A Histrionic Fit 3/3

July 13, 2012July 21, 2016 / Jordyn Redwood / Leave a comment

JoAnn Spears returns to let her nursing prowess diagnose mental illness among long lost monarchs. This series focuses on Elizabeth I and Mary Queen of Scots. Her popular previous series on Henry VIII’s illnesses can be found here:

1. http://jordynredwood.blogspot.com/2012/01/florence-nightingale-diagnosis-henry.html

2. http://jordynredwood.blogspot.com/2012/02/florence-nightingale-diagnosis-henry.html

3. http://jordynredwood.blogspot.com/2012/02/florence-nightingale-diagnosis-henry_03.html

Parts I and II were on Monday and Wednesday.

Today, JoAnn concludes this fascinating series.

A recap of Mary’s career is called for in arguing that she may indeed have had Histrionic Personality Disorder.

· The infant Queen of Scots, a fatherless political football, is punted to France.

Overall, the etiology of histrionic tendencies is poorly researched. Early loss of a parent, or unpredictable parental attention, may contribute to it.

· Adolescent Mary, pampered and acclaimed for beauty and talent, becomes Queen of France.

Lack of constructive criticism and discipline may lead to the emergence of a histrionic personality in adolescence. The pubescent Mary was almost universally doted on. Interestingly, her mother-in-law, that clear-sighted Machiavellian survivor Catherine De’Medici, was not nearly so sanguine about the burgeoning Mary.

· ‘Frenemy’ Mary makes cousinly noises toward Elizabeth I, Queen of England, while touting her own superior Catholic claim to Elizabeth’s throne.

Dramatic statements and lack of sincerity are strongly associated with the histrionic type. Being easily influenced by others is also characteristic; some aver that Mary’s strike at Elizabeth was incited by her scheming French relatives.

· Tragically widowed, Mary returns to backward, barbaric Scotland to reign. She and the unruly Scots clansmen learn the meaning of cultural clash.

Mary made the histrionic decision in choosing not to subdue the flashing of her considerable beauty, style, and elegance at the austere and Puritan Scots court, damaging her chances of political success.

· Wanton Mary, marrying in haste, repents at leisure, heavily pregnant, when her profligate husband helps murder her Secretary, Rizzio, right before her eyes.

Perceiving relationships as being deeper or meaningful than they are, or entering too deeply into shallow relationships, comes with the histrionic territory. Clearly, Mary’s initial assessment of her relationship with Lord Darnley was far from accurate. Likewise, she couldn’t or wouldn’t see how extreme and inappropriate the favoritism she showed her exotic Italian secretary was perceived by those around her.

· Desperate Mary re-widowed via a remarkably sloppy murder. The murderer, Bothwell, is believed to be in cahoots with Mary, if not her lover.

Dependency, the primrose path to getting others to do one’s dirty work, goes hand in hand with histrionic personality disorder.

· Mary is abducted and raped by Bothwell; even her supporters are confused when she marries him shortly thereafter. The legendary ‘Casket Letters’, written by Mary at this time, muddy the waters even further. Political mayhem ensues; Mary is captured by the Scottish clansmen.

Histrionic individuals are known to rashly shift from one perspective or plan to another. This can put them in the way of situations and relationships that are unstable or even threatening to their well-being or safety.

Histrionic communication comes across broad and vivid, creating an abstract-art, paint-can canvas of feelings rather than a crisp, clear snapshot or a delicately layered oil painting. In light of this, the heaving emotion and incidental minutiae of the Casket Letters comes as no surprise.

· Charmer Mary wriggles out of Scotland and over to England. Bothwell legs it to Denmark, where he dies after years spent chained by the ankle to a stake in a miniscule basement cell.

Darnley, Rizzio and Bothwell were not the only men who came a cropper in Mary’s wake. The poet Chastelard was executed for romantically hiding under her bed. England’s prime nobleman, Norfolk, was brought low by scheming to marry her. Her sex appeal blasted the career and marriage of Lord Shrewsbury, her eventual jailor. Lack of concern for the impact of one’s drama on others highlights the histrionic trajectory.

· Mary is imprisoned in England; her earlier claims to the throne of Elizabeth I have come back to haunt her. For years, she is moved from prison to prison by her jailors, and feels justified in plotting with politicos across Europe to assassinate Elizabeth I. She is a poor plotter, though, and falls for a sting operation known as The Babbington Plot.

