Miriam's feminine skills and unfailing sensual radar led to glorious friendships. She was successful in garnering the attention of most of the keener-minded gentlemen who were guests, as was she, in a sequential variety of retirement/nursing homes. As was said to her quite sincerely, she would become a very wealthy woman if she could just refine and sell her unique pheromones that unfailingly attracted the opposite sex. At the time she entered therapy Miriam, a longtime widow, was a sane, happy, and very intelligent pianist who nonetheless sought help because of nighttime music - music only she could hear - that would not allow her to sleep at all.
Not that the classic choirs, orchestras, bands and soloists she heard were unpleasant. The music was beautiful and re-minded her of the days when she had been most active with her musically talented family. Never boring, the themes would change. So far as she could figure it, there never was any actual or symbolic meaning to the specific variety of music she heard. She lamented that it mostly was incongruent to her present moods and situations.
Because she never thought herself as different now that she was in her mid-80's, Miriam had no stereotypical prejudices against her own daytime behavior. As a result, she enthusiastically went about enjoying the company of men - seemingly without inhibition. She found woman to be of far less interest than her new male friends - a fact that did not endear her to other ladies in any of her several retirement residences. Miriam thought of herself as a normal woman who minded her own business. She expressed constant surprise that men enjoyed her company so much and she appeared to be unaware of any aspect of personal seductiveness. She never considered teasing her admirers.
Miriam would bask in her popularity until the inevitable night that a rejuvenated, newly love-infused, suitor would show up at her bedside offering romantic suggestions. Then, she would panic, switch into her alternative modus operandi of total denial, experiencing a real sense of shock that what she'd subconsciously been drawn to indeed was possible. Her recoil from him would rebuff the suitor who understandably felt confused by her mixed messages. Luckily, the nursing homes that she lived in tried to be tolerant and to avoid micromanagement of these situations. They mostly just attempted to corral any excesses as best they could. Until her next, inexorable phase began, and that phase would always be dramatic, staff members endeavored to remain neutral, non-ageist and unflappable.
What predictably followed next was that Miriam, unable to live with what she, herself, had created, incriminated the men for their behavior. She suddenly would become inappropriately fearful of sexual advances. Although she previously had been mentally clear, she would lapse into an out-of-control, manic-paranoid psychotic break at this point unless there was active psychiatric intervention at exactly the right moment. This usually consisted of increased dosage of medications that reduced the likelihood and the severity of the customary outcome.
At their worst, Miriam's episodes involved elaborate delusions of persecution by male friends and men on the staffs of the Homes. She would begin to believe that many of these people were secretly in love with her and were stalking her. She reacted to her own misconceptions with a kind of bizarre, agitated terror. Early on, before the pattern was understood, a psychiatric hospitalization had been necessary.
Throughout the entire repetitious pattern of her behavior, the nonexistent bands played on. New retirement homes and new male acquaintances, led to the same behavioral script accompanied by the constant nighttime music. The use of sleeping medications, mood stabilizers, and a bedtime antipsychotic medication in pediatric doses turned down the volume of music to the point that Miriam could sleep, which in turn, reduced the likelihood of future manic adventures. Of course, efforts were made to help her take responsibility for and ameliorate her siren behavior to the point of comfort (i.e.) some-thing short of terrorizing herself with the results. She tried to comply and may have been increasingly successful in ameliorating the near-ritual cycles. It is true, also, that the nursing home staffs became more and more experienced in predicting and dealing with her cycles.
Miriam's multisystem physical symptoms were of real concern during the 6 years that she worked in psychotherapy. Her heart had begun to fail; attending doctors struggled to keep it lively. When she developed a widespread, intensely itching, fine red rash over most of her torso - a rash that defied her dermatologists, she allowed evaluation for tick borne diseases. There was only one such testing opportunity possible due to objections by the primary physicians. Her devoted family supported the testing, however, despite puzzlement as to its importance.
This constantly surprising woman startled caretakers again when the tests returned positive for the DNA of human babesia in her blood. Babesiosis infection is a tick-borne, intra red blood cell parasite much like the protozoa of malaria. Another test involving a fluorescent blood smear showed the "merozoite" babesia forms inside her red cells. (IGeneX Laboratory) Miriam tested positive to chronic human granulocytic ehrlichiosis (HGH) as well. Since these diseases are less likely to cause a rash in most people, it seemed reasonable that she had several other unconfirmed infections and that Lyme disease was one of them. Actually, one antibody test for Lyme was "equivocal."
Lyme disease also was a top suspect due to the fact that neurological infections such as Lyme infection of the nervous system (neuroborreliosis) often lead to musical hallucinations. Dr. Nicolai Nielson, another board certified psychiatrist, stated in a personal communication, "I have seen many patients with this musical viscosity or musical intrusiveness as it is referred to. It is amazing how the patients think everyone else experiences this." He adds, "It is seen in central nervous system Lyme disease as frequently as it is seen in head injury or in similar syndromes such as temporal lobe epilepsy."
Reuters Health News reported on the work of Dr. Eva Schielke and her colleagues at University Hospital Charite in Berlin, Germany. She described a 57-year-old man whose meningitis caused him to hear a boys' choir singing folk tunes. The patient only became aware that he was hallucinating several hours after the music began because he thought he was hearing a party in a nearby schoolyard. The article cited these researchers, whose original report was in the August 8th 2000 issue of Nuerology (1) as establishing that physical lesions in a part of the brain stem called the dorsal pons are the cause of musical hallucinations.
Other patients with Lyme disease describe relentless tunes that get stuck in their heads, even though sometimes the melodies are not heard as being outside of themselves. Often such patients will have been misdiagnosed as having obsessive-compulsive disorder or epilepsy, prior to tick borne disease having been suspected as being present in their central nervous systems.
Understanding the fact that hypersexuality is not infrequently seen in Lyme neuroborreliosis, then adding the fact that brain injury from the infection can cause personality oscillations and can create very intrusive, on-going, personal band concerts, a new perspective emerged. It was comprehensible that all of Miriam's symptoms--musical hallucinations, severe insomnia, dramatic mood instability, over-seductiveness to men and, possibly even her cardiac and other physical problems most likely were caused by cerebral infection with the spirochetes of Lyme in conjunction with her clearly identified co-infections such as babesia.
Antibiotic treatment, unfortunately only available for a very limited time, appeared to improve symptoms in all spheres, although full verification of this was not possible. Grievously, a continuous, steady decline in the patient's cardiac status eventually put a crimp in Miriam's activities, then in her availability for psychiatric care and then she was gone.
Knowing how delighted by music she was to the very end, one enjoys the fantasy that Miriam is attending celestial performances - at last of her very own choice - in a universe blessedly devoid of infections.
Reference Eva Schielke, Uwe Reuter Olaf, Hoffmann, and Jorg R. Weber. Musical hallucinations with dorsal pontine lesions. Neurology 2000 55: 454-455.