The sensation feels like bugs, worms or mites that are biting, crawling over or burrowing into, under or out of your skin. They must be there, because you can feel them and you are even pretty sure that you can see them. You may also believe that your home or furniture is infested, but you may be the only one who knows they are there. No one seems to think they exist except you. Nothing seems to get rid of them. So what are they?

University of California Statewide Integrated Pest Management Program

During my late teens, I discovered another kind of animal in my life in addition to all the cuddly toys, the domestic animals in books and cartoons, and various real animals of my childhood. These didn’t fit into any category of creature I’d previously known. They were, for sure, ‘insects’, but though I hazarded the odd guess, I couldn’t say precisely which insects they were. I knew them by another description: parasites. Funguses can be parasites, but what immediately comes to mind, when I think of parasites, are insects and crawling. The two go together. The other thing I knew about them was that they were my parasites. They lived on and possibly in me. I hosted them. Unwillingly. There was, apart from their very insistence on inhabiting me, no communication between us.

It started just after I left school, and continued during (although it was not the reason for) my time in various psychiatric hospitals then and later, in the mid and late 1960s. The diagnosis by the hospitals was specifically ‘depression’ and more generally ‘borderline personality disorder’. (This latter was at the time a common diagnosis, particularly of difficult young women.) I had some reason for my secret anxiety, initially. A boyfriend told me that he had pubic crabs and gave me a little pot of ointment from the chemist to deal with any he had donated to me. I never actually saw any on myself, although I looked carefully and often, and used the pot of ointment until it was empty. This was a year or two before my first hospitalisation in that period. I never really felt sure that I had got rid of the crabs: not, as I say, that I’d seen any in the first place, and I’d been assured they were easily visible to the human eye. I was horrified at the idea of crabs. Living things crawling on me, and so close to inside me. Of course, I was also upset that my boyfriend, much older than me, had them in the first place, presumably from sleeping around. An emotionally complicated situation, further complicated by my general decline into depression months later, my father dying suddenly, quitting school just before my A levels and then leaving my foster mother’s house for a bedsit on my own. Enough to get me hospitalised without anyone knowing about my private alarm.

From then on for two years or more, in hospital and out, I was convinced that I was infested. ‘Infested’ was the word, I thought, as well as ‘contaminated’. The pubic lice multiplied to a plethora and became imaginatively licensed to inhabit my entire body. They crawled on my arms, my torso, my legs, my hair, sometimes my face and neck. They had become all-rounder lice. Not even lice, if someone had pointed out the impossible ethology I had invented for them. They were … I didn’t know what they were, but they were. Insects, lice-like, flea-like, tic-like crawling creatures that lived on me, and indeed, in me. I thought they burrowed under my skin and emerged to wander about on the surface in the dark of night or under cover of my clothes. I felt them, tickling me in specific parts, and the redness I saw when I finished scratching my skin convinced me that they were there (so easy now to write that rational sentence). I saw them, always out of the corner of my eye. I became most distressed at night. I would feel their presence and then turn on the light quickly to catch them, but of course they had burrowed back into my skin by the time I could focus. It was a malevolent game of hide and seek. They had super-lice powers: they sensed me looking for them, and always dodged me. I was sure I saw them, yet I could never quite say what they looked like. I found evidence of them, even occasionally caught one and killed it as you do a flea, squeezing it between my fingers. Then I would put it in my palm and examine it carefully under a light. I saw it was something, a mote, a dot, black, white, grey, but never quite well enough to be sure exactly what. It could have been a flake of skin, a speck of dust, a tiny thread, but I knew it wasn’t. In that special way you know when you really know or are crazy.

