The Corpus Callosum

Climate Change Delusion

Joshua Wolf and Robert Salo of Melbourne’s Royal Children’s Hospital
reported, in the href="http://www.informaworld.com/smpp/title%7Edb=all%7Econtent=t768481832%7Etab=issueslist">Australian
and New Zealand Journal of Psychiatry, on a case of a person
with delusional beliefs regarding climate change.

There is no openly-accessible abstract, (the link to the paywall page
is href="http://www.informaworld.com/smpp/content%7Econtent=a791365692%7Edb=all%7Eorder=page">here)
so we have to make do with href="http://www.anorak.co.uk/global-warming/185486.html">a
news report:

We describe a patient with climate change delusion, a
previously unreported phenomenon. A 17-year-old man was referred to the
inpatient psychiatric unit at Royal Children’s Hospital Melbourne with
an 8 month history of depressed mood… He also …had visions of
apocalyptic events…

The patient had also developed the belief that, due to climate change,
his own water consumption could lead within days to the deaths of
‘millions of people’ through exhaustion of water supplies. He quoted
‘internet research’ to substantiate this. The patient described that ‘I
feel guilty about it’, had attempted to stop drinking… He was unable to
acknowledge that the belief was unreasonable when challenged.

This was taken quickly as fodder for href="http://blogs.news.com.au/heraldsun/andrewbolt/index.php/heraldsun/comments/melbourne_boy_first_victim_of_climate_change_delusion/">thoughtless
commentary:


The warming preachers truly are driving people mad
with fear…With internet reports like href="http://www.latimes.com/news/opinion/sunday/commentary/la-op-mckibben11-2008may11,0,5497066.story"
title="this">this and href="http://www.rollingstone.com/politics/story/16956300/the_prophet_of_climate_change_james_lovelock"
title=" this"> this, or Age
reports like href="http://www.theage.com.au/news/national/climate-an-economic-time-bomb/2006/10/26/1161749253919.html"
title=" this"> this and href="http://search.theage.com.au/click.ac?u=http%3A%2F%2Fwww.theage.com.au%2Fnews%2Fgeneral%2Fbuilding-our-own-asteroid%2F2008%2F07%2F01%2F1214678035727.html&t=4&n=2&s=climate+and+catastrophe"
title=" this"> this, how could he tell he was
unreasonable? Indeed, some global warming preachers now sound that they
need treatment, too.

The comment that “global warming preachers now sound that they need
treatment” is merely an expression of prejudice.  With a
garnish of hate.  More of the same, href="http://blogs.news.com.au/heraldsun/andrewbolt/index.php/heraldsun/comments/column_doomed_to_their_fatal_delusion">here.
 Milder version, href="http://straightshooters.blogspot.com/2008/07/turkeys-voting-for-christmas.html">here.

The physicians who wrote the case report were doing what academic
physicians always do: they describe manifestations of illness, then
publish their findings.  

This is not meant to be a groundbreaking paper.  The authors
are not trying to name a new illness.  In fact, this kind of
thing has been described before, just not with the exact delusional
content.

Such delusions can occur in mood disorders (depression with psychotic
features) and thought disorders (schizophrenia, schizoaffective
disorder).

The content of the delusions may vary with the times.  This is
well known.  In the early 1950s, it was Communists.
 In the late 1950s, satellites.  In the 1960s,
lasers.  And so on, for various persons with paranoia.
 

What little we can see of the case report suggests that this particular
patient had depression with psychotic features.  The themes of
apocalypse, death, self-deprivation, unworthiness, and guilt, all are
consistent with psychotic depression.  This could occur in
unipolar or bipolar depression.

In such a young patient, I would be particularly worried about the
possibility of bipolar depression.  However, for this
particular person, it will be necessary to see how this evolves over
time, in order to have much confidence in the diagnosis.

Update: the full text of the paper has been posted on a “self-serve
science” forum href="http://www2b.abc.net.au/science/k2/stn/newposts/3679/post3679389.shtm">here.

The authors report:

href="http://www2b.abc.net.au/science/k2/stn/newposts/3679/post3679389.shtm">Water,
water, everywhere, nor any drop to drink: climate

href="http://www2b.abc.net.au/science/k2/stn/newposts/3679/post3679389.shtm">change
delusion

Australian and New Zealand Journal of Psychiatry, Volume 42, Issue 4
April 2008 , page 350
DOI: 10.1080/00048670701881603

Joshua
Wolf, Department of Paediatrics, University of Melbourne and Integrated
Mental Health Service, Royal Children’s Hospital and Robert Salo,
Integrated Mental Health Service, Royal Children’s Hospital, Melbourne,
Victoria, Australia:

Clinicians caring for psychotic patients
have long noted that delusional systems are determined by ideas and
beliefs to which the individual has been exposed. We describe a patient
with ‘climate change delusion’, a previously unreported phenomenon.

