As a medical professional in the psychiatric department, what's the saddest thing a patient ever told you?

 

When you work in psychology, the main thing you learn is never to take anything for granted.

Emily Paton (Psych student, trainee neuropsychologist, disappointment) shares a story of Mandy;

Mandy couldn’t laugh.

She was young, about mid twenties, not much older than me. Her hair was unwashed, and her cheery blue eyeshadow had only got as far as half an eyelid. Her jeans were ripped, but not deliberately — the holes in her knees had been caused by abrasion, by falls, rather than fashion.

But the main thing was the darkness under her eyes. Those thick, purple creases, dark as bruises, made her look twenty— no, thirty years older than she was. If her makeup had managed to tone the colour down, then I dread to think what they looked like without it.

 

She fell heavily into the clinic room's chair, and smiled at me. I was just a student, not the psychiatrist, so it was nice to be acknowledged. Her smile was kind, if a little sad. I liked her.

She told the psychiatrist she had narcolepsy.

I didn't know much about the condition before this appointment. In simple terms, narcolepsy is a neurological condition that stops people regulating their sleep-wake cycles. Narcoleptics randomly fall asleep, even at inappropriate times, like the middle of a conversation or while driving. These “sleep attacks” generally come without warning, and people can collapse and lose consciousness. They are often very tired during the day, and have disturbed sleep at night, involving sleep paralysis, hypnogogic hallucinations and sleep walking.

In more complex terms, the condition is varied and can present in a myriad of ways. Some have warnings for their episodes, some don't. In some, the loss of muscle tone, known as cataplexy, can be triggered by strong emotions, like stress or anger.

Or laughter.!

 

That was Mandy’s trigger (and it isn’t uncommon). If she laughed at a joke, she would lose all muscle tone and fall.

Collapsing is dangerous — you could hit your head on the way down, seriously injure yourself — but the patient's main concern was embarrassment. It was humiliating, laughing with colleagues and then lolling over lunch. Once, while out with friends, she collapsed at a bar. The bouncer thought it was because she was too drunk, and kicked her out. Her friends had to abort their night to take her home. She was wracked with guilt.

 

The psychiatrist asked her if she avoided laughing, because it triggered her cataplexy. She said she had stopped going out with friends, because there's a chance she'd have too much excitement. She had quit her job, because her colleagues liked to mess about; she’d laugh, and then she’d have to explain to her boss why she was limp at her desk. She had never moved out of her mum’s house.

Her life had come to a halt, and her laughter had all dried up.

The patient was given some new drugs, but I have no idea if they worked. I can tell you that the psychiatrist was amazing, and I'm glad she at least had someone who took her problems seriously.

It’s hardly the most depressing thing I’ve heard in a psychiatrist’s office — there are patients who are suicidal, or psychotic, or dying of a brain tumour — but for some reason this really struck me. Not only was she exhausted all the time, unrefreshed by a chaotic and frightening sleep, but in her brief alert hours she wan’t able to fully enjoy herself. It sounds like something from a tale by the Brothers Grimm; the girl who is cursed to sleep every time she laughs. She has been forced to remove herself from anything fun.

It’s just so unfair!