Charlie and the Chocolate Factory

Reminiscing on the past can lead to a number of shocking revelations. For instance, I just realized that it's now been more than four years since I took my undergraduate abnormal psychology class.

At the time, in 2005, we were given a fairly simple assignment for one of our major class projects: to write some form of educational material for people getting into or involved with the field (at a fairly simple level) that covered some of the issues surrounding it.

I chose to write a rather sarcastic commentary on the then-current state of the psychiatric establishment. Of course, nothing's really changed since then, at least not regarding the issues my commentary was directed toward, so it's equally valid as a commentary on the psychiatric establishment today.

To make my commentary, I went through one of my old childhood favorites, Roald Dahl's classic book Charlie and the Chocolate Factory, in one hand, and a copy of the DSM in the other. The resulting effort was an essay that I'm still quite proud of to this day.

And yes, it's extremely sarcastic.

Anyway, the essay, in its entirety, read:

In past years, many pathological behaviors both in children and in adults were attributed to poor parenting. Today, however, we know that many, if not most, of these are actually due to neuropathology – malfunctions in the brain. Take, for instance, the behaviors observed both during and shortly before young Charlie Bucket’s visit to Mr. Willy Wonka’s Chocolate Factory.

Charlie’s family is a classic case of a family struggling to cope with mental illness. Charlie’s grandparents, despite a lack of any physical infirmity, have not left their bed in years. They show a chronically depressed mood, markedly diminished interest in almost all activities, chronic hypersomnia, psychomotor retardation, constant fatigue, and show some signs of diminished cognitive capacity. The expense of caring for the four of them on a single worker’s income has forced the family into extreme poverty, a factor which has likely contributed to their state. While Grandpa Joe’s depression appears to go into remission following Charlie’s receipt of the Golden Ticket, there is a considerable chance of a relapse.

Although it is unlikely that the family could afford the expense, new drugs such as Prozac® would likely help the grandparents enjoy their golden years without the constant cloud of depression that has long haunted their family.

Charlie himself, while not suffering from any diagnosable mental disorders, is suffering from severe malnutrition due to a diet consisting solely of bread, margarine, potatoes, and cabbage, with the sole exception of an annual chocolate bar. This merely serves to underline the difficulties his family is undergoing due to their struggle with the grandparents’ illness, however, and is only worthy of note in that it puts him at considerable risk for a variety of potential future problems.

Willy Wonka, the owner of the chocolate factory through which Charlie takes his tour, is suffering from a manic episode with psychotic features throughout the tour. In addition to constant talking, extreme distractibility, psychomotor agitation, and a lack of care for the severe injuries suffered by many of the children during the tour, Wonka shows signs of past periods of extreme, goal-directed activity. Additionally, his episode shows mood-incongruent psychotic features, as evinced by his belief of the existence of a nonexistent country (Loompaland) and the blatantly impossible origin of his assistants, the Oompa-Loompas, who are, frankly, even wonkier than Wonka, although not diagnosable at present. As he also shows signs of at least one past episode of depression, a tentative diagnosis of Bipolar I Disorder, Most Recent Episode Manic (296.44) can be given. However, a chemical analysis of some of his more esoteric confectionary may reveal some psychoactive agent, in which case the tentative diagnosis may be replaced with a substance-induced mood disorder with manic features.

Augustus Gloop is another example of a poor soul suffering from a textbook case of Binge Eating Disorder. While his lack of control of his eating resulted in a trip through the factory’s plumbing, drugs such as topiramate and antidepressants show promise for preventing such accidents in the future.

Mike Teavee, whose lack of attention and hyperactivity lead to an unfortunate case of being shrunken and stretched by a toffee machine, was likely suffering from Attention-Deficit/Hyperactivity Disorder. While the single day of observation is insufficient for diagnosis, he shows a failure to pay close attention to details, has difficulty sustaining attention in regards to things other than television, often does not listen when spoken to, is constantly “on the go”, talks excessively, and frequently interrupts and intrudes on others.

Veruca Salt, who would once be called a “spoiled brat”, is now known to have Oppositional Defiant Disorder. While the requisite duration of at least six months has not been directly observed, Mr. and Mrs. Salt’s reactions indicate that her frequently losing her temper, arguing with adults, blaming others for her misbehavior, and refusing to comply with adults’ requests and rules has been part of a longstanding pattern of behavior. While the fact that her parents allow and encourage her behavior is a likely contributor to her problems, they would likely diminish with the administering of an antidepressant or neuroleptic.

Of course, the drugs mentioned above have side effects. Prozac®, generally considered to be among the safest of the psychoactive drugs clinically used today, has been known to cause headache, tremors, dizziness, asthenia, insomnia, anxiety, agitation, sleep disturbances, drowsiness, fatigue, excessive sweating, nausea, disturbances of appetite, diarrhea, bronchitis, rhinitis, weight loss, muscle pain, joint pain, chills, sexual dysfunction, and frequent urination. In a vast minority of cases (.1%), it may cause abnormal gait, ataxia, hyperkinesia, hypertonia, lack of coordination, neck rigidity, extrapyramidal symptoms (including tardive dyskinesia), convulsions, an inability to tolerate light, myoclonus, vertigo, migraines, tinnitus, hypesthesia, neuralgia, neuropathy, acute brain syndrome, confusion, delusions, hallucinations, manic reactions, paranoid reactions, psychosis, depersonalization, apathy, emotional lability, euphoria, hostility, amnesia, increased libido, dry mouth, constipation, urinary retention, visual disturbances, diplopia, mydriasis, hot flushes, chest pain, hypertension, hypotension, syncope, heart attacks, arrhythmia, tachycardia, vomiting, stomatitis, dysphagia, belching, esophagitis, gastritis, gingivitis, glossitis, melena, chronic thirst, abnormal liver functioning, asthma, dyspnea, hyperventilation, pneumonia, epistaxis, generalized and peripheral edema, hypoglycemia, hyperprolactinemia, anemia, lymphadenopathy, acne, alopecia, arthritis, bone pain, bursitis, tenosynovitis, abnormal ejaculation, impotence, premature menopause, amenorrhea, abnormal breast growths, cystitus, dysuria, urinary incontinence, amblyopia, cysts, and malaise. However, the benefits to drug use outweigh the risks overall, especially in people as obviously pathological as those observed in this tour.