When A Doctor Decides Not To Treat The Hallucinations

Sometimes a good psychosis or delusion, is less harmful than medication — especially in a person who has previously been compromised by illness.

The first I saw was a veteran many years ago. Curiously enough, he was the kind of “old salt” you see plenty in San Diego street clinics but I saw him back at the Wichita V.A.

Then as now I enjoy the older veterans, The kind of folks who, although they were members of a nameless hoard of uniformed youth, have assimilated the serviceman’s identity into their own.

Being an “old sailor” may not have been an identity that made him stand out from the crowd in San Diego, but it surely made him stand out from the crowd in Witchita, Kansas. The city has a major Air Force base but being land-locked — no ship yards.

I mean, he lived in some rural suburb of Wichita which was famous for the biggest cow-pie throwing contest in Kansas.

He hadn’t particularly wanted to see me. He had been referred by his primary care physician, for a “musical hallucinosis.” The kind of rich anecdote that Oliver Sachs built his career on.

I was all ears.

He told me about the beauty of the sea. He laughed that his doctor, or anybody else for that manner, could have found it worrisome. He just heard the voices of sea nymphs singing him to sleep.

No other symptoms. Not depressed or nervous or any way psychotic. I asked him where he thought they were. He (correctly) opined that they had to pretty far way, since the nearest ocean or sea was pretty far from Wichita.

I started smiling as I finished his otherwise very normal psychiatric examination. Smiling because legends and myths are more durable than I had ever believed.

“Circe” had been a witch whose place Ulysses had found it necessary to sail past on the way home from the Trojan war. I believe sailors had been warned somewhere along the line not to go close enough to the island to hear the nymphs singing. Circe had changed a bunch of sailors into pigs, presumably in that manner. I remembered enough variants on what singing nymphs are supposed to do to fill a small dictionary of mythology.

Many were later. There was mention of the singing nymphs in Ovid’s Metamorphoseses. I had read this quite ardently in prep school when I found it in a library at Harvard since my Latin teacher had announced it was much too dirty to be read in a genteel girls’ prep school class like ours. Circe and her buddies figure in modern “mythological fiction,” would-you-believe published in 2018?

The “old salt” in Wichita had the delightful benefit of his sea nymph’s voice. He did not require medication for sleep, which much of the VA population certainly did.

I explained the benign nature of this “hallucination” to a confused rural Kansas doctor, who knew zilch about classical literature and probably sent the patient somewhere else for further evaluation when I was done with him. I’m sure he ended up on unnecessary drugs and was deprived of his beloved nymph music.

He probably didn’t sleep as well either.

That’s institutional medicine for you.

I talked on the phone today to an older gentleman who was totally bllnd, but hallucinated “clownlike” figures doing tricks. I could not think of any classical literature references, but he was surprised when I told him if nothing dangerous was going on (there was not) nobody could force him to treat this symptom.

There are times when it is more humane to leave someone with the hallucinations if they get comfort and there’s no danger.

And it is safer than the strong drugs used for such treatments.

Not all doctors agree with that decision — but that’s what makes me The Renegade Doctor.

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