It was a continuing hell. The horror of it lurked in the back of my mind always, even when I wasn’t frantically searching. And I kept silent about it. I repeatedly washed my bedding and clothes at the launderette, at the hottest possible temperature, but it was never enough. Eventually, I put all my bedding and my clothes, except for one outfit, into a plastic bag and threw them away. I couldn’t explain to people why I wore the same clothes all the time, or to myself what to do about the obvious fact that this last outfit must also be contaminated. But for all that, I functioned, as it were, normally. I didn’t discuss my obsession with anyone who was available to help me, doctors or friends. I kept it to myself, making it impossible for anyone to know and therefore do anything to assist me. The reason was that I was ashamed to be contaminated. I thought I must be the only person in the world, that this was the worst anyone could imagine (I could imagine) about another person, and that people would be disgusted and shun me. At the same time, I kept my distance from people. I was contagious. If people came close to me they risked becoming infested too. With that, I was at the same time both immensely powerful and completely powerless. There was another reason I didn’t speak about it: I sort of knew it was crazy, and that what I was convinced of was impossible, while nevertheless being sure that I was indeed infested. So I also didn’t mention it because it was so mad.

Just once I told someone about it. When I was in the first hospital, in St Pancras, I was getting exhausted with my searching of myself, it became unbearable, and I said to a nurse whom I liked that I thought I was infested. I suppose she told the doctor. I imagine now that she understood that I wasn’t actually covered with crawling insects, but it was arranged to my relief that I go to the infestation clinic, which happened to be next door to the hospital (an awful confirmation, it seemed to me at the time). I was escorted there and put into a disinfectant bath, went through the process of having my hair combed for nits and coating my body with whatever the lotion was that was used to get rid of body and pubic lice. They checked me all over, and said I was OK. I was content for about 24 hours before I knew it hadn’t worked. I told the nurse, who explained that the treatment was infallible. So I didn’t mention it again. But I bought stuff from chemists and regularly anointed myself with the chemical insecticide and dosed my head with lice lotion. Very gradually, without my really noticing, I seemed to grow out of it, as children do those indefinable stomach pains they have. Every now and then I’d have a panic and go to the chemist, but those episodes became more spaced out and, eventually, I realised that the terror had gone away, even if somewhere in me there remains a small dark area that twitches anxiously from time to time.

No one used the phrase ‘delusory parasitosis’. Actually, I only discovered that it was a condition with a name when I was reading for a book I’m writing on animals. I knew I’d been crazy during that period, but I didn’t know I’d been crazy with a condition that had a name, and that although it wasn’t common, it was well known in psychiatric literature. Not just psychiatric literature. Delusory parasitosis is where psychiatry meets academic entomology and pest control.

Varment Guard in Columbus, Ohio offers ‘complete residential pest control services’ and its ‘regular treatment programmes are designed to keep your homes pest free. Insects, rodents, bats and all nuisance wildlife problems are effectively addressed.’ It has an excellent website with a Pest Library that offers a chance to identify Pests of the Season and it also has a three-page essay describing delusory parasitosis. It gives full details of the symptoms and explains that Varment Guard operatives are trained to examine a house thoroughly, leaving sticky traps and investigating the areas the customer is suspicious of. Then:

If no candidate arthropods are found on the sticky monitors, upon examination, then the Varment Guard staff entomologist will call or visit the customer, tactfully discuss the findings from the monitors, and compassionately express caution that an indoor treatment of the residence or workplace with insecticide is not the solution and is not recommended for safety and legal considerations … In most instances, the delusory sensations will not subside unless the sufferer is treated with certain antipsychotic drugs, which must be prescribed by an attending psychiatrist.

The difficulty in helping victims of delusory parasitosis towards a lasting solution to their problem lies in the legal risks associated with suggesting an appointment with a qualified psychiatrist. A family physician is best qualified to recommend this course of action to victims or their relatives. Unfortunately, most physicians who become involved in such cases lend credibility to their delusory patient’s reports of bites and burrowing sensations and mistakenly recommend pest management as the answer.

A website called What’s That Bug? carries a letter from the operations manager of a pest management firm:

Dear Bugman, I’m nearly at my wit’s end. I work for a pest control company and I’ve had a gentleman calling me trying to verbally describe a bug that is ‘burrowing’ into his (and his wife’s) skin. He’s been to several Doctors, Dermatologists and Emergency Rooms – nobody can identify the problem.

