Practice A Patient’s Journey

Synaesthesia

BMJ 2009; 339 doi: http://dx.doi.org/10.1136/bmj.b3191 (Published 04 September 2009) Cite this as: BMJ 2009;339:b3191
  1. Anonymous, patient ,
  2. Steve Logsdail, consultant psychiatrist1
  1. 1Chiltern Hospital, Great Missenden, Buckinghamshire HP16 0EN
  1. Correspondence to: S Logsdail sjlogs{at}yahoo.co.uk
  • Accepted 21 March 2009

This patient has lived with synaesthesia since childhood, but the condition was diagnosed only when she sought help for depression

Fractions were the crunch. Up until then I got on fine. Then we started on decimal points and the more and less signs. How do you have more orangey red or less bottle green? They are what they are, surely? It was about then that I reckoned I wasn’t any good at maths. We moved into algebra, which turned into a greyish slur on the whiteboard, and literally, to me, dripped off in a sort of slimy haze. Yet geometry was fabulous. I could conjure up the shapes and work out the answers in my head in milliseconds; just don’t ask me to write anything down. I do things in tens; they array in front of my face in sets, and I count them out. But I don’t fathom dozens, pounds, pints, or anything else imperial. Thank goodness for American cookbooks.

I think I was about 15 years old when I mentioned to a friend that my numbers were colours, and she said I was weird. So I didn’t tell anyone again for nearly 25 years. For most of that time I thought maybe I really was weird and a bit mad. You see, it’s not only the numbers that have crossed over. Whole words are either strong or weak shades, and I have the unnerving experience of my feelings presenting through bursts and swirls of colour. I’ve developed my own systems and methods for working things out, and sometimes this makes me look strange. When I’m stressed, I just open my hand and let the shopkeeper take the money as I can’t count it out. Hardly anyone knows I struggle with counting; they see me as articulate and able.

Synaesthesia. Someone once explained that some of my senses had their wires crossed. For me it is as normal as having 10 toes and 10 fingers. The journey I’ve been on is one of discovering that it isn’t normal for everyone else and that some of the experiences I have lead to reactions and behaviour from other people that have been difficult for me to understand and deal with. A combination of events led me to seek help, but not initially for the synaesthesia—because of course I thought that was normal, and I didn’t even have a name for it.

A depression captured my body and mind, and I sought help. While the main priority was to understand and treat the depression, it was during one of the visits to my psychiatrist that my synaesthesia was revealed. While some things made sense at the time, not everything did—and I have since found the process of therapy with a psychotherapist to be very useful in really helping me to understand more about the meaning of what may be occurring. I know enough to understand that I have been fortunate to have a psychiatrist who could diagnose the difference between my spatially and colour orientated synaesthesia and schizophrenia. The two conditions are easily confused. Had I been diagnosed with schizophrenia, my life would have changed greatly, and I am thankful for the time my psychiatrist took and the patience he showed in making my diagnosis (box 2). So often emphasis is given to treatment, but for me the value has been in the diagnosis. It was an “Aha!” moment that has enabled me to progress on a personal journey of learning about how my perceptions work.

It feels like a personal process and not one that can be medicalised. I tap into a range of support systems as I feel I need them. My doctors and I have experimented with various medications, not so much to treat the synaesthesia directly but rather to treat related symptoms. I’ve found topiramate worked well as a mood stabiliser and helped me find ways to manage day to day and to deal with the confusion that mixed senses can bring. I no longer take this drug and now concentrate on sleeping well and minimising stress. Nothing I’ve taken has changed my experiences, though some drugs can help me cope better with what I do experience. I’ve noticed, however, that high doses of caffeine can make some colours seem a bit sharper. This has been a very private process, unlike my experiences with other medical conditions. It feels unique to me and difficult to describe to anyone else. I’ve chosen not to read widely about the condition. In fact what little I have found on the web looks like rubbish and irrelevant. Sometimes, when I hear someone else talk in a certain way, like “this drink smells pink,” I wonder whether they have similar experiences. But it’s not like cancer. It doesn’t seem to be something you talk about or have support groups for. Perhaps that’s because, for those of us who experience it, it feels so normal. It’s part of who we are.

Box 1 A doctor’s perspective

This description comes from a woman in her mid 40s referred initially because of a cycling mood disorder that had increased in severity over at least a decade and had started to affect her work. She had a background of substantial traumatic stress that had needed treatment in its own right and physical difficulties necessitating surgery during her psychiatric care. Her underlying personality was resilient and normal both at interview and in the judgment of her GP. Treatment for the mood disorder included pacing of activities, mood stabilisers, and low dose antipsychotic drugs, along with regular sleeping tablets at times of jet lag, which was an identified risk factor for mood instability in her case.

In her fifth consultation she described intermittent visual loss. On detailed inquiry she explained that she was able to see words, but not understand their meaning, leading to practical difficulties such as being unable to find or identify a platform number at a railway station. These episodes would last a number of weeks and then gradually fade. She also described a longer term association of colours and numbers—grapheme-colour synaesthesia—with these experiences sometimes located in external space rather than within the mind.

Neurological examination and magnetic resonance imaging scan were normal.

The neurological phenomena lessened a little with caffeine intake, and later, she observed, with mood stabilisers. Neither affective instability nor anxiety or stress had any effect on these experiences.

A practitioner might be unaware of synaesthesia. The visual disturbances did not bother the patient—indeed they sometimes enhanced her perceptual experiences. Of greater concern here was her report of difficulties with word recognition, which she described as visual impairment, and which led to an MRI scan even though this association had been reported in previous personal accounts. Her perceptions experienced in external space might seem psychotic to the inexperienced, but they are not based in mental disorder.

With appropriate treatment her mood swings are minimised, and she continues a busy and productive life as a businesswoman and author.

Box 2 The good and the less good

What went well?
  • Patient and listening practitioners

  • Therapy to give meaning to what happens and to manage my reactions to synaesthesia

  • Not mixing up synaesthesia with any other diagnosis

  • Being respectfully treated as a capable patient who sometimes couldn’t cope.

What could have helped?
  • An earlier diagnosis, though this is predicated on my ability to have been aware of the difference and spoken about it

  • Having some authoritative written resources to refer to (box 3).

Box 3 Useful resources

Notes

Cite this as: BMJ 2009;339:b3191

Footnotes

  • This is one of a series of occasional articles by patients about their experiences that offer lessons to doctors. The BMJ welcomes contributions to the series. Please contact Peter Lapsley (plapsley{at}bmj.com) for guidance

  • Competing interests: None declared.

  • Provenance and peer review: Not commissioned; not externally peer reviewed.

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