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1:58pm October 27, 2013

This is a relief to read.

From Wikipedia’s article on delirium:

[Delusions] usually relate to persecutory themes of impending danger or threat in the immediate environment (e.g. being poisoned by nurses). Misperceptions include depersonalisation, delusional misidentifications, illusions and hallucinations. Hallucinations and illusions are frequently visual though can be tactile and auditory. 

I don’t know how I missed that before.  Although I usually have researched delirium at times when I’ve still had lingering cognitive issues from delirium so I can see how I’ve missed a lot.

But the part about the delusions usually being persecutory and about the immediate hospital environment…

I’ve never had delusions while delirious except once, last fall, when I was in the hospital with pneumonia and complications of gastroparesis (I hadn’t eaten solid food for weeks).  And it was completely terrifying because I honestly believed that the entire ward was conspiring against me.  I do remember telling everyone how easy it would be to slip poison into my IV and freaking out about that a good deal.  And I had this week or two during the five-week stay, where…

Normally my hallucinations while delirious are visual and tactile.  As well as something that I’d call experiential hallucinations?  Like my entire sense of self is radically altered in ways that resemble hallucinations, it’s hard to describe in words.

But for this week or two (I don’t remember how long), I suddenly developed auditory hallucinations and delusions.  And they went along together.  I believed that the entire ward was talking right outside the door to my hospital room.  I could hear them as plain as you hear anything.  I thought that I could hear them and other people couldn’t, because I am autistic and have good hearing.  (Which is true, but it’s not why I was hearing voices.)

This was right around the same time I had one of my once-in-several years incidents where I had some usable speech (it’s apparently quite  common for autistic people without much speech to suddenly acquire it in an emergency situation and then lose it again, but this is the only time that’s happened in a big way for me, and it’s not even the worst emergency I’ve been in at all, so the stars must have all aligned just right).  And then the speech disappeared and right after it disappeared the auditory hallucinations started.  My friend thinks that the hallucinations happened because my brain was pushing too hard trying to talk and it sort of broke itself and went into dysfunctional-language-mode and combined with the delirium everything was shot to hell.  And that makes sense to me.  Speaking required so much effort that I honestly felt like my brain was splitting into pieces in the most painful way possible.  And just as suddenly as it appeared, it vanished and I had to type again.  And then I felt like hell and the same day, the hallucinations started.

The hallucinations often involved people describing my every movement and talking about how if I was vomiting I must have stuck my finger down my throat, things like that.  I must have really confused the nurses because I remember begging a nurse who had seen me vomiting to go tell them that I was vomiting for real and that I hadn’t stuck my finger down my throat.  And then I actually heard her go tell them – except she couldn’t, because there was nobody to tell.

Then they started saying that I wasn’t the one making myself sick, but my doctor and my friends were making me sick because they enjoyed making people sick.  And one voice (a resident, I don’t know how I magically knew the identities of the voices but I did, maybe because they weren’t real, but I never thought to wonder how do I know this person is a resident)… he actually said that there’s a specific ward, and he gave a nonsensical ward name that doesn’t exist in that hospital… that ward is this ward that my doctor puts patients that he’s gotten so sick that he’s tired of caring for them.  And that he puts them there and then he sees them one last time, then leaves them there to die because he can’t stand to see the results of the horrible things he’s done to people.

And the voices would argue with each other.  Some of them would say I was making myself sick, others would say that people close to me (it varied who) were making me sick, and others would “stick up for me” and say that neither one of these things were happening and that the rest of them were going to end up killing me if they continued thinking that way.

Slowly, though, the voices kind of faded out.  It wasn’t that they just slowly went away.  It’s that they became less complex.  They became just a few specific voices, each of which always said the same things.

Like the voice of the nurse who had seen me vomit would say, over and over again, “She was heaving.  HEA.  VING.”  That’s the main one I remember but I know there were others.  And they just became less and less complex, more and more repetitive, more and more just the same few “people” saying the same few things.

