There’s Crazy and then There’s Crazy

Having just about finished my third year of medical school including my psychiatric rotation I can say with confidence, “there sure are a lot of crazy people out there.” Considering that the prevalence of schizophrenia (http://www.emedicine.com/emerg/topic520.htm) is believed to be anywhere from .5 – 1% of the population, go into any large body of people and there’s a good chance a few of them will be completely out of their minds.* While that’s a bit disturbing, what is perhaps a bit more mind blowing – to me at least – is that sometimes these unfortunate people aren’t quite as crazy as they seem. Although the following stories are mostly fabricated, they’re loosely based on accounts I in at least some small part had a role in.

One patient, who since we’re in South Texas we’ll call him Juan, lived for years obsessing over the opposite sex. While this isn’t entirely too unusual for many guys, Juan’s obsession was accompanied by a full cast of supporting characters that existed only in his head. Throw into the mix a few delusions about the world around him and some unorganized thinking and we had ourselves a typical schizophrenic patient. Or so we thought. One particular story he consistently returned to, which we of course seeing through his psychotic ruse knew to be a hallucination or delusion of some sort, dealt with his recent girlfriend who we’ll call, oh, Juana. As the story goes, Juan, who as far as we can tell had never had a girlfriend before, met Juana at a friend’s place and they quickly hit it off. One thing led to another and they shortly became friends and then more than friends. One day, however, Juana decided to share her deep, dark secret that she, in fact, was a dude. Yes, only a short time ago she had been a man, but thanks to the miracle of cosmetic surgery she had fashioned herself into the woman she had always wanted to be. Juan was pissed and we were confused. Initially we saw this as an indication to step up his antipsychotic medications but through continued questioning with Juan, friends, and family we came to the realization that, despite the weirdness of it all, Juana did in fact exist, was in fact at one time a chic, and Juan, the poor guy, wasn’t quite as psychotic as we thought him to be. A troubled guy no doubt, but not all that crazy.

Our second unfortunate patient goes by the name of Juanita and she too had a long history of schizophrenia. She also had a long history of stories relating to people breaking into her apartment, messing around with her stuff, stealing a knick knack here and a few bucks there, and promptly leaving just as mysteriously as they came. Police efforts were hampered by the fact that Juanita kept a pretty messy place and there was no sign of forcible entry into her apartment. It would be months more during which she would receive treatment for the rest of her psychotic symptoms while fully maintaining that the stories of her home invaders were true before we’d find out the real source of her scattered paranoia.

It was on one not particularly unusual evening that Juanita came home to find that yet again things in her home were not as she had left them. She couldn’t quite place it, but things just seemed different. In particular there was an open beer can on her couch which she knew had certainly not been there when she left. Armed with this evidence she once again called the cops, and once again they came to do a cursory search of the premises. This time, however, the villain made it easy for them for they found, in the bedroom, a wallet casually lying about complete with identification. The owner of the wallet and license turned out to be a local vagrant who the police were already well acquainted with and within a few days he was arrested, questioned, and had confessed that, on a regular basis, he would wait till the woman left for work, sneak in through an unlocked window in her bedroom, help himself to her snacks and drinks while he watched television, and then promptly leave again before she returned home. Once again we realized that, in reality, saying crazy shit doesn’t always mean you’re crazy. And one out of five Americans have a Soviet-era chip in their brain.

*That’s not absolutely true as many schizophrenics receive treatment and control their psychosis while the really nutty ones tend to live in hospitals and under bridges, but it’s close enough if you add into uncategorized psychotics, the depressed people with psychotic features, and those actively nuts secondary to active drug use.