Storygram: Eric Boodman’s “Accidental Therapists”

Entomologist Gale Ridge in her lab at the Connecticut Agricultural Experiment Station in New Haven, Conn. The Madagascar hissing cockroaches on her sleeve are one of the species of insects she keeps there. (Originally published in STAT.)

 


The following story diagram—or Storygram—annotates an award-winning story to shed light on what makes some of the best science writing so outstanding. The Storygram series is a joint project of The Open Notebook and the Council for the Advancement of Science Writing. It is supported in part by a grant from the Gordon and Betty Moore FoundationThis Storygram is co-published at the CASW Showcase.


 

People often turn their heads from parasites and infestations. Bed bugs? Mysterious bloodsuckers? No thanks. The same goes for delusions—it can feel both violating and unnerving to witness a person whose mind is causing them such severe suffering.

Pair the delusion with the parasites and you get an actual disorder: delusional parasitosis. DP, as some experts call it, is a false belief of an infestation of insects, mites, or other creepy crawlies. This is the world into which STAT reporter Eric Boodman draws readers, in his award-winning feature article “Accidental Therapists: For Insect Detectives, the Trickiest Cases Involve the Bugs That Aren’t Really There.” Boodman does so with delicacy and deftness, acknowledging the trauma that people with DP face while also giving the reader key medical and scientific context.

Boodman centers his story on Gale Ridge, an entomologist in Connecticut. Ridge isn’t a medical doctor, but like many entomologists around the world, she is a magnet for desperate people who are convinced they are under attack by tiny assailants. For the most part, these patients feel shunned by medical doctors, who have deemed their disorder psychological, so they turn to entomologists in hopes of some relief. With them, they bring baggies and envelopes of evidence—what they think are tangles of insects, but in reality are usually lint, hair, or other household debris.

It may be tempting to make light of this behavior. Ridge’s moral compass sets the reader on a better path: Her empathy for the DP patients shows in each interaction and quote. And however you feel about bed bugs and hissing cockroaches, Ridge’s enthusiasm for insects is just as charming.

While Boodman’s piece covers a very specific medical disorder, it provides a good reminder—particularly in our current climate—to consider one another’s humanity.

 


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Story Annotation

Accidental Therapists: For Insect Detectives, the Trickiest Cases Involve the Bugs That Aren’t There
By Eric Boodman, STAT
Published March 22, 2017
(Reprinted with permission)

 

 

NEW HAVEN, Conn. — Gale Ridge could tell something was wrong as soon as the man walked into her office at the Connecticut Agricultural Experiment Station.It’s smart to start the sentence—and the story—with Ridge because, as we soon learn, she is the main character. It signals to the reader a hierarchy of importance, at least in the universe of this particular story. He was smartly dressed in a collared shirt and slacks, but his skin didn’t look right: It was bright pink, almost purple — and weirdly glassy.This is a great lede and immediately draws the reader in: We know something is wrong, and we assume that if we keep reading we’ll find out what it is.

Without making eye contact, he sat hunched in the chair across from Ridge and began to speak. He was an internationally renowned physician and researcher. He had taught 20 years’ worth of students, treating patients all the while, and had solved mysteries about the body’s chemistry and how it could be broken by disease.It would be easy (and wrong) to create a caricature of these patients, but Boodman smartly avoids doing so. Rather than jumping in with the psychological aspect of the illness, he first describes the patient as a person. But now, he was having health issues he didn’t know how to deal with.

“He was being eaten alive by insects,” Ridge, an entomologist, recalled recently. “He described these flying entities that were coming at him at night and burrowing into his skin.”

Their progeny, too, he said, seemed to be inside his flesh. He’d already seen his family doctor and dermatologist. He’d hired an exterminator to no avail. He had tried Epsom salts, vinegar, medication. So he took matters into his own hands, filling his bathtub with insecticide and clambering in for some relief.This is such a sad and vivid detail, wisely placed at the end of the paragraph. This placement lets it sink in for the reader during the brief pause as they move from one paragraph to the next.

But even that wasn’t working. The biting, he said, would begin again. Ridge tried her best to help. “What I did was talk to him, explaining the different biologies of known arthropods that can live on people … trying to get him to understand that what he is seeing is not biologically known to science,” she said.The opening is a bit unusual in that I don’t see an obvious nut graf. But it works. This quote, for example, helps set up the reader to understand that this story is a bit of a medical mystery. What the man thought was happening to him likely wasn’t, according to the science.

She saw him only four or five times. Three weeks after he first walked into her office, she heard that he was dead. Heart attack, the obituaries declared. No mention of invisible bugs, psychological torment, self-mutilation. But the entomologist was convinced that wasn’t the whole story.This sad, gripping end to the first section certainly raises the stakes and makes the reader want to go on.

