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Ms. Wheaton, who is writing under a pseudonym, is working on a master's degree in psychology. Send correspondence to her in care of Personal Accounts, Psychiatric Services, 1400 K Street, N.W., Washington, D.C. 20005 ( email@example.com ). Jeffrey L. Geller, M.D., M.P.H., is editor of this column.
During the early summer of 1993, when I was finishing my freshman year in college, I was admitted involuntarily to a psychiatric hospital and stayed there two weeks. The following are edited excerpts from my discharge summary.
Reason for admission: This 19-year-old single female was living in a dorm at the University of California at the time of admission. The patient had been involved in bizarre activity, including lighting five fires on campus that did not remain lit.
History of present illness: This young lady is a highly intelligent, highly active young woman who had been the president of her class in her high school for all four years. She had been going full-time to the university and working full-time at a pizzeria. She had called the police threatening suicide. When she was brought in, she was in absolute and complete denial. Patient claimed that everything was wonderful and she did not need to be here. She was admitted for 72-hour treatment and evaluation.
Hospital course: The hospital course initially was quite tempestuous. It was difficult to determine what the diagnosis was, as the patient was on the one hand very bright and very endearing to the staff and on the other hand was very unpredictable. She jumped over the wall on the patio (AWOL). The police were called and ultimately brought her back. She was subsequently certified to remain in custody for up to 14 days for intensive treatment because she attempted to cut herself with plastic and/or glass. She became more open after this, more tearful and at times more vulnerable. She tended to run from issues, to try to help everyone else, and not look at herself. Her father was seen in family therapy with her by a social worker.
other is reported by father to be both an alcoholic and have a history of bipolar illness. The patient herself reported sexual abuse by an older stepbrother when she was about age nine to age 11.
Initially I intended to use antimanic medication with her, either carbamazepine or lithium, but opted not to as she was adamant against medication. The patient did seem to stabilize without medication. She showed dramatic improvement, although the staff and I still have concern. The stable environment she has been able to pull together may not exist after discharge. She is scheduled to go to Washington, D.C., on July 1 to work as an intern in the office of one of the congressional representatives. She had done this two years ago working as a page.
Aftercare instructions: No follow-up appointment is scheduled because she is discharged today and will be leaving for Washington on the first.
Fire became a part of my vocabulary in my preschool days. During the summers our home would be evacuated because the local mountains were ablaze. I would watch in awe.
Below I have listed some of my thoughts and behaviors eight years after the onset of deviant behavior involving fire. I have also included suggestions for helping a firesetter.
Firesetting behaviors on a continuum. Each summer I look forward to the beginning of fire season as well as the fall—the dry and windy season. I set my fires alone. I am also very impulsive, which makes my behavior unpredictable. I exhibit paranoid characteristics when I am alone, always looking around me to see if someone is following me. I picture everything burnable around me on fire.
I watch the local news broadcasts for fires that have been set each day and read the local newspapers in search of articles dealing with suspicious fires. I read literature about fires, firesetters, pyromania, pyromaniacs, arson, and arsonists. I contact government agencies about fire information and keep up-to-date on the arson detection methods investigators use. I watch movies and listen to music about fires. My dreams are about fires that I have set, want to set, or wish I had set.
I like to investigate fires that are not my own, and I may call to confess to fires that I did not set. I love to drive back and forth in front of fire stations, and I have the desire to pull every fire alarm I see. I am self-critical and defensive, I fear failure, and I sometimes behave suicidally.
Before a fire is set. I may feel abandoned, lonely, or bored, which triggers feelings of anxiety or emotional arousal before the fire. I sometimes experience severe headaches, a rapid heartbeat, uncontrollable motor movements in my hands, and tingling pain in my right arm. I never plan my fire, but typically drive back and forth or around the block or park and walk by the scene I am about to light on fire. I may do this to become familiar with the area and plan escape routes or to wait for the perfect moment to light the fire. This behavior may last anywhere from a few minutes to several hours.
At the time of lighting the fire. I never light a fire in the exact place other fires have occurred. I set fires at random, using material I have just bought or asked for at a gas station—matches, cigarettes, or small amounts of gasoline. I do not leave signatures to claim my fires. I set fires only in places that are secluded, such as roadsides, back canyons, cul-de-sacs, and parking lots. I usually set fires after nightfall because my chances of being caught are much lower then. I may set several small fires or one big fire, depending on my desires and needs at the time. It is at the time of lighting the fire that I experience an intense emotional response like tension release, excitement, or even panic.
Leaving the fire scene. I am well aware of the risks of being at the fire scene. When I leave a fire scene, I drive normally so that I do not look suspicious if another car or other people are nearby. Often I pass in the opposite direction of the fire truck called to the fire.
During the fire. Watching the fire from a perfect vantage point is important to me. I want to see the chaos as well as the destruction that I or others have caused. Talking to authorities on the phone or in person while the action is going on can be part of the thrill. I enjoy hearing about the fire on the radio or watching it on television, learning about all the possible motives and theories that officials have about why and how the fire started.
After the fire is out. At this time I feel sadness and anguish and a desire to set another fire. Overall it seems that the fire has created a temporary solution to a permanent problem.
Within 24 hours after the fire. I revisit the scene of the fire. I may also experience feelings of remorse as well as anger and rage at myself. Fortunately, no one has ever been physically harmed by the fires I have set.
Several days after the fire. I revel in the notoriety of the unknown firesetter, even if I did not set the fire. I also return again to see the damage and note areas of destruction on an area map.
Fire anniversaries. I always revisit the scene on anniversary days of fires that I or others set in the area.
Fires not my own. A fire not my own offers excitement and some tension relief. However, any fire set by someone else is one I wish I had set. The knowledge that there is another firesetter in the area may spark feelings of competition or envy in me and increase my desire to set bigger and better fires. I am just as interested in knowing the other firesetters' interests or motives for lighting their fires.
Suggestions for helping a firesetter. The likelihood of recidivism is high for a firesetter. The firesetter should be able to count on someone always being there to talk to about wanting to set fires. Firesetting may be such a big part of the person's life that he or she cannot imagine giving it up. This habit in all aspects fosters many emotions that become normal for the firesetter, including love, happiness, excitement, fear, rage, boredom, sadness, and pain.
A firesetter should be taught appropriate problem-solving skills and breathing and relaxation techniques. Exposure to burn units and disastrous fire scenes may be therapeutic and may enable the firesetter to talk openly about physical and emotional reactions. Doing so will not only help the firesetter but also give mental health professionals a deeper understanding of the firesetter's obsession.
Prognosis given by psychiatrist: Prognosis is very guarded given the severity of her condition.
Mental status: She firmly denies… destructive ideation, including firesetting at this time.
Discharge diagnosis [33 hospitalizations after the initial hospitalization]: Axis I. Major depressive disorder, recurrent, with psychosis. Axis II. Obsessive-compulsive personality disorder; history of pyromania; Borderline personality disorder. Axis III. Asthma. Axis V. GAF 45.<
Having been diagnosed as having borderline personality disorder with a history of firesetting led my therapists and me to use intense biofeedback therapy, social skills training, and an amazing psychotropic drug called clomipramine. As a result, I have been fire-thinking free for eight months. Have we found a cure?
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