Morgellons and Lemons

Morgellons coverage in the local media has never been very good, with the natural tendency of TV news to compress things into sound bites, and to force emotional responses from their viewers instead of informing them.

This coverage reached a new low on 3/6/2008 with the broadcast of the KFMB piece titled : “Is Mysterious Skin Condition A Disease Or Delusion?”:

The majority of the segment is taken up with an interview with a woman who claims she has Morgellons.

Her symptoms began in July with what she thought was an insect bite. It soon evolved into skin lesions.

“One evening I was kind of scratching at one of them, what appeared to be a little white moth flew out of some of these lesions,” she said.

Her terror continues. She says citrus acid brings worm-like threads out of her body. Seeing is believing.

Here’s where things get ridiculous. The woman takes some freshly cut lemon, and rubs it vigorously over her hand for a minute, squeezing and twisting the lemon slice until her hand is covered with lemon juice and lemon pulp.

She then rubs her hands together, rolling the pulp around on her fingertips.

Then she points at some lemon pulp and says “This is worms, can you see it coming out right there?

Later, with hand dried off, she digs at a piece of dried skin at the edge of a wound – the unsaid implication being that this is the same thing.

The footage then cuts to her plucking off another piece of lemon pulp from a different region of unbroken lemon soaked skin.

The piece continues:

[She] has seen countless doctors, but her symptoms are getting worse.

“To be diagnosed by doctor after doctor as being delusional, it’s beyond frustrating,” she said.

I’m sure it is very frustrating, and I feel very sorry for her. However, little white moths are not flying out of her lesions. The “worms” are lemon pulp. I don’t know anything about her other symptoms, or her skin condition, which may well be related to a real medical condition, but in this regard, she holds a mistaken belief.

If countless doctors are telling someone the same thing, over and over, then is there not a chance that the doctors are right?

Despite the title of the piece, there is no questioning on the part of KFMB. They totally accept this woman’s story. Presenting her as a rational person who simply has worms coming out of her skin and is being ignored by countless doctors. They totally ignore the very obvious fact that there are no worms, and that all they are seeing is lemon pulp.

Itching is not delusional

There’s a key pararagraph in Brigid Schulte’s excellent Washington Post article on Morgellons:

At the Mayo Clinic in Rochester, Minn., doctors are beginning to discover how imprecise a diagnosis of “delusions of parasitosis” can be. In the past five years, 175 people have been admitted to the clinic with that diagnosis. After thorough evaluations, however, with doctors taking the time to search for underlying problems, only half of those patients left the clinic with that diagnosis intact. Doctors found a very real cause of the itching in the other half.

It’s key both because it illustrates the false dichotomy of “disease or delusion” that the media and the MRF have forced upon Morgellons, and because it offers a way out of this dead end debate.

Let’s say somebody itches. That’s all, they just itch, but really badly, so it’s a problem. They go to the doctor, and the doctor does a lot of tests to try to find out why they are itching. They do all kinds of tests, and discuss possible environmental causes with the patient, they keep at this for a long time but they can’t find out why the patient is itching.

Is the patient delusional?

No. Clearly not. They are just itching, and they can’t find out why. Now, this obviously would be a horrible situation to be in. Painful itching, and no solution in sight. Horrible. But just because the doctor can’t find a cause for their itching, it does not mean they are delusional.

Now consider the 175 people mentioned above. They were diagnosed with delusions of parasitosis, but after doctors looked for underlying problems, only half of them retained that diagnosis. Consider what this means.

For someone to be diagnosed with delusions of parasitosis (DOP), they have to have an unshakable false belief that they are infested with parasites. Now our hypothetical itching patient does not have this belief, they just itch, so they would not be diagnosed as delusional, since they hold no strange beliefs about their itching. No, to have itching and be diagnosed with DOP, you need TWO things:

  1. Itching
  2. Delusions of Parasitosis

Of course, one cause of itching is scratching (the itch-scratch-itch cycle), and one cause of scratching is DOP. But that’s just one cause. Just because someone has DOP does not mean that their itching is caused by their DOP. There are hundreds of causes of itching. Lots of non-delusional people have itching for which no cause can be found.

DOP, on the other hand, can certainly be caused by itching. It’s called secondary organic DOP.

