The woman was middle aged. Her presenting complaint was “Eye Problem.” She was ill-kept, making me think she might be homeless. She said she had been having “parasites” coming out of her eyes for a long time. At first, they were right inside her eyes and now, they were in the eyelids. Sometimes they were black and other times they were white, shaped like a string, probably when they were laying eggs. She had seen many doctors before but no one had ever been able to help her. It was unclear why she had decided to try again that night.
I talked to her for quite a while, looked at her eyes and skin, and then gave my honest impression. Her complaints didn’t fit any sort of parasite infection I was familiar with and I was not going to be able to help her. I told her it was probably all in her head, though I could be wrong and maybe some day somebody would discover with what she was infested.
I shared with her information on finding a doctor in a clinic, reassured her and sent her on her way.
The very next patient I went to see was listed as “Rash.” In the room was a man who was about the same age and apparent social status as the lady with the eye parasites though I made no connection between the two. He launched into a prolonged story about being infested with mites. He told me how they migrated around his body, showing up in different places at different times and looking different as they moved around and came out of his skin.
When I had heard enough and looked at his “rash,” I started into my “you may have something but it is probably all in your head” explanation when I was interrupted by someone in the hallway outside the room.
“He don’t believe us! He ain’t gonna do nothin’ for us!” It was the lady! They were living together on the streets and had developed a shared delusion about being infected with parasites.
I went over things with them, again, and they left, complaining that nobody ever believed them.
Here is a link to our old friend, Wikipedia, to explain that this sort of shared delusion is a well-described condition: http://en.wikipedia.org/wiki/Folie_à_deux
This reference has a couple of case studies that provide insight into how this can present itself: http://www.minddisorders.com/Py-Z/Shared-psychotic-disorder.html#b
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