Formication
From Formic having to do with ants as in Formic acid.
A previously abused addicted woman with many problems, had the common delusion of unceasing parasites crawling over her body called Formication, similar to visceral larva migrans. She had the workups and tests such as IgE, eosinophil counts many others to definitively exclude a medical diagnosis, but yet I was willing to treat her at the time “definitively” for visceral larva migrans with ivermectin, a drug I’d never prescribed. I found it was safe. It helped her. We got along well and talked a lot and she entrusted me with a heartfelt book she was writing about a family member she had lost. I couldn’t make sense of the writing but still have the book. She was seeming to do well as far as I knew when one day I was told she’d been found in her home. She lived alone. Calling around I was never able to get details. I guessed she took an overdose. (It was long ago but I did change some details to protect her privacy.)
Is it ethical to partly accept a person’s delusion in order to help them? I think it is an example of meeting half way, if there is no other way and your treatment plan is unlikely to harm. Some would call it dishonest. Better to stand your ground. Never compromise with the truth. So it is maybe a tough question.
When I started my neurology practice, I was a zealot for the truth. Early on I had another patient with well-controlled epilepsy whose chiropractor convinced her to stop drugs that he said were “poisonous.” Having gotten word she had more seizures, I delved into chiropractic I then know little about. I found it to be wholly nonsensical, 19th century Americana. I was livid. I called him and I called her but she never did return to the office. Later it came to be that the most highly regarded medical schools encouraged, due to popularity and pressure, all manner of hocus-pocus and even financed professorships of hocus-pocus alternative medicine. What do you call the alternative to the truth? I’d always taken intense pride in my medical training that strictly segregated science, hard-won, only in last 100 years, from darkness and superstition of the past. Then just yesterday I was ordering physical therapy for back pain when the lady asked me, “Can’t I just see a chiropractor?” I said, “Sure.” Point is we compromise with the truth. Of course, physicians are outnumbered by charlatans and pretenders even where we practice, I’m sorry to say.
I just read an article I heartily recommend, wordy, but worth it: “Bad Medicine: A Doctor’s War Against the Right-Wing Medical Freedom Movement by Matthew Hongoltz-Hetling, Available online newrepublic.com. It seems treat this difficult issue from all political angles.
