Sunday, January 1, 2012

Tracing the psychogenic origin of psychogenic polydipsia in an anxious woman

A woman in her late forties, a divorced mother of two children, who sees me for anxiety and insomnia, revealed that she loves to drink water, especially when she can put lots of ice in it, and loves the sound of the ice cubes clicking in that tall glass.

"How much water do you drink?"

"As much as I can. Easily 15 to 16 glasses a day."

The patient was astonished to learn that so much water is bad for her, and that anxiety and insomnia could be getting worse due to excessive water intake and shot back, "I always thought the more water you drink, the better it is for you. It flushes everything 'bad' out of you."

"I am not quite sure how much bad it flushes out of you, but it sure flushes the salt out of your system, and if the serum sodium gets too low, it causes anxiety, and if your heart and kidneys get overwhelmed with water, unable to pump or excrete it out respectively, a whole lot of other problems start, including swelling of your legs, and other areas of your body, including your brain."

Patient stretched out her hands to show me her fingers and admitted that her fingers are swollen, but could not believe that water could be harmful. She insisted that everybody tells you to drink more water. Every health  guru tells you to flush your system. Can they all be wrong? For besides cleaning your system, water fills up your stomach so you don't feel hungry. "You kill two birds with one stone."

"But at a huge price," I added. "It keeps you anxious, ruins your kidneys in the long run, and is an extraordinary burden upon your heart, which has to pump extra fluid through the circulatory system. So don't drink water unless you feel thirsty."

"I only drink when I am thirsty. I am always thirsty."

But then she changed her mind, and admitted that it is not thirst that makes her drink but perhaps an obsession to drink, and an obsession to hear the sound of clicking ice. She confessed that she drinks so much water that she has to go to the bathroom all night long. She is up every hour of the night emptying her bladder, and no wonder gets no sleep.

Tracing this obsession of hearing the sound of clicking ice led us to discover that her father and mother both were alcoholics. And it is the ambiance of drinking that she wants to create in her life."It is like the drug addicts. They too are more in the ambiance of doing drugs than seeking the actual effects of the drugs. I too perhaps want the ambiance of drinking but without the stupid effects of alcohol upon my mind," she said.

Patient added that she hates drinking. She cannot stand the smell of alcohol and can spot someone who has had even a single drink. She had to share a bedroom with an older sister who was a drinker, and she detested her drinking, and it was not hard to decipher analytically that behind that detestation of alcohol lay her dislike of her sister and behind that her Oedipal rivalry with her mother.

Further comments by the patient revealed that under the excessive water drinking was the unconscious wish to flush her mother out of her system. The clicking of ice was connected with her mother taking two glasses of brandy every night. The mother worked hard all day long and felt she was entitled to two tall glasses of brandy at night. She (mother) did not consider herself an alcoholic.

"My mother was an obsessive like myself. And did everything in excess. If she smoked, she smoked a packet of cigarettes in 2 hours. She did not all day long, but once she poured that brandy in that glass, she had to chain smoke and finish that entire packet in couple of hours. Quite often there would be two or three cigarettes lighted at the same time. When she drank she developed "ratchet jaw". She was afraid of my father, and his ugly drunk self. She was always inhibited and quiet. But when drinking she could talk and talk. She would call one person after another and gab endlessly.

"I am the same way but with water. I don't want to drink or smoke. But perhaps my desire to imitate my mother and be a drinker and smoker like her I do so through obsessively drinking water. The only thing I permit myself in which I actually become my mother is to click those ice cubes in the glass. Rest of everything about my mother and all the other damn alcoholics I detest, and want to flush them out of my system."

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