It also helped that once the nurses knew I was having auditory hallucinations they were totally wonderful about it.  Like beyond anything I could’ve imagined, wonderful.  Any time, night or day, that I heard voices, they’d grab a wheelchair and push me around the ward as many times as I wanted, to assure me that nobody was actually out there saying anything, and to show me how busy the ward was and that nobody could actually say those things.  And they assured me over and over and over that nobody actually thought that either I or anyone else was causing my symptoms.

I think the contents of the hallucinations were sparked by the awful experiences I’ve had with stalkers who try to tell people that I’m faking all of my disabilities and illnesses.  There was a time that I was really devastated by that and it left a mark on my brain, it became a sore spot.  So when there was an opportunity for paranoid delusions to form, they formed around that topic.

The amazing thing to me about the auditory hallucinations was that they were so realistic at first.  Not after they began to fade and become repetitive.  But at first, they said things that I’d never expect anything to say, had discussions and arguments about me, and mocked me relentlessly for everything I did.

Like if I threw up they’d say I must’ve stuck my finger down my throat, if I groaned in pain they’d say it wasn’t very “realistic”, sometimes they mimicked noises I made and made them back at me in a mocking fashion.  They said snide nasty little things about me that I’d expect a bully to say.  It was like having my own personal portable set of bullies that followed me everywhere.

But there were clues all along that they weren’t real.  They said things about me that people at the hospital would have no way of knowing.  They referred to things I was doing that they wouldn’t have been able to see through a closed door.  But I didn’t understand what was happening until my DPA flat-out told me “You’re delusional.”  This was after a day and a half of me pestering her to do something about these people who didn’t actually exist, and giving her moment by moment details of everything they were saying.

I’m just glad I had enough presence of mind to believe her.

She taught me a few ground rules, too.  Like never believe anything you hear unless you can physically see the person who is saying it.  That one helped me immensely.

And I’m still nervous talking about this.  I have all these weird fears about things that will happen if I tell anyone about it.

But I’m talking about it because these are things that can happen during delirium.  You can have hallucinations and delusions very similar to psychosis.  The difference is that it’s temporary and goes away faster and is connected directly to a physical illness.  But it’s such a relief to hear that persecutory delusions are particularly common, because I thought that my experience must have been unique or weird or made me a bad person somehow?  I can’t explain it all.  

I know my stalkers would have a field day with this:  "Proof" that I’m really psychotic after all (honestly if I was, I’d have said so by now…), “proof” that I fear being considered fake which must mean I’m really fake (um, no, I fear it because I have had really awful experiences with false accusations), “proof” that I could really talk if I wanted to (because for a couple days I could say some things some of the time, one of a couple instances in over ten years of being unable to say anything communicative whatsoever, even in much direr emergencies where I’d have given my eyeteeth to be able to communicate), etc.

But there’s also this fear that because I had delusions during a short span of delirium, people will assume I’m delusional if I report real medical discrimination.  This sort of thing is why I always try to gather proof, multiple witnesses, etc. because I have this fear of not being considered reliable enough on my own.

And now I always have fears that I really am not reliable.  Any time I hear someone talking and they’re behind a closed door where I can’t see them, I fear that I’m not actually hearing them talking at all.  I don’t trust my senses anymore, even though they’ve proven pretty reliable after the delirium went away.

One thing I don’t quite understand, is why the visual and auditory hallucinations seemed to cancel each other out rather than merge.

Maybe it’s something about the brain?

Because I had a period of time when I was hallucinating people in my room and I only noticed they weren’t real when they faded into mist.  

And when the auditory hallucinations started, that stopped.

So I never visually hallucinated a person and then auditorilty hallucinated their voice talking to me, at once.  It was always one or the other, never both.

Maybe the parts of the brain involved in each one aren’t well connected enough to each other, to be able to work in concert like that, especially during delirium.  Because delirium always feels to me as if it’s fragmenting my brain into little pieces, not making them work better together.

I don’t know.

But it’s some comfort to know that my experience is not that unusual.  Even if the rest of it freaks me out a good deal for a wide variety of reasons.