Thursday, May 08, 2014

Let There Be a Little Light

"The candle flame gutters. Its little pool of light trembles. Darkness gathers. The demons begin to stir."

The Demon-Haunted World:
Science as a Candle in the Dark (1995) by Carl Sagan

This story is a tad wordy and long, but it should be. It explains the reason why I do what I do, my raison d'être.

The Darkness.

It was more night than evening when my phone rang and the numbers flashing urgently on its screen were familiar ones. It was the hospital. I answered it and on the other end was a House Officer from the Emergency Department, and he had a referral for me. He told me that he currently had a 14-year-old girl in his care who, for the past one year, had been visited by the ghost of another girl who kept asking her to play. He believes that his patient is suffering from a psychotic illness with florid auditory and visual hallucinations.

"I'll be right there," I said. The story I got sounded clear-cut but I made a habit of taking medical history on my own in person regardless and far too often, I discover that referrals sound clear and cut because they had been filtered through the biases and inclinations of the patients, their family members and finally, through the referring medical personnel, who packaged it all neatly for my benefit. It is like a game of telephone or Chinese whispers: the final version of the tale that got to me tended to suffer from distortion and embellishment, and sometimes acquire a funny foreign accent along the way.

Anyway, I arrived at the Observation Ward in Casualty shortly and was introduced to a homely young Bidayuh teen girl sitting in bed with her mother. For the purpose of this story, I will call her Minnie. I beckoned to the mother to leave Minnie for a few minutes so I can interview her apart from her child. No surprises there. The mother's testimony mirrored the House Officer's: her daughter have been tormented by a ghostly girl ever since she started living at a boarding school.

"Leave Minnie alone with me for awhile. Go have a hot drink," I told the mother. "I have some questions for her."

That's an interview technique that I have adapted from the police's investigative protocol (or at least, what I understand about cop procedures from movies and TV) and in many ways, what I do is very similar to detective work except that instead of perps, I am looking to pin down a diagnosis. The human mind and its many malfunctions is an inexhaustible font of mysteries. I need to look for clues and evidence, establish motives and even check out alibis - and the less factors hanging around my interviewee that might influence her answers, the better.

After chatting with her for a few minutes, I nailed it. The House Officer was wrong, and he was wrong because he either didn't ask the right questions or didn't notice the evidence pirouetting right on his nose.

Minnie is a well-adjusted 14-year-old. She scored straight A's in her go at the UPSR. She enjoys writing stories as hobby and have an especial interest in romance lit. She told me that ever since she started attending a boarding school last year, she had been haunted by a girl's ghost who visits her two or three times every month. She described her visitor as having wavy hair and is dressed in a white nightgown. She couldn't tell me how the apparition's features look like because her face was covered in dirt - "grave soil" she elaborated colourfully. When the girl spoke to her, it was as if she was speaking directly to her mind. Come and play with me, come and play with me, was all she ever said. Minnie said that the visitations always occur as she was falling asleep or after she had been asleep for a couple of hours, in which case she would be woken up by the sudden presence - and that was the first clue I got which told me that I wasn't dealing with a psychotic illness (psychotic illnesses rarely oblige us by being predictable). Minnie then offered me the clincher: she claimed that she would find herself paralysed in these episodes, her limbs in rebellion against her will, and her scream frozen in her throat. "It is as if a great weight was holding me down," she explained quietly. Then, after a few seconds or a minute, the ghost would depart and free her body.

John Henry Fuseli - The Nightmare
The Nightmare (1781) by Henry Fuseli.

"I tried looking online to look for an explanation, but I couldn't find anything helpful," she told me.

"You'll be glad to know that I can help then," I said, smiling. I was pleased with myself because I knew exactly what she had been experiencing. "Have you ever heard of sleep paralysis?"

The Light.

In explaining sleep paralysis to patients, I always start by explaining why people don't usually act out what they say or do in their dreams. It's because there is something called REM atonia that kicks in during REM sleep and it paralyses all of one's muscles during these dreams through motor neuron inhibition (the exact mechanism of which is still being debated). I told Minnie that what she experienced was caused by a person "waking up" before their REM atonia have completely washed off, while they are still stuck in a sort of limbo between waking and sleeping. I explained to her that it is a common phenomenon that affects as many as 6.2% of everybody in the world and it is commonly associated with a feeling of terror and the sensing of a menacing, malevolent presence in the room. Vivid visual and auditory hallucinations are also commonly reported during episodes of sleep paralysis which would explain the  grave-soil covered intruder and her creepy-ass invitation to play. Sleep paralysis is also associated with stress, poor sleep, shift work, and other factors that disturb normal sleep cycles - which also explains why she only gets these episodes when she's sleeping in her school hostel and not at home.

Side note: I have often heard the misconception that dreams only occur during REM sleep being bandied about even amongst doctors. That is not true. One can dream even during non-REM sleep, though they are less common, less intense and less memorable than REM dreams.

As a bonus, I also told Minnie about my own isolated sleep paralysis incident in 2003. It was right after my SPM exams and there was a blackout. I awoke suddenly and found that I was helplessly paralysed in bed. I don't know how but I sense that there was someone in the room with me. Sighing whispers were coming in from the window and I could hear the sound of tinkling bells approaching my inert body, getting ever closer with every passing second... and then all of it disappeared in an instant the moment I re-commandeered by muscles and bolted straight up in bed. I wasn't afraid then because I have already read about sleep paralysis. I knew what it was and knowledge is a potent ward against fear - that is why horror movies stop being scary right after the priest, exorcist, or demonologist character explain what they are dealing with and how they can defeat it.

