Diagnosis that came too late for Diana
t was the great misfortune of the I late Diana, Princess of Wales, that the nature of the psychological illness that caused her so much misery, and exerted such a toll on the early years of her marriage, had only recently been described.
In 1979, just two years before the royal wedding, Gerald Russell, professor of psychiatry at London’s Royal Free Hospital, drew attention in a (now) classic paper in the journal Psychological Medicine to a “novel syndrome” that he labelled bulimia nervosa, “an ominous variant” of the well-recognised eating disorder anorexia nervosa.
He identified the distinctive feature of the condition as “episodes of over-eating followed by dramatic, intractable self-induced vomiting or purgation”. He noted how, nevertheless, most of those afflicted were able to present a normal persona to the world, their episodes of binge-eating (10 bars of chocolate, five packets of biscuits) and vomiting (often aided by a toothbrush) taking place in secret.
“Their outward appearance usually fails to convey their subjective feelings of gloom and suicidal thoughts,” he wrote, while “they expressed marked irritability towards friends or relatives who found them difficult to live with”. Ten years on, by when of course this novel syndrome was much better known, Andrew Morton in his (surprisingly good) 1992 biography, Diana, cites the princess verbatim on the severity of her bulimic episodes – on the eve of her wedding and four times a day while on honeymoon (“I would gobble up anything I could find and be sick two minutes later”).
None of this, needless to say, featured in the recent Channel 4 documentary – “muckraking spite posing as history”, as The Telegraph’s Allison Pearson described it. But it deserves to be more widely appreciated as it makes so much sense of subsequent events and why the royal household would have been so perplexed by the princess’s “difficult” behaviour.
Nightmare culprits?
The plight of the woman whose sleep is disturbed almost nightly by harrowing nightmares of terrible past events has prompted the usual fascinating correspondence. The first consideration is whether these might be induced by an avoidable factor affecting the neurochemistry of the brain – cheese (predictably), camomile tea and a pre-dinner G&T (or alcohol generally) being cited as possible culprits.
Also drugs, the antidepressant Citalopram, statins (“absolutely terrifying violent nightmares, huge adrenalin rush, heart pounding furiously”) and, interestingly, steroids, as described by a retired teacher whose recurrent nightmares – following a cataract operation – involved “pupils coming at me with knives and evil intentions”. Her mother, she recalled, had been similarly troubled when treated with steroids while in hospital (“I sat by her bed as she relived being a fire warden during the Bath Blitz”), prompting her to check out the ingredients of the eye drops she herself had been prescribed. They too turned out to contain “a minute dose” of steroids.
Several commend the psychological ploy of imagery rehearsal therapy (“create detailed non-frightening endings for repeated nightmares”), while others suggested this might be the manifestation of a spiritual problem: “An Anglican priest friend advised the laying on of hands and anointing with holy oil” – with immediate effect. “My constant terrifying nightly ordeal was over. Like exorcism, this sacramental act does not rely on the faith of the recipient”.
Whiff of a problem
‘Their outward appearance usually fails to convey their subjective feelings of suicidal thoughts’
This week’s medical query comes courtesy of Mr TY from Cambridge, who, when recently dealing with an electrical fault that had resulted in the melting of a plastic wall socket, inhaled a high concentration of noxious fumes. Since then, the unpleasant smell has persisted in his nostrils, driving out all other odours while “as soon as the scent of, say flowers, is sensed it immediately sets off the fume smell again”.
His doctor has advised this will eventually improve but might there be, he wonders, a speedier solution?