Not long ago I had a patient with symptoms that occurred only in the middle of the night. He would wake with chest tightness and a sense of foreboding. A creeping sensation took over him and develop into partial paralysis. His theory was not depression or panic attacks but the house was bewitched. He tried to exorcise the alleged ghost(s) with some sort of cleansing ritual but no luck: the symptoms continued. His PCP sent him on the possibility he was off his rocker. I didn’t think him ‘crazy’ but I wasn’t going with his hypothesis of spooks. I got him to have his place checked for black mold and the like. It turns out carbon monoxide was seeping in to his room from the near by garage. I thought the man would be grateful but he wasn’t. He was downright disappointed the explanation wasn’t supernatural. You’re welcome. People believe in a lot of mumbo-jumbo about illness and treatment. Because of my training in Jungian psychology patients expect me to be full of dungeons and dragons and they are dismayed when I cut through their rubbishy theories about every little fiddle-faddle. They want me to agree with their beliefs and take umbrage when I don’t

On the other hand I’ve learned if a patient is gung-ho about something for their treatment I go with it so long as their modest proposal does no harm. The placebo effect is a strong and useful medicine. If their way works, great; if it doesn’t, then next time it is my way.  It is important to be neutral about these things. A patient recently returned after a year of trying a myriad of non-pharmaceutical means to alleviate her depression, only to sheepishly admit (with a touch of rancor) only the zoloft works and would I please give her another prescription. OK is the answer, not I told you so you silly person.

Patients with paranoid delusions are particularly tough nuts to crack. I’ve learned not to butt heads yes it’s true no it’s not but to go with the affect.  “Gee, that must make you (angry/scared/frustrated) to have that happen to you” not only does this mirror the affect but it dodges the debate about the truth of it all.

I see Thursday’s roster has “Joe” coming in. He doesn’t want treatment per se but seems to be showing up solely to wear me out through attrition and get me admit I am wrong and affirm his belief about the supposed nightly break-ins. My two comments  a) how the hell can I know for sure and b) it sounds not likely and give it a rest neither appease or cause him to dismiss me as a quack and go elsewhere. He is determined to get me to confess yes he’s right. It’s all rather tedious. I am half-tempted to tell him his house is bewitched. It may actually raise his low opinion of me.