What was this strange thing that happened to my boyfriend?
March 30, 2013 10:22 PM   Subscribe

Two weekends ago, something REALLY weird happened to my boyfriend and I'm still struggling to try and figure out what it was. A hallucination? A psychotic episode?

Some background: he and I have been together almost a year, in our mid-twenties, both professionals recently out of grad school and in our first "grown-up" jobs. Both of us consider this a serious relationship and see it leading to marriage, perhaps in the next 2 years or so. We communicate really well on an everyday basis but we do have fights occasionally, mainly when one or both of us is sleep-deprived and/or stressed about work or something else, and we have talked a lot about it and are both working on conflict resolution skills, and I think it's been getting a lot better.

From the very beginning of our relationship, he has been extremely open and honest with me about his past. He grew up the middle child of a rather dysfunctional family and went through a very rebellious phase in high school and college, including using drugs. (He grew up a lot during grad school and stopped using all drugs about a year before we met.) During college, he went through a really bad stage of depression after a long-term girlfriend cheated on him and broke up with him. He attempted suicide during this phase of his life. I don't know the details; I've never pressed him about it. I know that he was admitted to a psychiatric hospital after this happened, I presume for just a few days since I don't think he ever had to take time off school for it. He was on antidepressants for a while but no longer takes them. Like I said before, he has always been 100% honest and open with me about all of this. It made me uncomfortable, of course -- no one likes to hear that their boyfriend has tried to kill himself before over an ex-girlfriend -- but he's promised me over and over again that this is a completely different phase of his life and he has grown up a lot since then, and he would never even dream of doing such a thing now. I believe him. There are times where he does show mild signs of depression, but overall he's a generally happy person and I have never been concerned about him until now.

Two weekends ago, we went out for St. Patrick's day with a female friend of ours (she's actually the girl who introduced us to each other). We came home to my house around 1:30 am. He was in a bad mood, because at around midnight I had wanted to go home and go to sleep and he wanted to go out to another bar for a couple hours. We had compromised and decided to go to the new bar for an hour and then come home. I could tell he was in a bad mood and had been holding it all in because our friend was around and he wanted to put on a good face while she was there. As soon as she left, we started to fight. Both of us had been drinking a little bit, but were not drunk by any means. (If anything, I was more tipsy than he was.) He started accusing me of not having a good time while we were out, because I wasn't dancing as much to the live music as he was, and because I had wanted to go home. It was a really dumb reason to be picking at me, but somehow it turned into a full-blown fight with both of us getting defensive and me crying. He was really upset -- I really think the whole night he had been annoyed at me because I wasn't acting like I was having a good time (when I actually was having a good time, I just don't get as into live music as he does -- we enjoy things in different ways.)

So we were sitting on my kitchen floor, I was crying, and he started crying. He suddenly looked at me with this really scared look on his face. I honestly thought he was about to break up with me -- I was really confused, and kind of scared. I had never seen him look like this before. He got really quiet for a long time and just had this odd look on his face but it looked scared. I calmed down and held his hand and asked him what was wrong. He didn't even acknowledge me. I kept trying to talk to him but it was like he didn't know I was even there. This went on for maybe 2 minutes or so. Then he got up and speed-walked out of the kitchen really quickly. I wondered if he was about to get sick or something, so I checked in the bathroom, but he wasn't in there. I found him lying in the bed, sobbing. I was really freaked out. I tried to talk to him, but he was doing the same thing where he didn't even acknowledge that I was there. This went on for another couple of minutes. I held him and told him it was going to be okay -- I didn't really know what else to do.

Then he suddenly jumped, like he was startled. He looked at me with a really confused look on his face. He said my name over and over like he didn't know why I would be there . He asked me where he was. I told him -- "you're in my house, you're in bed, I'm here with you, it's going to be okay." He then burst into tears and asked me "am I really here? are you real? Where's Anderson?" I had no idea who Anderson was... and this was starting to really scare me for real. After a few minutes he told me what he thought had happened. He couldn't really remember anything for the past 30 minutes or so. He did remember that we were in the kitchen and that we were fighting -- but he had no idea what we were fighting about. He just had a hazy memory of being upset. And then -- this is the part that gives me chills just typing it -- he walked over and picked up a kitchen knife and killed himself with it. That's why he was so confused when he "woke up" and was in bed and I was there with him.

He told me something similar to this has happened twice before. Both of these times were a very, very long time ago when he was struggling with bad depression and self-harming. At least one of those times, someone named Anderson was there with him and was the one who stopped him from actually hurting himself.