Officially, as a scientist in the state Experiment Station’s insect inquiry office, Gale Ridge’s job is to help the public with many-legged creatures that actually exist. She has an “open-door policy”: Anyone can walk in, ring the service bell, and benefit from her expertise.Most readers won’t be familiar with an agricultural experiment station. This opening does a great job of defining it without going into too many details that would bog down the story’s flow. It might sound like some dusty holdover from another, more agricultural time, when the fates of Connecticutters and critters were more closely intertwined. Records tell a different story. Between July 1, 2015, and June 30, 2016, the office dealt with some 8,516 inquiries. That’s over 23 a day. Her clients enter brandishing pill bottles, jam jars, and Tupperware containing roaches and weevils, meal moths and fabric moths, bedbugs and stinkbugs. Tiny mangled spiders come in on bits of Scotch tape; gypsy moth caterpillars by the wriggling bucketful. Some people even send in live beetles by mail: The envelopes arrive empty, with chew marks in the corner.These numbers and descriptions do a great job of providing vivid, quick context about the scope of Ridge’s work.

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In an age where we think more about software bugs than living ones, public entomologists like Ridge may be more important than ever, helping us make sense of the un-digital world. Ridge has seen it all. She has helped gardeners identify the scourges of their crops, she’s guided homeowners through the treacherous terrain of bedbug control, and she’s helped police investigate a murder by examining the maggots found writhing in the victim’s flesh.Boodman puts more context about the role of an experiment station scientist here, which is helpful. We get a broader sense of the job, but it didn’t come so early that it slows down the story.

But her most difficult cases haven’t involved spiders or bedbugs or chiggers or mites. Instead, the hardest bugs she has to deal with are the ones that aren’t really there.

She labels these cases DP, short for delusional parasitosis. Some entomologists prefer Ekbom syndrome, because it carries less stigma. In the Diagnostic and Statistical Manual of Mental Disorders, which most psychiatrists use, the condition is listed as one kind of delusional disorder, defined as an unshakeable belief that you are being attacked by bugs or parasites even when there is no evidence of infestation.We don’t get the definition for what was likely happening to the doctor in the opening scene until now, but I think it works well. Sometimes the writer’s instinct is to pack more context into the lede or a nut graf, but I like Boodman’s restraint on this—you can serve your readers just as well by saving key context for later. Doing so in this story also helped build a sense of mystery.

If said or jotted down by someone else, those words would be a diagnosis, but the “doctor” that precedes Ridge’s name is a PhD rather than an MD. It was earned from the University of Connecticut in 2008, with a 998-page thesis on externally identical species, identifiable only through dissection: You wash away their soft tissues and look at their inner architecture, with a special eye for the spurs where exoskeleton and muscle connect. It’s scientifically useful, but about as un-medical as you can get.This may seem off topic but it serves an important purpose: to contrast Ridge’s training with this unofficial role she’s had to take on.

If you’re enjoying this Storygram, also check out two resources that partly inspired this project: the Nieman Storyboard‘s Annotation Tuesday! series and Holly Stocking’s The New York Times Reader: Science & Technology.

Yet as far as Ridge can tell, when it comes to DP, most physicians don’t have much training. Some doctors look at the person’s own scratch marks and think they’re insect bites; some prescribe parasite-killing medicines that don’t work because there are no parasites to kill. When the bites and bugs don’t go away, some refer the patients to an entomologist.

Others brusquely tell the patient that their problem isn’t medical, or that they are crazy. “It makes me really angry. … Nobody takes them seriously,” said Dr. Nienke Vulink, a psychiatrist at the Academic Medical Center in Amsterdam. “Most doctors, including dermatologists or general practitioners, within five minutes they know — or they think they know — it’s not a medical problem. Within 10 minutes, they send them away. But these patients are really suffering.”This is such a key point for writing about this delicate issue. Even if DP is psychological, the symptoms and the pain are very real. It’s important to have an expert quote to back up this idea to help give it weight.

To be fair, DP poses a challenge even for the best-trained physician. You might know that the best treatment is an antipsychotic, but getting patients to accept that prescription or to see the proper specialist can be nearly impossible: The patients believe that the proper medication is not an antipsychotic but an antiparasitic, that the correct expert is not a psychiatrist but an insect specialist.This is a helpful summary of how these doctor appointments generally go down, which helps explain why the patients turn to people like Ridge.

So they seek out entomologists: Ridge sees as many as 200 of these cases a year. She isn’t the only one with this unintentional expertise.And this was a nice transition from the previous paragraph. It has a logical flow that matches the logic the patients are using: If the medical experts can’t help, maybe the insect experts will. A whole network of entomologists — at universities, research stations, and even at natural history museums — is all too familiar with these requests.Another good, quick job at showing how broad the problem is, but without getting too bogged down in the details. Helps give context while moving the narrative along.

 

Hinkle samplesCourtesy of Nancy Hinkle

Samples submitted to University of Georgia entomologist Nancy Hinkle by people claiming to be infested by bugs. In reality, this photo shows skin, lint, plant matter, and other debris. (Originally published in STAT.)

