Tiberius Claudius Germanicus, age 64 and the third emperor of Rome’s Julio-Claudian dynasty, presents to you and reports, “I have severe stomach cramps. I think my wife is poisoning me, but no one believes me. I need your help.”
Retrospective diagnoses are difficult and sometimes ill-advised, but pondering the psychiatric diagnoses of historical figures can alert us to possible differential diagnoses in today’s patients. Consider this imaginary interview between Claudius and a psychiatrist, which suggests several possible diagnoses.
History: terrible royal childhood
Though born into royalty, Claudius was such a sickly infant that his family was ashamed of him and kept him out of their home. He was raised by servants. As a child, he limped and was ridiculed.
He tells you he received little formal education but had many tutors. He learned several languages and became a distinguished historian, scholar, and writer. He served in the military, both in Rome and overseas. For 13 years he has ruled the Roman Empire but fears he will soon be overthrown.
Claudius’ reign began well. He treated his freedmen advisors well, diligently attended to court proceedings, built an aqueduct, and reorganized the Roman government. Recently, however, he has ruled more eccentrically and harshly. He has ordered capricious and costly public works, such as the futile attempt to drain the 12-mile-long Fucine Lake so that the land could be farmed. He has become fond of gladiatorial games and enjoys ordering the execution of political foes. He drinks several liters of wine daily and gorges himself at imperial banquets.
This patient’s family history is complex (Box) and fraught with antisocial behavior and mental illness. Three previous marriages failed, and he describes his current wife, Agrippina, as powerful and manipulative. She has a son, Nero, from an earlier marriage. Claudius fears being poisoned by Agrippina after she instigates a relationship between Nero and Claudius’ daughter.
Family history: Claudius married his niece, adopted his great-nephew
Claudius lived from 10 BC to 54 AD and ruled the Roman Empire from 41 AD until his death during a feast. Some historians believe that Agrippina poisoned him after her son, Nero, married Claudius’ daughter, Octavia. Because this marriage ensured Nero’s ascendancy to the throne, power-hungry Agrippina no longer needed Claudius.
Claudius was the son of Drusus Claudius Nero and Antonia (the daughter of Mark Antony). His older brother was Germanicus, father of Caligula and Agrippina. Even though Claudius succeeded Caligula as emperor, Claudius was Caligula’s uncle
Nero, in addition to being Claudius’ adopted son, was also his great nephew. When Claudius married Agrippina, he was marrying his niece.
Interview: ‘surrounded by enemies’
Claudius is uncooperative during the interview. He is irritable, tends to bark orders, smells of alcohol, stutters severely, and drools. He admits that he is depressed over myriad family problems.
He also believes that he will become a deity when he dies. He reminds you that he has the power to order executions and wonders if he should have Agrippina and her minions killed. He claims to have written 43 books and numerous historical monographs and to be the last person in the world to speak fluent Etruscan, but laments that no one appreciates his scholarly work. He says he is “surrounded by enemies” and rambles on about family intrigue, cabals, and executions.
He is oriented and shows no florid psychotic symptoms or signs of suicidality. His insight and judgment are severely impaired, and he rejects the idea that he might have a psychiatric disorder.
Claudius refuses a physical exam and abruptly terminates the interview after about 20 minutes, saying he must attend to important affairs of state.
Follow-up: claudius’ ‘last supper’
You want to get more information from family members but wonder if it is safe to do so. It becomes moot: Claudius dies one evening at dinner, days after the interview.
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The authors’ observations
Lead poisoning can cause a range of medical and neuropsychological problems, including attention deficits, antisocial behavior, and irritability.1-4 Romans—particularly the upper class—were exposed to lead from numerous sources:
- Drinking water was contaminated because lead was used extensively to build ancient Rome’s water transportation systems.
- Grape juice fermented to become wine was often preserved in lead vessels, which made it sweeter. The elite drank wine more profusely than did lower-class Romans, who probably could not afford wine. Lead-sweetened grape juice was also used in delicacies eaten by the wealthy.
- The rich also favored expensive, lead-lined bronze bowls and plates, whereas commoners used cheap earthenware. Thus, ancient Rome’s ruling class was ingesting lead-contaminated drink and food.