Since then, everything has been normal. We've both had a very stressful month at work, so we've bickered more these past several weeks than we usually do, but nothing like that has happened again. But I'm worried about him. He swears up and down that he doesn't have suicidal thoughts anymore, and hasn't in a long time, and that I make him happier than anyone else has ever made him. I believe him -- I think. I'm just scared because it seems like fighting with me brought out some terrible dark side of him. I don't even know what to call it. A hallucination? Temporary amnesia? Both? I'm a physician, so I have a pretty good understanding of basic psychiatric disorders but this doesn't seem like anything I've read about or heard about. I'm thinking that it was most likely some sort of transient thing brought on by severe stress. Has anyone ever experienced anything like this before? Should I be really worried?
posted by alysonagain to Human Relations (44 answers total) 10 users marked this as a favorite
Could he have had a seizure?
posted by JohnnyGunn at 10:30 PM on March 30, 2013

Best answer: Sounds like it could be a simple partial seizure.
posted by keep it under cover at 10:36 PM on March 30, 2013 [3 favorites]

Thirding the possibility of a seizure.
posted by EXISTENZ IS PAUSED at 10:49 PM on March 30, 2013 [1 favorite]

I truly hate to say this, but this sounds like faking illness as a cover for telling you he is suicidal. Or frightening you with the idea that he is suicidal. I truly hate to say it because so often, people get accused of faking things medically when they are not. So I don't say it lightly. But there are a variety of things here that don't seem to match up to each other in your description here. Either he has a severe psychological or neurological illness, or he is faking that he has one. Luckily the next step is the same either way. He needs to get medical help immediately.
posted by anonymousme at 11:05 PM on March 30, 2013 [13 favorites]

Best answer: I would definitely want to rule out anything neurological first, but if everything checks out with him brainwise, I'd suspect he experienced a dissociative episode. Some people do this under extreme stress; it's a coping mechanism. I'm wondering if he has any history of abuse or trauma, or ever witnessed violence at some point. He may not consciously have any suicidal ideation, but the fact that he's attempted to harm himself during one of these episodes is concerning. He might want to see a neurologist first, then a mental health clinician if a medical cause is ruled out. I'd suggest he avoid alcohol for the time being, too. Good luck.
posted by sister nunchaku of love and mercy at 11:08 PM on March 30, 2013 [10 favorites]

He wasn't sneaking booze was he? He could've blacked out for a minute.
posted by thylacine at 11:10 PM on March 30, 2013

During his rebellious phase, did he ever take LSD? It has been reported to cause flashbacks, or more severely, hallucinogen persisting perception disorder.

"Many emotionally intense experiences can lead to flashbacks when a person is reminded acutely of the original experience."
posted by keep it under cover at 11:18 PM on March 30, 2013

My initial impression is that he might be using drugs again.

(I'm assuming the drugs you reference in his past were something serious, as opposed to sporadic weed smoking or something.)
posted by vivid postcard at 11:27 PM on March 30, 2013 [2 favorites]

Perhaps some sort of split personality disorder?
posted by Dansaman at 11:36 PM on March 30, 2013

Response by poster: anonymousme: I see where you're coming from, but I really don't think he was faking. He went, in a split second, to picking a fight with me over something stupid to being essentially nonresponsive -- and when he woke up, he was genuinely confused for probably an entire minute about who I was, where he was, and what was happening. I've never seen anything like this before. And later that night/the next morning when I talked to him about it, he swore up and down that he had not had any suicidal thoughts in a long time. I don't know, maybe I shouldn't, but I believe him.

sister nunchaku: A dissociative episode sounds like an accurate description of what happened. You're right -- I know people with PTSD can have those. I don't know of any specific trauma or abuse that happened in his past; his parents have a lot of issues and are rather manipulative towards him and he's gone through a lot, but I don't know of any specific traumatic events. Other than the ex-girlfriend thing and the suicide attempt, which I don't know details of (and I'm not sure whether or not I want to...)

keep it under cover: He has taken LSD before, but I don't know if he ever did that frequently or if it was a "tried it a few times" thing. (honestly, it makes me sad to think of him being on drugs in the past, so I haven't dug too deeply into finding out the details of all that.) When I talk to him about this again I might bring that up thought.
posted by alysonagain at 11:40 PM on March 30, 2013

Does he take zolpidem?
posted by Wordwoman at 12:42 AM on March 31, 2013

Best answer: I have had episodes of depersonalization dissociative disorder at a much smaller scale, and at least to me, this is what it sounds like. It's possible that he wasn't really that upset when he was fighting with you, but in a weird mindset and maybe even a little scared of how odd he felt, and that's why he picked a fight. It's more reassuring to blame a disagreement for feeling disconnected to reality than to think oh...I have mental issues! These episodes are really scary and believe me, he is just pretending things are back to normal. He is probably scared shitless.

