Do Not Wash! May Shrink Or Fade

My friend 925, who did shrink training with me back in the day, used to claim that he could smell severe and persistent mental illness. That is, he believed there is some sort of pheromone or other subtle olefactory cue that could tip off a discerning professional (or, perhaps, trained dog) to the presence of a serious mental disorder.

The idea probably shouldn’t be poo-pooed out of hand-- lately, dogs have proven themselves useful in sniffing out other diseases. But I have maintained that any odor of “severe & persistent” was simply the mundane smell of poor personal hygiene.

I’ve been thinking about showering a lot lately. Last night, while helping 1 & 517 move into their new home, it was discovered that the control for the shower had issues, causing the hot water to alternate with ice water. Much groaning and despair. “Where I am going to shower?!?”, said 517. A few months back when my roof started leaking, the ceiling over my tub broke apart, causing the shower fixture to collapse. Similar panic on my part. “How am I going to get clean? I can’t live like this! I need to buy a new house!”

And yet just the previous month, I had shattered my own lifetime record for longest-period-without-bathing: 10 days, while crossing the Coral Sea on a sailboat with a water-misering captain. I did get doused with salt water several times, and sponge-bathed a bit. But overall I was pretty grimy-- and yet nothing really bad resulted.

Most of us grown-ups really enjoy a good, hot shower or bath, needed or not. Yet the same is often not true for the severely mentally ill. Many people think that “crazy” people have poor hygiene due to distraction and self-neglect; that’s part of it, but there is also an aspect of active cleanliness avoidance. On my unit at Green Acres, on any given day, there’s a good chance that one of our 24 patients really, really needs a shower and really, really doesn’t want one. Not uncommonly, I am asked to write a doctor’s order that a patient must shower. After that, a variety of ruses and sleights often follow—the patient closes the bathroom door and runs the shower without getting in, or just wets down his face and towel from the tap, or gets under the water but refuses to use soap or shampoo, etc. The permutations vary, but the intent always seems the same—avoid actual bathing at all costs.

When a shower becomes a real medical necessity, our staff may need to move a person into the shower physically. Sometimes this precipitates a bout of screaming that would make an onlooker think the victim was being branded with hot pokers or sent to the iron maiden. But after a few days or weeks, once the person has begun to improve mentally, this all stops, and he'll just shower on his own like the rest of us.

This phenomenon has long perplexed me, and I’ve found no good explanation for it. There are some idiosyncratic individual explanations—for example, the man who believed the CIA tried to assassinate him by putting gasoline in the showerhead—but most have no such obvious rationale. Some musings on etiology:

1) Is there a pervasive base delusion that equates loss of body grime with loss of special powers, like Samson and his hair? Does the perceived layer of oils, salts, and dirt on the skin somehow help a paranoid person feel insulated from a dangerous world?

2) Is there a regressive link to small children who scream, kick and cry at “bath time”? Plausible—but who can explain why so many little kids hate bathing? Was there, at some time, an evolutionary advantage to being dirty from, say, ages three to ten? Not out of the question—polio, for example, became a deadly epidemic problem only in the context of “clean” Western lifestyles.

3) Is there a component of truly adverse bodily sensation? It’s hard for most of us to picture anything more relaxing than a long hot bath or shower. Yet there is research suggesting that people with schizophrenia have overloaded sensory systems, and have difficulty desensitizing to “background” stimulation. Imagine if you had to feel, acutely, independently, and perhaps painfully, each drop from the showerhead? Could a shower really feel, to some people, like a spray of red-hot lava?

Sometimes, testifying in court while trying to obtain commitment for a very ill person, I may mention that he or she has very poor hygiene, and has refused to bathe for many days on end. Some of the patients’ attorneys have learned a bit about my adventurous outdoorsy pursuits, and ask pointed questions of me on re-direct (e.g., “Well, Dr. Turbo, in your opinion, for how many days can a person not shower and still be considered sane? Exactly how many days represents evidence of mental illness?”) As you may imagine, since returning from the Coral Sea, I’ve ceased mentioned bathing in court.