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The itch nobody can scratch
August 3, 2014 12:31 PM   Subscribe


 
I work in medicine, and apparently (from what I've heard) the most effective treatment for Morgellons is low-dose anti-psychotics.

My brother is bipolar with psychotic features. When he's having a tough time, his room is infested with "tiny bugs" that only he can see. He's used razor blades to get them out of his skin. He's also spent hundreds of dollars on bug sprays, traps, zappers, etc.

When he finally takes his meds, the bugs disappear.
posted by Avenger at 12:50 PM on August 3 [8 favorites]


I'm currently dealing with regular old ants in my apartment, and actual, verifiable bugs are pretty maddening. I know they're not spontaneously generating, but damn if it doesn't start to seem like it after a few days. I can't imagine having a condition that few others acknowledge.
posted by desjardins at 12:55 PM on August 3


I just started mindlessly scratching a dry spot I get on my hands as I was reading.

Crap.
posted by BungaDunga at 12:58 PM on August 3 [1 favorite]


That's fascinating, Avenger; I have bipolar two and am on anti-psychotics as one part of my treatment. I do occasionally see invisible bugs, if that makes sense, and I feel things crawling on me sometimes. Years ago, when I had not yet been diagnosed with bipolar and thus was just on regular antidepressants and having a VERY rough time, when I was in Maine I found a bump on my wrist (I'm pretty sure -- I definitely saw it there) and became convinced that it was a tick burrowing into my skin and I scraped and scraped until it bled trying to dig out the tick. Apparently this is NOT how ticks manifest, so it was probably either a mosquito bite or a delusion.

I hate the invisible bugs because I know that it's just my brain fucking up but the negative feelings are still there and I can FEEL them crawling on me and I hate being sabotaged by myself so often.
posted by Mrs. Pterodactyl at 1:00 PM on August 3 [17 favorites]


I think that last link was enough to sell me on the delusional parasitosis hypothesis.
posted by snofoam at 1:08 PM on August 3 [8 favorites]


Bug is a fascinating play/movie related to this concept.
posted by Sticherbeast at 1:11 PM on August 3 [6 favorites]


You want an itch you can't scratch, try diabetic neuropathy. You know, on a lark.
posted by dhartung at 1:12 PM on August 3 [7 favorites]


It all begins an hour south of Austin, Texas, in the lobby of the Westoak Woods Church convention center. Morgellons sufferers are gathering around the Continental breakfast buffet.

Worst conference ever.
posted by sfkiddo at 1:14 PM on August 3 [16 favorites]


See also the Matchbox Sign.

A lot of folks try to make hay about the strange fibers found in some biopsy specimens. Not unlike tattoo ink, patients with delusional parasitosis can scratch so hard, so deep that they introduce fibers from their clothing into their wounds. The wounds heal, but tissue macrophages don't have the oomph to clear away the fibers.
posted by The White Hat at 1:15 PM on August 3 [5 favorites]


When I was working in the area of microfabrication & implantable medical devices, we had a guy contact us with microscope images of stuff he had dug out of his skin. It looked like goopy fibers; he thought they were wire bonds and evidence that microchips had been implanted in him in secret.
posted by Mapes at 1:26 PM on August 3


Ugh ugh ugh. This is all horrifying, but (having read only the first link) I know I'm going to end up reading all of them; dwelling on this sort of phenomenon is a mental itch I find myself compelled to scratch.

It's certainly not helpful that it's gnat season here and our cats have had both ticks and ringworm in the last month. :(

Still, this is a good FPP, desjardins.
posted by daisyk at 1:35 PM on August 3




Three years ago, I nearly moved into an apartment with a bedbug infestation. Ever since then, just about every minor itch or little pink spot on my skin has tripped my mental bedbug alarm. And it's so easy for it to spiral out of control because not only will skin get visibly irritated if you keep picking at it, but itchy skin is super easy to get through the power of suggestion, so it definitely feels like something physical is going on. I can't count the times I've idly felt a bump on my skin and been unable to stop scratching it... until the moment I realize I'm picking at a mole or a chicken pox scar. And it's hard to appreciate how much lint and unidentifiable specks you can find around your house until you start searching for bedbugs.

