- Email: [email protected]
Dante Alighieri's narcolepsy
In Context
Focal Point Dante Alighieri’s narcolepsy Dante Alighieri’s (1265–1321) Canto 1 of Inferno describes the memorable episode in which he tries to climb a mountain towards his final redemption but encounters three wild beasts, one of which is a she-wolf, which scares him back down the mountain. As Dante steps back, he stumbles upon his mentor Virgil, to whom he says: “Behold the beast on whose account I turned:/ from her protect me, O thou famous Sage,/ for she makes both my veins and pulses tremble”. The poetic hendiadys in the final verse should be read as “my pulsating veins” or, in other words, “my arteries”. One can examine this famed collocation through a neurological lens and will find what appears to be a very realistic description of an increased pulse rate triggered by a fearful occurrence. Interestingly, this description comes close to that of a fight-or-flight response, first described by Walter B Cannon (1871–1945) in the 1920s,1 namely an autonomic response triggered by a sudden threat. For Dante, nonetheless, the nature of the fearful stimulus might be more appropriately described as an internal fear, or anxiety, quite different from a physical threat, albeit some overlap exists between the two stimuli.2 As Natalino Sapegno (1901–90)3 remarked, the she-wolf is a strong symbolic image capable of triggering a potent fear reaction. On account of the many episodes in Dante’s poems in which he describes sudden wake–dream transitions, hallucinations, muscular weakness, and falls, all of which are caused by very strong emotions, Giuseppe Plazzi4 proposed that Dante migh have had narcolepsy. Because narcolepsy is strongly associated with anxiety,5 this diagnosis could explain Dante’s psychological unrest and subsequent physiological effect. Irrespective of how erroneous Dante’s understanding of human physiology might have been, these verses could represent an ante litteram and fairly detailed description of a narcolepsy-caused, anxiety-driven, fight-or-flight response.
Francesco Maria Galassi, Michael E Habicht, Frank J Rühli 1 2 3 4 5
Cannon WB. Bodily changes in pain, hunger, fear and rage. New York: D. Appleton And Company, 1927. Steimer T. The biology of fear and anxiety-related disorders. Dialogues Clin Neurosci 2002; 4: 231–49. Alighieri D. La Divina Commedia. Volume 1 Inferno. Florence: La Nuova Italia Editrice, 1972. Plazzi G. Dante’s description of narcolepsy. Sleep Med 2013; 14: 1221–23. Fortuyn HA, Lappenschaar MA, Furer JW, et al. Anxiety and mood disorders in narcolepsy: a case-control study. Gen Hosp Psychiatry 2010; 32: 49–56.
www.thelancet.com/neurology Vol 15 March 2016
Lifeline Nanna Finnerup is an Associate Professor at The Danish Pain Research Center at Aarhus University (Aarhus, Denmark). Her main research interests are the physiology of and pharmacotherapy for neuropathic pain. What has been the greatest achievement of your career? Receiving the award as the Supervisor of the Year in 2013 at the Health Department at Aarhus University. It means so much to me that the students appreciate our collaboration and the research at the Pain Centre. What inspires you? Collaboration and discussions with good colleagues and friends at work, in research networks, and organisations such as the Neuropathic Pain Special Interest Group (NeuPSIG). Who have been your most influential teachers, and why? Professor Jens Zimmer. His inspiring teaching in neuroanatomy at medical school (Aarhus University, Denmark) was one of the reasons I chose neurology after my internship. The person who has had the greatest influence on my career in neuropathic pain research is Professor Troels Staehelin Jensen, who has always given me outstanding support, inspiration, and encouragement.
For Nanna Finnerup’s study of pharmacotherapy for neuropathic pain in adults see Articles Lancet Neurol 2015; 14: 162–73 For more on NeuPSIG see http://www.iasp-pain.org/SIG/ NeuropathicPain
What was your first experiment as a child? I don’t recall doing any experiments as a child, but I am trying to convince my own children how exciting it is to do experiments with glasses of cold and warm water in the kitchen to experience the thermal grill illusion (the illusion of burning heat when touching interlaced non-painful warm and cold bars). If you had not entered your current profession, what would you have liked to do? Probably become a mathematician, or a gospel singer—if I could sing. How do you relax? The European men’s handball championship starts soon, and even though it can be quite stressful if it is a close match, watching the Danish team is something that is relaxing and makes me forget things that ought to be done. If you were Bill Gates, how would you spend your fortune? On research and implementation of renewable energy sources, and research of cancer and pain…and a private cook and a house somewhere with mountains, a view of the ocean, and sunshine.
