The hallucinated demons of intensive care

I’ve got an article in The Observer about the psychological impact of being a patient in intensive care that can include trauma, fear and intense hallucinations.

This has only been recently recognised as an issue and with mental disorders being detected in over half of post-ICU patients it has sparked a serious re-think of how ICU should be organised to minimise stress.

Some of the most spectacular experiences are intense hallucinations and delusions that can lead to intrusive and surreal flashbacks that can have effects long after the person has become medically stable.

Wade interviewed patients about the hallucinations and delusions they experienced while in intensive care. One patient reported seeing puffins jumping out of the curtains firing blood from guns, another began to believe that the nurses were being paid to kill patients and zombify them. The descriptions seem faintly amusing at a distance, but both were terrifying at the time and led to distressing intrusive memories long after the patients had realised their experiences were illusory.

Many patients don’t mention these experiences while in hospital, either through fear of sounding mad, or through an inability to speak – often because of medical breathing aids, or because of fears generated by the delusions themselves. After all, who would you talk to in a zombie factory?

One of the interesting aspects is how standard ICU care is incredibly stressful and uncomfortable experience. I quote Hugh Montgomery, a professor of intensive care medicine, who says “If you think about the sort of things used for torture you will experience most of them in intensive care”!

Anyway, more at the link below.
 

Link to ‘When intensive care is just too intense’ in The Observer.

9 Comments

  1. deadendrite
    Posted January 19, 2014 at 3:31 pm | Permalink

    An excellent, excellent piece. A subject of very strong interest to me and I will someday write of my own experiences in more detail. I have come to understand that my strong, visceral, bordering on phobic responses to hospitals (and unfortunately, even just to doctors or nurses is in some cases) is down to trauma experienced by medical care after a long ago car accident (and more recently during two relatively uneventful labours). Each came with HIGHLY unpleasant experiences that were far beyond the actual conditions that brought me to hospital.

    I can recall starting to think to about how dreadful hospitals are designed in terms of patient healing when I read Jill Bolte Taylor’s book “My Stroke of Insight” – I don’t recall the exact details but she describes trying to recover (without speech or understanding) in a place of bright lights, loud and jarring sounds and medical staff that didn’t always seem to understand (or care?) that the patient (in whatever state) is a terrified and ill person in need of calm and compassionate care… I’ve often thought my biggest fear in developing a chronic or serious disease is that I’d have to be treated in a hospital – the disease would be bad but having to endure medical treatment would be far worse…

  2. Posted January 19, 2014 at 5:36 pm | Permalink

    Last year this time of year I spent three weeks in intensive care with Guillian beret which left me paralyzed.

    I was fighting for my life, lost 45pounds, caught pneumonia but mindfulness kept me in the current moment.

    I was never that focused and the nurses, doctors help noticed my journey and handling if ICU was different.

    I made friends and shared my journey with them.

    Do not believe everything you read.

    Paralyzed still I was transported to rehab. I was told by all staff doctors nurses physical and occupational therapists I would be in a wheelchair for a year, need assistance, special chairs and railings. Seven days letter I got up out of that wheelchair

    How they all asked. I told them that year in a wheelchair was their barrier wall, not my judgment.

    The mind can work miracles some think.

  3. Posted January 19, 2014 at 7:36 pm | Permalink

    Although most hospitals (at least in my area) have redesigned their ICUs so that patients are in private rooms, about a decade ago I was in an open-ward ICU (patient beds separated only by curtains, not walls) after brain surgery. The patient in the bed next to mine was a young man, comatose, who’d apparently suffered a TBI after a serious car accident. His (I’m assuming) mother was at the ICU from the moment they opened for visitors until the moment they closed. She insisted on *loudly* talking, singing, praying, etc in a misguided attempt to “wake her son up”. The noise greatly impacted *my* recovery, and made it much more traumatic than it needed to be, because I couldn’t get any rest. When my parents and I complained to the nursing staff, we were timidly told that “she had just as much right to be there” as my parents did, and they “couldn’t” do anything to quiet her down or make her leave.

    Not all ICU trauma has a psychological basis.

  4. Posted January 19, 2014 at 8:37 pm | Permalink

    Most people in ICU come from the op room where they had surgery and hence anaesthesia often by ketamine (a well known hallucinogenic if dose is to high)

    Sincerely

  5. Posted January 21, 2014 at 4:51 am | Permalink

    I think you make a valid point about hospitals being traumatic places, but I would also suggest that Delirium which can be caused by a host of illness be considered too. Delirium’s key feature is fluctuating levels of consciousness which includes hallucinations.

    (Disclaimer: I have not read the full article in the Guardian so if you have considered delirium, then please excuse my comment)

  6. Bill
    Posted January 24, 2014 at 1:37 pm | Permalink

    In the consulting psychiatry unit for which I worked, we had a name for this: “ICU Syndrome”. It was common to see patients experience psychotic symptoms or very severe anxiety. Each patient, of course, was different but the main factors were:
    Delirium often associated with the medical condition,
    Fear of death,
    Circadian disruption,
    Partial sedation and respirator distress,
    Benzodiazepine withdrawal,
    Disorientation.
    The ICU is a difficult place for any patient. There’s only about a 30% 6 month survival for patients who have entered those doors.
    Our main psychiatric work there was reassurance and reducing psychotropics. It’s under-recognized that many psychotropics can exacerbate delirium.

  7. Posted January 25, 2014 at 11:06 am | Permalink

    I had exactly the same experience. it is a multifactorially caused problem that urgently needs a problem oriented focused attention by ICU specialists in close cooperation with pharmacologists, psychologists and psychiatrists. It is humanly and economically imperative to minimize these effects.

    The psychopharmacodynamical effects of some anesthetics and pharmacokinetical after effects of withdrawal is often severely underestimated as many do not take into account the half life of medications patients take before entering OC and ICU and the many clinical reactions associated with withdrawal that enhance the psychological environmental distress such as anxiety (fi SSRI, H receptor etc).

  8. Posted January 26, 2014 at 2:04 pm | Permalink

    Without sleep you can go crazy . Dreaming is unconscious hallucinations and delusions, while awake is “psychotic” . In my ICU stay the monitoring machines beeped so loudly I got little sleep. I was told there is no volume adjustment level on the machines.

    There should be a dB Volume Meter in the rooms.
    ICU staff just laughed at my complaint that the machines were too loud.

  9. James
    Posted January 28, 2014 at 12:25 pm | Permalink

    I am reminded of the hospital scene in Jacob’s Ladder.


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