 

“Every state has somebody like Gale or me,” said Nancy Hinkle, a professor of veterinary entomology at the University of Georgia, in Athens. She estimates that these inquiries take up about 20 percent of her time. “I tend to stay a couple of hours every day to deal with the invisible bugs.”

Ridge gets more involved than most. She insists that she’s “unqualified,” but she recognizes that she has become an accidental specialist in mental health, spending months trying to make sure a person gets healed. She calls these people clients; sometimes, though, they act more like they were her patients. “If I didn’t stop them, they would completely undress in front of me,” she said. “They try, but I say, ‘I’m sorry, I’m not a doctor, I’m a doctor of philosophy.’”This is such a great quote, and it shows the intimacy of Ridge’s unofficial role as Doctor DP. It also shows how careful she is in these interactions—she isn’t posing as an expert in mental health, but is simply trying to help these people in an honest way.

To the medical community, DP is rare; in the insect world, it’s anything but — and entomologists around the country say they are seeing more and more cases. Fifteen years ago, Hinkle got maybe one DP call a week; now she gets one a day. It’s hard to say whether that’s an increase in raw numbers, or if the internet has just made it easier to reach an entomologist. Either way, there is a stark discrepancy.

“This may in fact be a much more common problem than is reported in the medical literature,” said Dr. Daniel Wollman, who teaches at Quinnipiac University’s medical school. “The entomologists are seeing 10 times as many people than actually come to the attention of medical professionals. Maybe it’s not so rare.”

Ridge is collaborating with Wollman and a medical student to try to figure out the incidence of DP, and to develop diagnostic guidelines.Good to point out that not only are they seeing patients, they are also trying to make it easier for others to diagnose the patients. But all that is in service of a more pressing goal: to prevent people’s lives from unraveling. “I’ve had one death and two suicides in 20 years of work,” she said — but there have been plenty of other clients who have isolated themselves, thrown out their belongings, and ended up living out of a car.

These stories tell a kind of cautionary tale. Ask her about DP, and the case of the doctor-turned-patient is among the first that jumps into her mind: “It’s a loss of life that I don’t think should have happened.” With the right medical care, he might still be alive.This great section kicker plays two key roles: It gives us insight into what drives our main character, and it also ties us back to the opening narrative thread of that poor doctor.

 

The shelves in Ridge’s office are crowded with samples of insects preserved in jars of French brandy, dating back to 1808. (Originally published in STAT.)

 

For someone terrorized by insects, an entomologist’s office is at once the best and worst place to go for help.Good transition here, tying the theme from the previous section kicker to an entirely different scene. The best, because those labs are uniquely equipped to identify what bugs you; the worst, because they can seem like an entomophobic’s personalized circle of hell.

Take Ridge’s office. When I visited in January, its shelves were crowded with jars of French brandy preserving whitish beetle grubs and caddis fly larvae still stuck in their protective pebble cases. In the front, where the visitors sit, she keeps a large tank of Madagascar hissing cockroaches: They spend most of their time lazing in the mulch like iguanas in the sun.I have seen many a hissing cockroach in insectaries and entomologists’ offices, and I love this description.

There’s another terrarium in the back, this one holding hundreds of American cockroaches, all descended from a bug discovered in the steam pipes of Yale.Great detail. They are well provided for, with toilet paper rolls in which to congregate; fresh fruit, bread, and fish flakes to feast on; and a yellowish calcium-fortified jelly called Fluker’s Cricket Quencher, so they don’t fall into a bowl of water and drown. “Those guys there, I love them,” Ridge said, gesturing to a roll darkened with roaches. “Great bedbug killers.”

But her real pride and joy is on the other counter. That’s where she keeps her 43 colonies of bedbugs, each group in its own small canning jar covered with a fine white mesh that she buys from Jo-Ann Fabric and Craft, where it’s often sold as bridal veil.Ah, a subject close to my heart. Although I have not seen Ridge’s bed bug collection, I’ve seen many others, and this detailed description brings back memories. This scene is very much like others I’ve witnessed. The bugs come from military bases and poultry farms, from Somalia to Argentina, Indiana to New Jersey to Vermont. Now, they live here in New Haven — pests turned study subjects. “Most bedbug research in the United States is how to kill them, and not to understand them,” she said. “And my feeling is that if you get a better understanding of how the insects tick, you are going to find the Achilles’ heel.”

Her understanding of the bugs is deep — and deeply personal. Every few weeks, Ridge carries the bedbugs out to her red Honda, puts them behind the driver’s seat, and brings them home. There, at six in the morning, she inverts the jars on the skin of her right leg. She positions them just so, leaning them up against her left thigh and covering them with a blanket so they don’t move. Then, as the bugs suck her blood through tiny holes in the bridal veil, she leans back and listens to the radio news of “Democracy Now!”Oh wow, do I love these details. We’re really getting insight into our main character. She literally gives blood for her work—it’s no wonder she gives so much to the DP patients, too.