Histrionic people have a strong need to be at center stage. Fading into background, keeping a low profile, and having only a bit part to play do not sit well with them. Mary could not allow herself to be forgotten by the European political world. She did all she could to stay on stage with them, even at risk of her own life.

· Mary, touting herself as a Catholic martyr, is executed by decapitation; her terrier dog is found hiding in her skirts at the scene and dies a few days later from grief.

Constant seeking of the approval and reassurance of others rounds out the histrionic personality. Mary, with histrionic insouciance, took herself from screaming drama queen to subdued sainthood without blinking. Such sainthood would bring her the approval of Catholic Europe, and ultimate vindication both from heaven and earth.

Mary’s legendary terrier dog, and his sad fate, bring home the final point about people with Histrionic Personality Disorder. View them as you will, saints, sinners, charmers, or victims, they are among the most compelling people you will ever meet.

Thank you JoAnn for such a wonderful series. Fascinating person she was!

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Six of One was begun in JoAnn’s native New Jersey. It was wrapped up in the Smoky Mountains of Northeast Tennessee, where she is pursuing a second career as a writer. She has, however, obtained a Tennessee nursing license because a) you never stop being a nurse and b) her son Bill says “don’t quit your day job”.

Drama Queens 2/3

July 11, 2012July 21, 2016 / Jordyn Redwood / Leave a comment

1. http://jordynredwood.blogspot.com/2012/01/florence-nightingale-diagnosis-henry.html

2. http://jordynredwood.blogspot.com/2012/02/florence-nightingale-diagnosis-henry.html

3. http://jordynredwood.blogspot.com/2012/02/florence-nightingale-diagnosis-henry_03.html

Part I was Monday.

There are four types of Cluster B personality disorders. Two of them, the Antisocial and Borderline Personality types, tend toward, but are not absolutely divided between, gender lines.

Antisocial personality is a diagnosis most often associated with law-breaking males. Disregard for the feelings or rights of others are hallmarks of this disorder, as are scorn for rules and social norms in general.

Elizabeth I’s father, Henry VIII, went from Defender of the Catholic Faith to excommunicated renegade over non-consummation of his sexual relationship with Elizabeth’s mother, the enigmatic Ann Boleyn. He could easily be touted as a prime example of this disorder. Mary Queen of Scots’ father, James V of Scotland, likewise had antisocial tendencies. His acknowledged illegitimate offspring outnumbered his legitimate children 3:1.

Borderline Personality has, in what is perhaps a gross oversimplification, been interpreted as the female side of the antisocial disorder. Fragmentation of personality, ‘bleeding into’ significant others, and detachment from reality, often for manipulative or self-serving purposes, are associated with this disorder; when it comes to the latter, one is tempted to invite Ann Boleyn to take a bow.

Both Mary Queen of Scots and Elizabeth I could behave in remarkably self-serving and unrealistic ways. However, each maintained, despite ups and downs, a solid and defined self from which each might venture at times, but to which stronghold each always returned, Mary on the Catholic side, and Elizabeth on the Protestant.

Where, then, do these two legendary queens fall on the personality disorder continuum?

There are two remaining personality disorders in Cluster B. Drama is central to both. The narcissistic personality could be said to generate drama within the self and inflict it on others. The histrionic personality, on the other hand, often drags drama from others, or somehow incites it from them. Those ‘others’ can be a varied lot; charmed volunteers, partners in crime, unwitting victims, or opportunists with an eye on the main chance.

Narcissistic personalities are preoccupied with issues of personal adequacy, power, prestige and vanity. These are ego-building structures in most people, but can become ego- challenges when underpinned by extremes of parenting in vulnerable individuals. Elizabeth I never knew her mother. Her father, Henry VIII, vacillated between tolerating Elizabeth, neglecting her, and avoiding her. A trusted stepmother, Katharine Parr, exposed her to exploitation by an irresponsible would-be stepfather. A fond surrogate mother, Kat Ashley, probably spoiled Elizabeth rotten, and ultimately set the stage for the conflicted personality that was inherent in Elizabeth, but yet to emerge. The likes of Walter Raleigh, Francis Drake, Shakespeare, the Lord Essex, and many more knew what it was like to live in the glare of that drama, directly or indirectly. For some, like Drake, it led to glory; for the likes of Essex, it led to an early death; for Sir Walter Raleigh, it brought both defeat and victory.

