Neurol Sci DOI 10.1007/s10072-014-1804-7
LETTER TO THE EDITOR
Christian VII of Denmark and Tourette syndrome: fact or fiction? Alberto Cavanna • Andrea E. Cavanna
Received: 8 March 2014 / Accepted: 14 April 2014 Ó Springer-Verlag Italia 2014
Sir, For most of his reign, Christian VII of Denmark (1749–1808) (Fig. 1) showed signs of behavioral abnormalities which affected government decisions and led to a situation of political instability whereby he was only nominally king and important decisions were taken by members of his attorney [1]. Between 1770 and 1772, Christian VII was under the influence of his personal physician Johann Friedrich Struensee, a German doctor who became de facto regent of Denmark and was the subject of a celebrated historical novel by Swedish author Per Olov Enquist [2]. Interestingly, Enquist’s portrayal of Christian VII’s motor and behavioral abnormalities appears to be consistent with the clinical picture of Tourette syndrome. Specifically, there are vivid descriptions of multiple motor and phonic tics: ‘‘He writes that before the
A. Cavanna Casa di Cura ‘Mons. L. Novarese’, Moncrivello, Vercelli, Italy A. E. Cavanna (&) The Michael Trimble Neuropsychiatry Research Group, Department of Neuropsychiatry, BSMHFT, The Barberry National Centre for Mental Health, 25 Vincent Drive, Birmingham B152FG, UK e-mail: [email protected] A. E. Cavanna School of Life and Health Sciences, Aston University, Birmingham, UK A. E. Cavanna University College London and Institute of Neurology, London, UK A. E. Cavanna University of Birmingham, Birmingham, UK
performance the ‘mad’ King Christian began wandering around among the audience, muttering, his face twitching oddly’’; ‘‘The King then began bowing mechanically, over and over, with fitful, almost spastic movements’’; ‘‘And then the spasms would come back, his fingers plucking at his stomach, his legs twitching, and then his hand pointing upwards and a word uttered, repeated, like a cry for help or a prayer’’. As in Tourette syndrome and other tic disorders, the tics appear to be characteristically exacerbated by stress: ‘‘upon hearing the news of his betrothed’s name, Christian had started in with his usual fidgeting, picking at his skin with his fingertips, drumming on his stomach, and moving his feet spastically’’. This is how Enquist portrayed the king in the carriage leading him to Christiansborg Palace in Copenhagen to celebrate his wedding with his 15-year-old cousin Caroline Matilda of Great Britain in 1766, the same year as his coronation: ‘‘The mood in the carriage was strained, and the King’s tics and twitchings were at times wilder than ever’’. Following a heated argument with his wife the Queen, ‘‘Christian once again seized by that nervousness which manifested itself in twitching gestures an tics’’. Conversely, both the tics and the impulsive outbursts can improve with relaxation: ‘‘After the decision was made, Christian seemed relieved; his tics diminished, his aggressive outbursts ceased altogether for a time’’. It is known that Christian VII remained childish and playful throughout adulthood. For example, diplomats complained that, while discussing affairs of state with them, he would suddenly slap them violently. There is also evidence of sexual promiscuity, temper dyscontrol, paranoia, hallucinations and self-mutilation. Christian VII had a difficult upbringing: his mother, Queen Louise of Great Britain, died 2 years after his birth and his father, King Frederick V, became an alcoholic and neglected him.
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Neurol Sci
that Christian VII suffered from a neurodevelopmental condition, his possible tics and the behavioral symptoms associated with tic disorders (which include impulse dyscontrol [3] and schizotypal traits [4] ) suggest that Tourette syndrome might offer a valid alternative to his questioned retrospective diagnosis of schizophrenia [5].
