Reader’s Question

During the last 5 months, my wife has been having a problem she doesn’t want to discuss with a doctor. She always feels that everybody in her life is against her. She feels that my baby girl (age 4) and I are involved in a conspiracy against her. Even the TV programs and radio are involved. My family members and my friends are all involved with the conspiracy. She asks me whether all the TV channels in the world are controlled by me and whether I let them air programs which disturbs her. She always complains about this to me, and she feels the whole world is with me and she is alone.

From my side, I never talk to her in a raised voice, but during the last few days when I get irritated with her talking I shout at her.

She doesn’t eat properly. She works all day thinking she is a maid, and she eats the left overs. She also resigned from her job and stays home now.

So please suggest to me what to do now. Thanks and regards.

Our Clinical Psychologist’s Reply

From your description, your wife is experiencing a psychotic and paranoid episode. A psychotic episode is caused by an increase in a neurochemical/neurotransmitter called Dopamine. As our Dopamine levels increase in the brain, we first become hyperalert and suspicious. We become emotionally and socially hypersensitive, being easily offended by casual comments or facial expressions. As Dopamine continues to increase, people become paranoid and assume that not only is everyone out to harm them, but that everything in their environment (family, friends, community, television, radio, etc.) is part of a conspiracy to harm them. As you describe, they assume everything around them is personally related to them — and in a bad way. Eventually they develop “delusions” or false beliefs, typically beginning with thought control — the feeling that others are planting thoughts, or stealing or monitoring their thoughts through some technology. Hallucinations follow — auditory at first, later followed by hallucinations of touch (tactile), smell (olfactory), taste (gustatory) and eventually visual.

While their thinking speed increases and their day fills with delusions, paranoia, and hallucinations, their ability to function in the home and community deteriorates. They often reduce or stop person hygiene, leave their jobs, detach from family, and become house-bound due to paranoia. Your wife is approaching this point.

Because this condition is produced by elevations in a neurotransmitter, our first job is to understand what happened. Several situations can produce her symptoms:

• Medications for physical problems/diseases can elevate Dopamine as a side effect. Has your wife recently started a medication, changed medications, or increased dosages? Has she taken prescription medications for diet or weight loss? If any of these are true, contact the prescribing physician immediately.
• Has your wife been using herbal remedies? Many “natural” or herbal remedies can create similar symptoms, especially those advertising weight loss, energy, or “boost” in mood.
• Has your wife experienced any significant events recently such as death in the family, surgery, or abrupt lifestyle changes? It’s not uncommon for stressful events to trigger these episodes.
• Has your wife gradually moved into these symptoms over a prolonged period of time, only now becoming very noticeable? If this is the case, she may be experiencing the early symptoms of a significant psychiatric disorder.

I’d strongly recommend a psychiatric consultation. A psychiatrist is the physician best trained to understand the causes of this type of disorder and provide treatment. Effective treatment is available, and I’d begin as soon as possible.