She knows this makes her sound nuts, but the bugs are tightly sealed in their jars with no chance of escaping.Interesting choice of words, perhaps to show a personal connection with the perceived psychology of the DP patients. And in the world of bedbug research, feeding them on yourself isn’t all that unusual.

“That’s what I do,” said Louis Sorkin, an entomologist at the American Museum of Natural History. It’s easier, he said: You don’t have to raise animals for the bedbugs to feed on, or buy blood.

Still, it’s hard to match Ridge’s interspecies empathy. “There is nothing worse or more sad to see than a frustrated bedbug who can’t feed,” she told me when describing one of her experiments.Another good insight into Ridge’s personality. She cooed parentally when showing a movie of a black widow spider that a client had found on a bunch of grapes from a local supermarket. Even her description of the smell of bedbug feces — which she doesn’t like — isn’t completely negative: To her it’s “cloying,” “sweet,” and “musky.”

This empathy developed early on, at her parents’ farm in the rich, windy grasslands of southwestern England. The nearest neighbor was three miles away, the nearest village five. They could only just hear church bells if the wind was right. There was nobody much to talk to; instead they had 90 head of cattle, and for a while, a flock of sheep.

“You were with the animals more than with people,” she said. She remembers acting as an animal midwife, reaching her small hand up into the birth canal to unlock a leg, reposition a head. She timed her movements to avoid contractions. The force would have broken her bones.

She had no particular interest in insects, though, and she grew up to be a pianist. Only in 1996, when she was looking for a more stable career that would allow her to raise a family as a single parent, did she return to school for biology. She thought she might end up in some medical-related field, but by chance she took a job in the Connecticut Agricultural Experiment Station — and she fell in love with insects.These are excellent biographical details that go beyond your basic profile. In a few short paragraphs, we get a sweeping view of Ridge’s career path that helps show how she landed in an agricultural experiment station. The last sentence also reveals that at one point she was toying with a medical career.

Even so, she didn’t involve herself with bedbugs; instead, they got involved with her.

“I was just minding my own business as an extension person here and about 2002, pest management professionals began to come in and present me bedbugs and say, ‘Well what’s this?’” she said. “… There were three or four generations who hadn’t even seen a bedbug, didn’t know what it was. It wasn’t even on their radar. At that point, a trickle became a flood became a torrent.”

And with the bedbugs she began to see the rise of another problem. She calls it the “ugly stepsister of human-feeding bedbugs.”It was vital to end the section on the DP issue, because we went on a little detour re: Ridge’s life and bed bugs. This brief section kicker does an effective job of snapping the reader back to the main topic.

 

Baggies of materialsCourtesy of Nancy Hinkle

Materials people collected from their body and clothing. (Originally published in STAT.)

 

It often begins with a phone call. The person hardly says hello before launching into a soliloquy, somehow insistent and hesitant at the same time.

“With those bugs, it’s terrible,” one woman told Ridge in March 2016. “I put bleach in my humidifier … we left the house, and when we came back, the bugs … they were angry. It’s so crazy. … It gets in my food, and sometimes I get it between my teeth. … I went to the doctor, and my husband’s got little bumps on his head, the mites sting him and lay their eggs there … and when they get in your ear …”These stories bring back a lot of memories for me. I still get emails from people who have read my book Infested, asking for help with bed bugs that have started crawling into their skin (which isn’t biologically possible). I guess once the doctors and entomologists don’t help, some people turn to writers. I hope Boodman doesn’t start getting those messages!

Even when an entomologist notices the telltale signs of DP, there is little that can be done over the phone. Biologists estimate that there are some 6.8 million arthropod species on earth; even the most fanciful description could, at its root, be a real insect.

“The main thing that I can do is encourage people to send me a sample of what they think is bothering them, because my job as an entomologist is to rule out whether there is a real bug infestation or not,” said Mike Merchant, a professor and urban entomologist at the Texas A&M AgriLife Extension Service.

And they do. They bring in bags and bags of body hair. They bring in scabs and skin flakes, pocket lint and dust and generalized schmutz. One woman arrived at Ridge’s office with her car trunk full of blankets and clothing; to her, every speck of fuzz on their surface was a bug.

“There was the time an individual sent us their vomit,” said Hinkle, the Georgia entomologist. “Not infrequently we get dirty underwear. But the vast majority are skin scrapings. … Ah, yes, I have a glamorous job.”Oh wow, this quote. It’s so visceral and great that I actually feel a little ill.

The entomologists pick through these samples under the microscope, meticulously searching for insects. If they find none, as is often the case, then a painful conversation is in order. They tell the person that they found no insects, and then the story changes — the bugs must have escaped, or metamorphosed, or become invisible. The person promises to send more samples.

Many of these people don’t agree with the entomologist that their problem is psychological. To them, the infestation is real. They can see it, feel it, hear it — and they are determined to get rid of it.

