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”.