Diagnosis Dickens: Ebenezer Scrooge had OCD and Tiny Tim was riddled with rickets

IT is the classic Christmas tale of the transformation of a friendless miser into a picture of generosity.

Now an analysis published in a medical journal has suggested Ebenezer Scrooge’s penny-pinching ways may have arisen from an underlying obsessive compulsive personality disorder.

The research also outlines how the character of Tiny Tim in Charles Dickens’s famous tale A Christmas Carol, who is described as needing a crutch and metal braces, was likely to have been crippled by a combination of TB and rickets.

The diagnosis of what could have ailed Scrooge and Tiny Tim has been published by Herbert Rakatansky, emeritus clinical professor of medicine at the Ivy League Brown University in Rhode Island, US.

But it is not the first time particular diseases have been pinpointed in the pages of Dickens’ s work – often long before they were properly understood by medics.

The first recorded description of dyslexia is thought to be in Bleak House, where it states shop owner Mr Krook will never read as he can’t put letters together to make words.

In The Pickwick Papers, the character of Joe is described as a “wonderfully fat boy” who can fall asleep anywhere – leading to the use of the medical term Pickwickian syndrome to describe a breathing condition in obese patients, which later became known as obesity hypoventilation syndrome.

Rakatanskyn, in the new analysis, which has just been published in the Rhode Island Medical Journal, notes that Scrooge had been distanced from his father and sent to boarding school, and it is likely he was emotionally deprived as a child.

He pointed out a planned marriage was called off because of his devotion to money, yet Scrooge lived modestly. Rakatansky said: “Did Scrooge have an underlying obsessive compulsive personality disorder?

“He certainly had a longstanding, fixed pattern of behaviour that was outside the spectrum of ‘normal’ and had negative consequences for him and others. These disorders are resistant to treatment and generally do not change easily, if at all.”

Rakatansky also addressed the idea that Scrooge’s experience of seeing ghosts and hearing voices on Christmas Eve may have been as a result of a brief psychotic disorder, which today would be treated with drugs.

But he said Scrooge’s experiences did not fully fit the criteria for this diagnosis as the ghostly “hallucinations” took place only during the course of one night. He added: “Perhaps his hallucinations really were just vivid dreams. He recalled the visual and auditory sensations as if he had been awake. We all have had dreams like that. They seem very real, but they do not change our lives.”

Rakatansky has also tried to pinpoint the crippling disease which affects Tiny Tim, the weak and sickly son of Scrooge’s clerk, Bob Cratchit.

He noted that there are no visual depictions of the character from Dickens’s time – even though his books were illustrated – which could provide clues as to the nature of the illness.

However, the tale does say that Tiny Tim recovers after Scrooge’s redemption, when he funds the latest and best treatment for him – showing it was an illness which must have been able to be successfully treated in 1843.

One theory which has previously been put forward is that Tiny Tim suffered from a genetic condition called type 1 renal tubular acidosis (RTN). This occurs when the kidneys fail to excrete acid into the urine, leading to a build-up of acid in a person’s blood and if left untreated, can be characterised by growth failure and rickets in children.

But Rakatansky notes that many children in London during Dickens’s era suffered from insufficient vitamin D levels, which can cause rickets.

This was due to poor diet and a lack of sunlight in the soot-filled, polluted city air, but also a belief that disease was transmitted due to “miasmas” – a mysterious property of the air, which led to many parents keeping their children fully clothed and kept indoors as much as possible to protect them.

Rakatansky notes that it is estimated 60 per cent of children in London at the time had rickets and 50 per cent suffered from tuberculosis (TB).

Both of these illnesses could have been helped by improved nutrition, vitamin D from cod liver oil – a common remedy for various afflictions at the time – rest and exposure to sunlight.

Rakatansky added: “Type 1 RTN is a rare genetic disease. Rickets and TB were ubiquitous. Tiny Tim’s response to treatment and the prevalence of rickets and TB suggest that these were his afflictions.”

But he goes on to state that while it is interesting to explore the medical diagnosis of the characters, the power of the tale is greater than its physiology.

He concluded: “Perhaps the story of Scrooge’s ‘brief psychotic episode’ or dreams (if you prefer) and Tiny Tim’s recovery can ‘transform’ the reader and lead to a better world. Thanks, Charles Dickens.”

Did Scrooge have an underlying obsessive compulsive personality disorder? He certainly had a long-standing, fixed pattern of behaviour that was outside the spectrum of ‘normal’ and had negative consequences for him and others