Pathology in the Hundred Acre Wood: a neurodevelopmental perspective on A.A. Milne

I am deeply concerned that you omitted the Heffalump from your clinical analysis. I fear that this omission might play right into Its hands, and actually cause direct deterioration in Its condition.

The Heffalump suffers from obsessive behaviour, to wit, extreme secrecy. No- one is aware of having seen It, and yet everyone seems to know of Its existence. This kind of Howard Hughes-ian behaviour is not helped by your obstinate refusal to delineate its condition, and in my opinion, will push It into further secrecy and obsession.

The worst outcome would be the Heffalump emerging into psychopathic disorders, perhaps even sowing the seeds of a serial killer. We've all heard the quotes of neighbours : "Well, he never went out much. He kept himself pretty much to himself".

Socialise the Heffalump! Don't let a potential killer emerge...

Conflict of Interest:

None declared

Your paper is fascinating. Whilst my interest is general rather than academic I am concerned that, as a devotee and regular reader or Pooh texts, my emotional and intellectual health may be in jeopardy. Furthermore, might my personal influence on my students (160 individuals from 4 to 17 years of age) and their parents, become negative and/or manic rather than positive because of my reading habits and devotions.

To clarify, I most admire the actions of Tigger. I aspire to his bounciness and its consequences (eg crushing of Rabbit's breakfast), but spend more time marvelling at and reflecting on Eeyore's philosophies of gloom.

Should I seek professional counselling?

Janice Crimes

Conflict of Interest:

None declared

While I find all these diagnosisi valid and well thought out, I feel that there is a slight connotation that what these individual characters portray is a "bad thing." I personally feel that, for children especially, there is an undeniable need to understand these "disorders" that by seeing them exhibited it allows them to better comprehend as well as interpret the world that they currently live in. Moreover, these different characatures allow children to relate to. On the other hand I can see that in certain instances this "It's ok to be worried, look Piglet is" attitude could lead to problems, but again I think programs that demonstrate various parts of the human pysche play a vital role to child as well as human mental development. Thanks

Conflict of Interest:

None declared

Sorry for spelling "humor", without the "u" so beloved of in the Commonwealth. Sadly, these days most Americans have been forced to cut back on our vowel usage.

I possess a BA in both Political Science and History from the University of Colorado. This has no relevance to the issue at hand, save for their paving the way towards my Masters of Education from Regis University.

Humo(u)r presents and excellent opportunity for students and educators alike to view their ideology from an abstract position. Humor (sic) serves as a mirror through which we may observe the absurdities of our professions without the interference of lawyers. Frankly, any profession from a street-corner hot-dog salesman to President of the United States that cannot "take a joke", as it were, ought to be examined very, very closely.

The capacity for humour (when in Rome) requires a higher level of intelligence than found in other mammals. While what we consider to be funny may be subjective, creating or appreciating humor is an abstract concept in itself. Abstract thought can only be achieved through higher brain function. In short, "hunting and gathering", though necessary, isn't funny. Perhaps this is why so few cave-drawings came with punch-lines.

I submit that it is not insignificant that the men behind "Monty Python's Flying Circus" were educated at either Cambridge or Oxford.

No doubt that the members of that merry band would have had a field day with members of a profession dedicated towards mental health, that failed to recognize a good joke when they read it. Their's was the theatre of the absurd, and while the article in question was most certainly absurd, it was also very funny, as its intent was to highlight the absurdity of a profession not generally seen as humorous.

So, sit back in the couch, tone down "stimulus-response", and dare I say, smile.

Hello. I would like to inform you of a small...how should I say this?...disrespect I guess I should call it about the comment you made about single parent families. I am a 16 year old son of a single mother and I do not condone the statement about Roo: "Roo is growing up in a single-parent household, which puts him at high risk for Poorer Outcome. We predict we will someday see a delinquent, jaded, adolescent Roo hanging out late at night at the top of the forest, the ground littered with broken bottles of extract of malt and the butts of smoked thistles." Thank you for that. I have to say that I have turned out just fine in my single parent household. My mom has done a great job raising me. And I think those comments about a child of a single parent household being a "delinquent, jaded, adolescent," because I sure as hell am not a deliquent. I demand a recant of that statement. Making the assumption that a single parent does not cut it is preposterous. Thank you for your recant.

Conflict of Interest:

The statement about Roo and single parent households.

Winnie the Pooh: A Case Study in Sublimated Fecal Incontinence and Anal Eroticism?

Re Sarah E. Shea, Kevin Gordon, Ann Hawkins, Janet Kawchuk, and Donna Smith 'Pathology in the Hundred Acre Wood: a neurodevelopmental perspective on A.A. Milne.'