In my case, it used to happen infrequently, until I started therapy and had to kind of face some things. That's when these episodes got more frequent and harder to control. To other people it would look like I was extremely dazed. I would have a weird ringing in my ears, and I would be making a huge effort to keep things looking normal, but I just couldn't. I didn't totally disconnect, though. It was like I was looking at my life trough a tube and things weren't real. A little bit like when they entered the tunnel in that Being John Malkovich movie. Stress or anxiety triggered these episodes, too; and in some cases, I would be at a place and I would have no memory of getting there (never left the house, just would "show up" on a different floor, for example). If he has had the full blown black out alternative reality thing, it's possible he has felt like I did before. I didn't even know it didn't happen to everyone until I told friends (with the air of someone who says "dejavu!") and they were like WTF are you talking about? And I realized it wasn't normal. Like I said, though, I mostly was enough in control to try to pretend my brain didn't think everyone was a puppet, but sadly the higher the intensity, the less control a person has to even be aware of what is happening.

At any rate, he MUST go see a doctor now. I personally would go to a neurologist and a therapist. I think you could be a good motivator for this, because he is probably trying to pretend for his own sake that there's nothing to worry about. He should probably not get tipsy or drunk for now, though. I haven't had one of these in forever and I'm pretty confident this is part of my past now, so don't think it can't be helped!

I know I would never have started to take care of myself without my SO's love and support. You sound like a loving partner, so I'm sure you will be there for him. Good luck!
posted by Tarumba at 2:04 AM on March 31, 2013 [5 favorites]

I had a friend with very similar drug/depression history and two known dissociative episodes. The first happened at skiing trip and included a brief hospitalization. The second happened at party, many years later, celebrating he and her girlfriend finally marrying, and included him sitting dazed and scared for hours and later telling about it with similar description as Tarumba, shrugging away if friends tried to make contact. They agreed to go to doctor first thing at monday, by that he was feeling better and normal enough so that they agreed a more in-depth meeting at two weeks.

Next day he was found dead in front of his apartment, in his underpants, jumped from a balcony. In the apartment police found his wife of one month, stabbed to death. The guy in question was a big friendly guy who never, in any extreme conditions, had showed any signs of violence. The number of stab wounds (>100) makes it impossible for us to believe he be able to do it in any sane condition.

This is the nightmare scenario of what could happen, and it happened. It would have required so little to go in a different way. Few more dissociative spells without that kinds of results and they would be better prepared to know how to handle it, when to prioritize personal safety and just run, and how to prevent it from going into full-blown psychosis or how to recognize dangerous developments.
posted by Free word order! at 3:33 AM on March 31, 2013 [1 favorite]

My ex-boyfriend used to have these dissociative episodes when stressed (usually after he picked a fight with me or if I was pressing him to get psychological help). They are terrifying and dangerous and I was in no way capable or prepared to deal with it or help.

Harsh words but... if he doesn't call a doctor about this first thing Monday morning and doesn't treat this as the psychiatric emergency that it is, break up with him. This is not going to get better on its own, it's only going to get worse. Can you picture yourself dealing with a dissociating husband if he becomes, say, stressed after being sleep deprived with an infant?
posted by lydhre at 4:11 AM on March 31, 2013 [16 favorites]

Suicidality can, in and of itself, be experienced as traumatic. However, PTSD is not the only cause of dissociation.

I would also consider a borderline personality disorder, as transient psychosis during stress is one way that it can manifest and he has been suicidal over a relationship problem.

Finally, I should note that this would be relatively simple to fake and that faking mental illness or obliquely threatening suicide when you resist his controlling behavior would point to possible abusiveness.
posted by the young rope-rider at 5:28 AM on March 31, 2013 [1 favorite]

This happened two weeks ago? Is there some reason why he hasn't already sought psychiatric help?
posted by tel3path at 6:03 AM on March 31, 2013 [4 favorites]

Some people are at risk of what sure appears to anyone else a psychotic episode any time they put alcohol in their body.

Many people hear the word blackout and maybe don't know what it could mean; myself, I'd always thought that it referred to drinking to the point of sleep / unconsciousness. I learned different, a number of years ago.

I was dating a lovely woman -- bright, beautiful, happy, talented, a gifted painter, smart, fun, funny. I'd known her for a while, casually -- she lived in my condo complex -- we were friendly but she was not my type, whatever than means. But that friendship warmed then heated and I've got my hand on her arm and Hey, what's this?

A trip to Dallas, meet her brother and his wife, do the museums there, having fun in the sun here in Austin, time going by, some day trips, meeting other family as it unfolds, things looking great. Am I ever lucky.

One night I see her and it's her but it's not, she's going on and on, in and out, not making sense. It was not completely word salad, she kept referencing words and music of John Lennon. I'm like um, yeah, okay, he was a great artist -- and ?