I'm grateful that I've become familiar with how the feedback loop works in my brain, so now I only go to Bedbug Threat Level Yellow instead of all the way up to red. But it's hard to shake off completely. Even though I'm convinced Morgellons is a form of delusional parasitosis (which is such an ugly phrase that makes the condition seem too out-there and "crazy"), I completely sympathize with its sufferers, and I can easily imagine myself having it if my circumstances were slightly different.

I hope we find a treatment method for Morgellons that is grounded in fact yet respects the minds of people who suffer. It may not be caused by mysterious inorganic fibers or tiny wasps, but it's real.
posted by Metroid Baby at 1:49 PM on August 3 [4 favorites]


Oh, Rense.com, that explains everything.
posted by Splunge at 2:07 PM on August 3


There are fibers, though they're not exotic or pathological; there is itching and discomfort and intrusive thoughts. Those are all real, in the sense that they can be empirically demonstrated. The problem here, it seems, is that sufferers have an ardent belief that they know the etiology of these experiences. That's the part which is delusional. People make assumptions based on how they feel and then they uncritically accept an explanation which they have no direct evidence for.

I suspect that for some of these people, the prospect of admitting that you badly need some kind of care that you may not even be able to define is frightening and (unfortunately, probably correctly) unlikely to result in any care being given, but I think that's probably at the root of at least some peoples' experience.

I hypothesize that this itching/obsessive/paranoid parasitological/emotionally captivated syndrome is not "all in their head" in the usual sense: these people's minds are finding a way to get a message to the world, something like "Please help me, I am accosted by nameless, faceless suffering, under my skin, in my body." I suspect that what's novel about Morgellon's isn't the fiber or some unelucidated pathological vector (though further empirical analysis could prove me totally wrong), but rather the complex way in which the mind is manufacturing evidence that the person needs help.
posted by clockzero at 2:12 PM on August 3 [11 favorites]


"The Itch" (New Yorker 2007, won "Best American Science and Nature Writing"). Describes a woman who itched through her skull into her brain. No pictures.
posted by stbalbach at 2:14 PM on August 3 [5 favorites]


"The Itch" was covered previously.
posted by stbalbach at 2:16 PM on August 3


I loved Leslie Jamison's essay The Devil's Bait: Symptoms, signs, and the riddle of Morgellons. It's about her experience attending a Morgellons conference in Austin. Fascinating reflections on empathy, her own fear of "catching" Morgellons, gender, body image and more.

Here's a representative quote:
This isn’t an essay about whether Morgellons disease is real. That’s probably obvious by now. It’s an essay about what kinds of reality are considered prerequisites for compassion. It’s about this strange sympathetic limbo: Is it wrong to speak of empathy when you trust the fact of suffering but not the source?

Calling Morgellons “real” generally means acknowledging there is actual, inexplicable stuff coming up through human skin. “Real” means a fungus, parasite, bacterium, or virus — anything that might persuade the skeptical medical establishment that these patients aren’t simply making the whole thing up.

The notion of “making it up” is also complicated, and could mean anything from intentional fabrication to hypochondria to an itch-scratch cycle that’s gotten out of hand...

That’s why “self-excoriation” is such a taboo phrase here, and why patients are so deeply offended by any accusation that they’ve planted fibers in their own skin. These explanations pin the blame back on them, suggesting not only that the harm inflicted is less real, but also that it’s less deserving of compassion or aid. In contrast, parasites and bacteria are agents of otherness, granting the legitimacy of external struggle.

This insistence on an external source of damage implies that the self is a single coherent entity, a unified collection of physical, mental, and spiritual components. When really, the self — at least as I’ve experienced mine — is much more discordant and self-sabotaging, neither fully integrated nor consistently serving its own good.
posted by overglow at 2:58 PM on August 3 [23 favorites]


Morgellons seems to represent a mystery even deeper than that of homeopathy.

I could only read that far into the first link.
posted by fredludd at 3:06 PM on August 3 [4 favorites]


Well, your loss, in the end it doesn't give any credence to either.
posted by desjardins at 3:13 PM on August 3 [6 favorites]


Metafilter: I know nothing about X, except what I read based on this thread.
posted by fifteen schnitzengruben is my limit at 3:43 PM on August 3


wow, thank you.

this i show i remember the internet, when 20-30% of all content was just like this. i especially liked the last link to morgellonsexposed.com. i used to spend untold hours upon hours poring over webpages just like this; reading every post on message boards and clicking every promising-sounding external link til the sun came up.

