(ORDO NEWS) — Sometimes, as a doctor, I am asked to examine a patient in the emergency room who is completely mute. They sit motionless, looking around the room. I lift their hand and it stays in that position. Someone takes a blood test from them, and they don’t even flinch. They didn’t eat or drink anything for a day or two.
Questions start to swirl in my head. What’s wrong with them? Would they react to someone else? Do they have a brain injury? Do they put it on? And – the hardest part – how can I know what’s going on if they can’t tell me?
I am a psychiatrist and researcher specializing in a rare condition known as catatonia, a severe form of mental illness in which people have trouble moving and speaking.
Catatonia can last from a few hours to weeks, months, or even years. Some people have recurring seizures. I have talked about this condition with doctors, nurses, scientists, patients and caregivers.
One question comes up more often than others: what do people with catatonia think about? Do they think at all?
When a person is almost unable to move or speak, it is easy to assume that he is not conscious. Recent studies have shown that this is not the case. In fact, everything is just the opposite.
People with catatonia often express intense anxiety and say they are overwhelmed. It’s not that people with catatonia don’t have thoughts – maybe they have too many.
But what are these thoughts? What can the mind do that makes you freeze? In a new study, my colleagues and I tried to shed light on this question.
Hundreds of patients
In reviewing the medical records of hundreds of catatonic survivors, we found that only a few reported what happened, either at that time or later. Many did not realize or did not remember what was happening.
Some described feeling overwhelming fear. Some were aware of the pain of being immobile for a long time, but still seemed unable to move. But the most interesting to us seemed to be those people who, at some level, had a rational explanation for catatonia. One patient’s notes read:
I met him kneeling on the floor with his forehead pressed to the floor. He said that he took this position to save his life, and all the time he asked to be looked at by a cervical doctor… He kept talking about his head falling off his neck.
If you really believe that your head is in imminent risk of falling, maybe it’s not so bad to keep it on the floor.”
For others, it was voices (hallucinations) that told them to do certain things. One man was told that his head would explode if he moved, a pretty good reason to stay still. Another thought that God was telling him not to eat or drink.
One theory for catatonia is that it is similar to the “death feint” that some animals exhibit. When faced with a predator that is larger or stronger than them, some predatory animals freeze, and it is assumed that the predator may not notice them.
One patient in the study vividly described seeing a snake (which also spoke to her). We cannot say from this example alone that her body has adopted a primitive defense against a predator, but it is certainly possible.
Catatonia remains a mysterious condition, stuck halfway between neurology and psychiatry. At the very least, by understanding what people may be experiencing, we can reassure them and sympathize.
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