Adam Staten is a GP trainee in Surrey and is on Twitter @adamstaten.
La folie à deux is a shared psychosis in which two people share the same delusion. As it is rare I felt compelled to share an interesting case that I have recently encountered. This unusual case concerns two men in their forties, let’s call them Ed and Dave.
These two men share little in common but both have interesting past psychiatric histories. Ed has had a previous prolonged episode of shared mania, a folie à plusiers if you will. For nearly thirteen years between 1997 and 2010 this manic episode led him to borrow and spend far more than he could afford and so he accrued huge and devastating debts. Dave, on the other hand, is a suspected case of dissocial personality disorder as he shows a callous disregard for the rights and feelings of others. It’s not known whether he harmed animals as a child but it seems likely that, at the very least, he whipped horses and chased foxes.
In recent times these two men have come to transfer a delusion between themselves. They have become convinced that the NHS should be run according to what people want rather than what they need and they share the delusion that this is best achieved by providing ever increasing access to general practice. For Dave this delusion has led to him calling for GPs to provide appointments for twelve hours a day every day. For Ed it is the delusional certainty that he can provide 8,000 more GPs to provide instant access to general practice.
As with all delusions it has not been possible to dispel these beliefs by providing superior evidence to the contrary. It doesn’t matter that the Royal College of General Practitioners has told both these men that there simply isn’t enough GPs, or even GPs in training, to fulfil their commitments. It doesn’t matter that it has been pointed out that the proposed working conditions will perpetuate and accelerate the mass early retirement of those who are able, and the mass emigration of those who are not. The delusion remains fixed.
These two hear voices too. But rather than internally generated voices that they cannot block out, they hear voices from outside that they refuse to pay attention to. It matters not that healthcare professionals insist that money is better spent on social services to aid in the discharge of medically fit patients from hospital, or that money should be invested in primary healthcare facilities and services, or even on public health education to ease the burden on these primary care facilities. Their condition dictates that they obsess about making headline grabbing statements about appointment times and GP numbers.
Like much mental illness this powerful delusion is not only a danger to Dave and Ed but potentially a grave danger to many of those around them. Treatment is difficult. The police have been reluctant to enact a section 135 on the premises of No. 10 Downing Street and so strategies to deliver treatment are limited. Mental healthcare specialists have mooted the idea of infusing the Westminster water supply with olanzapine but clearly this poses an ethical dilemma. Many worry that monotherapy with olanzapine will not be enough and, ethically speaking, are we not obliged to treat with something far more potent?