when Google first appeared i used to love clicking through ever-more-specialized links within their Directory, going off into smaller and smaller distinctions within their indexing system; Gay Bear Church Organists was one of my favorite subcategories. like a Loompanics catalog brought to life.

i was very heartened to find a link about *Chemtrails* on the bottom of the morgellonsexposed.com page. remember when all great webpages had banner links to even better webpages at the bottom?
posted by Conrad-Casserole at 3:59 PM on August 3 [12 favorites]


Just because a disease is caused by some brain malfunction doesnt make it less real for the patients. There is a tendency in our society to hear that a disease is all in the head, and then proceed to dismiss the patients as a bunch of nutters. They end up getting no treatment.
posted by humanfont at 4:33 PM on August 3 [5 favorites]


I wonder if a large part of the insistence that Morgellon's is a "real" disease (i.e., one with external physical causes) is because sufferers know that our medical system will do amazing things for you if you have a virus or a fungus or a bacteria, but if you are "just crazy", chances are incredibly high that you are going to be left out in the cold in some, if not all, aspects of your care. We take the insistence that Morgellon's is a body disease (and not a mental disease) as some kind of proof that the persons with it are delusional, but realistically they're probably doing the wisest thing they CAN do, under the circumstances.
posted by WidgetAlley at 4:37 PM on August 3 [11 favorites]


I had to take a short course of a medication that made me feel the creepy-crawly sensation of bugs on my skin. I felt kinda low-level itchy most of the day, but it was HORRIBLE at night when I had nothing else to think about. I was jumping out of bed ten times a night to check if there were actual bugs on me, scratching like crazy, taking benadryl for the itch ... I FELT like I was going mad and I knew it was just a side effect of the medication and I still had to get up to check for bugs over and over again. I called my doctor halfway through and said I couldn't make it because I couldn't sleep!

I feel SO BAD for these Morgellon's people, and I hope a lot of them can get the help and treatment they need. It is the most unpleasant sensation in the entire world, even if you know the bugs aren't real. The human body is not really equipped to let you ignore a "bug" sensation, even if it's a false positive.
posted by Eyebrows McGee at 4:47 PM on August 3 [11 favorites]


I have a skin-picking problem, which is a known disorder although it goes by a lot of names. Since hearing about Morgellon's--well, I feel very fortunate that I already had a concrete picture of what was going on for me, because the fibers? Those get into every place that I pick. Because they come off of clothes, sheets, etc. They're noticeable if you're looking for them. Prickly is exactly how the skin feels after you've picked and it's had a little time to heal but not enough, a combination of raised dry skin and scab. The redness lingers stupidly long after I have a bad night, spots there days later. But when I'm dealing with it well, when I break the cycle for a certain length of time, everything heals up fine. The descriptions of Paul's welts, of his scars? Eerily familiar. I've had black stuff or little hard white beads--both things skin happily produces on its own, especially for people with adult acne or keratosis pilaris, both of which are very common and which don't get much discussion in polite company.

I'm not saying I'm sure that anybody in particular who claims this has the same problem I have. I just know--the brain likes to fixate on skin imperfections. There's a whole genre of blemish-related Youtube videos that attest to this, it doesn't even have to be our own blemishes! This isn't precisely normal but it's not as far off from it as some people think, and I think the more it gets dismissed as a weirdo problem, the harder it is for anybody whose brain has already gone there. Parasites in a way make more logical sense than "you just itch because you itch and you pick because you can't not". I wonder how many more people would be open to a more psych-oriented treatment method if they didn't feel like they were being labelled as a socially-unacceptable degree of Crazy. They're trying to find answers that don't result in being Crazy and ending up more socially stigmatized as a result.

Some degree of picking is a thing many, many people go through at some point or another in their lives, especially in adolescence. Some people seem to be more prone to keep doing it than others. But I cannot understand why so many stories about this do not bring up that impulse-control disorders like skin picking are well-established fact of their own, and not delusional at all. If you've built up weird ideas to try to justify or explain your picking, you're not delusional, you just have a brain that is attempting to do its job and going a bit off the rails as it tries to do so. People would be less likely to do so if they knew that skin-picking (and hair-pulling, which is related) are not freakishly unusual, they're just little-discussed. Our tendency not to talk about things that are "gross" is, I think, really serving people poorly here.
posted by Sequence at 4:50 PM on August 3 [13 favorites]