Blackout drinking. She didn't have to guzzle two bottles of Southern Comfort to get there, either; seems she was / is vulnerable any time she put any alcohol in her body. When it happened, she sometimes made more sense than other times, without correlation to the amount drank, or anything else, aside from at least one drink.

It didn't happen every time she drank, but seems that it could. It was random.

Turns out that there was / is deep alcoholism in her family, both parents. And -- drum roll -- raging violence toward one another. Raging violence toward the children. A very, very broken family, though they looked good from the outside. Which was all-important.

Broken families turn out broken people.

Badly broken families turn out badly broken people.

Things went south, from that night forward. It's not her fault. It's not mine, either. Ending that relationship was very, very interesting.

I'm a broken person myself. Everyone is damaged in shipping, to whatever extent. Some more than others. It's not bad, it's just a fact, they aren't bad, it's just who they are. Life is interesting.

I don't know what's up with your man. But something is. I encourage you to be cautious, no more automatic green lights on the marriage thing, now flashing yellow lights, warning of hazard.

Good luck.
posted by dancestoblue at 6:31 AM on March 31, 2013 [14 favorites]

Is there any chance he's bipolar? (I know that's a popular diagnosis right now.)

He does seem awfully controlling. I'd dump someone who gave me a hard time because I wasn't having enough fun according to their observation.
posted by BibiRose at 6:44 AM on March 31, 2013 [5 favorites]

Oh yeah, the part that I forgot to mention is...as soon as I realized it wasn't normal I FLEW to the therapist, psychiatrist, did hardcore work until I GOT BETTER, and now I AM better. Anything less would have been grounds for dumping on the spot and I would have deserved it.

You have no duty to put up with this if after a reasonable amount of insisting he does not want to help himself. If he were too embarrassed, reluctant, etc. and didn't want to go see someone, you may want to try relationship counseling and bring it up as something you feel needs to be taken care of before formal engagement. A professional third party will know how to explain the urgency of the situation to him. He needs to realize this is huge.
posted by Tarumba at 6:55 AM on March 31, 2013 [2 favorites]

I don't even know what to call it... I'm a physician


Should I be really worried?

Yeah, because this guy is not marriage material in his current shape. Please read and re-read lydhre's comment.

"He had been annoyed at me because I wasn't acting like I was having a good time" is in the spectrum of abusive behaviours. There are all sorts of red flags here.

I don't understand why you would not have helped him access appropriate health care. What sort of medicine do you practice...?
posted by kmennie at 6:59 AM on March 31, 2013 [16 favorites]

Well, if I were you, I'd be worried about this:

* he attempted suicide after his last gf broke up with him
* te tells you that you make him happier than anyone else he's ever known (this is a massive red flag)
* he picked at you and accused you of not having as good a time a time as he thought you should be having
* he had bad depression but no longer takes medication
* he had a seriously terrifying episode and hasn't gotten help.

I can't even attempt to address what happened to him the other night, but I can tell you this:

if this guy doesn't get himself to a doctor AND into therapy immediately, I would DTMFA now.

You've been together for less than a year?

He's waving all sorts of red flags in your face. I hope you can see them.

(fwiw, there are more than a few of us here who have experience with abusive relationships. Please don't think we're being hysterical. When we say we see red flags, believe me; we do.)
posted by kinetic at 7:18 AM on March 31, 2013 [21 favorites]

* tells you that you make him happier than anyone else he's ever known (this is a massive red flag)

Isn't this how most people feel about their spouses? That they are the most awesome person in the world? I thought that's why many people call weddings "the happiest day of their lives". I have had many happy relationships, but my SO takes the cake of awesome relationships and I have truly never been happier, even though I was pretty happy before. How on earth would that make me abusive?

I think you're reading too much into it. She said herself that the argument felt dumb, so it doesn't look like it happens all the time. Besides, you've never had an argument over stupid stuff when you were drunk?

What's more, she also says SHE doesn't know the details of his suicide attempt. Do you know it was because his gf left him, like you are hinting? Even though we know he had depression? Since when is a previous, far-in-the-past suicide attempt grounds for calling a relationship abusive?
posted by Tarumba at 7:54 AM on March 31, 2013 [2 favorites]

Please don't waste time with the "LSD flashback" theory. It's a popular myth; you'll notice the article linked says there as is no medical verification that they exist. The other condition referred to in the Wikipedia link, HPPD, is nothing like flashbacks at all. It's not a more "severe" from of flashbacks, its a persistent condition that sounds nothing at all like what happened to your boyfriend.