Now, of the Mayo’s 175 people, 88 of them had a cause found for their itching, presumably this was addressed, and their itching was reduced (or at least explained), and so those people saw conclusively why they were itching in the first place, and were either cured of it, or no longer had false beliefs about it. Were they misdiagnosed? Not if they started out with fixed false beliefs about the cause of their itching. They were not misdiagnosed, they were cured.

Itching is not a delusion. Itching is a physical sensation. Formication is a physical sensation. A delusion is a fixed false belief. Saying someone is delusional does not in any way invalidate their itching. They still itch. It still could be caused by any of hundreds of illnesses, physical conditions or environmental factors. The fact that they hold some odd beliefs about it does not mean they don’t actually itch.

So, no, there is no evidence that Morgellons is a distinct disease, and no, the fibers are nothing to do with anything. But just because someone thinks they have Morgellons does not automatically mean they are crazy. They itch, they suffer from formication, they scratch. In many cases there are probably reasons behind this besides “delusions”.

Morgellons is not a Delusion

Morgellons is not a delusion. Many people say things like “Morgellons is just another name for Delusions of Parasitosis”, or “Morgellons sufferers are imagining their symptoms”, or “doctors dismiss Morgellons sufferers as delusional”. This is all wrong.

What is Morgellons? Morgellons is a list of symptoms of unknown causes. The main symptoms are skin lesions, itching, crawling sensations, the finding of fibers on the skin, and also other symptoms similar to Chronic Fatigue Syndrome.

Where is the delusion?

Skin lesions are not a delusion. There are thousands of reasons you can get skin lesions. People get them all the time. Obviously, they are not a delusion, as everyone can see them clearly on the skin of the people who have them.

Itching is not a delusion. It’s a symptom of a condition. There are thousands of conditions that can cause itching, including both medical conditions and environmental conditions. Itching and skin lesions can also cause each other, if you scratch an itch, it can cause a lesion, and the skin damage can cause more itching. This is called the itch-scratch-itch cycle, and it is not a delusion.

Crawling sensations are not a delusion. Like with itching, crawling sensations are a symptom of a condition, probably to do with the nerves in the skin. Crawling sensations are sometimes called “formication”, which is unfortunately sometimes defined as an “illusion or hallucination” that insects are crawling on your skin. This makes it sound like a delusion. But formication is not a delusion. It’s a sensation that feels like insects crawling under your skin. It is like when you have a high fever, but you feel cold. It’s not actually cold, but it still feels cold. Is that a delusion? No, it just feels like it is cold because the fever is creating the “illusion or hallucination” of cold. Really it’s just a sensation, and calling it a “hallucination” is a bit much. It’s not like you saw a ghost or something. Formication is not a delusion.

Finding fibers on the skin is not a delusion. If you can see a fiber (and other people can see it too), then it’s real. Fibers are everywhere. It’s not at all unusual to find fibers on your skin, I find them myself all the time. Skin also has a lot of fibers, and things that could look like fibers, naturally in it. Things like hair, blood vessels, nerve fibers, skin tissue, and sebum. These are not delusions.

I don’t think it is right to say “Morgellons is a delusion”. Lots of people have these real symptoms. They believe that their symptoms are linked to the fibers and that this means they have a distinct disease. I agree with the CDC when they say there is not sufficient evidence to say that Morgellons is a distinct disease, and I don’t think the fibers are related to the majority of the symptoms. So I think many people are making a mistake in saying they “have Morgellons”. I also think their health might suffer because of this mistake.

Morgellons is not a delusion. It’s a list of symptoms with many causes. Sometimes people have very strong beliefs about the connection between finding fibers and their other symptoms. Sometimes they describe things that sound impossible, like fibers moving by themselves and crawling out of the skin. If all the evidence shows the fibers are not connected to the symptoms, and they continue to believe unusual things about the fibers, then that might mean they are delusional about that.

But that does not mean their other symptoms are not real. Lesions, itching, crawling sensation, and even finding fibers, all these are real things. The fact that some people have some specific delusions about a part of their health does not mean that all their health problems are delusions. They have their health problems, and they maybe have some delusions. For some people, their delusions might be so strong that they interfere with treating their other symptoms. But this does not mean that all their symptoms are delusions. Morgellons is not a delusion, it’s a list of symptoms.


