VIVIAN

“I find her case to be quite unique”

Notes dictated 6 October, after third individual therapy session with Patient ref 7860, first name Laura.

Patient first presented two months ago with unclear complaint, wishing to discuss various issues in her life.  This was a self-referral.

Laura is 40 years old, slim and well presented.  Is not in a relationship and has no children.  She does not work but appears to be of independent means.

I would describe her as quiet, polite, intelligent, unemotional, self-aware.  She assures me she has no medical history of any relevance, and has not been taking any medication, though I have been unable to corroborate this, not having seen any medical records.  She says she is not registered with a British GP doctor as she has been living abroad.

She consented to blood and urine tests, and the results show no abnormality.  Her blood sugar and cholesterol readings are in the safe zone, and she shows no deficiency with regard to red blood cell count, or any standard nutrient.  I have taken her blood pressure on each visit and it is normal.

On her first visit, I questioned Laura about her early years and she described a happy childhood, with no trauma.  On further asking her to describe her past history and explain her reasons for seeking psychological care, she became evasive.  I asked if she had ever self-harmed, or harmed any other person, and obtained a clear and convincing negative.  I asked if she had suffered any abuse or been involved in a difficult relationship, and again her answer was no.

It was only at the end of the session that she made a relevant comment.  She said she believed she may be suffering from a delusion, and she wished to explore the possibility that something was happening in her mind over which she had no control.

In advance of my second meeting with Laura, I reminded myself of my studies in this field, and refreshed my knowledge of religious and other delusions.  I anticipated that I may be dealing with a case of someone who heard voices, or believed they were being visited by ghosts or angels, or that they could talk to G od.

Such cases were relatively common and well documented, and sometimes responded to chemical or psychiatric treatment.

On her second visit, we talked firstly about depression, and I was happy to rule that out as a diagnosis.  I had also given Laura some questionnaires to complete in her own time, and her scores in these did not indicate undue unhappiness or any indications of depression or mania.

I asked her to tell me what she had meant in referring to a delusion, and instead of replying, she spoke extensively of her reading on the subjects of split personality and religious visitations and indeed matters of a supernatural nature, including alien abduction and suchlike.  At this point she became rather agitated and embarrassed, and would not be drawn further as to her complaint.  However, she assured me she was coming close to explaining to me the nature of her problem, and said she would speak openly at her next session, if I promised to retain an open mind.

I assured her of my professional competence, experience and discretion, and encouraged her to speak to me of her concerns without fear.

I have now conducted my third session with this patient, which was of double the usual length.  I find her case to be quite unique.

Whereas in every other way she appears to be a well-adjusted and rational individual, this lady is convinced that she is capable of leaving her body at will, that is mind-projection, which is a topic on which a lot has been written but nothing proved (as it is clearly scientifically untenable).

More notable than this, however, is her assertion that she regularly leaves the planet Earth in non-corporeal form, and visits other planets which are impossibly far away for human beings to travel to.

I asked her to describe some of these planets, and she has done so in considerable detail.  Her descriptions are creative and convincing, however she blushes as she speaks and admits she is highly embarrassed at the idea of someone listening to her and believing her to be deluded.

I suggested the possibility that the experiences she believes she has had may just be dreams, possibly lucid dreams, and I explained to her that there were cerebral conditions where the barrier between the conscious and unconscious mind malfunctioned, and people experienced dreams whilst they were awake.

She appeared open to this as a possibility.

I also speculated whether there could be some unknown substance in her environment, or perhaps in her diet, which was having a chemical effect on her mind and causing hallucinations.  Although her tests were clear of any known narcotics, there could be some more rare factor at work.

Again she did not discount this explanation.  She seems to be keen to understand and determine precisely that point – whether there could be some specific discernible cause to her delusions.

For the first time today she appeared upset, and said repeatedly that she needed to know whether she was out of her mind, that is, ‘mad’.

I told her that such terms were not used in today’s medical world, and that there were several things we could explore.

I told her that I would very much like to undertake her treatment, but she would not commit to making another appointment, saying she needed to think about it.  However, I am confident that she will return, and I will give some thought to the best way forward.

The most likely psychological cause of Laura’s supposed problem seems to me to be ‘attention seeking’.  People with extreme delusions often prove to be lonely and feel worthless, and may fabricate something subconsciously in order to make themselves feel or be perceived as ‘special’ and important.  The fact she has herself sought out a clinician with my own specialised experience may support this proposition.

If this is the case, it may that once she has spoken to me at length about her perceived experiences, and if I react in a sympathetic and understanding way, the need to say something outrageous will decline, and she will eventually admit to her delusion being a conscious lie.

It may also be that suitable, more detailed probing into her past may indeed uncover some event or events which make her liable to create such a unique inner world for herself.  Perhaps there is something in this world which has made her wish to escape to other worlds.  Perhaps there is something in her mind – something hidden and horrible – which is making her believe she can escape it at will.

I will explore some of these therapeutic ideas with her, but indeed I may also suggest a course of medication.  Whilst science does not yet understand the workings of the human brain completely, there is good evidence to suggest that certain mental pathways function erroneously, and it might be that the right drug could be found to selectively ‘still’ the delusional part of her cortex.

If she does not respond to these treatments, and persists in her delusion, I may have to refer her another clinic, or at least seek advice.  For the moment, however, I find her case most intriguing and it could offer me the opportunity I have been looking for in terms of writing a high profile scientific paper.

Finally, as extreme delusions are often associated with, and can in fact lead to, criminal events, depending how the treatment progresses, I may need to seek the advice of the local Police department.  Certainly I need to somehow check on this lady to see whether she has a criminal record.  Maybe her strange descriptions of impossible places and events are a precursor to some sort of criminal confession, in which case I might be out of my depth, not to mention at personal risk.

However I will have to balance this against the excitement of coming across such an unusual and hitherto unstudied case of mental illness.  To get to the bottom of it would be most rewarding.

(Note to typist – if you could leave these notes out on my desk, I’ll check and sign them tomorrow, thank you.)