It sounds like a seizure. I've also seen people with migraines get very disoriented and confused, but this would be an extreme case. Point is, no one here knows and your boyfriend should speak to a doctor, rather than being diagnosed by after-school special scare stories. (Also, if it makes you "sad" that he did LSD, should you guys really be together? Your story of the evening leading up to the incident makes it sound like you to are really incompatible.)
posted by spaltavian at 7:56 AM on March 31, 2013 [4 favorites]

This was chilling and hard to read. I have an abusive ex who did this stuff. All of it. These episodes, which I always privately called "nervous breakdowns" were so frightening and horrible and really confusing.

You need to tell him that he needs help. If he does not get help, you need to leave.

Easier said than done, but the red flags pointed out above are real. These episodes are deeply destablizing and frightening. They caused me to stick around in what was an abusive situation because he was clearly - for lack of a better term - broken and I wanted to help fix him. But he didn't know he was broken, wouldn't see that he was abusing me, and completely disregarded and forgot about his nervous breakdowns and acted like they were ok.

If he won't get help, you need to leave.
posted by sockermom at 7:57 AM on March 31, 2013 [5 favorites]

I am not a dr or medic or psych professional, and this is second or third hand anecdata, but I have heard of people with Aspergers having similar breaks. I'm leaning more towards the dissociative thing, but there are clearly other possibilities.
posted by Jacen at 8:15 AM on March 31, 2013

You know, he could be genuinely experiencing this problem as you describe it and still using it to manipulate you.

What is getting people's hackles up, I think, is that he had this huge and very scary episode, *two weeks ago*, and *you* are the one asking how to deal with it. Meanwhile, as far as he's concerned, it could happen again at any time.

The fact that you've been together about a year also looks familiar to me. I've known manipulators to be very conscious of one year anniversaries. The reason being that it takes that long to establish trust.

Saying "you make me happier than anyone else ever has" is not eye-catching in itself, but combined with the cause of the fight - you wanting to do different things and compromising, him requiring you to display enjoyment in ways that met his specifications - that does start to look questionable.

Put these things together and you could have a future whereby he's only happy if you do everything exactly on his terms, and if he's not happy enough, he could have another of these episodes at any time.

I'm not saying that's what's happening to you, only that it is something that happens, and therefore could be an explanation for this strange thing that happened to your BF. Several people here can testify to that.

But supposing we're all just too cynical/paranoid/whatever and the only explanation that anyone should be considering is a medical one. Well, you're a physician, I assume this kind of thing is outside your area of expertise so you don't know what it is, and you also know that he can't be diagnosed over the Internet by a bunch of us. He would need a neurologist and a psychiatrist for something like this, wouldn't he?

So the question is... It's been two weeks and you, not he, are the one who's bothered enough by this to try to do something about that. Why you and not him? Maybe he's scared to face the truth? Okay, if he's scared to face the truth that's understandable. But you're scared too. That should matter to him, if you matter to him.

So he needs to see the right kind of medical specialist ASAP. If he doesn't want to do that... Whatever the explanation for that - even if the explanation is he just doesn't want to - it isn't good.
posted by tel3path at 8:35 AM on March 31, 2013 [17 favorites]

One thing nobody's mentioned -- are you sure he wasn't drunk? It's St. Patrick's Day. People drink more (sometimes on emptier stomachs) and drink faster and drink stronger, and bad shit can happen, and this sounds an awful lot like a brownout. (And if he is in fact doing drugs again, alcohol can exacerbate that, or that can exacerbate alcohol.)

It could be the other things too, but I wouldn't be so sure you were drunker than he was.
posted by dekathelon at 8:55 AM on March 31, 2013 [2 favorites]

Well here's a slightly different take.

I experienced massive anxiety and fear as a young person and the only way I could deal with it was to repress it heavily. That allowed me to continue living my life, but now that I'm older I am very aware that all that stuff is still inside of me. It has transmuted into grief, and sometimes it comes out.

I never seem to be able to figure out what's happening before it's too late, but usually when some of it is going to come out the first thing that happens is that I get really pissed off at someone for no good reason at all. Then later, after feeling terrible about my outburst for awhile, the extremely deep-seated waterworks start moving. The anger is me feeling that huge wave of emotion starting to crest but not understanding what is happening to me.

The timeline of events you describe--petty anger, fear and confusion, heavy sobbing--sounds like it could be a particularly intense version of this.

And believe it or not, this could be an (admittedly terrifying) sign of deep happiness with the relationship and connection with you. As I said I am full of this repressed fear and anxiety, and keeping it inside of me sucks and is responsible for a lot of the problems I have in my social life. I would dearly love to get it out of me, but the problem is my body will not let it out unless it feels completely safe doing so. By safe I either mean damned sure no one else is around, or with a human that I know knows me really well and cares for me unconditionally, read: a significant other. Or close family, though I am not able myself to let go completely with my parents/sibling.

The most intense time happened when I was alone--a roommate moved out and I had the house to myself and my body said "Ok, here goes!" I had a crazily intensifying sobbing jag that was leading to a panic attack that made me think "Hm. THIS must be the kind of feeling people get that makes suicide seem like a reasonable idea," before I was miraculously able to calm myself down.