This is not just semantics. Doctors are quoting as saying that Morgellons IS Delusions Of Parasitosis, and you can treat it with Orap. Suppose a 50-year old woman goes to the doctor and says she’s itching, has a sensation of insect crawling under her skin, she’s breaking out in acne, the itching makes her scratch so much she bleeds, she has muscle and joint pain, vision problems, hair loss, swelling, fatigue, irritability, insomnia, inability to concentrate, depression, memory loss, headache, anxiety, and nervousness. She saw the ABC special on Morgellons, and examined her acne and found some fibers. So she begins to think she has Morgellons. She goes to the doctor, says “I think I have Morgellons”, and hands him a printout of the MRF case definition, and a plastic bag with some fibers and specks she found in her lesions, and urges him to look at the fibers on her skin. So, should the doctor prescribe Orap?

No. She does not have Morgellons, she has Menopause (menopause is the medical condition that most closely matches the Morgellons list of symptoms, and a very large proportion of people who think they have Morgellons are women of menopausal or perimenopausal age).

The doctor should prescribe treatment for the symptoms, possibly HRT for the menopause, they should explain that the formication and other symptoms are common effects of menopause, they can be reduced with treatment, and will eventually go away. He should explain that the fibers are probably just lint or hair and that the CDC says there is not enough evidence to say Morgellons is a distinct disease.

Then if she remains convinced that Morgellons is behind this, and this is interfering with her health, then the doctor should treat that delusion as well as the other symptoms. She may be delusional, but she’s still menopausal.

Morgellons is not a delusion. It’s a broad list of symptoms with no evidence of a common cause. It’s easy for some people to think they have it since the symptom list is so vague. Sometimes people become obsessively convinced they “have it” and that the fibers they find on their skin are connected to “it“, and they start picking them out. That’s a delusion. Sometimes the other symptoms are somatic manifestations of the delusion, and the Orap will fix them, but a lot of times the delusion has a physical basis that also needs to be addressed. Sometimes, the delusion is just a mistake.


“How can thousands be experiencing the same DOP at the same time? That does not make sense.”

That’s a good question, because it’s a point often used by people who believe they have “Morgellons” to “prove” that it’s real.

Dismissing things because they “don’t make sense”, is an “argument from a lack of imagination“, which is somewhat ironic, since the one thing that Morgies do not seem to lack is imagination. They believe in several things that do not make sense, but they believe them because they seem to fit their view of the world.

So, how can thousands of people have the same condition? Obviously that’s the wrong question right there, as nearly every medical condition has thousands of sufferers.

No, the question being proposed is “how can thousands of individuals have the EXACT SAME DELUSION”?

This question actually has two complementary answers. 1) Easily, and 2) They don’t.

Let’s be clear about the delusion. A delusion is fixed false belief, held contrary to the evidence. The Morgellons delusion is not that people have sores, which they obviously do. It is not the fibers themselves, as there are clearly fibers everywhere. It is not the itching, since itching is a subjective experience. No, the Morgellons delusion is that the fibers are somehow connected to the sores and itching.

(1) How can people share this same delusion? Easily. People itch for a lot of reasons, some scratch a bit too much, forming blisters and sores. Sores are wet and sticky, they get debris in them, people think the debris (fibers, dirt, etc) is what is causing the sores, so they try to pick them out. Later they hear of Morgellons, and think “that’s it!”

(2) How can people share this same delusion? They don’t. They all have different delusions. They all have different experiences with their symptoms. Their physical illnesses are varied. Their theories are varied. Even the fibers are different. Compare Anne Dill, Greg Vigil, Stan Skoumal, Andrew Leitao, Mister X, Ever Hopeful, Cindy Casey. There’s a lot of variety there. They don’t all have the same thing.

People are ill. People are genuinely ill. They deserve compassion and they deserve treatment. Some of them have a lot of imagination. I just wish they could use that imagination to try to imagine the possibility that they might have been mistaken in some of their beliefs, and imagine the possibility that their lives might be a little better if they let go of Morgellons.

CDC Latest

Here’s an interesting article. Interesting in two parts, firstly because it contains more detail on what the CDC is doing, and secondly because it’s got such a ridiculous headline.