And so we are left to consider Mary, Queen of Scots, and the diagnosis of histrionic personality disorder.

JoAnn will conclude her series on Friday.

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Disorders in the Court 1/3

July 9, 2012July 21, 2016 / Jordyn Redwood / Leave a comment

JoAnn Spears returns to let her nursing prowess diagnose illness among long lost monarchs. This series focuses on Elizabeth I and Mary Queen of Scots. Her popular previous series on Henry VIII’s illnesses can be found here:

1. http://jordynredwood.blogspot.com/2012/01/florence-nightingale-diagnosis-henry.html

2. http://jordynredwood.blogspot.com/2012/02/florence-nightingale-diagnosis-henry.html

3. http://jordynredwood.blogspot.com/2012/02/florence-nightingale-diagnosis-henry_03.html

Part I is today. Parts II and III will be on Wednesday.

Welcome back, JoAnn!

It’s said that good judgment comes from experience, and that experience comes from bad judgment. England’s Elizabeth I is a fine example of this aphorism. Early misalliances with her exploitive stepfather Tom Seymour, and the less-than-suitable Earl of Leicester, for example, cost her dearly on a number of fronts. Nevertheless, she learned some lessons and finished the game as England’s own Gloriana, its supreme diva and arguably most successful monarch.

Mary Queen of Scots’ fund of experiences was also remarkable, even for someone of her rank and stature. Unfortunately, the tragic Stuart queen failed consistently at making her fund pay dividends of sound judgment and good choices. She was less challenged and far more advantaged, at the outset of their reigns, than her most famous contemporary–and relative–Elizabeth I. Still, she made choice after choice that led to an almost unbelievably disastrous trajectory and culminated in a lengthy and ignominious imprisonment. She died facing Elizabeth I’s executioner on what amounted to a gibbet of her own devising. What made the difference in the way things went for these two powerful and legendary women?

The point at which combinations of personality traits amount to health and success, or dysfunction and disaster, is not always easy to identify. Mental Health diagnosticians use a guide called the Diagnostic and Statistical Manual (DSM), now in its fourth revision, to help them make this determination in a systematic way.

The DSM IV categorizes mental health conditions into different spectrums, or Axes.

The first Axis contains the major mental disorders. These are the ones non-professionals often associate with mental health and illness; bipolar disorder and schizophrenia, for example.

The second axis categorizes conditions known as personality disorders. These are characterized by enduring, pervasive patterns in the way individuals think, feel, relate to others, and control–or fail to control–their impulses. There are three clusters of personality disorders.

People with Cluster A disorders tend to behave in ways that would be considered odd, eccentric, isolative, or even paranoid. Certainly, neither Mary nor Elizabeth were ever dismissed as odd; both were far too flamboyant and vivid for that, and both were at their best performing to an appreciative audience.

Cluster C disorders are associated with anxiety, inhibition, neediness, preoccupation, rigidity, and submissiveness. ‘Bloody Mary’ Tudor, sister of Elizabeth I, comes to mind here. Her religious zeal, which lead to the burning of numerous ‘heretics’, is what history at large remembers her for. Tudor aficionados will also note the pathetic, neurotic quality of her relations with the world at large, and with her husband, Prince Philip of Spain, the prototype ‘Cold Fish’ of the Renaissance era.

This leaves us, obviously, with Cluster B personality disorders. Dramatic, erratic, impulsive, tumultuous, and attention-getting, the folks in this Cluster are the ones who, in modern parlance, command the room. Clearly, both Mary Queen of Scots and Elizabeth I deserve a second look from a perspective that minimizes judgment of them, and demands a full and constructive exploration of their complex and fascinating personalities.

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JoAnn Spears is a registered nurse with Master’s Degrees in Nursing and Public Administration. Her first novel, Six of One, JoAnn brings a nurse’s gallows sense of humor to an unlikely place: the story of the six wives of Henry VIII. Six of One was begun in JoAnn’s native New Jersey. It was wrapped up in the Smoky Mountains of Northeast Tennessee, where she is pursuing a second career as a writer. She has, however, obtained a Tennessee nursing license because a) you never stop being a nurse and b) her son Bill says “don’t quit your day job”.

Florence Nightingale Diagnosis Henry VIII: Part 3/3

February 3, 2012July 21, 2016 / Jordyn Redwood / Leave a comment

This has been an amazing series by JoAnn Spears. I’ve enjoyed having her and I hope you learned something new about medicine during Henry VIII’s time.