I am a very monogamy oriented person and my body always yearns for the company of a lover/partner. Though I am single and 'available' now I am very hesitant about starting a new relationship because I am pretty sure once I really get to know someone and start to feel safe and intimately connected with them my body is going to scream "Open the floodgates!" I am scared that I'm going to let loose an emotional atom bomb on whoever she turns out to be.

So that's what your description sounds like to me, except more serious because of memory loss and suicidal ideation. It sounds like he's got a whole lot of stuff compressed heavily inside of him and maybe his id feels safe enough with you to let some of it out.

And yes there should be help sought from professionals because even if his good character is not suspect it is under a lot of stress, more than he can handle himself by the sound of it.
posted by My Famous Mistake at 10:32 AM on March 31, 2013 [3 favorites]

Can you clarify: you're a medical doctor?
posted by latkes at 12:02 PM on March 31, 2013 [2 favorites]

Response by poster: Thanks for the answers, everyone. I'm on my phone at the moment so I will type more later, but I just wanted to say a couple things:
1. I am going to talk to him tonight and let him know that he needs to call tomorrow and get an appointment with a psychiatrist. I mentioned it to him the day after it happened, and he didn't exactly blow it off, but he was still kind of shaken up about what happened and I didn't push it like I should have. He's also been out of town for work the entire past week so I haven't seen a lot of him or had time to really have a discussion, and I wanted to be prepared to talk it over with him and have reasons and be able to discuss some of the different possibilities of what could have happened. I feel fairly confident that he'll agree to go. I'll keep you guys posted.

2. To the poster who listed all the "red flags": I appreciate your concern, I really do. But part of the reason this fight upset me so much is because it seemed to come out of nowhere. Yes, if we had fights like that every day, I would agree with you that it would be a sign of controlling behavior. But obviously the reason I'm so concerned and want to get help for him is because this was part of an episode where he acted very strangely and was not acting like himself. Also, in regards to the "you make me happier than any person ever has" I don't see that as a red flag at all. Of course he makes ME happier than any relationship I've been in in the past, otherwise I'd still be with those other people, right? I didn't imply that to mean "I can't live without you" or any other codependent variation. He was a much happier, well adjusted person long before he met me. He has even said before, that he is so glad he was able to get past the rough stuff he went through and learn to love himself and be happy as a person before he ever met me, so that he could be a better person and better able to love me without having to be codependent.
3. I'm an internal medicine physician. And yes, I am aware that he needs medical treatment. But I also knew that what happened was not criteria for hospital admission. I was very careful to ask him after the episode, and again the next morning, about any suicidal ideation and he denied it. I know that had I brought him to the ER (because I work in ERs) the answer would have been "follow up with psych as outpatient." In fact, I don't even know whether to call that suicidal ideation, since it didn't appear to even come from his conscious mind, and the whole episode didn't last longer than a few minutes.
posted by alysonagain at 12:17 PM on March 31, 2013 [1 favorite]

Response by poster: yes, I'm an MD.
posted by alysonagain at 12:22 PM on March 31, 2013

You're right, the ER probably would've been a disaster. You're also right, it doesn't really sound like suicide ideation... BUT HOLY SHIT, IT WAS SOMETHING.

I read your question last night right before going to bed.. And it kept me up. What you described was terrifying -- both from your perspective and from what I imagine his had been. Just READING about it made me too scared to sleep. I can't imagine how terrified I'd be if this had actually happened to me, or if it had happened to my boyfriend. I cannot imagine living with that terror for TWO. WEEKS. Like others, I'm gobsmacked that it's taken you this long even to just ask the question.

I get the feeling from your question that you are very concerned about this. It's clear that you are concerned with how to diagnose him... But I'm worried that you're not insisting on him seeking help as emphatically as I believe you should be. In other words: I'm not seeing the sort of panic I think your situation deserves. Let me say it this way:


You ask if you should be worried. I say HELL YES YOU SHOULD BE WORRIED. I think you're focusing too strongly on the suicide element of this, and not enough on the BEING TOTALLY FUCKING CRAZY FOR A PERIOD OF TIME. He can't do anything to reassure you that he's perfectly well. Maybe he can reassure you that he isn't really suicidal, but he CERTAINLY is not in a position to reassure you that he's perfectly healthy, that this won't happen again, that there isn't something going on that requires treatment. And you're not in a position to, either.

What you describe is the sort of event that deserves considerable FREAKING OUT. It deserves an ALL-CAPS OMG GET TO A DOCTOR YESTERDAY response, in my estimation.

