Pathology in the Hundred Acre Wood: a neurodevelopmental perspective on A.A. Milne
Their report begins:
Somewhere at the top of the Hundred Acre Wood a little boy and his bear play. On the surface it is an innocent world, but on closer examination by our group of experts we find a forest where neurodevelopmental and psychosocial problems go unrecognized and untreated.
On the surface it is an innocent world: Christopher Robin, living in a beautiful forest surrounded by his loyal animal friends. Generations of readers of A.A. Milne’s Winnie-the-Pooh stories have enjoyed these seemingly benign tales.1,2 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-IV3 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.
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?
Pooh needs intervention. We feel drugs are in order. We cannot but wonder how much richer Pooh’s life might be were he to have a trial of low-dose stimulant medication. With the right supports, including methylphenidate, Pooh might be fitter and more functional and perhaps produce (and remember) more poems.
I take a PILL-tiddley pom It keeps me STILL-tiddley pom, It keeps me STILL-tiddley pom Not fiddling.
And what of little Piglet? Poor, anxious, blushing, flustered little Piglet. He clearly suffers from a Generalized Anxiety Disorder. Had he been appropriately assessed and his condition diagnosed when he was young, he might have been placed on an antipanic agent, such as paroxetine, and been saved from the emotional trauma he experienced while attempting to trap heffalumps.
Pooh and Piglet are at risk for . . .