Kris Dreemurr (they/them) of the Pnictogen Wing

A long long time ago I watched a movie starring one of my favorite British character actors, Sir Nigel Hawthorne (the Sir Humphrey Appleby of my childhood, for I was a keen fan of "Yes, Minister") playing George III of England, having one of his spells of mental instability that are thought to have been caused by acute intermittent porphyria: a metabolic disorder in which porphobilinogen, a biochemical precursor in the body's synthesis of heme, accumulates in the urine and sometimes causes it to turn unusual colors.

The 1990s Madness of King George film is keen to show how the court physicians who were all obsessed with some particular physical symptom or method of treatment, something they put all their trust in like, such as giving him purgatives or focussing on his bowel movements, while only one radical new man named Francis Willis seems capable of directly addressing the derangement of his mind.

And yet there's a scene in the film which explicitly shows how the court physicians, despite their trust in physical investigations and treatments, roundly dismiss a piece of physical evidence that they simply have no place for in their formulaic approach to doctoring: King George's piss turns purple, and nobody except the lower classes seems to notice or care. Surely it must mean something? But the physicians blow off the symptom.

(cont'd)

Nov 25 at 8:23pmWeb
Show threadKris Dreemurr (they/them) of the Pnictogen Wing1d ago

The understanding of organic chemistry and biochemistry that would have enabled some perceptive physician to deduce a possible metabolic disorder from the unexpected appearance of porphobilinogen in the urine just wasn't there. Why urine was any particular color at all was, I suspect, very imperfectly understood in King George's time. Urobilin, the primary organic coloring matter in human urine, was not discovered until 1868.

But the film takes care to note that the strangely colored urine disappeared as a symptom after King George emerged from his psychotic break. The hint was there of a physical marker of the strange disease which afflicted George III and which eventually led to his permanent derangement and death.

(cont'd)

Show threadKris Dreemurr (they/them) of the Pnictogen Wing23h ago

In other words, an obvious piece of physical evidence simply went ignored, discarded as negligible, because it did not fit into whatever scheme George's physicians had learned about the significance of a sick person's urine. And while the film's shallow presentation of the court doctors as mere figures of fun (or pettifogging authoritarians much like the Italian musical men of Amadeus) doesn't get this across, there IS a solid general principle to keeping track of a patient's eliminations.

The frequency of these excretions, and their approximate range of expected physical composition, in a healthy organism are likely to hover around some definite mode. This is the result of homeostasis, the maintenance of approximate chemical equilibrium through the organic body. A being in homeostasis will be excreting urea and ionic compounds and other common constituents of urine in a relatively steady manner, a slow chemical oscillation between normal thresholds of concentration.

(cont'd)

Show threadKris Dreemurr (they/them) of the Pnictogen Wing23h ago

Even if the physicians of George III's time didn't know any fine details about the composition of the King's piss, they would have had broad physical observations to go on: frequency and quantity of urination, specific gravity, raw quantity of dissolved solids per unit volume, and so forth. Color would have been one of those basic pieces of information, and yet it was very unlikely that any of those court doctors could have gotten anything more out of the symptom beyond the bare obvious: "when George's pee is the wrong color, he's likely to be sick in the head."

But I suggest that there was always some chance, however small, that the right person existed back then—at the time of "The Madness of King George"—who could have inferred something truly significant from the urinary anomaly, given the matter a previously unprecedented amount of intellectual scrutiny, and worked out something the underlying nature of the metabolic disorder, a century before acute intermittent porphyria was first described as a definite condition.

(cont'd)

Show threadKris Dreemurr (they/them) of the Pnictogen Wing22h ago

That leaves open the question, though: if there's a physical symptom that is quite definite, yet evading any obvious connection with a mysterious disorder, then how should one go about studying and analyzing the phenomenon, in the most general possible way?

And that touches upon a central conundrum of regarding human beings as sick in any way: ultimately it's the patient's decision, in a free society. If a patient feels they've got some sort of condition or disorder, they will be themselves the gauge of the disorder. The patient has some intuitive grasp of their own homeostasis. They know what it feels like to be well, everything humming along in some sort of happy equilibrium. Therefore they know what sickness is: a persistent departure from that equilibrium.

(cont'd)

Show threadKris Dreemurr (they/them) of the Pnictogen Wing22h ago

Well... that's the theory, anyway.

In practice, here in the United States at least, the commonly accepted notion of who's sick and who's well is increasingly out of the hands of the individual. One is determined by some external authority to be sick or deranged in some way, according to an officially accepted and recorded diagnosis.

Thus, for example, has #autism become routinely discussed as if it were an epidemic in need of treatment even though (a) to be autistic is not to be infectious and (b) autistic persons themselves, left to their own devices and allowed to make their free decisions, do not regard their autism as a disease any more than one would regard flat feet or myopia as a "disease" even if it was an inconvenience to one's life in some minor respects.

(cont'd)

Show threadKris Dreemurr (they/them) of the Pnictogen Wing22h ago

If Christian extremists or other similarly intolerant persons were to go on a crusade against a purported epidemic of near-sightedness caused by (oh, let's say) childhood vaccination or common food additives, and demand immediate and far-ranging social changes in order to protect their children's visual acuity from being corrupted by measles shots or food dyes deliberately pressed on children with full knowledge of the danger to eyesight, that would be an incomprehensible moral panic of approximately similar weight to the reactionary Christian panic about #autism.

There are parents who can't pounce fast enough on some medicalized way of regarding their children as broken.

(cont'd)

Show threadKris Dreemurr (they/them) of the Pnictogen Wing22h ago

If we inhabited an alternate Universe in which autism did not exist, these same extremist parents would latch onto some other disorder that they regarded as (a) intolerable and impossible to live with in peace, and (b) conveniently caused by something obvious and nefarious, like chemicals in the clouds or mysterious food additives. Left-handedness would be construed as a badge of corruption, or speech impediments.

#Autism, however, seems to have this one important trait, as a universal cause of childrens' ruination: by the miracle of doublethink, if you're the right sort of person, with a high enough social status, it's GOOD to be #autistic. It's special.

~Chara of Pnictogen

Show threadClaude LeChat14h ago

@kris_of_pnictogen Being left-handed literally used to be treated that way. You're a tiny bit different from the norm? Burn the witch!

(Also being thin, reading books... the list goes on.)