(A note: I apologize if anyone is offended by me describing his behavior as "totally fucking crazy." I know a lot of people dislike use of the word "crazy," when it is used as a general description for mental illness. But, in this case, we don't know what the more appropriate description is -- he hasn't been diagnosed with anything and, from what little we know, it doesn't sound even sound like mental illness. I don't know any better way to describe it but "acting crazy." A doctor specializing in neurology or psychiatry would. This, OP, is why you should be screaming at the top of your lungs for your boyfriend to be going to see a neurologist or psychiatrist or whoever else could properly examine him.)
posted by meese at 12:55 PM on March 31, 2013 [11 favorites]

"controlling behavior..."
"red flags" relationship..."
"abusive behavior..."

This is not a relationship question - this is a medical question.
Above all, he needs to be diagnosed by a mental health specialist. That diagnosis will reveal either a condition, or trickery. But, to turn this into a relationship-center question terribly misdirects needed attention from a potentially sick person to some other issue. If he was having a heart attack, the very first advise should not be to "figure out if you want to really marry this guy with his inability to be there for the long haul given his heart disease..."
posted by Kruger5 at 12:56 PM on March 31, 2013 [4 favorites]

This is not a relationship question - this is a medical question.

Yes, so it would seem. And you, a physician, have put it to us as a relationship question.

I'm sorry if those of us getting our hackles up about possible manipulation and "red flags" and so on, seem alarmist to you. But you're asking what could explain this incident, and given the context we can each of us only answer from personal experience. Some of us have found, through personal experience that stuff like this is explained wholly or partly by manipulation, so that's why we're answering in those terms, not because we want to be alarmists with hammers who see every problem as a nail. I hope your BF isn't manipulating you, I really do. I don't rack up points for correctly identifying a manipulator in the wild, it wouldn't be rewarding to me if I were right about this. But if that isn't any part of the explanation, I can't tell you what is.

Other than that... I am not sure why you think there was no "suicidal ideation" when he told you he hallucinated that he "picked up a kitchen knife and killed himself with it" and was then surprised to be still alive. That looks like suicidal ideation to me, but then what do I know? I'm in no way qualified to tell one way or the other, insofar as it's a medical matter.

I didn't see what happened so I'm going on what you're telling me and I just can't help but wonder why a physician would ask a question about possible explanations for an apparent medical incident, but put it in the relationship section, whereupon we're faced with a question that none of us have any way of answering. We're not physicians and we can't help you, say, figure out whether or not you really want to marry a guy who had a [heart attack | break with reality]. So, and this is not a rhetorical question: why did you, a physician, ask us this question, and why did you put it in the human relations section? What do you know about this that we don't?
posted by tel3path at 1:23 PM on March 31, 2013 [2 favorites]

Some of us have found, through personal experience that stuff like this is explained wholly or partly by manipulation

I would also just caution that manipulation is tied into all our behaviors to some extent. My niece had several psychotic episodes over the course of a year while her relationship with her birth-mom was a problem, and I would almost call every single one of them "manipulation", but more in the sense that "I can't process what's happening to me and I need you to know that in the most dramatic fashion possible". She would have no memory (or -- to be sure -- claim such) of the episodes themselves. In one she was literally crawling along/up walls; in another she was having a psychosomatic asthma attack. Physical tests revealed nothing wrong.

One notable trick the attending performed was the hand drop test -- when she appeared to be in a catatonic state, with her eyes under her lids, he held her hand above her face and let go. She did not let it hit her face. I'm sure as a physician you're familiar with such shortcuts.

Basically, this all cued up a series of follow-ups that led to regular therapy sessions (as much as Medicaid would pay for, anyway), and she's much healthier today. But to be in those experiences was utterly terrifying. In short, stuff like you saw should. not. happen.
posted by dhartung at 3:01 PM on March 31, 2013 [2 favorites]

Best answer: I'm a therapist, but I'm not the OP's therapist nor her BF's therapist. I'm trained in diagnosis, and see weird things like this more often than I would like. What your boyfriend experienced DOES sound like mental illness, namely a dissociative episode, which may or may not be a symptom of a dissociative disorder. Episodes like that are also associated with PTSD, borderline personality, or major depression, among other conditions. I'm not going to diagnose him third hand for reasons which are obvious. If physical or neurological causes are already ruled out, I agree he should see a pdoc or a therapist soon who will evaluate him and help you guys figure out what is really going on. I also urge your BF to be very open and honest with this person so that he or she can do a good assessment, including taking a careful and detailed history of his issues, both mental and physical. OP, with your BF's permission, you might also be able to provide collateral information about this episode to the person doing the assessment.

Here are some really detailed first hand descriptions of dissociative episodes, some of which sound similar to what OP's boyfriend reported. They are scary.