Several responses suggest that delusory parasitosis might be the answer, and finally one from Nancy Hinkle of the Department of Entomology at the University of Georgia suggests referring the clients to her department, where a study is being made of the subject. It’s not uncommon for sufferers to go to entomologists on their own. The second (even the first) port of call for someone plagued by imaginary insects is an expert who will provide a practical solution. Entomologists have an instant diagnosis known as ‘the matchbox sign’. The client will bring out a matchbox (or container) for the entomologist, containing what they insist is the problem bug which they have brought for identification. The bug expert sees a speck of skin, a hair with a follicle attached, or dandruff, and knows great tact is called for. Hinkle has written a detailed paper in the American Entomologist describing the condition of delusory parasitosis and her experiences with clients who’ve come to her for help. It’s distracting for someone whose work is to study cattle infestation to have to deal with psychiatric patients, but she isn’t alone. Nor is she lacking in understanding. There is something about insects, as we all know, and most kinds of madness have echoes in the ‘normal’ world. Those with delusory parasitosis often spread it to other members of their family, who believe they can see the creatures too. Hinkle isn’t surprised:

Entomologists who deal with delusory parasitosis cases will attest to this. Despite finding no arthropod in any samples provided, there is a strong urge to take a shower following these examinations. Consciously, one realises that there is no infestation, but subconsciously one often feels the ‘creepy-crawlies’ after looking through the victim’s scurf. In fact, the author, while reading through the delusory parasitosis literature in preparing this article, found herself absentmindedly scratching; before the manuscript was completed, her arms and legs bore distinct scarification.

People can be deluded about all manner of things, but the belief that insects have invaded the body and cannot be seen or effectively dealt with suggests a particular horror of something other – a living, deliberate other – far too close to our known selves. Think of The Fly. In my recollection, I had a terrible secret, and it was shared only by the creatures that had come to inhabit me. In some decidedly unpleasant way, the insects and I colluded in a truth that other people couldn’t be party to or understand. The creatures had chosen me, were closer to me than any person I knew. They and I were an us. They say that there is never more than six feet between you and the nearest rat, even though they remain invisible for most of the time. Derrida was anxious about his cat looking from a bathroom’s distance at his naked body. I was host to a multitude of animate creatures who had come very much closer.

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Vol. 32 No. 9 · 13 May 2010

Jenny Diski’s piece about ‘crabs’ reminded me that there’s also what might be called ‘illusory parasitosis’: the belief that you’ve been infested by insects when the real source of your itching and twingeing is something else that isn’t in your head either (LRB, 22 April). Some years ago I was living in a cottage on the edge of Silicon Valley in an area known for its flea-friendliness. One morning I woke up covered with bites, which I recognised from a past unhappy house-sitting experience. I bundled up bedding and clothing for the laundromat and went to the hardware store for flea-spray, and that evening sprayed every room in the cottage. During the night, though, I could feel tiny mandibles leaving new bites. I threw on the light and examined myself and the sheets, but couldn’t catch the fleas at work. The next night I was sleeping naked with the light on, but the little devils were still faster than I was. On the third day I began to feel really rotten and decided I was killing myself rather than the fleas with the flea-spray. Wondering whether the problem might be to do with the tiny poisonous spiders also known in the Bay Area, I went off to the library, where the librarian took one look at my sweaty, flea-bitten face and sent me off to a corner by myself with a book about Californian arthropods. By the next day the itching was intolerable and I went to my local clinic in search of anti-itch medicine. How they laughed! My flea problem turned out to be chicken pox.

Judith Rascoe
San Francisco

Jenny Diski writes: Ah, yes, I remember in the bin there was a young Australian woman (we were all young then) who was there because she had a psychosomatic rash that wouldn’t go away no matter how many antidepressants and antipsychotics she was given. Eventually, after she insisted, they tested her for allergies. She was allergic to rubber. She always slept with a hot-water bottle – cold in England for an Australian. They let her out.

I don’t know what you’d call that.

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