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Sunday, December 15, 2013

How The Grinch Was Misdiagnosed: A Christmas Tale (aka Not Part III Of a Visit to the LHC)

In the spirit of the holidays, I have been considering the problem of the Grinch, who, as all know, once made an attempt to "steal Christmas."  Attempts to analyze the Grinch Problem often consider the matter from a psychiatric standpoint, asserting that the Grinch may have suffered from a combination of chronic depression and narcissistic personality disorder, with aspects of grandiosity.

However, as a medical man myself (as the Eldest Offspring never tires of reminding me, I "have a degree in baloney," though I consider this a base slur against the ancient art of Chinese medicine) I think the matter is best considered from a purely pathophysiological perspective.

For an explanation for the malevolent tendencies of the personality of the Grinch, we need look no further, in my opinion, than the fact clearly noted in the classic case history presented by Dr. Seuss, MD, DDS, MRCS, etc. etc. in which it is quite clearly stated that the heart of the Grinch is, and I quote, "two sizes too small."

This reference to a pathological condition of the cardiac organ has often been thought, given the author's other well-respected analyses of psychopathology (especially concerning the origins of visual and aural hallucinations in the trauma of abandonment; see "Horton Hatches The Egg," i.e.) to be an uncharacteristic flight of metaphorical fancy on the part of this otherwise notoriously pragmatic clinician.  I propose, however, that Dr. Seuss was no more than noting the bare facts of the case, and that it is in this chronic cardiac insufficiency that the secret to the mysteriously unpleasant personality of the Grinch may be found --and furthermore I assert that the utmost importance of this very fact eluded the notice of Dr. Seuss, the Grinch's most famous chronicler.

Consider the inescapable consequences of this lamentable affliction.  With a heart "two sizes too small," numerous sequelae of the most unpleasant nature must inevitably follow.  Such chronically moribund cardiac output will result in hypotension and poor delivery of oxygen, glucose, and other vital substances to the cerebral cortex, producing a profoundly, and perpetually, dysphoric mood state --identical, indeed in many respects indistinguishable, from that produced by hypofunction of the thyroid gland.

Exertional fatigue, cyanosis (one need only note the characteristic complexion, as shown by Dr. Seuss clearly in his coloured plates --which may, as well, indicate obstruction by stones of the common bile duct) as well as persistent, painful cramping of the muscles (in particular in the lower extremities) must also ensue.  The long term stress induced by this condition will also lead to excessive secretion of stress hormones, in particular cortisol, and again we need only observe the distended abdomen of the Grinch to see that in addition to his other woes, he suffers from advanced Cushing syndrome.

The obviously cruelly cold climate he inhabits would predispose him, thanks to poor perfusion by blood of the extremities, to the painful cold-induced condition known as Raynaud's syndrome.

In short, his desire to "steal Christmas" is the result not of some deep rooted defect of character, but of the almost unbearable physical pain and stress occasioned by what is obviously a tragically undiagnosed congenital cardiomyopathy --compounded by an entirely natural hostility towards the time of year when, thanks to the turn of the seasons, his condition would be most exacerbated.

 Though some may feel that my review of the case is an uncollegial slur against Dr. Seuss' reputation -the envy of a lesser man for one long regarded as eminent in our field --it is rather, I feel, to the Grinch that the medical profession owes an apology, for a decades-long act of character assassination that could easily have been avoided through a judicious course of a cardio-tonic --extract of digitalis would have answered nicely.

Happy Holidays!