When Hannah Farrell lost the ability to speak and carry out her daily activities, doctors thought she had a mental disorder. But later it was discovered that her symptoms had a physical cause.
“I have a very vivid memory of my doctor saying, ‘You’re mentally ill and you need to accept help to get better,'” says Hannah.
The British woman was healthy, 20 years old and studying psychology. She was living with her family when she started showing flu-like symptoms.
“I went to see my doctor and she told me that virus infections usually go away, that I just needed to stay home and rest.”
For the doctor, the young woman had glandular fever – also known as mononucleosis or kissing disease.
Although Hannah felt very tired and her symptoms fit this picture, she began to show some changes in her personality. Soon after, she lost the ability to speak.
“I had to ask my mother to come with me, sit next to me and talk to the doctor for me.”
“I would write to my mother what I needed to say, and she would say [para a médica].”
gets worse
Hannah returned home with antidepressants and guidance to see a psychologist. But the symptoms worsened, and a short time later, she was admitted to a psychiatric hospital, where she was given antipsychotic medication.
A psychiatrist examined her and ordered an MRI. In the examination result, the doctors found a cyst in her brain. The student was referred to the emergency room so that her condition could be better analyzed.
“When I got to the emergency room, they checked the cyst and said I was probably born with it. Maybe it had nothing to do with the symptoms.”
“They realized from my blood test that my body was fighting some kind of virus.”
There were more tests, and after three weeks, Hannah finally received a diagnosis: anti-NMDA encephalitis. “It’s an autoimmune form of encephalitis, which is an inflammation of the brain.”
a common confusion
A neurology specialist at Guy’s and St Thomas Hospital in the UK, Professor Guy Leschizner says that confusion between physical symptoms and mental illness is not uncommon.
“Sometimes, we see individuals with psychoses and severe changes in behavior, and the initial diagnosis is a psychotic illness like schizophrenia. But, in fact, as the days or weeks go by, while they are in the hospital, it starts to become evident behind it: some autoimmune condition”, explains the neurologist.
It has been known for more than a century that damage to certain parts of the brain and tumors can cause changes in personality or behavior.
“In the last 20 years or so, we have begun to recognize that there are several immune conditions that cause the immune system to attack the brain and cause damage to brain functions”, says the professor.
“In Farrell’s case, it took doctors several weeks to realize that this was a serious autoimmune condition that required treatment with very powerful drugs.”
come back to live
Hannah Farrell says that after her diagnosis, she was transferred to the hospital’s neurology ward.
“I was completely mute. I had lost my ability to dress, bathe and feed myself. At this stage, I was really trapped in my own body.”
The young woman underwent immunotherapy treatment and 13 plasma exchanges – a process in which the blood is filtered before being pumped back into the body.
Although the treatment initially didn’t work and the doctors told her parents she probably didn’t have much longer to live, after two weeks Hannah woke up and was able to say a few words.
Over the next few weeks, she learned to talk and walk again. It was like learning to live again, says the Brit.
“I look at the person before I had encephalitis and I don’t really know them. I just can’t connect with that person.”
Five years have passed. Hannah has recovered, although she is still undergoing immunotherapy treatment. This makes you more vulnerable to infections and can affect your fertility.
“I wish general practitioners knew more about encephalitis because they are the first point of contact for many patients,” she says.
“I wish my doctor knew more about this to have guided me on the right path. If you imagine all the people who had encephalitis and died in psychiatric hospitals or asylums, I wouldn’t be able to sleep at night.”
A two-way connection
In the case of the British woman, encephalitis, a physical illness, was confused with a mental illness. But sometimes the opposite happens.
“We know that the connection between the body and the mind goes both ways. Physical problems can cause psychiatric symptoms, but psychological problems can also contribute to physical illnesses,” says Leschziner.
The professor says he sees patients with symptoms such as seizures, paralysis and numbness without an obvious physical cause. Some are finally diagnosed with a functional neurological disorder.
“We don’t fully understand what causes these conditions. It seems that anyone can be vulnerable to changes in the ‘software‘ that defines how our nervous system works.”
“But we do know that there are some risk factors. Namely, stress, anxiety, depression and past psychological trauma in particular. But ultimately, anyone can develop these functional neurological disorders.”
Overall mental and physical health
Worldwide, hundreds of thousands of people develop functional neurological disorders each year. Conditions like these, and the experiences of people like Hannah, have led some doctors to believe that we need to stop thinking about physical and mental health separately.
“I think we should stop defining diseases or disorders that are of the body or the mind. We know that, in reality, in almost all cases, there are contributions from both”, says Leschizner.
“Even in conditions considered purely physical, we know that how people interpret their symptoms is important in terms of quality of life.”
“Understanding this and ensuring that everyone has access to physical and psychological treatments is really of utmost importance for almost every condition that our healthcare systems address,” he concludes.
*This article was adapted from a BBC Ideas video in collaboration with the Open University. Click on here if you want to watch the video (in English).
This text was originally published here.
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