. Ideas of reference, tangentiality, circumstantiality, clanging, neologisms, derailments, perseveration, thought blocking, thought insertion, thought broadcasting, logorrhea, aphasia, word salad. And so on. You sit there in the lecture hall gaping in disbelief that people who are that crazy can be crazy in just the same way that other people can be that crazy.

I once had two patients at the same time who both believed that Elvis is still alive and has a very special, personal affection for each of them. The government conspiracy is rarely just a government conspiracy; it's always the CIA or the FBI. Never the Department of Agriculture, the Public Health Commission, or the trash collector. Even though most of us have far more contact in our lives with the trash collector, and the trash collector probably has a legitimate reason to be out to get us ("Putting six months' worth of newspapers out on the same day! I'll fix her wagon!") he never is in the mind of a paranoid.

So I shouldn't have been surprised today when one of my patients -- a nice enough middle-aged lady how seems to have had a psychotic episode as a side effect of some other medications, and who seems to be pulling herself together really nicely -- said to me, "Yes, now I understand exactly what's happened to me. All these stressful things like I told you yesterday, my back injury, leave from work, financial pressures, teenage daughter, and then those medications. Yes I understand now. The only thing I still don't understand is whether I'm staff here or a patient. But I talked it over with my husband. Tom, dom, hom, lom, mom. I talked it over with my husband and he's picking me and Tom over there up and taking us all home. Driving away home. Oh well, been there, done that. Been there, done that. Been there, done that." Indeed.

Cheers,

Madeline