Baby blues

Nursing Diagnosis: Sexuality Pattern, Ineffective

Nursing Diagnosis: Role Performance, Ineffective

In Tudor times, one of the main imperatives on a king was to father sons. Henry’s inability to achieve this goal was the impetus behind the Reformation in England, and has been made much of in fact and fiction. The fact is, though, that his full complement of male children was two legitimate sons, and one illegitimate son. One of the legitimate boys died in infancy and the other, Edward VI, died in his teens. The illegitimate Henry Fitzroy died shortly after he was married, at the age of seventeen. Henry also fathered two healthy girls, Mary I and Elizabeth I. He was in his mid-forties when he sired his last child.

Rhesus or Kell issues, in which incongruent parental blood types can cause a stillbirth or compromised infant, have been suggested as causes of the many miscarriages suffered by Henry’s first two wives. However, his first healthy daughter was born subsequent to his first wife having a succession of pregnancies, which is quite the opposite trajectory to that usually seen with such incompatibilities.

Syphilis, which, untreated, can lead to mental health problems in both parents and offspring, is an embedded but unlikely part of Tudor medical lore. Henry’s impulsive and violent propensities were not described by contemporaries in a way associated with the dementia and deterioration typical of tertiary syphilis. Also, none of Henry’s surviving children exhibited symptoms of congenital syphilis.

Henry’s first three wives each conceived quickly after marriage and, in the case of the first two, conceived multiple times. None of his subsequent three wives conceived. Henry’s symptoms of substantial weight gain and compromised circulation became noteworthy around the period between Henry’s third and fourth marriages. Erectile dysfunction is another potential side effect of both diabetes and poor circulation, and would account for a lot of the personal history of Henry and his last three wives.

Exit strategy

Nursing Diagnosis: Mobility: Bed, Impaired

Nursing Diagnosis: Risk for Compromised Human Dignity

Henry VIII’s last years were anything but majestic. The handsome, charming, 6’2” blond athlete of earlier days was a bloated, irritable, sickly being who was largely confined to bed and chair. A mechanical hoist was required to get the king onto a horse once he donned his outsized armor. The purulence of his leg ulcers caused a nauseating stench. His very last days, in which he was confined to his bedchamber, were spent hammering out a succession plan for the progeny he and his sisters would leave behind.

Henry was in his mid-fifties when he died. During the era he lived in, his would not have been considered an advanced age, but a death at that age was certainly not considered untimely. The actual cause of his death is unknown. An embolus to the heart or lung has been suggested. However, either of these would probably have killed Henry quite quickly, and there were days’ worth of succession planning and priestly officiating before the death. Stroke has also been suggested, but the tenor of the deathbed activity around him is not entirely congruent with the suddenness of a cerebrovascular event. Given the circumstances, the eventual succumbing of a once-healthy body to years of chronic disease seems as likely an explanation as any of Henry’s death.

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JoAnn Spears is a registered nurse with Master’s Degrees in Nursing and Public Administration. Her first novel, Six of One, JoAnn brings a nurse’s gallows sense of humor to an unlikely place: the story of the six wives of Henry VIII.

Six of One was begun in JoAnn’s native New Jersey. It was wrapped up in the Smoky Mountains of Northeast Tennessee, where she is pursuing a second career as a writer. She has, however, obtained a Tennessee nursing license because a) you never stop being a nurse and b) her son Bill says “don’t quit your day job”.

Florence Nightingale Diagnosis Henry VIII: Part 2/3

February 1, 2012July 21, 2016 / Jordyn Redwood / Leave a comment

Today, JoAnn Spears continues her nursing evaluation of Henry VIII.

The King’s pains.

Nursing Diagnosis: Tissue Perfusion, Ineffective, Peripheral

Nursing Diagnosis: Pain, Chronic

Nursing Diagnosis: Skin Integrity, Impaired

Henry VIII and his bandaged, suppurating, painful legs are the stuff of Tudor legend, as is “the gout”. Gout was common in Henry’s time, when diets were high in triggering, purine-rich foodstuffs such as beer, ale, and organ meats. Gout does cause excruciating pain in the lower extremities, but it tends to be episodic and associated with inflammation, rather than chronic ulceration. If Henry did have gout, it may have been the least of his problems.

