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Windmills Tilted, Scared Cows Butchered, Lies Skewered on the Lance of Reality ... or something to that effect.


Thursday, January 16, 2014

The Hundred Acre Wood could use a therapist

Or, alternatively, society could stand to think a little bit more about whether, in our efforts to understand mental illness and get help for people who need it, we're leaning a bit too far towards medicalizing difference. That's the point a group of pediatric neurologists were trying to get across back in 2000, when they published a commentary in the Journal of the Canadian Medical Association concerning the possible DSM diagnoses of Winnie-the-Pooh and his animal friends.
We begin with Pooh. This unfortunate bear embodies the concept of comorbidity.

Most striking is his Attention Deficit Hyperactivity Disorder (ADHD), inattentive subtype. As clinicians, we had some debate about whether Pooh might also demonstrate significant impulsivity, as witnessed, for example, by his poorly thought out attempt to get honey by disguising himself as a rain cloud. We concluded, however, that this reflected more on his comorbid cognitive impairment, further aggravated by an obsessive fixation on honey. The latter, of course, has also contributed to his significant obesity. Pooh's perseveration on food and his repetitive counting behaviours raise the diagnostic possibility of Obsessive Compulsive Disorder (OCD). Given his coexisting ADHD and OCD, we question whether Pooh may over time present with Tourette's syndrome. Pooh is also clearly described as having Very Little Brain. We could not confidently diagnose microcephaly, however, as we do not know whether standards exist for the head circumference of the brown bear. The cause of Pooh's poor brain growth may be found in the stories themselves. Early on we see Pooh being dragged downstairs bump, bump, bump, on the back of his head. Could his later cognitive struggles be the result of a type of Shaken Bear Syndrome?
While the letters replying to this article seem to be behind a paywall, you can read the authors responses to several of the letters, including one where they explain that the goal was poke fun at the modern tendency to see pathology everywhere.
Contrast this with an article written about in 2010 that attempted to diagnose the mental problems of Darth Vader, Lord of the Sith, a project that had the stated goal of removing some of the stigma from mental illness. Looking solely at the authors' goals, I think the Pooh Bear paper succeeds where the Vader paper fails. After all, Vader pretty clearly has some problems, including a tendency towards genocide. It might be fun to give him an armchair diagnosis, but I don't see how that helps real people with mental illness seem less scary or their illnesses less taboo. Pooh Bear, on the other hand, for all his supposed problems, lives a pretty happy existence. As does Tigger and, arguably, most of the residents of the Hundred Acre Wood, with the exception of, probably, Rabbit (who really could use someone to talk to, I think) and Eeyore (but he likes it that way). Part of what distinguishes difference from mental illness is the question of whether traits and behaviors are getting in the way of your ability to live a healthy, happy life. It seems to me that Pooh has a pretty good lifestyle, Shaken Bear Syndrome notwithstanding.
Also, there are GIFs
 


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