too bad it isn't just a babelfish

November 17, 2009 5:27 AM

Physical problem or mental problem?

I have a friend (I know you're not her doctor) who has a history of of mental illness. Paranoia, delusion, etc. She has been in a mental health facility twice in the past. Once, we visited where she had her breakdown and just being there, I saw this unreasonable paranoia coming out. Today she came by and said that she had a hole in her eye and that yesterday she saw something fly out of her nose. Also that she hocked a lougie and three little orange things came out.

There are two options. One, that there really is a parasite (or something) and she needs to get it checked out (uninsured, but she's working on figuring out how to get to a doctor), and the other option I can see is that she's having some sort of relapse.

I'm worried about her. I've been busy lately and haven't seen her for the past few weeks, but she has other friends who she does spend time with, and they've got her back (and are keeping an eye on this).

My question is twofold.

1) Do you know of any parasite that does this 'burrow into the eye and fly out the nose' thing, and if so, what would her symptoms be? She looked ok to me, but I know I have felt pretty sick before and looked fine.

2) I'm distrustful of the California mental health care system. Although I have no experience with the mental health care system at all, I worry that it can often be as much of a problem as a solution. I have this image of it as under-funded and that over-prescribing, and my desire to protect a smart and vibrant friend from something that wouldn't necessarily make her better comes into play.

It's late at night. I hope this was coherent and that I didn't leave anything important out. Thank you in advance for your advice and experiences.

posted by anonymous to health & fitness (9 comments total)

Today she came by and said that she had a hole in her eye and that yesterday she saw something fly out of her nose. Also that she hocked a lougie and three little orange things came out.

I think you know, but I will tell you anyhow. You say there are two options. However, when these two options are squeezed through a lens of "what is real-world likely to be happening here" one option [relapse] is much much more likely than the other. If your friend had just come from a foreign country, had been working with farm animals or otherwise in situations where she might be exposed to parasites, it is possible [though terribly unlikely] that she could have some parasitic concern. Otherwise this falls into the "highly improbable" range.

Put another way, a doctor can tell your friend if she has parasites [the tests are simple] versus if she is having delusions. Your concern should be encouraging her to seek medical attention for her problem since delusions can be problematic and worse if left untreated. You can help her navigate the system if you want, but this is a situation where it's more important to be an advocate than to stay away because you're not totally comfortable.
posted by jessamyn at 5:50 AM on November 17, 2009

jessamyn is right. Encourage her to go get checked out by a physcian. Let the doc reccommend treatment for mental health issues if that is what is happening. It sounds like that to me.

Large bureaucracies have good people working in them too, it is just finding them that can be the problem. I live in a state with a huge community mental health program, and although there are some dickheads in there, there are also some skilled and good therapists. Our system has ombudsmen to help out, if needed. Publicly funded systems are notoriously underfunded, but that still doesn't mean your friend can't get good help there.
posted by chocolatetiara at 5:58 AM on November 17, 2009

she sounds delusional.

this does happen to people. not to be armchair, but maybe paranoid schiz?

medication would make probably make her better.

but you are right to be distrustful of the health care offered to the uninsured. where i am, you can only get free/lowcost mental health care if you are a drug addict. sliding scales are still pretty prohibitive.

if she has a job, she may have access to something called Employee Assistance Program (EAP). she does NOT need to have insurance to have access to this. it is COMPLETELY confidential. if she is not working, a family member who is working may have access to the EAP at their place of employment. most EAPs will provide some level of assistance to close family members.

for example, before i qualified for insurance at my job, the EAP provided me with 3 free counseling sessions with a psychologist - a real one, not an overworked drug counselor. this enabled me to then get a diagnosis and a prescription from a family doctor. i only had to fork over for the family dr and meds which was better than that plus 3 psych visits!

while it ultimately ended being a wrong diagnosis, it did give me temporary respite.

on the other hand, your friend is obviously being delusional and may be a harm to herself or others quite unintentionally. what if she starts trying to go after the "bug" in her eye with tweezers in the bathroom?

i don't know if you know her family and how her relationship is with them, but this might be a good time to get in contact with them.

best of luck to you and your friend. it's good she has someone who cares.

on preview, what jessamyn said. advocate for her and help her, don't stay away.
posted by sio42 at 5:58 AM on November 17, 2009

I think your friend is probably delusional, for historical reasons. However, it's always possible that she actually does have a parasite. Botflies come to mind. And just fyi, it's frequently extremely difficult and unlikely that a physician will find a parasite. There are not easy tests for them (or any tests at all that I am aware of). A coworker's husband came back from Belize with a botfly once and a lot of doctor's thought he was crazy. Turned out he just had a maggot living inside of him. :c\

Another interesting read about them.

