Taking A Leaf Out Of An Old Book

A precious case from Middle Earth

BMJ 2004; 329 doi: http://dx.doi.org/10.1136/bmj.329.7480.1435 (Published 16 December 2004) Cite this as: BMJ 2004;329:1435
  1. Nadia Bashir, medical student1,
  2. Nadia Ahmed, medical student1,
  3. Anushka Singh, medical student1,
  4. Yen Zhi Tang, medical student1,
  5. Maria Young, medical student1,
  6. Amina Abba, medical student1,
  7. Elizabeth L Sampson, lecturer in old age psychiatry (e.sampson{at}rfc.ucl.ac.uk)1
  1. 1 Department of Mental Health Sciences, Royal Free and University College Medical School, London NW3 2PF
  1. Correspondence to: E L Sampson

    Tolkien's character Gollum is certainly disturbed, but is he physically or mentally ill? Gandalf the Wizard provides the history

    Sméagol (Gollum) is a single, 587 year old, hobbit-like male of no fixed abode. He has presented with antisocial behaviour, increasing aggression, and preoccupation with the “one ring.”

    Sméagol comes from a wealthy and influential family, his grandmother being a wise woman in the river folk community. Nothing is known about Sméagol's birth or schooling. He was spiteful to others and had only one friend, Deagol, whom he later murdered after stealing the ring from him. For Sméagol this was an important life event; the ring enabled him to disappear and listen secretly to conversations. His family and community, appalled by his actions and believing he was a thief and murderer, banished him to a solitary life in the misty mountains. He lived for many years with the ring as his only friend and began to detest the outside world—loathing the sun, moon, and wind. He ate only live animals or raw fish. Eventually Sméagol created Gollum, the outsider, who had a more violent personality. When Gollum was 25, the ring was stolen by Bilbo Baggins.1 Since then Gollum has had obsessional thoughts and has dedicated his life to reacquiring it, sometimes with violence.

    His forensic history consists of Deagol's murder and the attempted murder of Samwise Gamgee. He has no history of substance misuse, although like many young hobbits he smoked “pipe weed” in adolescence. Sméagol has forgotten many memories of his childhood, and we have limited collateral history on his premorbid personality. Before obtaining the ring he was an inquisitive child with odd interests, who enjoyed causing mischief and solitary activities such as burrowing under trees to look at roots. He dislikes himself, stale raw fish, and “hobbitses.”



    Embedded Image

    Gollum, from the film trilogy Lord of the Rings

    Credit: IMAGENET/NEW LINE PRODUCTIONS

    Mental state examination

    On general examination, Gollum is a pale, emaciated hobbit, with scanty hair and big eyes: “A skulking gangrel creature with an ill-favoured look.”2 He is unkempt and wearing only the remains of a loin cloth. He displays animal-like behaviour, including crawling and hopping. He shows no evidence of clinical depression, although he subjectively feels sad and is anxious to be reunited with his “precious”—the ring. Objectively, he is emotionally labile and becomes jittery and nervous when discussing the ring. His speech is abnormal and he repeats phrases and noises—for example, “Yes, yes, yes” and “Gollum, gollum.” In The Hobbit Tolkien writes of the many solitary years Gollum spent in the misty mountains: “He always spoke to himself through never having anyone else to speak to.”2

    There is no disorder of the form of thought. He uses neologisms such as “triksy” and “hobbitses.” Gollum has nihilistic thoughts, believing that he is a murderer, liar, and thief; although there is some basis in fact for this and he shows little guilt or remorse. He is preoccupied with, and deeply desires, the ring. He has obsessive thoughts but no compulsions, though he would do anything for the ring. He is hostile towards Frodo, the current owner of the ring. He has paranoid ideation about Sauron (“the eye is always watching”) and about Samwise Gamgee (“the fat hobbit… he knows”). Gollum has difficulty controlling his thoughts and actions, exacerbated by prolonged contact with the ring. As Gandalf and Frodo have similar symptoms in the presence of the ring, we can attribute this somatic passivity to the ring. There are features of dissociation. Sméagol has separated his personality and is now Gollum as well.

    He shows no evidence of any cognitive impairment. He has poor insight into his condition but he is aware of the Gollum-Sméagol dissociation.

    Diagnosis

    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. His reduced appetite and loss of hair and weight may be associated with iron deficiency anaemia. He is hypervigilant and does not seem to need much sleep. This, accompanied by his bulging eyes and weight loss, suggests hyperthyroidism. Gollum's dislike of sunlight may be due to the photosensitivity of porphyria. Attacks may be induced by starvation and accompanied by paranoid psychosis.

    An internet search found over 1300 sites discussing the nature of Gollum's “mental illness.” We asked 30 randomly selected medical students if they thought Gollum had a mental illness. Schizophrenia was the most common diagnosis (25 students), followed by multiple personality disorder (three). On initial consideration 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.3

    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.3 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.

    Acknowledgments

    We thank Peter “Treebeard” Raven for his encouragement.

    Footnotes

    • Contributors and sources NB, NA, AS, YZT, MY, and AA came up with the idea and participated in the design, analysis, interpretation of data, and writing of the article. ELS was responsible for writing the paper and revising it critically for publication and is the guarantor.

    • Funding ELS is funded by the Royal Free and University College Medical School and Camden and Islington Mental Health and Social Care Trust

    • Competing interests We are all of short stature and have very large, hairy feet.

    References

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