A difficult case: Diagnosis made by hallucinatory voices

In 1984, a British homemaker was reading at home when a voice told her, 

Please don’t be afraid. I know it must be shocking for you to hear me speaking to you like this, but this is the easiest way I could think of. My friend and I used to work at the Children’s Hospital, Great Ormond Street, and we would like to help you.

Trying to ignore what she had just heard, she continued reading, but the voice talked again:

“To help you see that we are sincere, we would like you to check out the following…”

With three different pieces of information provided that she did not know at the time, she reluctantly decided to check them out. When each one turned out to be true, the woman started to panic. Part of her couldn't help but believe the voices that had mentioned Great Ormond Street Hospital, but her children were all in exceptional health.

An examination found nothing, so he diagnosed her with a functional hallucinatory psychosis, and after two weeks of counseling and thioridazine the voices ceased and she went on holiday. But they soon returned, telling her that she needed immediate treatment and giving an address, which turned out to be the computerized tomography department of a large London hospital. The voices told her that she needed a brain scan because she had a tumor and her brain stem was inflamed.

The voices had been right about so many other things. Finally, she started to believe them. By the time she returned to her psychiatrist the following day, she was in such a state that Dr. Azuonye requested a brain scan to try and allay her seemingly all-consuming fears.

Despite asking for a scan on account of the content of his patient's hallucinatory voices and her subsequent state, with no physical signs suggestive of a brain lesion the request was refused. The consideration that the psychiatrist had requested such an expensive test for simple reassurance was also frowned upon.

But as the voices continued with urgency and his patient's emotional state rapidly deteriorated, after much negotiation she was given a brain scan. Initial findings led to a repeat scan with enhancement.

What came next was chilling to hear. 

She had a brain tumor.

The meningioma inside her head measured 2.5" by 1.5" and after discussion with her husband, the neurosurgeon decided to embark on surgery with no further delay. There was one other input to the discussion, heard only by the patient.

The voices inside her head told her they completely supported the decision.

When she regained consciousness, she heard the voices for the last time. They said, “We are pleased to have helped you. Goodbye.”

When Azuonye presented this case at a conference in 1996, three opinions seemed to prevail. Some thought that the voices had been telepathic communications from people who had learned about the tumor psychically and were trying to warn the patient. Others thought that the patient had known about the tumor before coming to the U.K. and had invented the story to get free medical care under the National Health Service (this seems unlikely, as she’d been living in the U.K. for 15 years before hearing the voices).

The third explanation, which Azuonye shared, was that the presence of the meningioma had triggered enough residual sensations to alert her that something was wrong and that her fear had led her unconsciously to take in information about London hospitals, which was expressed by the voices. The fact that the voices stopped when the tumor was removed showed that the symptoms had been related to the presence of the lesion.

Sources

Quoted from Futility Closet.

 WriterI

IkechukwuObialo Azuonye