Mental illness has such a stigma that it's evidently better to make up diseases and seek useless treatments from a dermatologist than to see a psychiatrist. Maybe one of the reasons the CDC study "couldn't find a cause" because it's a disease made up on the internet. Hard to find a source of mysterious fibers when there isn't one:
The fibers and materials collected from case-patients' skin were largely consistent with skin fragments or materials such as cotton and were either entrapped in purulent crust or scabs, suggesting the materials were from environmental sources (e.g., clothing) or possibly artifacts introduced at the time of specimen collection and processing.
But fear not, there are some related items on The Worst Things for Sale:
Conspiracy Theory book
Album to cleanse you of your disease
posted by fifteen schnitzengruben is my limit at 4:58 PM on August 3


Mental illness has such a stigma that it's evidently better to make up diseases and seek useless treatments from a dermatologist than to see a psychiatrist.

I am trying not to put this in too hostile a way, but--do you see the connection between the first part of your comment and the rest of it? I'm really generally pretty forgiving about the general sin of making fun of people on the internet, but if you're looking at something where there's a good indication that people are already hurting because they're stigmatized for their problems, it would seem like this is the worst possible time to engage in mockery for the sake of personal amusement. Not that these coping mechanisms should necessarily be met with enthusiastic approval, but there's a big gulf between approval and just not making fun of people when they're going through a bad time.
posted by Sequence at 5:08 PM on August 3 [6 favorites]


I think we have to be careful when we conclude that because anti-psychotics make the bug feeling go away, the patient must have psychotic symptoms. I have bipolar with psychotic features, and my medications have various side effects. Anti-psychotics can be quite sedating, or they can alternately make one extremely restless, depending on how an individual reacts to a med. We only sort of understand how these meds help the brain; we know how they function, but that's different than understanding why that function helps.

The med may settle the bug feeling as a side effect. For example, I also have trichotillomania, which is compulsive hair-pulling. My pulling is reduced when I'm on an anti-psychotic. But I don't pull because I think bugs are in my hair; my hair feels itchy or uncomfortable, or sometimes the texture feels different. I don't know if the anti-psychotic sedates me enough to stop the pulling, but it certainly doesn't change what I think about my hair, even though I pull less often while I am taking it.

While I'm sure it's true that there aren't actually bugs or fibers based on the CDC study, there may be some other cause. Claiming it's all in their heads could limit research. Disclaimer: I did not look at all of the links because disturbing pics are disturbing.
posted by veerat at 5:11 PM on August 3 [4 favorites]


Dr. Oaklander, from the first link, I think puts forward a very plausible explanation when she talks about "chronic itch disorder". That there can be psychological or physiological explanations, and these can also intertwine. People experiencing nerve disorders that cause chronic itching can find themselves at a loss to explain what's going on, and a GP will be more likely to refer someone coming to them with these symptoms to a psychiatrist rather to a neurologist. The explanation some of these sufferers came to about the cause of their illness might not be what they think it is, but that doesn't necessarily mean that, at least for some of them, the itch itself has no physiological cause. I think she's right to point out that seeing a neurologist might be of some benefit to many of them.
posted by Aya Hirano on the Astral Plane at 5:22 PM on August 3 [3 favorites]


Wow. How horrible! I am presently dealing with a bad outbreak of eczema on my feet and reading this just made me itch all over. I can't imagine dealing with all over all of the time.
posted by harrietthespy at 5:30 PM on August 3


I consider the potential for Morgellons to be an exploit vulnerability in the human nervous system. It's a disease people get by finding out it exists, and as such we should be very careful about how it is addressed and publicized. The itching is as real as any other itching is, and the suffering is definitely real. The fact that it exists as a positive feedback loop between a fear of parasites (leading to excessive picking and scratching) and the symptoms of over-attentiveness and the natural sensations that go with healing don't make it any less real.
posted by idiopath at 5:47 PM on August 3 [3 favorites]


"You’ve just got to get in there. And there’s this sense of incredible release when you get something out of it."

This is why they are being diagnosed with a head thing instead of a body thing. This is classic response for a lot of hair yanking, skin picking behaviours that have no obviously physical causes.

Well, other than physical causes caused by the person yanking hair, etc.
posted by clvrmnky at 5:57 PM on August 3 [1 favorite]


I don't know if the anti-psychotic sedates me enough to stop the pulling, but it certainly doesn't change what I think about my hair, even though I pull less often while I am taking it.

