Grandmother Tormented by Invisible Fleas

Reader’s Question

I am from Singapore and recently found out that my grandmother has some symptoms that are quite fascinating.

My grandma is 73 this year and has suffered diabetes for many years. Recently the condition worsened, so she has to be sent for kidney dialysis (twice or thrice per week). She stays with my uncle in Malaysia. My auntie sells chicken and has a stall of her own. Every morning except Monday, she will be off to her stall to sell the chickens and will only be back after evening. My uncle is a delivery man; he will set off after breakfast with my grandma and is always back home quite late as well. A few years back, one of my cousins (Cousin A) came to singapore to work, and she would only get to go back home once every two weeks. So, now there’s only one cousin (Cousin B) left to accompany my grandma through the afternoons. Two months ago, Cousin B was sent to study away from home. That left my grandma all alone in that empty house and the only past time will be watching TV, as she is illitrate. Other than that she will have to face loneliness all by herself.

Two weeks ago, while she was sitting by the balcony, a wind suddenly blow past, and after that she found that there’s fleas all over her head. From then on, she has been telling everybody that the fleas are everywhere. But the problem is no one sees the fleas except her. From head to toes, she told us, it’s everywhere. She said that, she can’t even have a proper meal, with all the fleas coming out from her nose, eyes, ears, mouth. They jump to the rice and in the end she would rather not eat than swallow those fleas. She has to bathe many time a day. What’s more ridiculous, is that she sprays insecticide all over her head. We really believe that she really is seeing something as she can describe every detail of the fleas she saw. The colour of the fleas’ eggs, etc.

Days ago, my mother fetched her to our house for a 3 day, 2 night stay. From what we saw, she really seems totally fine like a normal person, but always does actions to get rid of the ‘fleas’, eg. using handkerchief to clear her nose, ears.

Once, there was this Chinese fortune teller that told her that she will live to 73 years old. So I am wondering has this become a fear in her heart that she can’t overcome, and that’s why she starts seeing and imagining things?

Is this all imaginations due to her loneliness? She’s someone who is very afraid of being lonely; is this one of the reason for her illness? May I know what are the possibilities for this illness?

Psychologist’s Reply

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It’s quite possible that your grandmother is experiencing an “organic psychosis” which is related to her dialysis. A person can develop psychotic symptoms — auditory and visual hallucinations, paranoia, false beliefs, etc. — due to many conditions. Most commonly, we see psychosis when the brain’s neurotransmitters are involved, especially excessive Dopamine.

An “organic psychosis” is very different. It surfaces with little or no prior psychiatric history and is almost always related to changes in the structure or metabolic processes in the brain. “Organic psychosis” typically has two types of hallucinations that are rather rare — visual and tactile (touch) hallucinations. The patient experiences a sensation of skin crawling, movements, picking at invisible objects, etc. She may actually “see” the fleas. In my clinical experience, an organic psychosis may also have only one specific area of delusions and/or hallucinations — your grandmother having an issue with “fleas” and no other objects.

In “organic psychosis”, as in the case of your grandmother, many report an incident or experience of some kind that serves as the foundation for the symptoms. It’s as though the metabolism of the brain changes at that moment, and whatever is being experienced is incorporated into the psychosis. I had a dialysis patient who was coherent one morning and that evening was convinced that a popular restaurant was trying to kill him. Nursing staff concluded that he was watching television and became suspicious following a commercial for the restaurant.

As you observed, the active hallucinations of the psychosis may disappear as the brain stabilizes. However, the original delusions are considered totally real by the individual. She may continue to behave as though fleas are still an issue although I suspect those behaviors will fade with time.

From a treatment standpoint, it’s important to bring her symptoms to the attention of her dialysis team. While her behaviors and symptoms might be viewed as Psychiatric in nature, they are actually neurological and metabolic and should be reported to her physicians.

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