Sometimes I look through scholarly journals for cases that I wouldn’t find in popular media. The reports of experts for experts often contain real gems. Recently, I found a case of body hoarding and triple psychosis, or folie à trois
Back in the 19th century, some alienists discovered a rare syndrome in which delusions were transferred from one psychotic person to others. Typically, these shared delusions occur among people who in close relationships (siblings, parent/child, or married couples). If the relationship weakens or is severed, the tenets of the transferred psychosis tend to weaken or dissolve, too.
Social isolation is a strong factor because with limited access to outside perspectives, the delusions can freely develop. Devotion to the relationship reinforces the warped perceptions.
In a recent case from the Journal of Forensic Science (Jan 2014) reported by five Italian mental health professionals, police performing a welfare check found a 70-year-old woman in an isolated villa in a small town in southern Italy. She had lived there with her two sisters but was now alone. She resided amid squalor that would rival the worst hoarders on that cable TV series. She hadn’t washed or changed her clothes in months, and she lived on rainwater and fruit.
The authors referred to her as Ms. C, the youngest of the sisters. Due to her shocking state of dehydration and malnutrition, she was taken to a hospital for evaluation. Disgusting odors led the officers past the scattered remains of decomposing cats and dogs to other areas of the house, where they found the mummified remains of Ms. A and Ms. B.
They wondered if Ms. C had poisoned her sisters. On top of both cadavers were blankets, waste, dead flowers, and other items. Ms. A, still in a red dress, was covered in rags. Small religious pictures were found near both.
It was difficult to tell how long they’d been dead, but poisoning was soon ruled out. After consulting records, the medical examiner concluded that Ms. B had died a year and a half earlier, age 78, and Ms. A had died three months after her, age 73. Ms. A had a fractured leg, and the lack of medical attention had probably been a factor in her lingering death.
Psychiatrists evaluated Ms. C, but found no overt psychosis. Within a few days, she appeared to be merely confused about what had happened and how she had been in such a disheveled state. She felt as if she had just “awakened from a nightmare.”
Her extensive diaries told an interesting tale, starting with the almost medieval religious beliefs of her parents. The mother had been a devout Catholic who was particularly attached to a Capuchin monk. This monk, who saw them daily, had advised the daughters never to marry. In fact, they all had died as virgins.
The father’s death eroded the family stability and launched the start of a pervasive paranoia. The family felt persecuted and targeted for death. They withdrew into a small circle of friends who shared their mystical beliefs. This included healing by prayer and the resurrection of the dead. Eventually, even these friends were shut out.
The sisters used their dreams for guidance, especially when populated by religious figures. They viewed their pets as guardian angels who gave them signs.
Ms. A and Ms. B eventually became bedridden, so Ms. C sent out for food, which she arranged through notes to a neighbor. She would not call for medical assistance, because they all believed that disease was an expression of the devil and that prayer alone would heal them. So they waited for a miracle.
When the two sisters died about three months apart, Ms. C didn’t know what to do. She thought that they might eventually rise from the dead. She let herself go, stopped feeding the animals, and no longer sent out for food. She engaged in daily conversations with imaginary figures until she was found by police.
The experts surmised that the mother had probably been the primary psychotic figure and had cultivated the paranoia that the sisters had adopted. When the mother died, the older, dominant sister carried on the beliefs. The other two “were obliged to agree to this to maintain the family cohesion.” The sisters co-create a world of parallel psychosis. Despite the fact that the two ailing woman were not healing, they firmly maintained their beliefs.
When it all fell apart with the deaths of A and B, the youngest and most passive sister could barely function. She became disoriented. Had police not intervened, she would have wasted away from malnutrition. She thought she was waiting for the Apocalypse.
Taken to a nursing home, Ms. C regained her health and cognitive functions. There was no sign of psychosis. She still believed in God, but in a much less mystical manner. Without the bond of delusion, she was free to be herself.
Such cases are rare but intriguing in terms of the invisible links that close connections can foster. The experts offered tentative explanations for how this situation had developed, but they were clearly mystified by the power of group perception based in one person's beliefs.