This is actually not all that much of a mystery. Dopamine. Antipsychotics cut your dopamine, stimulants like Adderall increase it, impulse control disorders respond very strongly to differences in the level of dopamine reward for the behavior. I mean, could go beyond that, too, but it's really having exactly the result one would expect.
posted by Sequence at 6:10 PM on August 3 [1 favorite]


We adopted a young tom cat back in October. Sweet little guy. I found a couple of cat fleas on myself recently. For each flea found there are a good ten or twenty imaginary fleas who itch just as much as the actual fleas.
posted by metagnathous at 6:13 PM on August 3 [1 favorite]


Morgellons has always seemed to me a case of delusional parasitosis...where the infection vector is the internet. Much like I think (based on a particularly sad case of an acquaintance who is a normal suit-and-tie white collar dad except for his obsessive belief that Sandy Hook was a nefarious government plot for "the powers that be" to gradually disarm and then imprison us all in FEMA camps) that the internet creates a network for people with psychotic illnesses (diagnosed or not) that never existed before.
posted by blue suede stockings at 6:14 PM on August 3 [1 favorite]


Just because a disease is caused by some brain malfunction doesnt make it less real for the patients. There is a tendency in our society to hear that a disease is all in the head, and then proceed to dismiss the patients as a bunch of nutters. They end up getting no treatment.
I primarily treat people with epilepsy. But a nontrivial number of people come to epilepsy clinics with fits that are not only not epileptic seizures, but are also not symptoms of any physical disease which can imitate epilepsy. Their fits and spells are entirely psychogenic.

The tendency is for neurologists to make the diagnosis and then refer the patient on to a psychiatrist. There is also a tendency for psychiatrists to be overly skeptical of neurologists' ruling out of epileptic seizures and to be less than interested in treating these patients.

Moreover, in my experience, the wrong approach to delivering the diagnosis can lead to loss of trust in physicians and a spiral of doctor-shopping and poor care.

Mind you, this is when it is correctly diagnosed. One study found the average time between onset of psychogenic seizures and correct diagnosis to be seven years, with over 85% of patients having been treated with antiseizure medications (which do not work for psychogenic seizures).

Psychogenic seizures are very real for patients. They are not consciously controlled and they can be as disabling as epileptic seizures. Also tougher to treat.

So my approach has been to maintain contact and a therapeutic relationship with these patients. When I deliver the diagnosis I emphasize that it is a real disease with real consequences, only that the cause, and therefore the treatment, is different than previously thought. I send them to a psychiatrist/psychologist for cognitive behavioral therapy and I initiate treatment with SSRIs for depressive or anxious symptoms. I follow up with them and answer their phone calls when they have setbacks.

I don't know if they have better outcomes in terms of symptom relief. I need to study that at some point. But they do seem to maintain better insight into their condition (not an insignificant thing) and are somewhat more hopeful for the future. And it feels better to treat them like people.

Haven't had any Morgellons patients. But I guess I would do something similar.
posted by adoarns at 6:51 PM on August 3 [22 favorites]


Sequence it is still a mystery, and not as simple as you would have it. Not everyone reacts the same way as I do. I have been following the (limited) research on trichotillomania for many years, and there is no known cure.
posted by veerat at 6:54 PM on August 3


See... here's the thing... how do we know these people aren't experiencing a genuine physical malady, but because everyone is looking in the wrong place we have labeled them delusional? I have MS, and sometimes my nerves misfire and I get this intractable, maddening itch on the inside of my left ankle that takes every ounce of will power not to scratch. Because I know I have MS and that this is a neuropathic issue, I don't jump to strange conclusions about it, but if I didn't know that, I would be out of my mind trying to figure out what was causing it. Who's to say these people don't have a condition that is caused by a non-dermatological source? It seems to me that the crazy fiber aspect of the disease is just rock for these people to cling to in the absence of answers, and the medical community is so convinced these people are crazy they aren't exploring many possibilities beyond crazy or dermatological.

Then again, I had the symptoms of MS for over 15 years, but until I almost ended up in a wheelchair and blind in one eye, the doctors told me I was fat, neurotic, depressed, and seeking attention, so this kind of thing is a bit of a hot button issue for me.
posted by evilcupcakes at 7:00 PM on August 3 [10 favorites]


See... here's the thing... how do we know these people aren't experiencing a genuine physical malady, but because everyone is looking in the wrong place we have labeled them delusional?