245
Focal Point Dante Alighieri’s narcolepsy Dante Alighieri’s (1265–1321) Canto 1 of Inferno describes the memorable episode in which he tries to climb a mountain towards his final redemption but encounters three wild beasts, one of which is a she-wolf, which scares him back down the mountain. As Dante steps back, he stumbles upon his mentor Virgil, to whom he says: “Behold the beast on whose account I turned:/ from her protect me, O thou famous Sage,/ for she makes both my veins and pulses tremble”. The poetic hendiadys in the final verse should be read as “my pulsating veins” or, in other words, “my arteries”. One can examine this famed collocation through a neurological lens and will find what appears to be a very realistic description of an increased pulse rate triggered by a fearful occurrence. Interestingly, this description comes close to that of a fight-or-flight response, first described by Walter B Cannon (1871–1945) in the 1920s,1 namely an autonomic response triggered by a sudden threat. For Dante, nonetheless, the nature of the fearful stimulus might be more appropriately described as an internal fear, or anxiety, quite different from a physical threat, albeit some overlap exists between the two stimuli.2 As Natalino Sapegno (1901–90)3 remarked, the she-wolf is a strong symbolic image capable of triggering a potent fear reaction. On account of the many episodes in Dante’s poems in which he describes sudden wake–dream transitions, hallucinations, muscular weakness, and falls, all of which are caused by very strong emotions, Giuseppe Plazzi4 proposed that Dante migh have had narcolepsy. Because narcolepsy is strongly associated with anxiety,5 this diagnosis could explain Dante’s psychological unrest and subsequent physiological effect. Irrespective of how erroneous Dante’s understanding of human physiology might have been, these verses could represent an ante litteram and fairly detailed description of a narcolepsy-caused, anxiety-driven, fight-or-flight response.
Francesco Maria Galassi, Michael E Habicht, Frank J Rühli 1 2 3 4 5
Cannon WB. Bodily changes in pain, hunger, fear and rage. New York: D. Appleton And Company, 1927. Steimer T. The biology of fear and anxiety-related disorders. Dialogues Clin Neurosci 2002; 4: 231–49. Alighieri D. La Divina Commedia. Volume 1 Inferno. Florence: La Nuova Italia Editrice, 1972. Plazzi G. Dante’s description of narcolepsy. Sleep Med 2013; 14: 1221–23. Fortuyn HA, Lappenschaar MA, Furer JW, et al. Anxiety and mood disorders in narcolepsy: a case-control study. Gen Hosp Psychiatry 2010; 32: 49–56.
www.thelancet.com/neurology Vol 15 March 2016
Lifeline Nanna Finnerup is an Associate Professor at The Danish Pain Research Center at Aarhus University (Aarhus, Denmark). Her main research interests are the physiology of and pharmacotherapy for neuropathic pain. What has been the greatest achievement of your career? Receiving the award as the Supervisor of the Year in 2013 at the Health Department at Aarhus University. It means so much to me that the students appreciate our collaboration and the research at the Pain Centre. What inspires you? Collaboration and discussions with good colleagues and friends at work, in research networks, and organisations such as the Neuropathic Pain Special Interest Group (NeuPSIG). Who have been your most influential teachers, and why? Professor Jens Zimmer. His inspiring teaching in neuroanatomy at medical school (Aarhus University, Denmark) was one of the reasons I chose neurology after my internship. The person who has had the greatest influence on my career in neuropathic pain research is Professor Troels Staehelin Jensen, who has always given me outstanding support, inspiration, and encouragement.
For Nanna Finnerup’s study of pharmacotherapy for neuropathic pain in adults see Articles Lancet Neurol 2015; 14: 162–73 For more on NeuPSIG see http://www.iasp-pain.org/SIG/ NeuropathicPain
What was your first experiment as a child? I don’t recall doing any experiments as a child, but I am trying to convince my own children how exciting it is to do experiments with glasses of cold and warm water in the kitchen to experience the thermal grill illusion (the illusion of burning heat when touching interlaced non-painful warm and cold bars). If you had not entered your current profession, what would you have liked to do? Probably become a mathematician, or a gospel singer—if I could sing. How do you relax? The European men’s handball championship starts soon, and even though it can be quite stressful if it is a close match, watching the Danish team is something that is relaxing and makes me forget things that ought to be done. If you were Bill Gates, how would you spend your fortune? On research and implementation of renewable energy sources, and research of cancer and pain…and a private cook and a house somewhere with mountains, a view of the ocean, and sunshine.
245