Skin-sore sufferers cast off as delusional

The headline is “Skin-sore sufferers cast off as delusional, and the article also says: “Most have bounced from doctor to doctor and been dismissed as delusional“, and “ Doctors tried to blame her case on stress and depression from the death of her husband in a car accident five years ago.”

Here’s the problem. Obviously people are sick, and they have physical problems. They are not imagining their sores. Yet the article says they have been “cast off” and “dismissed” as “delusional”. This gives the impression that the doctors think the patients are imagining their sores and other symptoms.

Symptoms are not delusions. Symptoms are symptoms. The delusion is in attributing the cause of their symptoms to a new disease which is making fibers come out of their skin. The delusion is thinking that there is stuff under your skin that you have to dig out with your fingernails.

The cases presented in the article are very sad. One woman digs out “grains of sand” and “curly white fibers” with her fingernails. She refuses to take the medication her doctors prescribe. The other woman pulls out “threads, black specks and crystals” from her skin, with tweezers, causing her pain. She also “follows doctors’ advice to bathe in bleach and vinegar baths.”

Are their sores entirely self inflicted? Or are they compounding a skin condition like pseudomonas folliculitis? Either way, they are not helping with their scratching and tweezing. I’d like to know what kind of “doctor” told her to bathe in bleach.

Clearly a lot of people who think they have Morgellons are delusional (or, as Randy Wymore says: “a bit eccentric”). This does not mean that their entire condition is delusional, it just means that delusion is a component of their condition.

The article clears up one thing: it was a 900 fiber database, and a 100,000 organic compound database used by the Tulsa PD, not a 100,000 fiber FBI database, as some reports suggested.

Read the article for the information on what the CDC is doing. I’m looking forward to the CDC’s initial report. It should clarify things immensely.

Nancy Hinkle on Delusory Parasitosis

Most people who strongly believe they have Morgellons will complain that their doctors dismiss them as “DOP”, a common abbreviation for “Delusions Of Parasites”.

The Morgellons activists seek to portray their plight as a struggle of genuinely sick people against an uncaring medical profession that dismisses their symptoms as “all in your head”. Any suggestion of anything like DOP is reviled, and the believers wander from doctor to doctor, seeking those who will look beyond this.

To understand the Morgellons community, you need to understand DOP. One of the worlds leading experts on DOP is Nancy Hinkle, PhD. Hinkle is not a physician, she is an entomologist, so if anyone can find the bugs, it’s going to be her. Back in 2001, before the MRF got off the ground, she had an interview on this subject with the Discovery Channel in Canada.

If you are interested in Morgellons, I highly recommend you watch this video (it’s only about six minutes long), as it provides a simple overview of DOP, as well as the varied causes, which are mostly physical in nature. She also makes the distinction between those who are simply mistaken, and those who are delusional.

Out of the hundreds of samples that people have sent Dr. Hinkle over the years, NONE had insects in them. Her most telling quote: “If they are desperate enough they will usually find something”.

Dr. Hinkle also wrote a highly lucid paper on the subject in 2000:

Scratching may produce papular eruptions. Any
repeated skin irritation produces a friction blister.
Repeated rubbing of an area often produces a bleb
(small blister) which, when ruptured, yields an open
sore that may become infected. Once the sore
begins oozing plasma and a scab forms, hairs and
cloth fibers become entrapped in the sticky fluid.
These flecks are dislodged and called mites or
insects because they look like they have “antennae”
and “legs” (Fig. 2). Hair follicles often are pulled
out; the follicle accompanied by the associated
sebaceous gland looks like a worm.

Morgellons on Television

The Morgellons Research Foundation is an advocacy group. It has orchestrated the current media coverage by spoon-feeding a story to television news, both local and national. For those in the media who would like to do a similar story, I present the following 12-step method:

Step 1 – Find some Morgellons Patients. This is not difficult. Simply ask around on the Morgellons Research Foundation’s recommended Lymebusters forum. There are many people there who love to talk about their symptoms. Beware, as there are a few oddballs around, who might not quite be on message. Beware of patients with web sites that make them look obsessive, such as Anne Dill on Good Morning America, or Richard Vigil on 10News

Step 2 – V.O. – describe the symptoms of Morgellons in a scary manner, you want to hook your audience here. Note that thousands of people across the country have Morgellons, and there are hotspots of the disease in California, Texas and Florida.