We don't, but people often want to believe they 'know' what's going on, and sometimes that may be as delusional as anything else that goes on in the human mind. Questions that lack ready answers are very uncomfortable for a great many people.
posted by metagnathous at 7:25 PM on August 3


evilcupcakes, you're not alone. If you click through to the "an itch no one can scratch" link, search down to the section where the author talks to a Dr. Oaklander. She thinks that "Morgellons" is *neither* bugs-and-fibers-in-the-skin *nor* delusional parasitosis, but an undiagnosed/unknown neurological disorder that causes itching. If she's right, the disease would involve delusions (about the reason for the itching) but would not be psychosomatic (in that there would be a non-psychological cause for the itching).

And yes, God help a sufferer from a serious illness who wants to be actually diagnosed and treated but has the misfortune to also be female, fat, and depressed. :(
posted by edheil at 7:41 PM on August 3 [8 favorites]


Not everyone reacts that way, but it's consistent with what one would expect of how the things interact. So not so much that it's not a mystery in that we totally understand how the whole set of related disorders work, because we totally don't, but "antipsychotics" are known to work on a much broader set of things than just stuff we've defined previously as psychotic, and dopamine's got a pretty strong connection to this sort of thing much like serotonin does to depression. Not that any given medication is definitely going to help anybody to any particular degree, but it's not baffling to see why it would help if it did.
posted by Sequence at 7:54 PM on August 3


adoarns: "There is also a tendency for psychiatrists to be overly skeptical of neurologists' ruling out of epileptic seizures and to be less than interested in treating these patients."

Depends. One of the single biggest comorbidities of psychogenic non-epileptic seizures is epileptiform seizure disorder. People with seizures have a much greater risk of also presenting with pseudoseizures. I think this mix, and the difficulties of getting longform video EEG, contribute to a lot of the diagnostic confusion and back-and-forth. The greater hostility/externalising in the population also play a role. And since so much of the psychiatric comorbidities with PNES involve affective and borderline disorders, using AEDs is effective here for mood alleviation. If someone arrives in my office for rule-out PNES, and their neurologist already has them one one (or more) effective AEDs, that's often the mood control component taken care of right there. Many people with notable somatisation and externalisation features are simply not good prospective candidates for the kind of cognitive schema or uncovering work required to make a dent in their dissociative convulsions: they are either unlikely to benefit from the work, or unable to tolerate it. For such unfortunate patients, I'd tend to recommend medical and somatic treatments. Which is exactly where I'd go with many people with this kind of delusional parasitosis. Refer to derm or PCP to treat the skin excoriation, consider prescribing antipsychotic or TCA with reasonable antihistaminergic potency.
posted by meehawl at 9:44 PM on August 3


This insistence on an external source of damage implies that the self is a single coherent entity, a unified collection of physical, mental, and spiritual components. When really, the self — at least as I’ve experienced mine — is much more discordant and self-sabotaging, neither fully integrated nor consistently serving its own good.

This is what bipolar disorder is like much of the time -- various versions or distillations of your "self" doing things in direct opposition to any holistic healthy notion of "self." Little self-sabotaging sub-selves. Knowing hours into it that you should stop (like go to sleep now) and continuing anyway because "fuck that other guy who will be complaining about this me tomorrow."

And the itching / bug stuff...for me it's part of mania especially if you're staying up all night like right now. I see the bugs the later I'm up, every so often there is a real spider or bug to be vanquished, more often than not you're just sort of seeing the delayed construction of reality projected on your visual cortex...or something. The itching is normal and most people endure some degree of random itching, likely without knowing it. The hypersensitive individual, for whatever reason, can be more highly attuned to that itching, and direct too much attention to it. Since being bitten by bugs at night seems to highly correlate with dying of horrible diseases like malaria, I could see there being a natural "what was that" reflex that gets increasingly corrupted and distorted by an unquiet mind.
posted by aydeejones at 2:54 AM on August 4 [1 favorite]


(and yeah I learned a long time ago when you actually scratch any sort of itch, real or imagined, it's a whole new ball game. Chicken pox and being eaten by mosquitos at various points from a very early age ingrained an instinct not to scratch myself to death, but I have occasionally removed a mole by accident)
posted by aydeejones at 2:55 AM on August 4


I am going to sleep, BTW, not literally staying up all night any time soon if I can help it, and on the subject of random itching -- moisturizing and eating a balanced diet with omega 3 fatty acids and such, and not taking too hot of a shower and all sorts of things improve the general first-world human condition of randomly itching, of course, but the whole concept of itching implies a complex dance of receptors and neurotransmitter pathways (dopamine, sodium / calcium channels, etc) that are rife for exploitation by the same "flaws" that might underlie a "mental" illness. A neurological illness, perhaps. The lines continue to blur between neurological and "affective" and "mood" disorders and so forth...

