On Fri, 20 Aug 1999, David brought to our attention the following
interesting note from the BMJ:
> http://www.bmj.com/cgi/content/full/319/7208/520/b
>
> British Medical Journal 1999;319:520 (21 August)
> [...]
> Few unambiguous descriptions of schizophrenia before 1800 exist,
> although some people argue that the disease has been known for many
> thousands of years. Bark has proposed that in Shakespeare's King
> Lear, Edgar, in his guise as Poor Tom, had chronic schizophrenia.
> [...]
> "Edgar: Poor Tom, that eats the swimming frog, the toad, the tadpole,
> the wallnewt, and the water; that in the fury of his heart, when the
> foul fiend rages, eats cow dung for sallets, swallows the old rat and
> the ditch-dog; drinks the green mantle of the standing pool; who is
> whipped from tithing to tithing, and stock-punish'd, and imprisoned;
> who hath had three suits to his back and six shirts to his body"...
>
> As with so many other aspects of medicine and human relations, the
> Bard's description of the wearing of layered clothing by schizophrenic
> patients is correct, insightful, and most poetic.
>
> Eric Altschuler, research fellow.
Wait a minute, Eric. The layered clothing symptom is impressive. But
note that Edgar's speech describes Poor Tom as being "whipped from
tithing to tithing". Rather than a sign of cognitive disorder, perhaps
the layered clothing merely represents a clever adaptive response to
his cruel environment. It's not for nothing that the time-honoured
technique of spanking requires the prior removal of clothing from the
target area.
On the other hand, most of the quoted passage focuses on the unusual
ingestive practices of Poor Tom. These behaviours are indicative of a
different psychiatric disorder, called pica. Perhaps Poor Tom, being
poor, also had a nutritional deficiency, often a cause of pica. Was
the Bard of Avon also a nutritionist?
Here's a rare case of pica combined with schizophrenia. Perhaps Poor
Tom had both.
-Stephen
Int J Geriatr Psychiatry 1998 Sep;13(9):638-41
An unusual case of pica.
Beecroft N, Bach L, Tunstall N, Howard R
Maudsley Hospital, London, UK. [EMAIL PROTECTED]
Pica is the persistent, culturally and developmentally inappropriate
ingestion of non-nutritive substances (DSM-IV). AB is a 75-year-old
lady with a 40-year history of schizophrenia and a 20-year history of
pica who, at emergency laparotomy, had 175.32 Pounds of loose change
in her stomach. Although pica has been reported to coexist with
schizophrenia, she had had no positive symptoms of schizophrenia for
at least 20 years. She has CT evidence of fronto-tempotal atrophy most
marked on the left in the temporal lobe and on the right in the
frontal lobe. Pica has been found to be related to cognitive deficits
and hyperoral behaviour to temporal lesions. Neuropsychological
testing reveals deficits closely related to these changes.
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Stephen Black, Ph.D. tel: (819) 822-9600 ext 2470
Department of Psychology fax: (819) 822-9661
Bishop's University e-mail: [EMAIL PROTECTED]
Lennoxville, QC
J1M 1Z7
Canada Department web page at http://www.ubishops.ca/ccc/div/soc/psy
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