For a middle-aged woman in Toronto, it began with a visit from an out-of-town friend, who mentioned something about an infestation picked up on a plane. She, too, began to see them. The bugs were all over the house, she said, they were all over the car, they were all over her body. She sprayed the house with a smelly “natural” insecticide. She threw out clothes, books, fake plants, mattresses, beds. Sometimes she got so afraid of the contamination she wouldn’t let her husband into the house. He took her to the doctor, leaving a note so the physician knew what was going on, but nothing changed.Details like these, as well as those in the following paragraphs, come from a lot of tough reporting. It takes an emotional toll—and a lot of empathy—to ask people about these difficult moments in their lives.

“At her peak of stress and anxiety, I was seriously considering going to a judge and getting the police to take her to a mental health hospital,” he said, speaking on condition of anonymity. It’s not an easy decision to allow a source to be anonymous, and it’s one that writers should weigh heavily. In this case, I think Boodman made a good call, since the source is a private citizen talking about sensitive medical and legal issues. An aside to new writers: Talk to your editors before you report a sensitive story to help make a plan for potential anonymous sources. He had read Nancy Hinkle’s paper on the subject, and reached out to the entomologist; he knew his wife needed a psychiatrist, but she wouldn’t go.

Another woman, who lives in Atlanta, said she was misdiagnosed with scabies, and then humiliated in a hospital corridor by a doctor shouting that she was psychotic. She agreed to see a psychiatrist, but is still convinced that her skin is covered with bites. When she scratches, red, black, or white specks come out; they look like roach turds or eggs, she said. “Anybody with eyes can’t help but see it.”

 

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For another Atlanta woman, a psychiatrist recognized the problem behind her itchiness and her obsessive cleaning, but those appointments haven’t helped. “She wants me to cut down on the cleaning … but in my mind I can’t stop, because if my kids start getting more attacked and I haven’t cleaned …” she said over the phone. “I’m sitting here right now and I feel things crawling all over my feet. I’ve been tested for neuropathy, MS, and cancer. I’ve been tested for everything.”

By now, she hopes the condition is psychological; she just can’t convince herself of it. “It’s ruined my life,” she said. She began to cry.Wow, this is sad. But it also helps bring the reader back to the fact that these are humans in pain. Yes, they are acting in ways that don’t seem rational, but there’s real trauma behind that.

 

Handwritten notes from clients and a report on cases of delusional parasitosis in Ridge’s lab. (Originally published in STAT.)

 

In medicine, there is a subspecialty for everything, and DP is no exception: These patients fit perfectly within the purview of clinics focusing on disorders involving both the mind and the skin. Most of these centers are in Europe — there are at least three in the Netherlands alone — but a handful are scattered across the United States, like missionary outposts spreading the gospel of psychodermatology far and wide.This is interesting context, showing that, while rare, these treatment facilities do indeed exist. Based on the story that came before this, it also suggests that these places are a bit siloed from the mainstream medical community.

At one such clinic in Amsterdam, the patient is first seen by a dermatologist. Only later, when a relationship of trust has been established, a psychiatrist joins them. “We are not telling them you have a delusion, we are not telling them you are crazy,” said Vulink, the psychiatrist who helped found the Psychodermatology Outpatient Clinic seven years ago. “The most important is that you confirm that the patient is suffering … ‘You can’t go outside, you don’t want to see your friends anymore, you sleep separate from your partner, so we want to treat you.’”Nice details showing how to work with the patients in a respectful way that emphasizes their humanity.

Within a few weeks, most patients can be convinced to begin medication. A 2014 paper showed that some drugs for delusional disorders also happen to kill parasites, and Vulink sometimes uses this research to help persuade patients that these antipsychotics will relieve their suffering.

Ridge, of course, does not have the power to prescribe.This was a good moment to bring us back to our main character, before we got too deep into the details about the psychodermatology clinics. She hopes instead to steer many of these people toward the proper professional. She knows, though, that someone with DP is likely to have already seen a long string of medical doctors. Visiting Ridge may be a last resort; she doesn’t want to scare them off.

Her assessment begins as soon as they walk in the door, before a word is exchanged. “It’s written all over their face,” she said. “This stiff movement, very focused, you know, clenched hands, tight body position, clear indications of high anxiety. And so my approach is to try to get them to relax. I’m somewhat jocular in the language, I keep the language very simple.”

She asks them to sit down. And then, from across the desk, she listens to whatever is bothering them. What might seem like insect bites could be caused by almost anything — mold, drug interactions, thyroid problems, a new detergent — so she takes a careful history. She asks where they live, with whom, what health problems they have. She asks about their pets.Good details again showing how Ridge employs empathy with the DP patients.

Once, she was called in about the laundry workers at a hospital who were all convinced they were being attacked by insects. When Ridge arrived, she could feel it herself: a distinct itchiness in the air. The culprit turned out to be an industrial dehumidifier — it made the room buzz with static electricity.