I don't so much "see bugs" late at night as I see random movement, blurs, etc, and every once in awhile it's a bug way out in my field of vision, or perhaps at my feet. Bugs are so obnoxious to a "sensitive" person that I could see it becoming a neurosis, and every so often you catch a real fruit fly or gnat and it reinforces the delusion.

For me seeing random motion is like a reptilian sense of motion "occurring somewhere" in a quadrant of vision and usually it's just sensing the motion of your own head relative to shadows, reflections, etc, and having some exaggerated response. Staying up multiple nights and skipping / rebounding meds is definitely a recipe for something "else" that emerges from mania. Something that non-bipolar people can experience as well, by subjecting themselves to such deprivation. Each stage is an escalation. Too often we identify a single "disease" or "disorder" rather than understanding how it can escalate and morph into increasingly extreme conditions, but is not necessarily doomed on the outset to reach such outcomes, but for the fear and detachment that comes with facing such challenges head-on.
posted by aydeejones at 3:12 AM on August 4


Great article.

I think we have to be careful when we conclude that because anti-psychotics make the bug feeling go away, the patient must have psychotic symptoms. I have bipolar with psychotic features, and my medications have various side effects.

Good point. Do Morgellons sufferers report less itchiness when they are on antipsychotics, or are they just as itchy but less prone to form bizarre beliefs on the basis of that itchiness?
posted by painquale at 3:15 AM on August 4


I should qualify that I learned not to scratch itches most of the time, but I almost always "touch" an itch before it comes bothersome. Touch or rub it or the surrounding areas with a finger pad or two, reinforcing that there is real sensation and real information being transmitted in the area and all around, but the itch itself is better off being merely acknowledged without literally "scratched." It's not always that easy, of course
posted by aydeejones at 3:21 AM on August 4


Sequence it is still a mystery, and not as simple as you would have it. Not everyone reacts the same way as I do. I have been following the (limited) research on trichotillomania for many years, and there is no known cure.

I have trich too, and reading this articles, the stories seemed very familiar. And no one has a cure nor does anyone know the cause.

Its really hard to wrap my mind around this being a purely mental, rather than a physical, condition.
posted by MisantropicPainforest at 6:44 AM on August 4


This is a "disease" created out of cases of itching with no obvious cause and the subculture that trusts everything the alternative care community says because reasons and distrusts anything the medical establishment says because sometimes it does corrupt or erroneous things. I feel sorry for the folks trapped in this zone, because they will never get effective help due to the self-perpetuating nature of such epistemic bubbles. I'm trying hard not to compare this to any other, non-health-related bubbles.
posted by Mental Wimp at 12:09 PM on August 4


This is a good FPP, desjardins.

Seconding that, this was something that I hadn't heard of; but having eczema that flares up and is difficult not to scratch, I can see how it would drive you mad if there was a constant itching and no known cause.
posted by arcticseal at 2:06 PM on August 4


And no one has a cure nor does anyone know the cause.

I think that's kind of misleading. There's no cure for depression, either, but there are well-studied treatments that have a statistically significant impact. There's significantly less progress with picking/pulling, but there are treatments that have empirical support and which are helping a lot of people. Maybe not yet enough people, but the state of current research isn't just a giant black hole, and effective management is not just a pipe dream.
posted by Sequence at 3:15 PM on August 4


One of the single biggest comorbidities of psychogenic non-epileptic seizures is epileptiform seizure disorder. People with seizures have a much greater risk of also presenting with pseudoseizures.

