Neurological Disorders in Literary Fiction: A Single Author Case Series
Correspondence Address: Source of Support: None, Conflict of Interest: None DOI: 10.4103/0028-3886.344636
Source of Support: None, Conflict of Interest: None
Keywords: Epidemiology, literature, neurology
Stephen King is the most widely read writer of horror fiction alive today. His masterful dominion over the genre has enabled countless readers to deal with horror from the controlled and safe environment of their homes or reading spaces. Across his vast bibliography, mentions of medical conditions are common. A fact that has previously been noted in the fields of psychiatry and neurology. Nevertheless, the relationship between Mr. King's works and neurology appears to be stronger than what has been previously described since numerous characters endure specific neurological conditions. In some cases, the neurologists are even called into action to deliver the diagnosis. Based on these facts, this study aims to describe the epidemiology of neurologic disorders depicted in the writings of Stephen King.
From 1997 to 2020, the 60 published novels by Stephen King (including seven under the pen name Richard Bachman) were reviewed by the researcher. In each novel, the characters depicting neurological diagnosis were registered, initially in a handwritten list and from 2006 to 2020, in an electronic spreadsheet. When available, the name and age of the character were also registered. To be included in the list, the character in question had to suffer from a neurological diagnosis. The diagnosis itself had to be written in the text of the novel. In the event of the character's demise, only deaths related directly to the neurological diagnosis were registered. Firearm injury to the Central nervous system (CNS) was not recorded, but all other forms of traumatic brain injury were.
Once the list was complete, the frequency, prevalence, lethality, and mortality of each diagnosis were calculated. Even though there is no official account of the total number of characters created by Stephen King, for the calculations, a total of 1,349 characters was used since it is the most extensive list available. The prevalence and mortality rates are expressed per 1,000 cases.
Out of the 60 novels, only 12 (20%) did not portray any characters with a neurological diagnosis. These novels in chronological order of publication were Rage, The Long Walk, The Running Man, The Dark Tower: The Gunslinger, Christine, Cycle of the Werewolf, The Regulators, The Girl Who Loved Tom Gordon, The Dark Tower VI: Song of Susannah, Cell, Gwendy's Button Box, and Elevation.
In each of the 48 remaining novels, at least one character with a neurological diagnosis was present. In total, 150 characters exhibited a neurological diagnosis, for a mean of 2.5 characters per novel (3.1 when counting only those novels with at least one character identified). The novels carrying the highest number of neurologic cases were Under the Dome, The Institute, and The Tommyknockers with 15, 10, and nine cases, respectively. [Table 1] shows the complete list of characters and their diagnosis. The overall prevalence of neurological disorders in the characters created by Stephen King was 111.2.
The median age was 20 years (range 76). Nevertheless, the age was described in only 33 characters (22%). Regarding sex, 100 (66.7%) were males. In one case, the sex was not described (0.7%).
Concerning neurological symptoms, headache was the most common, present in 53 cases (35.3%), followed by symptoms of stroke in 43 (28.7%), seizures in 25 (16.7%), altered consciousness in 15 (10.0%), and cognitive symptoms in 14 (9.3%).
[Table 1] shows the frequency of each neurological diagnosis; the most common was an unspecified stroke, which constituted 22.4% of all the diagnoses. Remarkably, highly specific conditions were present. The examples included cases of Creutzfeldt–Jakob disease, neurosyphilis, and psychogenic nonepileptic seizures. The prevalence rates per 1,000 characters were 24.5, 17.8, 32.6, 8.2, 13.3, and 9.6 for headache, epilepsy, stroke, dementia, TBI (Traumatic brain injury), and CNS cancer, respectively.
In this series, lethality was 28.7% (43 deaths). The highest lethality was associated with the CNS cancer diagnosis (61.5%) and stroke (61.4%), while no fatal cases were present among the patients with headache and dementia. The reports from two autopsies were found, both confirmed the diagnosis of CNS cancer. The overall mortality rate was 31.9 (5.9 for CNS cancer and 20.0 for stroke).
Literary fiction allows the readers to make inferences and invest emotions into complex characters and circumstances that might not be encountered in their lives otherwise.
Although it might seem that Stephen King's stories rely on the supernatural phenomena to induce fear, a careful reading reveals that the actual horror is commonly portrayed through real-life situations, commonly based on facts and general scientific knowledge. This tendency to incorporate elements of the real world into the novels' narrative has produced more than one unnervingly convincing portrayal of real events, even before they take place.
This case series results show that Stephen King's novels contain a vast array of characters suffering from neurological disorders. Moreover, the proportional contribution of the various neurological disorders present in his writings almost perfectly matches the world's burden of neurological disorders, including the age-standardized disability-adjusted life-years rates, which are significantly higher in men than in women.
Through the appreciation of the data analyzed in this study, three main issues come to mind. First, the role that neurological disease plays in Mr. King's work. In some instances, it is used to advance the plot (i.e., a character with severe TBI who cannot possibly be responsible for the crime), and in some other instances, it is more a character attribution (i.e., a character with a chronic severe headache that clouds its judgment or throws him into desperation). Second, the symbolic meaning of neurological disease, as some inevitable ominous force inflicted upon the character with catastrophic consequences just like in real life. And third, the accuracy of Stephen King's presentation of neurological diseases. As a neurologist, this is a fascinating aspect of the novels. The neurological cases present in them can be divided into two main categories: those where the diagnosis appears without further explanation, and details about the evolution of the illness are not provided, and those where a textbook description of the sickness is narrated. The later cases can then undergo the natural history of the disease until the demise, or some intervention is introduced to change the course of natural history. The type of intervention can be medical or supernatural. Elegant examples are the case of a young male described in Under the Dome, who undergoes Sinonasal Cancer (SNC) cancer's natural history and the accurate depiction of a patient with Creutzfeldt–Jakob disease in Revival. Other notable mentions include a character in Duma Key acknowledging that triptans work best for a migraine if taken early in the attack and the inclusion in the Thinner of an extreme hydrocephalus case cited in the medical literature.
Whether these findings are the result of a conscious or unconscious effort is uncertain. However, what is unquestionable is that given Mr. King's impact on the collective culture, his use of neurological disorders as a narrative tool carries the potential to influence the knowledge and awareness toward neurological disorders worldwide.
The relationship between neurology and literature is well established, although it is most commonly described in literary genres distant from horror. Still, the epidemiology described in the novels of Stephen King parallels that of the real world and provides insight into the contribution of neurological disorders to the global burden of disease, of interest for neurologists, and the general population alike.
To Mr. Stephen King for the countless hours of thrill and excitement found in his stories.
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Conflicts of interest
There are no conflicts of interest.