Reaching Down the Rabbit Hole (12 page)

The average American has at least one unexplained symptom every week or two, and less than one-fifth of survey subjects report no symptoms at all during the three days prior to a random query. Headache, tingling, pain, dizziness, briefly blurred vision, a slight imbalance when walking, loss of train of thought, feelings of jabs and jolts: these are the most common symptoms, and they befall any healthy nervous system, then disappear and are forgotten. In some instances, however, there is no way to disabuse a patient of his or her symptom. Where a normal, functioning person might say, “Well, things happen,” some patients develop an attachment to or an excessive worry about a specific extrinsic cause of their suffering. They fixate on it.
Depending on the decade, it might be electrical fields or Lyme disease, environmental allergies or chronic candida infection, hypoglycemia or sick buildings, perfumes, or even alien abduction.

The trick is to communicate the fact that you know, and that the patient needs to know that you know, and the family also needs to know, that the problem is not organic, somatic, neurological, medical, life-threatening, contagious, critical, or cataclysmic. That is not to say that it isn’t disabling in its own way. Hysterias and factitious disorders prevent people from getting on with their lives, and prevent their loved ones from getting on with theirs. They are highly disruptive. Whatever strategy we choose to take is obliged to acknowledge that it is an illness like any other, and work from there. But there are limits to what I can tolerate.

Elliott slides a letter across to me, and then resumes his mandarin pose: head bent forward, eyes closed, elbows on the padded arms of his desk chair, hands interlocked in the church-and-steeple grip, index fingers slightly indenting his pursed lips.

It is a long letter, and Elliott holds his pose while I scan it.

“Well?” I say.

“I refuse to see them,” he replies absently. “Might as well open the floodgates.”

“But this is something rich, don’t you think? Aren’t you curious?”

“No. It’s loony tunes.”

“Well, I’ll see them,” I say. “In fact, I have just
got
to see this.”

On the appointed day, I take the couple to one of the examining rooms. Prescott K, age thirty-five, who wrote the letter, and his wife, Lizette, age thirty-three, have come a great distance with an electrifying story. They are clearly prosperous, very well-dressed. He’s in the hedge fund business, and wears khakis and loafers without socks. She is thin, not unattractive, and is wearing a stunning Chinese jacket of red silk, with a traditional collar, black piping, and a magnificent
Hermes scarf. Prescott immediately looks around and backs himself into a corner of the room.

“What are you doing?” I ask him.

“Well, the outlet there, and your computer screen are making me extremely uncomfortable.”

“How do you mean?”

“It’s that buzzing feeling. It’s what I came to you for. There’s an internal vibration that’s extremely violent, and goes up to my head. Let me explain, Doctor. I got this problem first, even before we were married three years ago. I began to notice that my whole body buzzed when I walked by electrical outlets or appliances when they were on. After living in our new house for six months, my symptoms got much worse, and my wife got exactly the same symptoms. I had electricians rewire the house, but it’s still happening. I know what you are going to say, but we are not crazy. I didn’t have this in my first house with my first wife.”

I know something about electrical fields, I know something about neurology, and I know something about baloney. Baloney is not hysteria or a conversion reaction. Unlike conversion, which has everything to do with overt neurological dysfunction, the more outrageous the better, baloney involves the exaggerated reporting of personal neurological experiences that is focused on nonsense, usually abetted by the hyperbolic popular press, all bordering on the delusional.

Schizophrenics, who suffer from something tragically real, have manias that have kept pace with technological advances. First, voices spoke to them from the dark, then voices came out of the radio, then voices came out of the television, now voices come out of the computer, from the Web. This much they have in common with the electrical couple: the aggravating factor is the world itself, if not the universe. They can’t tolerate the world we live in. But while the schizophrenic can’t pick his demons, for the electric couple it’s a lifestyle choice.

