the world inside your head

psych is a lot of listening to peoples stories, then sorting through very emotional interpretations of events (real or imagined) to get to what they're really trying to tell you, which is what they think is wrong, what they're worried about, and why they came to you for help.

it seems like this could be all of medicine, but I feel like getting to the meat of the story is harder in psych because often to help, you have you treat someone within their own insight into their illness.

and also because often the stories people tell are vivid and exciting or terrifying but fascinating or tear at your heart strings to the point where all you want to do is hug them

often I find myself wanting to get lost in the story with the person instead of trying to pull out the important parts so I can help them. but maybe that's the struggle of a good physician? You listen to the whole story but you know what parts to hold onto. It's not as intuitive as one might think...

One woman I admitted the other day was incredibly scared and frustrated because she believes that there are bugs, "ringworms" she calls them, crawling under her skin and tunneling through her fascia. She believes this so much that she has actually scraped off a good portion of her skin, leaving huge open wounds all over her body.

After hearing her story about how the bugs got into her skin, what they look like, and how she thinks I should treat them (SO FASCINATING),

here's how I weaved through her story to help her:

(1) looked at the medical examiner's note (no parasites)

(2) examined her back (the only place she can't scratch - and coincidentally, the only place the "bugs" missed; it's a good check if you suspect people are picking/scratching unknowingly)

(3) reminded myself that "ringworm" is actually a fungus, not a worm at all

she has delusional parasitosis, a disease that cannot be treated by telling the patient what it is, as they do not have any insight into the cause of their illness and truly feel like the bugs are real.

the bugs aren't real, but her fear is, so we cleaned her wounds and gave her antibiotic cream that she could put on them (to kill the bugs?), then put her back on her medications for anxiety. two days later, she's glorious.

and sometimes, even though I know it's not real,

I can't help but getting sucked into the story.

a patient today told me that he could hear the thoughts inside my head.

which at that moment, were mostly about what it would be like to be inside his head

and he looked at me so intensely, I found myself wondering,

for just a moment,

if maybe he could.

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"In telling the story of my father's life, it's impossible to separate fact from fiction, the man from the myth. The best I can do is to tell it the way he told me. It doesn't always make sense and most of it never happened...

but that's what kind of story this is."

-Will Bloom in Big Fish