Catatonia: A person’s body may be frozen, but their brain is not – new study
Occasionally, as a doctor, I am asked to see a patient in the emergency department who is completely mute. They are sitting motionless, staring around the room. I raise his hand and he remains in that position. Somebody gets a blood test done and he can’t even laugh. He hasn’t eaten or drank anything for a day or two.
Questions start running in your mind. what’s wrong with them? Will they answer someone else? Do they have a brain injury? Are they putting it on? And – hardest of all – how do I know what’s going on if they can’t tell me?
I am a psychiatrist and a researcher specializing in a rare condition called catatonia, a severe form of mental illness where people have problems with movement and speech. Catatonia can last anywhere from a few hours to weeks, months, or even years. Some people’s episodes are coming again. I have spoken to doctors, nurses, academics, patients and caregivers about this condition. One question comes up more than any other: what are people with catatonia thinking? Are they thinking too?
When a person can barely walk or speak, it is easy to assume that they are not even conscious. Research in recent years has shown that this is not the case. In fact, if anything, it is the opposite. People with catatonia often express intense anxiety and say that they feel overwhelmed by emotions. It’s not that people with catatonia don’t have any thoughts – maybe they have too much.
But what are these thoughts? What can the mind possibly do that stabilizes you? In a new study, my colleagues and I try to shed some light on this.
hundreds of patients
Looking at the case notes of hundreds of patients who experienced catatonia, we found that few spoke about what had happened at that time or later. Many did not know or remember what was happening.
Some described experiencing extreme fear. Some were aware of the pain of being rigid for so long, but still, seemed unable to move. What we found most interesting, however, were those who had – at one level – a rational explanation for catatonia. One patient’s note read:
I met him kneeling on the floor with his forehead on the floor. He said that he had taken up this position to save his life and kept asking to see the neck doctor… He kept talking about falling head from the neck.
If you really believe that there is an imminent risk of your head falling, it probably wouldn’t be such a bad idea to lay it on the floor.
For others, it was the voices (hallucinations) instructing them to do certain things. A man was told that his head would explode if he moved – a very compelling reason to remain still. Another thought was God telling him not to eat or drink.
Woman with catatonia ‘mudra’. Internet Archive Book Image/Wikimedia
death faint
One theory for catatonia is that it is similar to the “death spirit” that some animals show. When faced with a predator of enormous size or strength, some prey animals will freeze and the predator may not notice them.
One patient in the study explicitly described seeing a snake (who also talked to him). We can’t say from one example that his body was adopting a primitive defense for a predator, but it is certainly a possibility.
Catatonia remains a mysterious condition, halfway between neurology and psychiatry. By at least understanding what people are experiencing, we can provide reassurance and empathy.
