December 21, 2004
Technology (film), Myth (Lord of the Rings) and Diagnosis
Leave it to the BMJ to publish a diagnostic review of Smeagol aka Gollum from Lord of the Rings. Did he suffer from mental illness or was he just plain evil?
The authors from the Department of Mental Health Sciences, Royal Free and University College Medical School, London offer a case presentation on Gollum - complete with history, mental status and diagnostic considerations. It is entitled "A precious case from Middle Earth."
As part of their analysis of Gollum, they suggest that several differential diagnoses need to be considered, and we should exclude organic causes for his symptoms. A space occupying lesion such as a brain tumour is unlikely as his symptoms are long standing. Gollum's diet is extremely limited, consisting only of raw fish. Vitamin B-12 deficiency may cause irritability, delusions, and paranoia.
Schizophrenia seems a reasonable diagnosis. However, in the context of the culture at the time it is unlikely. Delusions are false, unshakeable beliefs, not in keeping with the patient's culture. In Middle Earth, the power of the ring is a reality. The passivity phenomena Gollum experiences are caused by the ring, and these symptoms occur in all ring bearers. Gollum does not fulfil the ICD-10 criteria for the diagnosis of schizophrenia.
The presence of two personalities, Gollum and Sméagol, raises the possibility of multiple personality disorder. In this diagnosis one personality is suppressed by the other and the two personalities are always unaware of each other's existence. In this case, Gollum and Sméagol occur together, have conversations simultaneously, and are aware of each other's existence.
Gollum displays pervasive maladaptive behaviour that has been present since childhood with a persistent disease course. His odd interests and spiteful behaviour have led to difficulty in forming friendships and have caused distress to others. He fulfils seven of the nine criteria for schizoid personality disorder (ICD F60.1), and, if we must label Gollum's problems, we believe that this is the most likely diagnosis.
The authors rule out addiction but they overlook the power of the Ring which seems to have an overwhelming influence on anyone who comes into contact with it. Other possibilities?
A perfect clinical debate for the holiday season.
Posted by rsk at December 21, 2004 12:48 PM