Step 3 – Have the patient describe what is wrong with them, and have them show their lesions.

Step 4 – V.O. – Say these patients are being ignored by doctors, who claim it is all in their heads. It is important to set up sympathetic contrast in anticipation of step 9.

Step 5 – Zooming photos. Show photos of fibers and multi-colored fuzzballs, zoom and scroll while doing this, as it looks a lot more dramatic. Speak with a tone of amazement while describing the photos.

Step 6 – Professor Wymore soundbites – like “there’s definitely something going on“. Show Wymore in his Lab and wearing a white coat. Make it look like he’s an expert in this field. Do not mention he’s not a doctor. Do not mention he’s actually an assistant professor.

Step 7 – (Optional), show Wymore holding the letter he has written for sufferers to take to their doctors.

Step 8 – More zooming photos, this time describe how people find fibers inside their lesions. Try to make it sound impossible.

Step 9 – Find a doctor, interview him for hours, and show the line where he mentions “Delusions of Parasites“. Ignore complex terms like Neurotic Excoriations, Dermiatitis artefacta or “Case Definition“, as these cloud the issue.

Step 10 – Back to Wymore (or Ginger Savely), and have them say something to make the doctor seem silly. If it’s Savely, don’t mention she makes her living treating people who are convinced they have Morgellons.

Step 11 – A ray of hope: say that, at long last, the CDC is investigating Morgellons. Do not mention they are just investigating if there is any evidence that it exists in the first place.

Step 12 – Tie it up, cut back to your initial patient to remind the viewer of the human side of the story. V.O. about the hope they have. Make it real.

Physical and/or Mental

One of the problems with discussing Morgellons is that the argument tends to be polarized by the issue of mental illness. Inevitably, the people who believe they have Morgellons (“Morgellons sufferers”) will accuse their doctors and other skeptics of explaining away their symptoms with “delusions or parasitosis”, or some other mental disorder, and ignoring their physical symptoms.

In reality things are no so black and white. Let me try to clarify my position here, since I feel it’s been misinterpreted.

It is very clear that people with Morgellons do not all have the same problem. In fact the cases discussed on boards such as Lymebusters are very varied.

Some Morgellons sufferers might have a single physical condition. Some might have more that one.

Some Morgellons sufferers might have a single mental condition. Some might have more that one.

Some Morgellons sufferers might have physical conditions, but not mental conditions.

Some Morgellons sufferers might have mental conditions, but not physical conditions.

Some Morgellons sufferers might have both physical and mental conditions.

Let me be very clear here, my UNCHANGED position on this topic is:

I do not think that all Morgellons sufferers are mentally ill.

And just to emphasise this a little more, I’ve changed the word “and” in line 3 of my header to “and/or”.

Lesions are real, and there a number of things that can cause them, including many known diseases, mostly physical, some mental.

Fibers are real, and there a number of things that can cause them. But as yet, no known disease causes fibers to emerge from lesions. No credible evidence suggests that fibers are emerging from the skin.


Here’s a fascinating article from India:

A study of skin disorders in patients with primary psychiatric conditions.

Which neatly goes over a “mixed variety of physical and mental illnesses”.

Only 2% were diagnosed with DOP, and less than 5% of the skin disorders were psychogenic.

Now, I don’t think this group is at all representative of the people who claim to have Morgellons, since it’s a sample of people who have a primary psychiatric condition. But the varied nature of the study group is probably representative of the mixed variety of Morgellons sufferers.

Here’s a nice quote:

“The skin occupies a powerful position as an organ of communication and plays an important role in socialization throughout life. The interface between dermatology and psychiatry is complex and of clinical importance”

Morgellons Fact Check

The following Q&A is aimed at addressing some of the misconceptions regarding Morgellons that have been propagated in various media articles.

(Note: This will be a work in progress – please email me suggestions and corrections at

Q) What is Morgellons Disease?
A) Morgellons is an proposed disease, unrecognized by doctors, promoted and self-diagnosed via the internet. People claiming to have Morgellons have widely differing symptoms, the most common of which is they feel they have been misdiagnosed by their doctors. Supporters claim the most notable feature is fibers emerging from the skin, yet everyone has fibers on their skin.