I am afraid that the authors of this, otherwise excellent, article have missed the most glaring element of all in this sorry clinical saga. The name of this poor unfortunate creature is, after all, 'Pooh' (colloquially known as, and pronounced 'Poo') and given the cited and convincing evidence of his fixation on food, and in particular honey, this clearly adds up to a classic case of sublimated Fecal Incontinence* and Anal Eroticism.(*It should noted that the scurrilous use of 'code brown' is to be avoided in referring to this disorder (see Adam T. Fox, Michael Fertleman, Pauline Cahill, & Roger D. Palmer: 'Medical Slang in British Hospitals' in Ethics and behaviour: 2003, Vol. 13, No. 2, 173-189, at http://www.leaonline.com/doi/abs/10.1207/S15327019EB1302_04;jsessionid=iafjqvt2frzcu5op0I?cookieSet=1&journalCode=eb 10th Jan 2006, accessed at 11.45 am GMT)

And here, perhaps, we can turn to Freud for valuable extra assistance. Since the unconscious mind of Pooh and several other denizens of the Hundred Acre Wood represent nothing less than a 'bubbling cauldron of fears, conflicts, distorted perceptions and guilt-initiated emotions' described by Freud in cases of sublimation and regression. (see Korn, Errol R., and Johnson, Karen: VISUALIZATION: THE USES OF IMAGERY IN THE HEALTH PROFESSIONS, Dow-Jones Irwin, Homewood, Ill., 1983. http://www.lucidexperience.com/HypnoPapers/502.html 10/01/06 accessed at 12.05 am GMT)

In fact, the following passage from Jensen's 'Gradiva' and Other Works' (1906-1908 Volume IX:) http://www.nyfreudian.org/abstracts/abs_volumes/vol-09.htm (accessed 10.20 am GMT 10/01.06) offers the potential to establish a causal and decisive linkage between the character/name of the poor unfortunate Pooh (or 'Poo') as an expression of sublimated Anal Erotism and latent Fecal Incontinence vis: "The relationship between character and anal eroticism is discussed. The people that Freud describes are noteworthy for a regular combination of the 3 following characteristics. They are especially orderly, parsimonious, and obstinate. These people took a comparatively long time to overcome their infantile fecal incontinence, and even in later childhood they suffered from isolated failures of this function. Anal erotism is one of the components of the sexual instinct which, in the course of development and in accordance with the education demanded by our present civilization, has become unserviceable for sexual aims. It is therefore plausible to suppose that these character traits of orderliness, parsimony, and obstinacy, which are so often prominent in people who were formerly anal erotics, are to be regarded as the first and most constant results of the sublimation of anal erotism. Freud theorizes that the permanent character traits are either unchanged prolongations of the original instincts, or sublimations of those instincts, or reaction formations against them."

Now, while it is clear that Pooh (AKA 'Poo') is not the most orderly, and parsimonious of creatures (although it must be granted that he does strive very to be so) he more than makes up for this deficit with his obstinacy, and besides I refer critics back to his alter ego name!!!)

I therefore humbly submit this additional diagnosis in order to correct one glaring omission from the profile of the key figure, Pooh, in the original article.

Dr David Baker

Conflict of Interest:

None declared

Dear Madams and Sirs,

I read with great interest the study by Sarah E. Shea and collegues. However, I am disappointed by some of their conclusions.

As a general psychiatrist, pediatric psychiatrist and cognitive therapist, I was astounded when I read Winnie the Pooh to my 3 year old son in 1991. What first struck me was the typical maladaptive beliefs and cognitive distortions of the different characters. After a diagnostic study, I have been lecturing on the disorders of Pooh and friends throughout the Eastern United States. Combining elements of cognitive theory, pediatric psychiatry and developmental science, the following represent a more accurate diagnosis of some of the characters:

Winnie the Pooh clearly suffers from Prader-Willie (not Winnie)syndrome: mental retardation manifested by his concrete and simplistic vocabulary, "I am a bear of no brain", compulsive overeating and insatiability, physical anomalies (typical Prader-Willie facies, small hands and feet, very small chin and hypogonadism: no pants but nothing detectable), overall cheerful mood (except with food related frustrations). Empirical evidence: all medical students and residents rotating through my service receive the task of diagnosing Pooh (only clue given is the fact that it is not a disorder in DSM): over 80% get the diagnosis in less than two weeks and bring in pictures of Prader-Willie patients.

Tigger fits most criteria for ADHD, combined type, and yes, should be treated with stimulants. A differential diagnosis could be traumatic brain injury (frontal lobes).

Eeyore has a major depressive disorder: his psychomotor retardation, anhedonia, consistently depressed mood, low energy, and sad affect are features too severe for dysthymic disorder.

Piglet, indeed, has a generalized anxiety disorder, which is characterized, among other features, by the cognitive distortions of catastrophizing, jumping to conclusions, etc.

Owl has dyslexia, but also narcissistic traits (he knows it all, or so he thinks).

Rabbit has OCD and could use SSRI or exposure and response prevention therapy related to being "a cleaner and checker".

And finally: Kanga and Roo have separation anxiety disorder, manifesting itself through overprotectiveness and some parent - child conflict.

Respectfully submitted, Leo Bastiaens, MD Clinical Associate Professor of Psychiatry University of Pittsburgh