OP, I hope you guys can get him some help, whether it turns out to be medical, psychiatric, or both.
posted by sister nunchaku of love and mercy at 3:04 PM on March 31, 2013 [2 favorites]

Schizophrenia can start at around this age.
posted by yarly at 4:50 PM on March 31, 2013

Response by poster: Thanks, everyone. I should clarify something -- this is my first metafilter question ever, and I wasn't sure exactly where to post it. The categories looked pretty general to me, and I didn't offhand see a "medical" category, so I decided human relations was probably appropriate. It wasn't really a conscious decision to put it in this category vs. another one.

I always, from the beginning, have intended to talk to him about getting in to see a psychiatrist. That may not have been clear from my original post. Perhaps I should have done so more urgently, but for most of the past two weeks he's been out of town for work -- working on a huge project that could very likely have cost him his job had he not spent nearly every waking minute of the last two weeks traveling and working on it. Had I pressured him during this time, I can almost guarantee it would have been a losing battle.

Like I said, I know how ERs work, and had I ever suspected it was a situation where a psychiatrist would have wanted to see him immediately I would have taken him in. After reading some of these stories and experiences, you guys are right, I think I was underestimating the urgency of this. My real intent in posting the question was that I wasn't even sure what to call it and what exactly even to be worried about. I was googling hallucinations but I knew that wasn't quite right, and I wasn't really sure if it was psychosis. If I had a patient who presented like this, I would have been a lot more likely to come up with the title dissociation on it, but when it's someone you love, it's a lot harder to be objective, especially about psych problems.

After reading all of this, I have a little clearer understanding of what's going on here, even though obviously nothing is for sure. I do think it was most likely a dissociative episode brought on secondary to stress. (See first paragraph re: his recent work stress.) Really, I wanted to be better armed for my discussion with him, rather than just being like "oh my gosh what you did was CRAZY INSANE AND I DON'T KNOW WHAT IT IS AND YOU NEED TO SEE A DOCTOR FOR CRAZY PEOPLE NOW" I think now I will be able to be a lot calmer and spell out exactly what things I'm concerned with, and specific reasons why a psychiatrist and/or a therapist could help him, and this conversation will be a lot less likely to end up with either one of us getting defensive and/or arguing.

I know firsthand that it's tough to hear from someone that you need to go to a psychiatrist. I had a brief depressive episode myself several years ago (just your typical depression symptoms - no suicidality, no crazy spells, no psychosis, etc.) and when two friends showed up at my apartment one day and told me that I needed to see someone about it, it felt like a slap in the face. Even though they meant well, and I'm grateful now that they did. I know it's hard to hear, and I just want to be sure that when I talk to him later tonight it is as rational a discussion as possible.

Thanks again, everyone. I'll keep you posted.
posted by alysonagain at 6:36 PM on March 31, 2013 [1 favorite]

Best of luck in a scary and overwhelming situation.
posted by latkes at 9:03 PM on March 31, 2013 [1 favorite]

Best of luck. I'm chiming in a little late after your updates, but nthing the possibility of a seizure as well -- I just say this to reinforce that a neurologist is a good call in addition to psych.
posted by desuetude at 10:27 PM on March 31, 2013

*hugs* and I agree with desuetude. This reminded me very much of a friend who has occasional partial seizures. From what my friend explained to me, the short duration of the absent period is very indicative of a partial seizure, and it is very hard to reproduce in a clinical setting. His seizures are often dissociative and he often remembers traumatic things happening while he's externally unresponsive.

A good psychiatrist can evaluate both the possibility of a psychiatric dissociative episode and a physical partial seizure. First stop: psychiatrist.
posted by SakuraK at 11:44 PM on March 31, 2013 [1 favorite]

Just nthing seizures - my sister has a seizure disorder. Her seizures increase in frequency and severity with stress, and were manifesting as mood swings and memory loss (well, until she had a grand mal at work...). It turns out she'd was having dozens of tiny ones a day for years - she just thought she was a "bad reader"/poor student, and "moody". Looking back... she's extremely bright (no reason at all to be a bad reader/student), and her moods were/are totally irrational. Meds helped - A LOT. Best wishes - this stuff is really scary. Knowledge is power.
posted by jrobin276 at 12:04 AM on April 1, 2013 [1 favorite]

Is there any chance he's bipolar? (I know that's a popular diagnosis right now.)

He does seem awfully controlling. I'd dump someone who gave me a hard time because I wasn't having enough fun according to their observation.

There's a chance that anyone in the world might have bipolar disorder, but there isn't the least evidence that this guy has bipolar DO presented in anything written here.
posted by OmieWise at 5:37 AM on April 1, 2013 [2 favorites]

Hi alysonagain, have things improved? I hope both of you are feeling better and healthier.
posted by iamleda at 6:21 PM on April 20, 2013 [1 favorite]

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