The psychiatric definition of an illusion is the misinterpretation of actual sensory input. Unlike hallucinations, when one perceives things that do not actually exist, illusions are reality misconstrued. Lately it feels like the part of my brain that is supposed to interpret what's going on isn't functioning properly. I feel like I'm losing touch with reality.
Psychiatrists define the term “insight” as the ability to tell how crazy oneself is. In terms of prognosis, it's generally accepted that the more insight a patient has into their condition, the greater their chance of recovery. And so, as a good medical student, in my mental checklist, I put “insight” under the list of “good things” to have. However, I've recently come to realize that while insight might be good for prognosis, it's probably one of the most distressing experiences I've ever had. In some cases, it means that you become a bystander of sorts that desperately is trying to get your mind, and thus life, back.
Chief Complaint: possible illusions
History of Present Illness:
J first started to feel like she might have illusions about a year ago. She noticed that her medical school class was highly, however informally, segregated by race, not only in social groups, but also in such simple things as seating within the lecture hall. While others noticed this phenomenon not everybody interpreted it as manifestations of the same thing. J was convinced that, however unconscious, the root cause was in the worst case scenario, unconscious racism, and in the best case scenario, unconscious xenophobia. She was able to find validation of this belief among selected classmates.
As time has continued J has grown more alienated from her surroundings (not just in medical school, but also in the general community of Ann Arbor, and sometimes even to mainstream America). Her possible illusions have grown proportionately.
J believes that her opinions, when shared with her classmates, are generally perceived differently than when her white or male or straight classmates speak out. She points out examples where other folks, by her estimation, have sent out more inflammatory emails that have been better received than her own emails that have caused her to be perceived as angry and scary. She says that she has received emails from anonymous classmates telling her to take her “op-eds somewhere that cares” though she is sure that other folks who expressed their opinion on the same topic were not sent the same email. At the same time, classmates, even close friends that she trusts, seem to imply that her perceptions of this dichotomy are not quite accurate.
J is pretty sure that the poor handling of her girlfriend's car being mistakenly towed from her apartment complex parking lot was due to discomfort with her queer relationship. However, certain discussions about this event have led J to believe that folks do not totally agree that homophobia played a role.
In general J gets the sense from several interactions that her reactions are seen as “too angry” and “too sensitive” to issues related to identity and the state of “other.” Folks point out that her examples have mediating factors and furthermore, she's not the only woman, person of color, or queer person in the class, yet she seems to be the only one who feels this way. One person has told her that it was just her personality, not anything related or race or homophobia. While a year ago, she was more certain that her interpretations of the world were valid from at least some perspectives, lately she feels like she gets so much feedback that she's wrong in both her feelings and opinions, that she's sure she must be unable to interpret reality correctly.
J has spent a significant amount of time and energy trying to analyze if she is suffering from illusions. She describes intense feelings of guilt and a decreased sense of self and self worth for being unable to conform to what seems to be a more appropriate world view. In an attempt to hide her possible disconnect from reality, she has tried to stop discussing such issues, especially with those that she believes might disagree with her. She reports “being scared” of conversations that might remind her that her interpretations of reality do not align with those around her.
When asked if this has ever happened before, J states that all her life she's seemed to be a bit outside the mainstream and did not always hold popular opinions or feelings. However, this episode seems to be different. In the past she had the confidence to believe she was different but not necessarily crazy. She does not know why this time is different.
When asked if she ever feels like she's not going crazy or that her feelings and perceptions might be valid she says, “Yes, but only when I'm talking to my girlfriend or I'm reading books by folks of other about race/identity or when I go to conferences about marginalized communities. Then I feel ok, but then sometimes I get angry that I feel crazy in my life when maybe I'm not.”