Disney Plus Dream Job: Babes in Toyland

Introduction

Faculty, residents, and students at my university are participating in the Disney Plus Dream Job challenge to watch 30 Disney films in 30 days. Course directors successfully incorporated the 30 films (and shows) into our preexisting curriculum that teaches psychiatry to future physicians through film and other aspects of popular culture. Views Through the Psychiatrist’s Lens will publish daily blogs throughout the Disney Plus Dream Job challenge. Our fifth blog is on the 1961 film, Babes in Toyland.

Synopsis

The official start of the Christmas season is ushered in with the final float in the Macy’s Thanksgiving Day Parade. We kick-off the season with Babes in Toyland (1961); a Christmas musical based on Victor Herbert's 1903 operetta of the same name. The film follows the narrative of Tom Piper who is kidnapped by Roderigo and Gonzorgo who work for the evil Barnaby. At the time of this posting, the film holds a rating of 6.3 out of 10 on IMDb and an audience score of 60% on Rotten Tomatoes.

What it has to do with psychiatry

The Walt Disney adaptation was the second film version of the operetta released to movie theaters and the first in Technicolor. Let’s then consider color playing a central role in the analysis of the film. One “colorful” topic in psychiatry (segue) is an early theory of personality development. Hippocrates theorized that personality was based on temperaments associated with four fluids (“humors”) of the body: choleric (yellow bile from the liver), melancholic (black bile from the kidneys), sanguine (red blood from the heart), and phlegmatic (white phlegm from the lungs).

We are first introduced to Barnaby when Tom and Mary drink a lemonade in Mother Goose Village. In the dance scene (“Mother Goose Village and Lemonade”), we see a polka dot windmill in the background (Figure 1).

Figure 1

Source: Anthony Tobia, MD

Taken together, we follow the symbolism to a literary work from Roderigo and Gonzorgo’s heritage: Don Quixote (1605), which is considered to be the most influential work of literature from the Spanish Golden Age. Simply stated: didn’t the opening scene (Spanish influence, fantasy world, windmill, etc.) remind of and Don Quixote?

For those not familiar with Cervantes’ work, the plot revolves around the adventures of a hidalgo (noble) named Quixano whose behavior isn't reality-based and believes that he is living out a knightly tale. As a result of intemperate reading (Annie Wilkes), he struggles with insomnia which causes his “brain to dry.” In Hippocratic theory, Quixano’s temperament is likely choleric (yellow lemonade bile from the liver), explaining his delusional belief that every word in the fictional books of chivalry to be true. In Renaissance thought, individuals such Quixano who suffered from an imbalance of choleric humor were thought of as violent and short-tempered. Thus, there is a parallel between Quixano from Spanish literary canon and Barnaby in our film.

If we are to make this inference, why then does Barnaby attack windmills that he believes to be ferocious giants? One possible explanation is that similar to Jonathan Swift’s Gulliver, Barnaby is experiencing macropsia (Brobdingnagian hallucinations) as part of an underling medical condition. Such an etiology is central to the understanding of temperament and personality in that a personality disorder can not be ruled-in until medical explanations (e.g. pain syndromes such as migraine headaches) are considered and investigated.

The exact cause of migraine headaches isn’t fully understood. However, neurologists have identified several factors that can induce or trigger a migraine. Once induced, migraine attacks tend to have distinct phases including a a) prodrome, b) aura, c) headache, and d) postdrome.

Triggers

The list of migraine triggers is comprehensive. Some of the more common migraine triggers (1) can be remembered by the acronym BABES IN:

Bright light and fluorescent or flickering bulbs

Alcohol and caffeine; medications

Barometric pressure and other changes in the weather

Estrogen (hormones)

Stress; Sexual activity

Insomnia

Nutrasweet® and other artificial sweeteners (diet)

For Barnaby, stress (greed) and insomnia (if we agree that he’s a reimagined Don Quixote) appear to play an etiologic role in his behavior and therefore may be identified as triggers to his prodrome.

Prodrome

Understanding and identifying prodromal symptoms (2) can further help people manage their disease as these signs signal the need for abortive medication (3). These signs can be remembered by the acronym TOYLAND:

Thirst

Oliguria and frequent urination

Yawning

Lethargy

Appetite (food cravings)

Neck stiffness

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Why Do Antagonistic People Think They’re So Perfect?

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Depression (including irritability, insomnia, difficulty concentrating, and constipation)

A prodromal stage may precede the attack proper (stage C) by 2-3 days (4). Since we only see Barnaby when he’s “in Mother Goose Village” (see aura below), we are unable to identify a prodrome in this case.

Aura

Between 20-25% of people with migraine headaches experience an aura as a distinct phase in the progression of their attack. People experiencing aura might endure periods of paresthesia and visual disturbances such as visual hallucinations. While the head toy maker does complain of paresthesias (upon sticking his foot on the shrunken bed; "My goodness. This is only good if my foot is asleep."), the entire film can be interpreted as a visual hallucination of Barnaby. Visual symptoms occur in more than 90% of migraine auras (5). The perceptual disturbances that Barnaby experiences as Mother Goose Village may be an aura to a migraine headache. Symptoms usually develop gradually over 5-20 minutes and typically last for less than 60 minutes. The loss of time perception may be due to the effects of the headache or its treatment (e.g. opioid analgesics).

Headache

Barnaby does not demonstrate evidence of a headache in Babes in Toyland. “Migraine aura without headache” is the accepted term to describe episodic symptoms (visual hallucinations) believed to be migrainous auras but not followed by a headache. It is a rare variant with an incidence of 3% in women and about 1% in men, respectively (6). For discussion about the postdrome (Stage D), we’ll have to wait for the sequel.

Is Babes in Toyland a case study of a rare neurologic disorder that affects about 1-3% of the population? If not, then it at least serves as a fun and classic platform to review and learn about the triggers, prodrome, and aura of migraine headaches.