Friday, January 23, 2009

Pathology In The Hundred Acre Wood

I ran across an older article today diagnosing the characters in Winnie-the-Pooh.
However, perspectives change with time, and it is clear to our group of modern neurodevelopmentalists that these are in fact stories of Seriously Troubled Individuals, many of whom meet DSM-IV criteria for significant disorders (Table 1). We have done an exhaustive review of the works of A.A. Milne and offer our conclusions about the inhabitants of the Hundred Acre Wood in hopes that our observations will help the medical community understand that there is a Dark Underside to this world.
I have some quibbles. I would diagnose Eeyore with a Major Depressive Disorder rather than Dysthymia, and I don't see Roo's socioeconomic status as dire. But it is generally an excellent article. There were followup letters to the editor at the link, which I have not read. There will be some people who didn't get that it was a joke. Others will be offended by sections even though they know it's a joke. Many people will offer additional possibilities for diagnosis and interpretation. Maybe, someone will make reference to The Pooh Perplex, an excellent collection of faux-literary/social commentary essays from the 1960's about Pooh.

That article reminded me of another, which I was pleased to find online. Jordan Smoller's Etiology and Treatment of Childhood is the best I have ever read in the diagnostic sendup genre.
Childhood is a syndrome which has only recently begun to receive serious attention from clinicians. The syndrome itself, however, is not at all recent. As early as the 8th century, the Persian historian Kidnom made references to "short, noisy creatures," who may well have been what we now call "children." The treatment of children, however, was unknown until this century, when so-called "child psychologists" and "child psychiatrists" became common. Despite this history of clinical neglect, it has been estimated that well over half of all Americans alive today have experienced childhood directly (Suess, 1983). In fact, the actual numbers are probably much higher, since these data are based on self-reports which may be subject to social desirability biases and retrospective distortion. The growing acceptance of childhood as a distinct phenomenon is reflected in the proposed inclusion of the syndrome in the upcoming Diagnostic and Statistical Manual of Mental Disorders, 4th edition, or DSM-IV, of the American Psychiatric Association (1990). Clinicians are still in disagreement about the significant clinical features of childhood, but the proposed DSM-IV will almost certainly include the following core features:

1. Congenital onset
2. Dwarfism
3. Emotional lability and immaturity
4. Knowledge deficits
5. Legume anorexia
Masterful, including the footnotes.

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