

I guess zombies do bleed

One of my psychiatric patients suffers from what is known as a Capgras delusion, where she believes her entire family was replaced by impostors. She thinks these impostors underwent plastic surgery to look like her family, then killed her real family and took their place. She says this has happened because of a large conspiracy which she has uncovered, involving the CIA. She will not even entertain the possibility that it is all in her head; this is her reality.

It is so difficult for me to wrap my head around how she could possibly believe this is all true. Other than the delusion, she appears to be a normal, intelligent, friendly young woman. It seems like there has to be some way to snap her out of this.

When discussing this case with my very wise attending psychiatrist, I suggested that we get a DNA test to prove that her family is indeed related to her. In true psychiatrist fashion, he did not answer my question directly, but rather with a fable of sorts:

Many years ago, there was a medical student working in the Psychiatric Emergency Room. Her patient came in floridly psychotic, claiming that he was a zombie who was raised from the dead. After the medical student sat down with the patient to listen to his entire crazy story, she asked the patient, “Do zombies bleed?” The patient thought about it for a moment, then replied, “No. We’re dead. Of course we don’t bleed.” The medical student then put an IV into the patient’s arm, which drew a few drops of blood. She waited for the patient’s response, expecting a realization that he was in fact human. “Huh,” the patient said, “I guess zombies do bleed.”

I took two concepts away from this story: first, patients who truly believe their delusions are real will force anything they see to fit into their delusion. Second, medical students often make the mistake of trying to use logic with a person whose brain thinks illogically.

Now I can predict my patient’s response to seeing the results of her family’s DNA test: “The laboratory is in on it too!” It might even further convince her of her own delusion. So the question remains: how in the world do I help this patient see that her delusion is not real? How can we get her to the point where she feels safe going home to her family? It seems hopeless, but maybe with the right psychiatric meds, we can get her to the point where she can ignore the delusion. I’ll keep you all updated on her progress.

Categories: General, Psychiatry
Marianne DiNapoli

3 Responses

  1. Devon says:

    Yea, while always tempting to cure, irrationality is not a diagnosis. Symptom, yes but not a diagnosis. The delusion is what needs treatment and successes there will effect the symptom. Treating the symptom alone will likely spur further expression of the diagnosis.

  2. not surprised says:

    Thank you, MD2B for your sharing your experience with us.

    I suspect “hounder” from your previous blog entry would have advised the logical medical student in your attenting psychiatrist’s story to continue to make the patient bleed until she learns the lesson that delusional thinking does not pay – one pint, two pints, three…

  3. Devon – you are completely correct. He is being treated for his underlying psychiatric disorder.

    not surprised – you are very welcome. And HAH!!