“Where the Ditches are Deep”

This was a fascinating case I saw in the hospital several years ago of a man in his 30’s who had no previous psychiatric diagnosis, but had likely suffered from a psychotic illness complicated by drug use for most of his adult life. He was unique in the sense that he used drugs to see “real things” which to me sounded like hallucinations and paranoid delusions. When these types of things occurred apart from drug use he took that as further proof of the objective existence of the things he was seeing and experiencing. It was enough that he was perceiving them for it to be true and in the story below he seemed to suggest that other people saw these things too.

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In his own words: 

When I was a little boy my mother would invite people over and do drugs with them in our house. They would start acting weird. One guy would be peeking out through the curtains and say “there’s someone out there.” Another one would be on his hands and knees trying to pick things out of the carpet. I wanted to know if what they were seeing was real. So when I got the opportunity as I got older I started using all kinds of drugs to try and see what they saw. I was not trying to get high. I wanted to see for myself if what they were seeing and experiencing was real. I want to tell you about something that happened to me so you will understand.

I was in a barber shop with some friends, well it was a tattoo shop, and Homey had some spice. He took a hit and then passed it to me. I took a hit and then passed it to Walter who was applying a tattoo to a woman customer’s leg. He then passed it back to Homey. Something changed and I saw Walter’s face looking down in shock at the work he was doing as the tattoo lifted off her leg and evaporated like smoke. He was real shook up and laid down his inking gun. He left the shop quickly and I followed him because I had seen it too. It was real. I found myself outside in a dark place where the ditches are deep.

I walked down the street and turned right at the corner. From there I could see my Grandmother’s back porch and my uncle was sitting on it. As I approached he was looking at me but not saying a word. The door was open next to him as if he were waiting for me to go in. I walked into the house and it felt like a dark form had followed me in. My Grandmother became upset and said, “What did you bring in here with you?” I suddenly felt like I was a little boy again and was in trouble, like she was going to spank me or something.

Then I noticed her little dog and I saw it transform into a snake creature and rise up. It came at me and I put my hands together like a fist and smashed them down onto the floor. The mirror, a glass coffee table, and the picture frames on the walls shattered from the force. It was real. I saw it myself. My uncle grabbed me and tried to hold me, yelling “What is wrong with you?!”

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The most striking thing for me in this story that he told was his description of the dark place where “the ditches are deep.” This seems to me to be a telling metaphor of someone struggling with mental illness - whether depression, anxiety, or the inability to distinguish reality from unreality. In my psychiatric residency at Walter Reed it was described to me by a young African-American woman on the inpatient psychiatric unit who said it was like being trapped in a nightmare where “I don’t know what is real and what is not real.” Everyone goes off the road at times but for some the consequences are significantly more catastrophic. The ditches are deep indeed.