Poor peripheral circulation seems a more likely explanation of Henry’s lower extremity woes. The weight and immobility that were part of his life after the age of about forty could certainly have caused or contributed to this condition. The weight gain may in turn have been either the cause or the effect of type 2 diabetes. This is the type of diabetes which is acquired later in life. To continue a sad spiral, diabetes also contributes to lower extremity problems such as easily damaged skin, neuropathic pain, and ulcers that will not heal and become chronically infected.

Size Matters.

Nursing Diagnosis: Nutrition, Imbalanced: More than Body Requirements

Diabetes is a disorder of glucose metabolism, and type 2 diabetes is associated with excess food intake. Henry’s much vaunted gluttony and his weight in middle age—estimated by some to be as much as five hundred pounds—argue strongly in favor of this diagnosis, but not exclusively.

Hypothyroidism is also associated with weight gain and mental irritability such as Henry displayed. This condition is, though, more commonly seen in women than in men.

Tudor portraiture makes a strong argument for Cushing Syndrome as the cause of Henry’s obesity. Pituitary tumors which disrupt normal cortisol activity are a frequent cause of this disease. Portraits of Henry in later life feature the typical moon face of Cushing’s Syndrome and the characteristic distribution of excess fat deposited in the core rather than the extremities. Ironically, Cushing’s Syndrome can also cause or exacerbate mental status changes and diabetic processes, as well as erectile dysfunction

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Florence Nightingale Diagnosis Henry VIII: Part 1/3

January 30, 2012July 21, 2016 / Jordyn Redwood / Leave a comment

I’m so excited about hosting JoAnn Spears and her series on Henry VIII’s medical issues. I have my own personal theories as to what caused Henry’s demise. What are yours?

Welcome, JoAnn!

Henry VIII never had nursing care as we know it today. In his time, care of the sick fell to family members or servants, generally female. Henry’s last wife, Katherine Parr, certainly fulfilled this role for Henry.

Obviously, the modern medical testing which can categorically confirm or rule out disease cannot be brought to bear on Henry’s case. Nursing diagnosis, which evaluates the human responses to alterations in health status, can be, and can elicit useful medical information about Henry VIII for those writing Tudor fiction.

A mind is a terrible thing…

Nursing Diagnosis: Risk for Injury

Nursing Diagnosis: Thought Process, Disturbed

Nursing Diagnosis: Violence, Risk for

Henry VIII excelled in all of the sports and athletic activities enjoyed by the Tudor nobility. He wrestled, hunted on horseback, played tennis, jousted and danced.

Henry VIII suffered a serious fall from a horse while jousting in 1536, at the age of forty-four. He lost consciousness for a period of time after the fall, indicating that a significant brain injury may have occurred.

This event coincided with the beginning of Henry’s divesting himself of his second wife, Ann Boleyn. As is well known, he eventually went on to execute Ann, another wife, and numerous friends and political advisors.

It has been suggested that this head injury ‘turned’ Henry VIII violent. In view of his track record prior to the injury, this theory is not 100% supportable. That track record includes the executions of Bishops More and Fisher and the ruinations of Henry’s first wife and of his erstwhile friend Cardinal Wolsey.

Porphyria, a genetic condition of the metabolism, has also been mooted as a cause of Henry’s mental proclivities. The disease causes numerous physical and mental symptoms, including mental irritability and derangement. Arguments that porphyria caused the “madness” of George III, a distant Tudor relative, bolster the porphyria theory, but not convincingly. McLeod Syndrome, a genetic blood disorder with some similar symptoms to porphyria, seems a likewise distant possibility.

Of course, there is no physical evidence extant to support any argument for a genetic condition causing Henry VIII’s various symptoms. A look at his family tree, though, might shed some future light on such a possibility.

Henry’s elder sister, Margaret, was, like Henry, significantly overweight. A descendant of Margaret’s, Queen Anne the Good (1665-1714), is probably the Tudor relation whose health issues most closely resemble Henry’s. She suffered severe obesity later in life, lower leg pain and ulceration, functional immobility, and a very sad reproductive history. She had at least seventeen pregnancies, which produced only four live children who died in infancy and one very frail hydrocephalic boy who died in his teens. Her possible medical diagnoses have never aroused the interest that Henry’s have, but a thorough comparative study of Anne’s and Henry’s health issues might prove informative. Diabetes, hypothyroidism, and Cushing’s Syndrome would all likely feature as “rule in/rule out” diagnoses in such research.

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