Of course, sharing the illness du jour with large numbers of fellow-sufferers has a supportive, salutary effect. In this case, the affliction is called electromagnetic hypersensitivity, or just electrical sensitivity
syndrome. There is a wealth of Web sites and chat rooms devoted to it. Sadly, when it comes to dealing with, much less treating, such borderline theories, I have no spiel to offer, and sometimes revert to being a jerk. In this case, I suggested that they both might be magnetized. As an experiment, I said, he and his wife should float on their backs in their swimming pool to see if they both pointed north. I was guessing that they had a pool. I was right.

They never came back.

The malingerer is not an hysteric. He (it’s usually a man) is purposely putting on a show to dodge the cops, avoid jail time, get out of work, receive compensation, or score some drugs. Likely he’s had practice, and has been to a couple of emergency rooms where he has honed his act like a stand-up comic.

Ethan R is a twenty-six-year-old graduate of Brandeis University, where he played soccer and majored in labor relations. He is unemployed, overwrought, increasingly desperate, and possibly in pain. It is hard to tell.

The residents are appalled. Without saying anything, it’s clear what they are all thinking: “Why did you admit this guy, Dr. Ropper? He’s nothing but a drug seeker!” Thus have I revealed, on only the second day as the attending, a fundamental weakness: my first instinct is to take what people tell me at face value.

In the outpatient clinic, Ethan told me that ever since falling off a ladder a day earlier, he had been suffering such excruciating sciatic pain that he couldn’t sleep, couldn’t even find a comfortable resting position. Now perched on a bed up on the ward, in a room he shares with a heroin addict, Ethan becomes a method actor. As I examine him, his eyebrows circumflex into an emoticon of anguish. The whole shtick is way over the top, and I see some of the residents roll their
eyes. What he wants is precisely what the pain service refuses to give him: intravenous Dilaudid and a prescription for oxycodone and Percocet.

Two things give him away as a drug seeker. The first is his preemptive insistence that he is not one. The second is his familiarity with drug names and dosages. His frustration seems to stem not so much from the pain as from our refusal to give in to his requests for drugs.

“We’re not going to do very much,” I tell him. “We’ll see how you’re doing tomorrow, but let’s talk about the drugs up front, now, because I saw you in the office, and I thought you were a pretty straight shooter. I don’t want there to be conflict about it. What we need to do is to start to taper the drugs off, and move things toward something that’s a little bit more manageable as an outpatient.”

“I understand what you’re saying. I’m not going to ask you for any medications to take home. The thing is, the way it starts and it stops . . . there’s no decline in pain, there just
isn’t
.”

“So you mean that once you get into one of these cycles of pain, it’s just there?”

“Yeah. I mean at first, it’s just . . . it’s hell, it’s hell on earth.”

“But you can still walk out to the elevator and go out and have a smoke?”

“Yeah, I can. I could at the beginning. With help.”

“But I’ve seen you walking around. I know you’re uncomfortable, but . . .”

“I have a very high tolerance for pain.”

Such a high tolerance that, at the end of the workday, Elliott sees Ethan in the lobby, perched on the edge of a sofa, laughing it up with one of his buddies as he casually munches on a fruit cup.

The following day, the family comes in—both parents—very concerned. In Ethan’s room, Elena, one of the junior residents, gives them “the talk”:

“Mr. and Mrs. R, this is a problem that needs to be addressed before moving on, but it can’t be properly addressed or solved in the hospital
because we don’t have the tools here. You need psychiatry, you need physical therapy, and in fact, we’re doing you a disservice by having you here in the hospital at all. The best thing we can do for you is to hook you up with these amazing services that could actually help you.”

Brilliant!
I’m thinking, even though the message has a depressive effect on Ethan, not that he even matters at this point. What matters is his parents, because they are inadvertently enabling and facilitating this.

Elena makes the phone calls to set up the appointments, we offer salves, we offer some therapy, but in the end, just to get rid of him, Elena has to bribe him with a shot of intravenous Dilaudid. That’s what he came for, and that’s what he gets on his way out the door.

Children under about the age of eight do not get hysteria, probably because they are guileless. On the other hand, if a young woman, especially an adolescent, is suspected of hysteria, a pink bunny or teddy bear next to her pillow is a tell. It is almost a guaranteed sign of a conversion disorder.