Case Histories

Case Histories - A Clowning Achievement
20 AUG 2014 3

A Clowning Achievement

The woman sitting with me one day in 1996 was outwardly a picture of youthful haute couture. In actuality, when she spoke, I could see she was an anxious, middle-aged waif of a person appearing more like a hunted/haunted zombie. She was in my psychiatric office on an emergency basis. Alicia trembled and shook as she tried to tell me about the panic attacks and total insomnia that she had been experiencing despite the fact that she had been taking massive amounts of prescription medication to counter these problems. Her symptoms had led her to admit herself to a local mental hospital in the recent past in the hope of finding relief, but it was not to be.

Actually, nothing had seemed to work for Alicia either in the hospital or out. She demonstrated no hint of the competent real estate agent that she once had been; she actually appeared somewhat limited. She was childlike, passively accepting of the ambient idea that she somehow must have been defective to develop all these unexplained symptoms.

Alicia was married to a well-known radiologist who had high expectations of others. In an attempt to justify herself in his eyes, she tried in extreme, unasked for ways to anticipate his needs. She began to develop compulsive checking and other new habits such as rising daily in the morning's wee hours in order to vacuum the house. She developed odd obsessions. Occasionally she would rave that she "couldn't take it" any more. She had become less able to organize tasks so was better able to function when there was less complexity in the environment which, in turn, abetted her tendency to clean the house at 4 AM. It didn't upset her to do this because she couldn't sleep anyway, not at all, night or day for weeks at a time. While some of her symptoms improved with my assistance, I kept puzzling over why the others did not.

Now in her second marriage, Alicia remembered well that she had experienced a horrific physical trauma in her teenage attempt at matrimony. She wondered if that shock long ago could have weakened her so that she ended up a shuddering mass of nerves, although she had functioned well and competently before 1992 when her symptoms began. She unsuccessfully had sought help from a caring psychologist and from numerous doctors and now, desperate and depressed, saw me as a last resort.

It was only after two years of working together that I began to suspect tick-borne diseases (TBDs) were behind all her symptoms and that Lyme disease was the reason that she had never regained the ability to sleep on her own nor overcome her sense of urgency. Although she was no longer zoned out on multiple medications, she still required fairly significant doses of the medications that were needed so that she could function. Her extreme compulsive behavior and her sense of anxiety lessened somewhat but did not go away despite therapy targeting these symptoms.

In the 6 years since the onset of her symptoms, and even in the 2 years that we had worked together, Alicia had not had one moment of joy or peace - her sense of herself had changed unshakably to "inadequate." A woman who had loved to cook creatively and to do interior decoration, she had become a frazzled phantom struggling to do its best so long as meager energy reserves held out.

It was only when Alicia began to lose her hair, have severe jaw joint (TMJ) paint, major weight loss, fatigue, muscle aches, and unexplained ear pains, that it became obvious to me (1998) that she needed to be tested for TBDs. In the meantime, Barry, her husband, was becoming high-handed. He was constantly irritable and could be demanding. He was impatient to an unreasonable degree at times. There was no sense of humor in either him or her and no hint of the change that was to occur when his own chronic TBD's were properly diagnosed and treated, along with hers. We were all surprised at that development. When one knows a person well, gradual changes in personality, as happen with chronic Lyme disease, are not so noticeable and tend to be explained away by daily stresses.

Alicia and Barry did not need any convincing that their positive tests for the tick borne diseases Lyme, babesiosis and ehrlichiosis needed urgent attention. They undertook intensive treatments, including the rigorous one, quinine, for their malaria-like babesiosis. They made truly remarkable recoveries. The unique thing was that they recovered more than they had lost!

As he continued his antimicrobial treatments, Barry began to develop a sense of playfulness. He took delight in entertaining children and to the amazement of his wife and her psychiatrist, he became a professional clown on his weekends. Today, he still thrills the sick kids at local hospitals - in a role quite different from the more usual isolated-from-patients employment of many radiologists. He is no longer seen by others as a distant authority figure but is experiencing the joy of his own creativity and the affection it brings to and from others. His patience has grown and he is a happy man with a happy wife who is proud of him for many old and new reasons.

Alicia accompanies him now during his hospital events. She assists in his act. She enjoys creating outlandish costumes for his "performances" and loves the laughs they share together in the process. She has returned to her own hobby of painting, untouched during the many years that her sense of organization and her own sense of playfulness were unavailable to her. And her cooking! Her husband kids that he will open a gourmet restaurant with her as the stellar attraction.

A colleague, Dr. Rick Brand, once mentioned that his patients who were afflicted with Lyme disease experienced a spurt of creative imagination in the recovery phase. His words rang true when Alicia brought me photos of Barry in his latest colorful home-made clown regalia. This couple's emergence from the personality-distorting effects of chronic Lyme disease demonstrated joyful evidence of their sharing such a rebirth together.

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