Hallucinating Zombies

Applying for Supplemental Security Income (SSI) or Social Security Disability (SSD) due to a psychiatric disability is usually a prolonged and arduous process, even when using the computer instead of paper forms. You have to gather extensive documentation—hospital records, letters from psychiatrists, psychological test results—to support the application. Almost every application is rejected and has to be re-submitted.

But the first time I helped a client apply, his application was approved within a matter of weeks. I can't take credit for the alacrity—the client's symptoms were so severe, even the toughened social security examiners must have recognized how drastic his illness was.

My client, Sheldon, had schizophrenia. Psychotic disorders are somewhat more likely to be classified as disabling than mood disorders. But not only did he have psychosis, he had two rare and extremely troubling symptoms.

Sheldon had obtained his commercial driver's license and worked for several years as a truck driver. But as his illness worsened, he began to get into more and more accidents. Frequently, when he glanced to his right before making a turn, he would see a zombie in the passenger seat; alarmed, he often crashed into other vehicles. (This was many years before “The Walking Dead.”) Ultimately he would lose his job, and even if he was able to find another, he would lose that job as well.

Visual hallucinations in schizophrenia are rare. But most often, visual hallucinations are of living people, not the undead. Sheldon also came across zombies in his kitchen or living room, from time to time. Fortunately, they didn't speak, move, or attack, but they were extremely disturbing. And they prevented him from working.

The other symptom, olfactory hallucinations, was tied to childhood trauma. As a young boy, Sheldon was sexually abused by his uncle. The adult Sheldon didn't see his uncle, but he smelled whiskey—like many pedophiles, his uncle used alcohol to disinhibit himself enough to commit the abuse.

“I smell the liquor when I'm lying in my bed,” he told me, “and it's like I'm six years old again, and my uncle is coming in to my room and touching me. My wife and I don't keep no liquor in the house, so I know it ain't real, but when I smell it, I get real anxious and sad.”

Before being released from prison, Sheldon was taken off his medication; for reasons I can't fathom, that's the procedure in New York State. By the time he came home, he was severely symptomatic. Enrolled in our substance abuse treatment program by his parole officer, Sheldon confessed to heroin use, although he prided himself on inhaling sparingly rather than injecting. Like other clients of mine, he had found that heroin interrupted the hallucinations and delayed their return.

Before we began the SSI process I referred Sheldon to a psychiatrist, and he achieved partial remission of his symptoms fairly quickly. However, he knew from experience that it might take time for the medication to eliminate his symptoms entirely. He was frustrated because prior to his psychotic relapse and incarceration for possession of a controlled substance (heroin), he had enjoyed working.

“I know all the best shortcuts in the city,” he said. “I love driving those big trucks. You get to meet new people with some deliveries, and with your regular deliveries sometimes you make good friends.”

“The great thing about SSI,” I told him, “is that you can start working again part-time while you're still collecting it. If you want to go back to work full-time you can close your case, but it's not too difficult to reopen it if your symptoms come back.”

Employment is therapeutic on many levels. Having a schedule and a routine is mentally and emotionally stabilizing. Earning money and doing a job well build self-efficacy and feelings of competency, agency, and pride. I had no doubt that Sheldon would one day return to the big rigs and New York City streets he loved. But this time, there would be no zombie in the passenger seat.