Q) Is Morgellons a real disease?
A) Not by conventional medical standards. The offered case definition is very long, and very vague. It fits a very large number of existing diseases, and simply suggest co-morbidity of a variety of conditions such as eczema, chronic fatigue and anxiety disorders. The “evidence” for Morgellons is entirely anecdotal.

Q) What is the History of Morgellons?
A) Morgellons was first proposed in 2002 by Mary Leitao, to explain her 3-year old son’s eczema. Leitao looked at her son’s skin under a microscope and found fibers on it, and decided she had discovered a new disease characterized by fibers emerging from lesions, and started a foundation. Her son’s eczema cleared up naturally. His symptoms did not include those of the more recent claims of Morgellons. The list of symptoms has rapidly expanded as more people registered. Leitao encouraged people to seek out fibers in their lesions. The idea of Morgellons was spread over the internet.

Q) Are the most cases in California, Texas and Florida?
A) Yes, because that’s where the most people are, those states have the highest populations. Morgellons is a self-diagnosed disease. People “register” over the internet by filling out a simple form on

Q) Who is Ginger Savely?
A) Ginger Savely is a nurse practitioner who was unable to find a doctor in Texas to supervise her practice, due to her unorthodox and possibly dangerous treatment of Lyme disease patients. She gives similar treatments to self-diagnosed Morgellons suffers. She is a member of the Morgellons Research Foundation, and co-authored an article on it with Leitao. She is active in the Media campaign, and is seeking new patients. She makes a living from selling her unorthodox treatments.

Q) Have researchers determined the fibers are not environmental?
A) No. Randy Wymore is the director of Research at Leitao’s MRF. He works on a volunteer basis using the facilities of OSU. He has been examining fibers sent (often anonymously) to him. Many fibers he would discard as environmental, but there were a few he could not identify. Not being able to identify a fiber is not the same as proving it is not environmental. Fibers go unidentified all the time in forensic cases. To prove it was not environmental, you would need to prove it was generated inside the body. This has not been done.

Q) Do most doctors dismiss Morgellons Sufferers as having Delusions of Parasitosis?
A) No. There are a wide range of things going on here. Doctors understand that people might mistakenly think fibers found on their skin are connected to their disease, without the patient being delusional. If a patient has lesions or itching, then there are a vast range of possible causes for this, and doctors would attempt to diagnose and treat them. Delusions would be diagnosed if the patient claims to see things that are not there. There are some people who are clearly delusional and who are highly resistant to any hint of a psychiatric diagnosis. These people are likely to latch onto anything they feel explains their symptoms.

Q) Do people “sweat black tar“?
A) No. Again this is based on one statement, and was then picked up by the media. This time Savely was quoted as saying: “These people will have like beads of sweat but it’s black and tarry“. She was probably referring to what other people call “black specks” (dried blood, necrotic tissue, or blackheads). The imagery was just to vivid for the press to pass up.

Q) Does Morgellons cause muscle twitching?
A) No. It’s not a real disease, but the list of supposed symptoms was extended to include “uncontrollable muscle twitching” after a report (May 2006) that former Oakland A’s pitcher Billy Koch has Morgellons. The extensive Morgellons Research Foundation’s “Case Definition“, written (Feb 14 2006) a few months before the Koch report, does not mention muscle twitching even as a secondary symptom.

Q) Is it odd that some fiber analysis shows some fibers to be made of cellulose, a molecule generally found in plants?
A) No, far from it. Cellulose is what the majority of environmental fibers are made from. Paper, tissues, cotton, q-tips, linen, ramie, rayon, tencel and lyocell are all made from nearly pure cellulose.

Q) Is it true that “Dermatologists claimed the filaments were all delusions, although none had studied them“?
A) No. Dermatologists often look at samples that patients bring in, in order to eliminate the possibility of parasitic infestation such as follicle mites, scabies or lice. Filaments themselves are not delusions, they are physical objects.

Q) Where do the Morgellons sufferers on TV come from, if this is not real?
A) From the internet. The TV report have been orchestrated by Ken Cowles, the MRF director of media relations. He seeks out people in the local area who have registered with the MRF, and sets up interviews, and supplies photographs and video. The people featured are often active in promoting Morgellons on internet message boards. For example, the Alabama WKRG report featured the family of Leigh Ann Cofield, very active on the Lymebusters forum