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Morgellons: A Medical Anthropology Perspective

Anthropologists have suggested that the body that conforms to cultural expectations of ‘healthy’ is symbolic not only of individual wholeness and harmony but also reflective of its society. Similarly, the ‘sick’ or deviant body may conversely represent ‘social disharmony, conflict, and dis-integration’ . Considering this, those who encounter mainstream biomedicine presenting with symptoms of Morgellons disease represent what the anthropologist Mary Douglas described as ‘matter out of place’ , referring to something that disrupts order and harmony within a given cultural framework.  

Those suffering with Morgellons, irrespective of its aetiology, represent something beyond the currently accepted and defined taxonomic boundaries of biomedical classification and identification , and therefore diagnostically challenging to the accepted biomedical paradigm. Consequently, mainstream biomedical epistemologies have strived to bring it back into 'order' through what could be considered critically as a process of reductive objectification.

Morgellons and biomedicine

Considered through a biomedical perspective, Morgellons is an example of a disease which has medically unexplained symptoms (MUS). Consequently, people with Morgellons are often diagnosed as suffering from delusions (according to the criteria in the Diagnostic and Statistical Manual of Mental Disorders 5th edition. In cases of MUS, it is often left to the discretion of the general practitioner or other medical professional to consider whether the patient's symptoms are legitimate. In other words, our medical professionals become the gatekeepers of illness legitimacy. This opens to a consideration of Morgellons from an anthropological perspective: that disease is not necessarily a biological fact, but rather the product of a decision made by society to consider it so. This illustrates that in Western societies there is often a higher regard held for biomedical knowledge of health and illness over personal subjective experiences.

Diagnostic practices in biomedicine can serve to reproduce social order, whereby having a formally recognised diagnosis gives the patient permission to be believed and to assume a 'sick role' in society. Patients with MUS who are dismissed by biomedical practitioners as suffering from delusions or hypochondria often experience considerable distress, with first person accounts of people with Morgellons showing that they feel stigmatised and isolated. Unfortunately, this approach has the potential to drive some individuals with Morgellons further into online communities where conspiracy theories and paranoia can fester. As such, this may create the potential for further marginalisation of the afflicted.

Classifying Morgellons

The contested nominalisation of the condition as both ‘Morgellons Disease’ and ‘delusions of parasitosis’ foreshadow potential conflict between the patient, the medical practitioner, and their respective communities. Whilst Morgellons Disease is often considered by patients as a biological condition, biomedical practitioners generally diagnose the condition as a form of delusion, a psychological condition. How health conditions are classified can impact how they are perceived by patients, medical practitioners, and their communities .

This underlying conflict is useful to consider through the lens of the “shamanistic complex” , in which a patient believes in their condition and seeks validation from an authority on health and disease. Anthropologists have noted the powerful impact that beliefs (formed and sanctioned by culture) can have upon the healing process, both positive and negative. Therefore, for healing to occur there must be a shared belief in both the diagnosis and the treatment, not just between the patient and healer, but through group consensus of their community.  When a patient doesn’t receive validation, they potentially lose faith in the medical practitioners’ ability to treat them. The rejection of the classification of the condition as psychological rather than somatic can negatively impact treatment by constructing a nocebo effect. Ongoing contestation of how the condition is classified may continue to undermine the acceptance of both diagnoses and treatment.

The psychological dimension of Morgellons

The subjective experience of Morgellons has been described as comparable to an invasion by a “terrorist” or something “from outer space”, metaphors that echo Douglas’ concept of ‘matter out of place’. Clearly, Morgellons is a highly disturbing and distressing condition to endure. This leads to a consideration of how mainstream medicine conceptualises Morgellons as a psychological illness by categorising it as a form of delusional parasitosis.

Delusional parasitosis has been used by the medical profession to explain Morgellons largely due to the presence of skin lesions on patients. People with delusional parasitosis are often convinced that they are infested with parasites and may consequently exhibit symptoms of paranoia. In some instances, such beliefs may negatively impact and distort people’s perceptions of their bodies, potentially leading to self-mutilating behaviours as a desperate and drastic measure to rid themselves of the parasites they believe they are infested with such as self-inflicted skin trauma, chemical therapy, or excessive practices of self-cleansing. Such problematic behaviours are common in cases of delusional parasitosis.

Similar to other forms of diagnosed delusional parasitosis, low self-esteem can also be a common side effect in those suffering with Morgellons, which can potentially to increased levels of social phobia. Increased levels of social isolation may then exacerbate low self-esteem, as such, therapeutic measures such a cognitive-behavioural therapy, a method intended to foster self-worth in a patient are applied to manage the psychological dimension of Morgellons.

Clearly, Morgellons is a multi-faceted condition that impacts people physically, psychologically, socially, and, due to its highly contested nature, politically. Consequently, any reductionistic approach towards treating this condition may reinforce potential harms and conflicts rather than reducing them. A medical anthropological perspective seeks to subvert these limitations by emphasising the critical importance of understanding the lived experiences of patients within their broader social and cultural contexts.