References
Fig. 1 Portrait of Christian VII of Denmark (1749–1808)
Moreover, the young prince was notoriously subjected to severe beatings throughout his childhood by his brutal governor the Count of Reventlow. While it is highly likely
123
1. Langen U (2008) Den Afmægtige: En Biografi om Christian VII. Jyllands-Postens Forlag, Aarhus 2. Enquist PO (2003) The Visit of the royal physician. Vintage, London 3. Wright A, Rickards H, Cavanna AE (2012) Impulse control disorders in Gilles de la Tourette syndrome. J Neuropsychiatry Clin Neurosci 24:16–27 4. Cavanna AE, Robertson MM, Critchley HD (2007) Schizotypal personality traits in Gilles de la Tourette syndrome. Acta Neurol Scand 116:385–391 5. Christiansen V (1978) Christian den VII’s sindssygdom. Odense Universitetsforlag, Odense
LETTER TO THE EDITOR
Christian VII of Denmark and Tourette syndrome: fact or fiction? Alberto Cavanna • Andrea E. Cavanna
Received: 8 March 2014 / Accepted: 14 April 2014 Ó Springer-Verlag Italia 2014
Sir, For most of his reign, Christian VII of Denmark (1749–1808) (Fig. 1) showed signs of behavioral abnormalities which affected government decisions and led to a situation of political instability whereby he was only nominally king and important decisions were taken by members of his attorney [1]. Between 1770 and 1772, Christian VII was under the influence of his personal physician Johann Friedrich Struensee, a German doctor who became de facto regent of Denmark and was the subject of a celebrated historical novel by Swedish author Per Olov Enquist [2]. Interestingly, Enquist’s portrayal of Christian VII’s motor and behavioral abnormalities appears to be consistent with the clinical picture of Tourette syndrome. Specifically, there are vivid descriptions of multiple motor and phonic tics: ‘‘He writes that before the
A. Cavanna Casa di Cura ‘Mons. L. Novarese’, Moncrivello, Vercelli, Italy A. E. Cavanna (&) The Michael Trimble Neuropsychiatry Research Group, Department of Neuropsychiatry, BSMHFT, The Barberry National Centre for Mental Health, 25 Vincent Drive, Birmingham B152FG, UK e-mail: [email protected] A. E. Cavanna School of Life and Health Sciences, Aston University, Birmingham, UK A. E. Cavanna University College London and Institute of Neurology, London, UK A. E. Cavanna University of Birmingham, Birmingham, UK
performance the ‘mad’ King Christian began wandering around among the audience, muttering, his face twitching oddly’’; ‘‘The King then began bowing mechanically, over and over, with fitful, almost spastic movements’’; ‘‘And then the spasms would come back, his fingers plucking at his stomach, his legs twitching, and then his hand pointing upwards and a word uttered, repeated, like a cry for help or a prayer’’. As in Tourette syndrome and other tic disorders, the tics appear to be characteristically exacerbated by stress: ‘‘upon hearing the news of his betrothed’s name, Christian had started in with his usual fidgeting, picking at his skin with his fingertips, drumming on his stomach, and moving his feet spastically’’. This is how Enquist portrayed the king in the carriage leading him to Christiansborg Palace in Copenhagen to celebrate his wedding with his 15-year-old cousin Caroline Matilda of Great Britain in 1766, the same year as his coronation: ‘‘The mood in the carriage was strained, and the King’s tics and twitchings were at times wilder than ever’’. Following a heated argument with his wife the Queen, ‘‘Christian once again seized by that nervousness which manifested itself in twitching gestures an tics’’. Conversely, both the tics and the impulsive outbursts can improve with relaxation: ‘‘After the decision was made, Christian seemed relieved; his tics diminished, his aggressive outbursts ceased altogether for a time’’. It is known that Christian VII remained childish and playful throughout adulthood. For example, diplomats complained that, while discussing affairs of state with them, he would suddenly slap them violently. There is also evidence of sexual promiscuity, temper dyscontrol, paranoia, hallucinations and self-mutilation. Christian VII had a difficult upbringing: his mother, Queen Louise of Great Britain, died 2 years after his birth and his father, King Frederick V, became an alcoholic and neglected him.
123
Neurol Sci
that Christian VII suffered from a neurodevelopmental condition, his possible tics and the behavioral symptoms associated with tic disorders (which include impulse dyscontrol [3] and schizotypal traits [4] ) suggest that Tourette syndrome might offer a valid alternative to his questioned retrospective diagnosis of schizophrenia [5].
References
Fig. 1 Portrait of Christian VII of Denmark (1749–1808)
Moreover, the young prince was notoriously subjected to severe beatings throughout his childhood by his brutal governor the Count of Reventlow. While it is highly likely
123
1. Langen U (2008) Den Afmægtige: En Biografi om Christian VII. Jyllands-Postens Forlag, Aarhus 2. Enquist PO (2003) The Visit of the royal physician. Vintage, London 3. Wright A, Rickards H, Cavanna AE (2012) Impulse control disorders in Gilles de la Tourette syndrome. J Neuropsychiatry Clin Neurosci 24:16–27 4. Cavanna AE, Robertson MM, Critchley HD (2007) Schizotypal personality traits in Gilles de la Tourette syndrome. Acta Neurol Scand 116:385–391 5. Christiansen V (1978) Christian den VII’s sindssygdom. Odense Universitetsforlag, Odense
