Wednesday, October 31, 2012

The Top Of My Head, Part II - Claudius Britannicus Dystonicus Non Erat

(OK, OK, sorry if the Latin's wrong). 

The jolly boys.

The gang of four.

No matter what glib euphemism you attach to them, you can't really get away from their nastiness. That's what they were, just nasty. It gets into you eventually, and you realise that you're in danger of getting into serious moral trouble when you realise you've written four and a half thousand words in two and a half hours attempting to justify their actions in the light of the illness from which they might, just might, have suffered. When I realised that's what had happened I deleted it all immediately, and have never felt better about losing so many words in one go.

What is surprising about the recent analyses of the lives of the Julio-Claudians in the context of their respective neurologies is not that it is being done, but that something which now seems so obvious took so long to come to light. To the best of my knowledge and belief, the genius who kicked the whole thing off is a Canadian doctor with a literary bent named George M. Burden. Genius? No, it's not too strong a word. Burden looked at their histories and made the connection that some kind of dopamine dysfunction was at work, the truly original thought that nobody else had ever had before, leading him to publish a paper entitled 'The Imperial Gene' in 1996, suggesting that they suffered from Tourettes.

What might have impeded the issue coming to light was not the study of neurology but the study of history. Historians are accustomed to examining the Julio-Claudians in terms of the order of their reigns rather than in the order of their relationships. In terms of their reigns, Tiberius preceded Caligula, who preceded Claudius, who preceded Nero. However, in terms of their relationships, Tiberius was the uncle of Claudius, who was the uncle of Caligula, who was the uncle of Nero. To my understanding, this might make them one of the more important study groups in neuropsychiatry, if only because there are so many of them, they are all in the same degree of relationship to each other and all exhibited what might be different elements of dopamine dysfunction.

I have already outlined the reasonings for my belief that Claudius, the most obviously afflicted of them all, suffered from some kind of secondary parkinsonism at some length. However, in his recent book 'The Twelve Caesars' Matthew Dennison records how the American classicist Josiah Osgood has stated a belief that Claudius suffered from a variant of dopamine dysfunction named 'Dystonia'.

The principal paper making this suggestion seems to have been written by Dr. Jane Rice, and appeared in  The Journal Of The Royal Society Of Medicine in April 2000. It's entitled 'The Emperor with the shaking head - Claudius' movement disorder(.pdf). Do please read it. 

I would not seek to criticise Dr. Rice's excellent and thoroughly researched paper. However, one could make a few suggestions. The developed neck musculature shown on coins of Claudius might have been a function of 'hypertonia' seen in some Parkinsonians (Dennison refers to a statue of Claudius showing unusually well-developed chest muscles; this could be another example of the same phenomenon). My own view on his stammer is that it was common palilalia. In terms of the factors involved in the onset of his condition, the issue of birth stresses might be worth a look at - Claudius was born six weeks prematurely, apparently as a consequence of the shock his mother Antonia received at being present during an assassination attempt on his father, Drusus (birth stresses might also have affected Nero, who was a breech birth). Robert Graves paints a picture of Claudius having suffered from a litany of childhood illnesses - if true, he must have been possessed of a phenomenal will to live.

However, I'm disinclined to change my original view that he suffered from some kind of Parkinsonism, because he might, just might, have exhibited a feature of that illness which is still seen to this very day - Claudius gambled like nobody's business.

"Dopamine dysregulation syndrome (DDS), sometimes known as hedonistic homeostatic dysregulation in Parkinson's disease, is a dysfunction of the reward system in subjects with Parkinson's disease (PD) due to a long exposure to dopamine replacement therapy (DRT). It is characterized by self-control problems such as addiction to medication, gambling, or hypersexuality"

Where did he get dopamine from? From a diet rich in beans, as suggested by Oliver Sacks, who saw just about every single behaviour exhibited by the Julio-Claudians under hospital conditions in Beth Abraham in 1969? Claudius almost certainly drank like a fish (they all did), perhaps using alcohol in its perennial capacity of dopamine regulator of last resort. We don't and can't know. But friends and foes of Claudius alike all note his love of gambling, and to my utterly irrational, untrained mind, that clinches it. He was a Parkinsonian who was able to boost his dopamine levels in some way that pushed him into reckless, exorbitant behaviour. He might just have been a gambler - but to suggest that he was just a gambler when he appeared to present so many other symptoms and was a very heavy gambler into the bargain seems unreasonable. 

In no small measure on account of the work of Robert Graves, there is, to my mind, something of a cult of Claudius. There shouldn't be. His profound disability notwithstanding, he was a deeply unpleasant piece of work. The evidence of this is in the history of his involuntary movements, for by their involuntary movements shall you know them; ticquers have absolutely no capacity for artifice. Peter the Great's tics seemed to start once he became Tsar - Claudius's diminished markedly after Gratus pulled him from behind the curtain. After a lifetime of great stress in the sewer at the top of Roman high politics, Claudius was at last its biggest rat. This easing of his symptoms suggests to me that all the previous talk of love for the the republic was just cant, that he had coveted the imperial chair, and that once he had climbed on it the pressure was off and he could set about doing the job he'd always wanted. 

It is a pity that it has taken two millenia for history to mark his card in the manner it deserves. 

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