When the person brings her samples, she picks through them carefully. She dumps them into a lab dish, and with the flick of a switch and the twist of a knob, they come into focus under Ridge’s microscope. The machine is connected to a screen facing outward, so everyone in the room can, at least for a moment, see through an entomologist’s eyes.This is great description, showing what a patient might see if they seek help from Ridge.

The ensuing examination is collaborative: no, that thing is not a mite but a twist of hair, not a beetle but a ball of lint. She listens, and listens, and listens, not agreeing with them, but not dismissing them either. “The medical profession is not allowed to offer time,” she said. “I can offer time.”Another great nod to Ridge’s empathy. Boodman does an excellent job of profiling a sympathetic character without slipping into hero worship or sappiness. He does this by showing her actions.

It sometimes takes her months to win clients’ trust. At first, they argue, citing websites like stopskinmites.com as proof of their infestation, and Ridge needs to counteract the misinformation they have found there. “This is a piece of lint,” Ridge told me, pointing to a photo that the website suggested was a mite. She sees these sites as a ruse to get people to buy pseudo-medical products, and as a danger to her clients.

“Often in the early stages there’s lot of pushback,” she said, “but they keep coming back, which means they have — deep down — doubt. I keep reassuring them: I’m not judging them.”

She can be maternal, careful to validate what her clients are feeling, becoming stern when she needs to. She sometimes organizes family interventions in a conference room at the Experiment Station, with as many as 11 relatives around a table, trying to address the problem together. She likes “the satisfaction of seeing someone healed.”

“I can help those cases when they have not been invested more than six months, and when they have support from loved ones or friends,” she said. “Those that have become isolated, and have developed habits of self-treatment are very hard to pull back from the brink.”

They don’t often open up at first. As the relationship develops, though, they begin to confide in Ridge. And there is usually something to confide, some emotional upheaval in the background: a divorce, a stressful move, the loss of a loved one. She saw an uptick in these cases right after the 2008 recession.I’d guess that a lot of reporting went into writing these sentences—long interviews about all of these different cases. After the physician-researcher’s death, she found out that his family had left him. The separation had happened right around the time of his first bites.Again, Boodman uses the section kicker to bring us back to that original narrative thread: the doctor. Tricks like this help make a story feel complete.

 

When clients comes in, Ridge puts their samples underneath her microscope, as she demonstrates here with bedbugs. (Originally published in STAT.)

 

One unseasonably warm day in late January, Ridge was in her lab showing me videos of a particularly gregarious colony of bedbugs when the service bell rang on her front desk.Nice, brief callback to the bed bug section, which helps that thread come through the piece. Waiting for her was a white-haired woman in a puffy coat, wool scarf, and black-framed glasses. When she spoke, her words were halting. “I need some help,” she said, pausing, as though afraid to continue, “identifying a bug that is not allowed in my house.”

“OK, that’s what I’m here for,” said Ridge. Her wry tone was gone; instead she sounded like a kindergarten teacher, her voice an octave higher than usual and almost aggressively chipper.This and the following scene/dialogue help show Ridge in action, which is a nice way to wrap up what we learned of her in previous sections regarding her personality and work ethic.

The woman looked like she could use the comfort — and maybe a strong drink. “I only hope it isn’t a cockroach,” she said, sitting down.

Ridge took the container that the woman had brought in, and tipped its contents into a plate. Out fell a jumble of spiny legs, antennae, folded up wings. Ridge fiddled with the microscope and the bugs came into focus on the attached screen.

“Hi, guys,” said Ridge in the same bright voice, as the insects began to untangle themselves. Then, she added, under her breath, “They’re just scared out of their minds.”

“Well, they should be!” the woman said. “They should stay out of my house!”

The woman’s house had been completely bug-free for 30 years, she said. But then, just before Christmas, she had found one of these red-and-black critters in her living room. She found another the week after — and another, and another. She was worried they might be cockroaches. She’d gotten new furniture; could that be the culprit?

No, Ridge said. They weren’t cockroaches, and they hadn’t come in on the furniture. These were box elder bugs, she explained. They feed primarily on the seeds of the female box elder tree. Sometimes, in winter, instead of hiding out in rock crevices or tree hollows, they find their way into the warmth of people’s houses. They were harmless. No need for insecticides.

“They don’t bite?”

“Nope.”

“Do they carry disease?”

“Nope.”

Under the microscope — and, simultaneously, on the screen — the bugs began to scrape their dusty black legs along their beaks, the arthropod equivalent of washing one’s face.

Ridge took her time elucidating every aspect of the case. She drew a diagram of where the woman’s house might need caulking, read aloud and then printed out official information about box elder bugs and their host trees, and suggested a broom and dustpan for pre-caulking bug-removal. No, there was no risk of them being transported on her shoes and infecting anyone else’s house, Ridge said. No, she was under no obligation to inform anyone else that she had a bug problem.