Minnie was visibly relieved after hearing my explanation and it had piqued her curiousity about how regularly our massively clever brains can screw things up, leading to questions about optical illusions, the nature of dreams and memories, mental illnesses and near-death experiences - all of which I was happy to answer to the best of my ability. I like to think I have planted a seed of scepticism in her. Before meeting me, the only explanations that Minnie received from her friends, her teachers, her parents and her priests were all supernatural, that she was plagued by demons or ghosts. They told her to pray whenever that happens to her, to comfort her with the thought that God will protect her from this evil beyond the grave. I did better than all of them: I explained it using real scientific knowledge. Prayers only helped to arm her against her fear. The knowledge I gave showed her that there is actually nothing to fear in the first place.

On Lighting Candles.

And it is not their fault that her friends, teachers, parents and priests could offer nothing better than superstitions. My Chinese ancestors have called it 鬼压身 (pinyin: guǐ yā shēn) which literally meant "ghost pressing on body". Christo-European cultures have attributed it to sex demons like incubi and succubi. Arabic cultures think that shayṭān or an ‘ifrīt is responsible and that reading the Throne Verse of the Quran can supposedly prevent it. Just about every group of people in the world have their own take on what causes sleep paralysis. It struck me how everyone claims to have the answer but none can actually back their claims up - until science came along to establish the phenomena using electroencephalograms, fMRI scans and whatnot.

My meeting with Minnie is a microcosm of what I usually do in the Department of Psychiatry. I deal with people who experienced malfunctions of their brain, people who hear voices when there are none and see things that are not there, and rarely can I get away with just explaining to my patients what it is that afflicts them (like I did with Minnie) but the general idea is the same - I help to guide my patients back to reality either through my words or through medications. And very often, my patients only end up in my care after they have consulted priests, imams, shamans and witch-doctors exhaustively to no avail. Aside from the stigma associated with mental illness, I guess people just naturally gravitate towards the easy answers that we in Psychiatry do not give, and there is a lot in Psychiatry we do not yet fully understand. But hey, at least we are honest about it.

I suppose this field of medicine holds such a strong attraction to me because I already have a desire in me to "straighten the record on reality", so to speak. It is this desire that lead me to criticise all manners of pseudoscience, superstitions and religious beliefs when I am not at my day job. And speaking of religion...

On False Light.

How easy it is that the very architect of this universe revealed himself on our provincial planet and have all the answers we will ever need compiled in little books which form the foundations of his religions? He said "let there be light" and poof, all darkness went away. Or at least, that's what we are told. God is the answer to everything. So are ghosts. So are magic. They are answers we grasp for when we fail to think of any other. Why are there thunder and lightning? God is ticked off at gay people. Why do people go mad? They have been possessed by demons and evil spirits. What is sleep paralysis? Some ghost, devil, witch or goblin making a chair out of you. So, why should anyone have to suffer the inconvenience and ignominy of ignorance when we have such flexible, omni-explanatory answers in our hands?

Alas, I am a sceptic. I inhabit a far darker world than the one most people live in. No God have brought an all-illuminating light into mine - and however bright believers think that light is, it is false. It fooled the cleverest of men, convincing them that they are enlightened while in actuality, they stumble in the darkness, bumping into walls and one another. I believe that the real answers did not drop on our laps from the revelations of prophets and shamans who assure us that they have insider knowledge on the workings of our reality from the Creator himself. I believe that the answers are out there, hidden in the shadows at the edge of human knowledge, and we find them by lighting one candle at a time.

This time, I lit a candle which exorcised a ghost and made a young lady's world a little less haunted. Someone's got to do it. After all, who else do we have with us in the dark besides each other?

k0k s3n w4i


Amy Leah Leu said...

Sleep paralysis. My old enemy. I used to freak out too, believing that I was being plagued by some otherworldly being (parents giving the traditional ghost pushing explanations didn't help either). It's occurred a handful of times in my early high school days and I felt as if someone was pushing my body down but at the same time I felt myself being tugged away from my body? It was only in my last year of high school that I finally googled the symptoms described and realised it was sleep paralysis. After that I tried to sleep on my side instead of on my back (worked for me, maybe not scientifically proven).

Though there was one particular time it happened and I really felt my life was at risk. I frequently have the problem of suffering from a blocked nose at night, so that night I woke up and opened my eyes and I couldn't move my limbs, but I was struggling to breathe because my mouth was closed and I couldn't open it. Struggled like mad and somehow flopped my hand up to my face and pulled down my jaw to breathe. Couldn't even feel my hand, just the sensation of something on my face. I guess that's my closest brush with death? (maybe I would have survived either way but it was scary)

Enough on me. I'm glad you shared the tale of why you do what you do. Helping people understand and move away from backwards mishmash. It's always interesting to see how people construct their own meanings and motives for life.

k0k s3n w4i said...

Amy Leah Leu: Couldn't feel your hand? Did you sleep on it or something? I sometimes get that if I sleep in a bad position. As far as I can tell, no one died from sleep paralysis before.

Amy Leah Leu said...

Nope. Was facing up with both hands on my sides. I couldn't really move any part of my body during that time, and what I meant was that I could feel that my hand was on my mouth (pulling down bottom lip so I could breathe) but I couldn't really feel the hand itself as something connected to me (for that short moment).

How would people know if someone did die of sleep paralysis or not? Aren't there cases of people just dying in their sleep without a definite apparent cause? I guess it's possible it was sleep paralysis?

Or I was just overthinking and would have been fine.

k0k s3n w4i said...

Amy Leah Leu: If you are paralysed to the degree that you can't open your mouth, how did you move your arm to manually pull your lips open? Doesn't add up to me. Maybe I am missing something.

Amy Leah Leu said...

*shruggish sounds* eeeh~? I don't know either. :/