A
17-year-old man was referred to the inpatient psychiatric unit at Royal
Children’s Hospital Melbourne with an 8 month history of depressed
mood, social withdrawal, school avoidance, social anxiety, amotivation,
poor concentration, anhedonia, feelings of guilt and worthlessness,
insomnia, suicidal ideation and self-harm. He also described hearing
his own voice making derogatory and command statements, and had visions
of apocalyptic events.

Admission was precipitated by acute
deterioration in his condition consisting of increased emotional
distress and suicidal behaviour. Prior to admission he was treated with
fluoxetine (40 mg day) and olanzapine (5 mg day).

The
patient had also developed the belief that, due to climate change, his
own water consumption could lead within days to the deaths of ‘millions
of people’ through exhaustion of water supplies. He quoted ‘internet
research’ to substantiate this. The patient described that ‘I feel
guilty about it’, had attempted to stop drinking and had been checking
for leaking taps in his home to prevent the catastrophe. He was unable
to acknowledge that the belief was unreasonable when challenged.

There
was no history of substance abuse. Physical examination was normal
except for psychomotor retardation and superficial forearm lacerations.
The final diagnosis was major depressive disorder with psychotic
features. He was treated with oral fluoxetine (60 mg day), clonazepam
(1.5 mg day) and olanzapine (10 mg day). After several days his
mood improved considerably and he denied persisting delusional beliefs.
The experience of hearing his own voice persisted, but he no longer
found it as distressing.

There have been numerous reports of
incorporation of contemporary phenomena, such as the internet [1-3],
into delusional systems, but a search of Medline and Psychlit did not
identify reports of delusions related to global warming. Climate change
has rapidly become a dominant issue in Australian society. A 2007 poll
found that 85% of Australians were ‘very’ or ‘fairly’ concerned about
climate change, significantly more than the proportion concerned about
terrorism [4].

This case provides another fascinating
illustration of the cultural and environmental specificity of
manifestations of psychosis.

References

1. Tan S, Shea C, Kopala L. Paranoid schizophrenia with delusions
regarding the Internet. J Psychiatry Neurosci 1997; 22:143.

2. Schmid-Siegel B, Stompe T, Ortwein-Swoboda G. Being a webcam.
Psychopathology 2004; 37:84 5.

3.
Lerner V, Libov I, Witztum E. ‘Internet delusions’: the impact of
technological developments on the content of psychiatric symptoms. Isr
J Psychiatry Relat Sci 2006; 43:47 51.

4. Gyngell A. Australia
and the world: public opinion and foreign policy. Sydney: Lowy
Institute for International Policy, 2007. [Cited 22 October 2007.]

After reading the full paper, I still think this describes depressive
psychosis.  The “visions of apocalyptic events” and the
checking behavior are suggesting of OCD.  OCD, however, rarely
attains a psychotic extent, and would not have the full set of
vegetative signs.

Note also tha there is a tinge of grandiosity:

[H]is own water consumption could lead within days to
the deaths of
‘millions of people’ through exhaustion of water supplies. He quoted
‘internet research’ to substantiate this.

That does not change the diagnostic impression, but it does add to the
worry that this could be the index episode in what later evolves into
bipolar disorder.  

Another notable point:

The experience of hearing his own voice persisted,
but he no longer found it as distressing.

Unfortunately, that is fairly common: the hallucinations become less
bothersome, quickly, but do not completely resolve for a while.

Persons with conditions such as this generally require treatment with
either 1) a combination of antidepressant and an antipsychotic) or 2)
ECT, to have a realistic chance of improvement.

Comments

  1. #1 Andrei
    July 9, 2008

    Modern american war machines run on the blood of Middle Eastern children. how is that for manic-depressive?

    Have you started you car this morning? Did you think about the millions of other people that did the same, in a blink of an eye changing the course of natural history forever? I get that sinking feeling every time i wake up in the morning and look out over the smog that covers downtown in a brown haze of toxic pollution.

    I read your blog and many other wonderful blogs on SB…I take this rare moment to record my presence and show my appreciation for your work. dont thake this the wrong way, but it seems to me if we got of our collective blogging asses and actually did something, anything, talked to a few people that dont have access to internet…we would all be better off by that little bit.

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