Through pursed lips, the woman let out a sound of relief: “Well, that’s wonderful. Boy, I never thought I’d say that it’s wonderful if I identify a bug in my house.”

After she’d left, and Ridge had let the bugs out into the grass outside, she walked back toward the bedbugs and cockroaches in her lab.

“Did you see how her demeanor was at the beginning?” she said. “Tense, to say the least. And then as she began to get more educated … how it completely lifted, this mantle of anxiety?”

The bugs that had been tormenting this woman were real. They were made of chitin and myofibrils and hemolymph if not quite flesh and blood; they crawled, felt warmth, ate seeds with their piercing-sucking mouthparts. But it wasn’t hard to see how this creature could potentially shape-shift in her mind, from a harmless half-inch garden-dweller to something much more sinister: an uncontrollable swarm. Already, these few bugs had taken up residence in her thoughts. That could happen to anyone.Even though this woman wasn’t dealing with DP, Boodman deftly ties what he witnessed back into the main topic of the story.

And Ridge knew just how fragile the boundary could be between the insects in someone’s house and the ghostly insects of the mind.Nice transition back to our main character, to end the story where we began. She knew better than to point out that the woman was sitting right beside a tankful of Madagascar hissing cockroaches, their sleek, segmented bodies dozing a foot or two away from her left shoulder, waiting harmlessly for nightfall. “Insects are most often not the problem,” she said.

The problem is us.Kickers are always so tricky, and I think this short, snappy sentence works well—particularly since it pulls readers into the same pool as the rest of the humans in the story. It’d be easy to treat the patients as others. Boodman avoids this by showing their humanity, and wraps up the theme here in just four words.

 

(Editors’ note: See CASW Showcase’s earlier interview with Eric Boodman here. Brooke Borel interviews him about this story below.)


A Conversation with Eric Boodman

 

Brooke Borel: Did you discover delusional parasitosis first, or Gale Ridge? In other words, did you find a topic and go looking for a story, or did you meet the main character first?

Eric Boodman: So, I guess, I’ve been interested in delusional parasitosis for a few years. I heard about it from someone who was in medical school and did a rotation at a tropical disease clinic. She saw something that was a little different, but related. It got me thinking about the idea of these folks who are convinced they’ve got some kind of infection or infestation, when scientists can’t actually find one and are convinced there’s nothing there and that it’s psychological. I put that at the back of my mind and then I heard about Gale Ridge a few years afterwards and thought, that seems like a really interesting way into this idea.

BB: What did your editor say when you pitched the piece?

EB: I think he could detect how excited I was to delve into this piece. You know, sometimes we get excited about different things, but in this case, I think he was also really excited and just wanted to know when I could have the piece in.

BB: How long did you spend on it?

EB: Well, that’s sort of a complicated question to answer. When I first got in touch with Gale, my thought was that the best way to tell the story would be through someone who was actually going through the process of delusional parasitosis. So I spent a number of months waiting to see if Gale could find anyone who might be interested in speaking with a journalist, and it’s especially complicated when it comes to a delusional disorder because, you know, you don’t want to mislead anyone about what you’re writing about and they don’t think they have a delusional disorder. So, I was thinking maybe someone who had actually cleared the disorder and felt comfortable speaking to a journalist might be a good fit. But in the end, we just decided to go ahead with the story without that central figure.

BB: At what point did you decide to make it a profile of Gale Ridge—to tell the story through her?

EB: I think that was always there in the idea for the story—to have Gale at the center because she’s such a fascinating person and researcher and thinker, and she occupies this pretty strange position when it comes to both entomology and healthcare. I think it could have been possibly even richer if we could have also had one of her clients who was really fleshed out, but I think the piece works without that, or I hope so.

BB: I thought it did. When you ended with the woman with the box elder beetles, I did wonder if part of the reason you chose her was because it was difficult to find someone who was going through actual DP.

EB: Yeah, and I spoke to a few people who were convinced that they had infestations of some kind or another, and I spoke to, you know, the husband of someone who is convinced that his wife has DP, but his wife herself won’t hear of the suggestion. And those were people who I had found actually through a different entomologist, and because Gale puts in a special amount of work and a special amount of thought into working with clients with DP, I didn’t feel like I could structure a whole piece around any of them.

BB: Those patient accounts were so vivid. As I was reading, I was imagining it must have taken a lot of reporting to get all of those stories, and I was wondering if there were even more stories that you didn’t include because they weren’t quite the right fit or people weren’t as forthcoming. How many DP patients did you interview?

EB: I think I tried to include something from each of the people I did get to speak to. The issue always is that I would have liked to share their entire story. I really just gave glimpses of each person’s account of their infestation, but they really talked about what they were experiencing very vividly, in great detail, and would tell me stories that spanned years. It had totally changed their family lives, and often I couldn’t include all of that, and I wish I could have.

BB: Was that for space or just for overall flow of the story?

