There was nothing seriously wrong with George until that day in late November when his wife, Georgina, brought him to the emergency department. He was 28 and seemingly healthy. He had earned a degree in Physics, was working as an engineer, and was happily married. That isn’t to say that his life was ideal. George faced worries, insecurities, and challenges: he was still mourning the death of his mother who died several months prior, his wife was pregnant, and the couple had just moved from northwestern to northeastern USA leaving their friends and family behind. None of these difficulties could explain what happened next.

In early November, George, who has always been outgoing and friendly, became agitated. He was yelling and cursing his wife and family without apparent reason. His thoughts seemed to be racing in his mind, and his speech became bizarre. He was repeating the same phrases over and over again. Georgina couldn’t believe her own eyes and ears. This isn’t the George I’ve come to know, she thought. Then, she remembered that she had observed George presenting a similar behavior 10 years earlier when he was a college student. It lasted for a week, then resolved after George had taken a long period of restful sleep.

The doctors recommended that George will be hospitalized. George agreed. In the hospital, at the psychiatric unit, George continued to behave erratically. He seemed suspicious of everyone: patients, nurses, and doctors. He was following, with suspicion in his eyes, the movements of fellow patients and nurses. He was showing disregard for boundaries and personal space. “This hospital is trying to poison me,” he shouted angerily. He was blinking a lot. His thoughts seemed disorganized. He was repeatedly, bizarrely talking about “important philosophical symbols.”

The doctors gave George anti-psychotic and anti-anxiety medications. These helped to some degree.

Has George gone mad? Where should the line between sanity and madness be drawn, and who is to decide? These are philosophical questions of utmost interest, but, today, I will focus my attention on another important question: what happened to George?

A quick look at George’s lab report has given his doctors an important clue: his plasma’s calcium levels were high. Another test showed that his parathyroid hormone level was also elevated. An endocrinologist was called for consultation and imaging studies were taken. A diagnosis of hyperparathyroidism was made.

Let me explain: There are four parathyroid glands. These are located just behind the thyroid gland in the neck. These glands produce the parathyroid hormone. A hormone is a chemical massanger. The parathyroid hormone, like other hormones, is made in one part of the body (the parathyroid glands) but exerts its effect by signaling to other, distant tissues and organs.

Overproduction of parathyroid hormone, called hyper-para-thyroidism, occurs in 1% of the adult US population. The effects of hyperparathyroidism can be diverse and devastating. To remember the wide array of signs and symptoms of hyperparathyroidism, medical students use the following mnemonic: stones, bones, abdominal groans, and mental moans. Indeed, hyperparathyroidism can cause urinary stones; bone loss, osteoporosis, and bone fractures; abdominal pain; and psychosis.

On further questioning, George told the doctors that he, indeed, had a kidney stone episode about a decade before his hospitalization. His psychosis, in November, which seemed to have occurred out of the blue sky, were another manifestation of a long-standing hyperparathyroidism.

The affected parathyroid gland in George’s neck (only one of the four glands was hyperactive) was surgically removed. He made a complete recovery and his symptoms abated.

To what degree is our state of mind governed by the physical characteristics of our brain–its anatomical structure, physiological status, and the metabolic environment in which it operates? George’s case illustrates that we aren’t always the masters of our minds. And that our mental status is, in many cases, the result of a delicate interplay in which matter wins over mind.

EDITOR’S NOTE: Shahar Madjar, MD, MBA, is a urologist and an author. He practices in Michigan, at Schoolcraft Memorial Hospital in Manistique, and in Baraga County Memorial Hospital in L’Anse. Find his books on Amazon or contact him at smadjar@yahoo.com.