That's extremely interesting, Meehawl, and your second linked article, which reports a comparison of a group with Psychogenic Non-Epileptic Seizures but not epilepsy to a group with Somatoform Disorder, contains a paragraph which is downright startling:
Twenty (83%) patients in the PNES group had experienced one or more episodes of minor head traumas with loss of consciousness from seconds to minutes, compared with one person in the SD group and none in the healthy control group .... The head traumas did not cause focal MRI lesions, but unspecific EEG changes consisting of minor to moderate theta activity were observed in 12 patients.
I think the fact that many people with epilepsy also have non-epileptic seizures suggests that the apparently separable seizure part of an epileptic seizure could be viewed as one way an epileptic copes with and even ameliorates an epileptic seizure, somewhat the way a fever is a coping response to a bacterial infection.

But that paragraph from the second link, reporting that a history of head injury and current EEG abnormalities tend to distinguish the psychogenic seizure group from an otherwise behaviorally similar group, suggests that non-epileptic seizures can help prevent epileptic seizures from happening in the first place.

In other words, here we have two matched groups of people with psychiatric diagnoses; the first group was chosen so as to have pseudoseizures, but not actual epileptic seizures; the second group was chosen so as not to have seizures at all, but to have characteristics we want to investigate in the first group in order to help set standards of care for the first group. And one of the things we find is that is the first group, the group with pseudoseizures, has a hugely greater rate of prior head trauma and abnormal EEGs, which are both typical characteristics of people who have epileptic seizures -- and this, taken together with the fact that many epileptics also have pseudoseizures, seems to suggest that pseudoseizures are helping this group avoid real seizures.

Which I think casts considerable doubt on the wisdom of calling non-epileptic seizures "psychogenic" at all.

As far as Morgellons is concerned, the Guardian did quite a good story on the Austin Morgellons meeting mentioned above, but things get really interesting starting around pages 4 and 5 of the comments section, with discussion, by people who think they have Morgellons, of Agrobacterium tumefaciens as a possible causative agent.

Agrobacterium tumefaciens (aka: Rhizobium radiobacter, "crown gall disease" bacterium) which attacks a very wide range of woody and herbaceous plants, causing them to form galls which host and feed the bacteria.

Agrobacterium tumefaciens is also widely used to insert the outside genes into GMO plants.

In the wild, Agrobacterium tumefaciens first attaches itself to plant cells with cellulose fibers (here is a micrograph of bacteria attacking carrot cells; note the fibers) then it builds a little tube (the pilus)
which injects genetic material from a plasmid, and that material integrates itself into the genome of the cell (as illustrated here).

However, Agrobacterium tumefaciens has shown the ability to transfect human cells in the lab:
...Under laboratory conditions the T-DNA has also been transferred to human cells, demonstrating the diversity of insertion application.[14]

The mechanism by which Agrobacterium inserts materials into the host cell by a type IV secretion system is very similar to mechanisms used by pathogens to insert materials (usually proteins) into human cells by type III secretion. It also employs a type of signaling conserved in many Gram-negative bacteria called quorum sensing. This makes Agrobacterium an important topic of medical research as well.
The view of some Morgellons sufferers appears to be that their lesions are, like and very similar to the galls it produces on plants, caused by Agrobacterium tumefaciens.
posted by jamjam at 3:28 PM on August 4 [1 favorite]


Not wholly convinced, I slip back into the conference room, where Margot is using her $1,100 WiFi iPad telescope to examine herself. Suddenly, I have an idea.

That she was at the wrong conference?
posted by changoperezoso at 9:15 AM on August 5 [1 favorite]


Gabapentin (AKA Neurontin) is both one of the most important pain management medications for diabetic neuropathy, and a potent anti-depressant. Which makes sense, if you think of depression as a problem with the nervous system.

What do you think the mind is made out of?

Morgellon's can both be real, and treated with anti-psychotics.
posted by effugas at 9:48 AM on August 5


Morgellon's can both be real, and treated with anti-psychotics.

Well, that's stretching the definition of "real" a bit.
posted by Mental Wimp at 10:39 AM on August 5


It's "real" in the sense that there is actual suffering that is caused by some physical process, even if that process consists only of non-optimal levels of dopamine.

What's not real is that there are mysterious fibers growing out of human skin.
posted by desjardins at 10:56 AM on August 5 [1 favorite]


What's not real is that there are mysterious fibers growing out of human skin.

Which is what sufferers mean when they say Morgellons is "real." There's definitely a pathology going on, but it may not be only one condition and it definitely has a specific delusion associated with it. We who don't have them tend to define delusions as not real.
posted by Mental Wimp at 1:57 PM on August 5


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