The Devil's in the Details

I saw a psychiatric patient today; an inpatient who was generous enough to volunteer to be interviewed by medical students, while other medical students watched on. She has a lifetime history of visual and auditory hallucinations, uncontrolled emotional and violent outbursts, suicide and self-mutilation. She described her childhood as lonely, remembered the name of her one friend in first grade, and said that "no one wanted to be my friend because I was strange" even in elementary school. Her first suicide attempt was at 14, when she blamed herself for her parents' divorce. Though her life had been difficult, she had a history of trying to make herself better: leaving an abusive husband, quitting a drug addiction, and seeking out therapy. However, even with all the medication she was taking, the voices could penetrate periods of stress. Her worst influence was "the devil". She said she could feel when he was going to come, because the room got hot and things just felt strange. He would tell her that he would not leave her alone until she did as she was told. She said that sometimes she would hurt herself just to make him go away.

She spoke coherently and was normally aware of herself and her environment. She appeared to be above average in intelligence, with knowledge of not just her medication and its dosages, but also how some of it worked. She spoke about her illness with clarity and complex understanding, noting that certain drugs would calm her down and prevent the voices from coming. As she was leaving she told us to study hard and come work at the treatment center when we graduated.

But right before she left she said something interesting, one of those statements that could have come straight out of One Flew Over the Cuckoo's Nest. She had been talking about how the drugs and therapy were helping her deal with her voices, and then she said, "But you know, I mean, the devil is real. I mean he's in the Bible. He's come to other people in history. If that stuff is real, I mean, who's to say that he doesn't come to me?"

As I looked around the room filled with medical students, probably half of them belonging to some religion that requires them to believe in things with much less evidence than this woman had, I had no idea how any of us could possibly argue with her.