Oh, and they can get into the eye.
posted by sickinthehead at 6:14 AM on November 17, 2009

1. No. I don't believe there is such a thing as a little orange, eye-ball chewing, snot residing parasite. Of course I could be wrong. But I doubt it. I'm pretty sure she's experiencing somatic delusions.

2) Number 2 isn't really a question. Sure. State mental health systems are not so great as a general rule. But it's what she's got and it sounds like she's on the road to getting sick.

Now. For the question you didn't ask: You can't really make your friend get help if she doesn't believe she's sick. Arguing (or trying to rationalize) with a person experiencing delusions is a big fat waste of time. Imagine someone trying to tell you right now that you are not reading this on your computer screen; that in fact you are a staring at a blank wall instead of a computer. That's how real delusions are for the person experiencing them. The pink elephant IS REALLY in the room for that person.

How aware is she of her mental illness and how much does she generally commit to treatment? I get the impression that even though she's had two hospitalization, she's not continuing community treatment as a rule.

As a mental health case manager, I would take a statement like your friend's to mean that my client was on the road to getting pretty sick. But I wouldn't do much more than monitor her and suggest (in a different conversation so that she doesn't have to defend her delusion) that she follow up on medication management for her mental illness. If the client was treatment resistant, I'd watch for any self harm. Having a somatic delusion is not a reason for involuntary hospitalization. Trying to dig out your own eye to remove an eyeball burrowing parasite is a different story, however. That's a 911 call.
posted by dchrssyr at 6:22 AM on November 17, 2009 [1 favorite]

2) I'm distrustful of the California mental health care system. Although I have no experience with the mental health care system at all, I worry that it can often be as much of a problem as a solution. I have this image of it as under-funded and that over-prescribing, and my desire to protect a smart and vibrant friend from something that wouldn't necessarily make her better comes into play.

While I've never worked in the California public mental health care system, I think your fear sounds overstated. This is partly based on your admission that you have no experience with it, and partly on my knowledge of other public mental health systems, which actually function fairly well, all things considered.

But the issue really isn't about the nature of the care that your friend might receive. The choice is between no care for her hallucinations and delusions, and care for them. You should consider these types of delusions to be a life-threatening condition and do everything in your power to have her assessed by someone who is qualified to do that.

(I think jessamyn wrote a very even response I always say that it's impossible to diagnose over MetaFilter, but I feel 99% sure that your friend does not have a parasite. Or, at least, that the high chance of her being delusional suggests that needs to be assessed immediately.)
posted by OmieWise at 6:37 AM on November 17, 2009

Physical and mental usually go hand in hand and I wouldn't entirely dismiss her symptoms as being merely *mental* for the patient is surely experiencing all of pain and anguish on all levels. My feeling is that is could likely be Morgellons -which has been cited by the psychiatric community as a manifestation of known medical conditions, including delusional parasitosis. More info HERE. I wouldn't put all my faith in the mental health field to treat her but would go the holistic route including full blood chemistry work ups and if at all possible heavy metal (mercury) testing as well to rule out any toxin that could be an underlying contributing factor to the *psychosis*.
posted by watercarrier at 8:12 AM on November 17, 2009

You're concern over California's mental health system are justified but you have to weigh those against the consequence of not getting treated at all.
posted by chairface at 11:57 AM on November 17, 2009

My mother was schizophrenic, spent the last twenty years of her life in and out of hospitals. She was sure that a mysterious fungus had invaded her body, she would show us the black crud the fungus forced out of her pores, and various other manifestations, all invisible to anyone else. She had every test under the sun, and several docs assured her that she did not have a fungus, to no avail.

On a couple of occasions I had to commit my mother to mental hospitals because she had stopped taking her meds and was really out there. It's very difficult to compel someone to get mental health treatment in the US, even as a close family member with proof that the person in question has a long history of mental illness. Good luck!
posted by mareli at 1:21 PM on November 17, 2009