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Ophidianthropy: the case of a woman who ‘Turned into a Snake’.

Shivanand Kattimani1*, Vikas Menon2, Manohar Kant Srivastava3 and Aniruddha Mukharjee4 - (Authors details)

Abstract

• Introduction: Western and Eastern cultures both contain mythss of humans being transforming into animals either voluntarily or under a curse. Psychopathological case reports include persons claiming that they have turned into a wolf, a dog, a cat or a bee. There are no reported cases in the literature of any person claiming that they have turned into a snake. This rare case is presented on account of its unique phenomenology, the diagnostic problems it posed and moreover because treatment itself was a challenge.
• Case presentation: A 24 yr old urban female, educated till middle school from a middle class family presented with a 15 day history of delusiosn of nihilism anda delusion that her body had been transformed into that of snake. Over 5 months various diagnostic possibilities were considered and various trials of treatment essayed. Despite this she continued to harbour her false beliefs and continues to pose a challenge to pharmacological interventios.
• Conclusion: A rare case of nihilistic delusions and along with another novel delusion which could be called as Ophidanthropy, the delusion that one has been transformed into a snake. There was significant impairment in her functioning due to this. A psychodynamic forumulation of her symptomatology is considered but considering her severity of symptoms we first aimed to control her symptoms with psychopharmacological interventions. It is our experience that when a patient presents with rare psychopathology like this management can be difficult one.

Introduction

The mythology regarding the transformation of humans into animals is controversial and topical in Western popular culture. Main domains of such discussion lie in the mythology of both Eastern and Western cultures. In Greek mythology such metamorphosis is referred to as ‘therianthropy’ (Podolsky, E. 1953). Hence the term therianthropy or zoanthropy is used in clinical parlance when someone one has a delusion that they have turned into an animal. There are reported clinical cases of humasn claiming that they are turned into wolves, hyenas, cats or dogs (Garlipp et al 2004). Where such delusions specifically involve the belief of being turned into wolf this has been termed lycanthropy. These are rare psychiatric syndromes not associated with a particular psychiatric disorder or neurological condition (Keck et al 1988). Many consider them in clinical sense as a disorder of self-identity that is found either with mood disorder or schizophrenia or other psychiatric disorders (Garlipp et al 2004). We have recently encountered a case of a delusion of being turned into snake.

Case presentation

A 24 year young girl presented to us with complaints that she had died 15 days before and that in her stead she had been turned into a live snake. At times she would try to bite others claiming that she was a snake. Her food intake and other behaviour remained as normal. We showed her photos of snakes and when she was made to face the large mirror she failed to identify herself as her real human self and described herself as snake. She described having snake skin covering her and that her entire body was that of snake except for her spirit inside. She repeatedly said that her saliva wass that of snake’s and very poisonou . She would often complaint of difficulty in swallowing telling that was due to snake skin being wrapped around her neck. She had protruding sharp upper incisor teeth which she could claim were snake fangs. She was distressed that others did not understand or share her conviction. She felt hopeless that nothing could make her turn into real self. She made suicidal gestures and attempted to hang herself twice on the ward and once when she was sent for short leave home. There were depressive symptoms accompanying this theme.

There was no significant contributory medical history. She was sole wage earner for her family of four.

Our investigations for organicity were negative.

She was treated with optimum doses of the following drugs for adequate duration in sequence: fluoxetine 40mg for 6 weeks, risperidone 6 mg for 4 weeks, olanzapine 20mg for 4 weeks, trifluperazine 25mg for 4 weeks, carbamazepine 800mg for 6 weeks. Most medications were changed due to non-response. In the case of risperidone beside non-response patient developed intolerable extrapyramidal side effects. She stayed on the ward for 5 months and during each drug trial there was some initial improvement in her symptoms but later she would return back to same conviction of her beliefs. In the initial period she was also treated with ten sessions of modified electroconvulsive therapy for her suicidal ideas in the context of additional depressive symptomatology.
She underwent psychometry which showed predominantly mood symptoms. Currently she is receiving escitalopram and quetiapine combination and still harbouring thesame psychopathology.

Discussion

Our initial diagnosis - as she predominantly presented with depressive symptoms and suicidal attempt along with delusion of nihilism - was a severe depressive disorder with psychotic symptoms as per ICD-10. As she additionally had a delusion of being transformed into a snake we consider the diagnosis of an acute transient her psychosis. While she remained in the ward her behaviour with our other patients and personal hygiene was well preserved except for brief periods of exacerbation of her psychopathology lasting for few hours to two days wherein she would enact being a snake.

There was also consideration of a diagnosis of dissociative disorder. But her overall psychopathology pointed towards something more than that. In addition to nhilistic delusions, she had the striking delusion of being transformed into snake, which was bizarre from the point of view of the patient’s cultural background. So, we ecalated it to consider a diagnosis of schizophrenia. Diagnosis was debated with other colleagues without reaching any consensus other than it represents a psychotic illness. But patient and her relatives were more interested in a relief from her distress which we were unable to provide. Our next plan is to employ supportive psychotherapy in combination with pharmacotherapy.

References

1. Podolsky, E. (1953). Encyclopedia of Aberrations: A Psychiatric Handbook. New York: Philosophical Library.
2. Garlipp, P, Godecke-Koch, T, Dietrich, D E, Haltenhof, H. (2004). "Lycanthropy-psychopathological and psychodynamical aspects". Acta Psychiatrica Scandinavica 109 (1), 19–22.
3. Keck, P E, Pope, H G, Hudson, J I, McElroy, S L, Kulick, A R. (1988) Lycanthropy: alive and well in the twentieth century. Psychological Medicine. 18(1), 113-20.

Authors

Address: 1Assistant Professor; 2Senior Resident; 3Associate Professor; 4Junior Resident, Department of Psychiatry, JIPMER, Pondicherry, India.

Author 1 and *corresponding author
Shivanand Kattimani
MD, Assistant Professor
Department of Psychiatry
JIPMER (Jawaharlal Institute of Postgraduate Medical Education & Research)
Pondicherry-605006
India

Author 2
Vikas Menon
MD, Senior resident
Department of Psychiatry
JIPMER (Jawaharlal Institute of Postgraduate Medical Education & Research)
Pondicherry-605006
India

Author 3
Manohar Kant Srivastava
MS, DNB, Associate Professor
Department of Psychiatry
JIPMER (Jawaharlal Institute of Postgraduate Medical Education & Research)
Pondicherry-605006
India

Author 4
Aniruddha Mukharjee
MBBS, Junior resident
Department of Psychiatry
JIPMER (Jawaharlal Institute of Postgraduate Medical Education& Research)
Pondicherry-605006
India

First Published September 2010

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