EB: Both. I think also because it was structured around Gale Ridge, I think if we put too much of an accent on any one of those people who said they were experiencing an infestation, then that might have drawn the reader’s eye a little too much away from what Ridge is trying to do.

BB: As I read your piece, I kept thinking back to “The Itch Nobody Can Scratch,” by Will Storr, and the delicacy of writing about people that have this sort of disorder. How do you make sure that you have the medical and scientific context, but that you are also being fair to the patients who are going through real trauma and pain?

EB: I think part of it is just reporting what they say and reporting what they experience as something that they are experiencing, which is actually something that Gale Ridge talks about a lot as well, in her own way of speaking with these clients. I’m not a doctor. I’m not an entomologist. I’m not a scientist. I can’t actually say whether the infestations these people are describing are necessarily real or not. In many cases, from a scientist’s perspective, it seemed pretty clear that they weren’t necessarily real, but at the same time, I just wanted to give them a place to describe their experiences.

BB: How did the patients react when you asked them for interviews?

EB: It really changed from one person to another. Some were very wary and insisted on anonymity. Some were totally fine with their name being used. And this is not at all my usual modus operandi, but in once case I felt like it made me uncomfortable to use a person’s name when they were telling me such sensitive stuff, and so I felt like it was fairer to anonymize all of those people who were telling me about these experiences.

BB: How about the scientists and doctors?

EB: Some of them were really excited. I think especially if you’ve been working on this for a long time, it’s not exactly at the forefront of a lot of practitioners’ minds, and so there was some excitement that there was some interest in this seemingly obscure issue. I mean, you know, there were some who just didn’t want to speak to me and that’s fine. I encounter that with every story.

BB: With profiles, especially with scientists, I’ve found sometimes they don’t feel entirely comfortable in the spotlight. Did it take some coaxing to convince Gale Ridge to be such a central character?

EB: I think there was some back-and-forth about that, and originally she had some discomfort with the idea of details of her bed-bug-keeping being published, but I also told her I was putting that into a wider context of bed bug research. To me, her work on bed bugs and her work on DP were intimately connected, and I feel like it’s important for readers to sort of make that connection for themselves, given that Gale Ridge is making that connection as well.

BB: I know from my own experience that writing about insects—and especially bed bugs—can be both fascinating and itch-inducing. How did you feel about insects and parasites before this story? And did that change?

EB: I definitely felt itchy while doing all of these interviews. Personally, I’m fascinated by insects. I think they’re really beautiful. Of course, there’s a part of me that’s also a little nervous being around bed bugs. But you know, I think I’m more on the Gale Ridge side of the spectrum where I’m drawn to look at insects.

BB: Back to the structure of the story: There are a lot of threads that you tied together really well. Were there any strands that you really wanted to include but that you ultimately had to cut?

EB: Gale is working with a student who is trying to write a scientific paper about her archive of delusional parasitosis cases, and I was totally fascinated by this spreadsheet that the student showed me that she was trying to use for data collection. What she was essentially trying to do was turn very complicated emotional stories into data points. I thought that was a really interesting idea. But it just didn’t really fit in the overall article, so we did end up cutting that. But that’s how it goes.

BB: Is there anything else that you would like to add about what it was like to put this piece together?

EB: I just loved reporting it. As soon as I started talking to Gale Ridge on the phone—by the second minute of our phone conversation—I felt like this had to be a piece, no matter how it was going to be a piece. She was just too interesting for me not to write about her.

  

Eric BoodmanCourtesy of Eric Boodman

Eric Boodman

As a reporter for STAT, Eric Boodman‘s work has brought him into operating rooms and monkey labs, cattle auctions and desert refugee clinics. He got his start writing book reviews for the Montreal Gazette, and his pieces have since appeared in the TheAtlantic.com, Discover, and other publications. Eric’s narrative journalism has won a number of awards, including the American Society of Magazine Editors’ “Next” Award and the Evert Clark/Seth Payne Award for Young Science Journalists, both in 2017 (“Accidental Therapists” was part of the winning package for the latter). Follow him on Twitter @EricBoodman.

 

 

 

 

Brooke BorelCourtesy of Brooke Borel

Brooke Borel

Brooke Borel is a journalist based in Brooklyn, New York. She has written on everything from the seedy world of cannabis pesticides to the rise of the bed bug for the likes of Scientific American, Popular Science, Nature, The Guardian, The Atlantic, BuzzFeed News, and FiveThirtyEight, among others. Both the Alicia Patterson Foundation and the Alfred P. Sloan Foundation have supported her work. She teaches writing workshops at New York University and the Brooklyn Brainery. Her books are Infested: How the Bed Bug Infiltrated Our Bedrooms and Took Over the World and The Chicago Guide to Fact-Checking, which Library Journal named one of the best reference books of 2016. And she is the host of the new podcast Methods, which is about how we know what we know. Follow her on Twitter @brookeborel.

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