“The Wizard of Oz:” A Depiction of TBI-Related Neurobehavioral Syndromes

Abstract

“TheWizard of Oz,” a musical produced in 1939, based on Frank Baum’s classic children’s book, “The Wonderful World of Oz,” has become one of the most famous films of all time (1). The story’s enduring place in American cultural and film history is supported by the 13 Oz sequels Baum wrote in response to popular demand, the annual airing of the movie by television networks since the 1950s, and the successful contemporary Broadway production of “Wicked,” the backstory to the original production. The musical depicts Dorothy, a young girl discontented with her life on a rural Kansas farm, who is knocked unconscious during a tornado and dreams of amagical trip to a land called Oz, peopled with familiar faces from her life. Her journey ends when she realizes her own power to return home, and develops a new gratitude for her relationships in the waking world. The story lends itself to interpretation, and “The Wizard of Oz” has been viewed as an allegory for the American debate over the gold standard (2), adolescent sexual development (3), and the lesbian and gay movement’s struggle for cultural acceptance (4). It has also been called a “parable of injury, loss, and redemption” (5): “when you have lost your brain, youmightwant to go on a journey to find a wizard to give you a new one.” If extended further, this comment points to the film being a useful depiction of the complications and course of traumatic brain injury (TBI) survivorship. More specifically, Dorothy’s dream of the Scarecrow, the Tin Man, and the Cowardly Lion accurately represents the three traumatic brain injury syndromes often experienced by brain-injured patients, namely, the syndromes of dysexecutive confusion, apathy, and disinhibition. We have found a usefulness in the famous “Wizard of Oz” story both for understanding and learning these complex clinical syndromes associated with TBI. As detailed in a recent volume of the journal Psychiatric Annals (6), awareness of the effects of traumatic brain injury is an important educational goal for psychiatric residents in training in the 21st century. Traumatic brain injury is the signature injury of soldiers and veterans of the current wars in the Middle East. Sports organizations and occupational health organizations are increasingly concerned about the prevalence and acute and long-term effects of all severities of brain injury, including concussions. Psychiatric residents will find themselves caring for TBI survivors in all treatment settings, as TBI-related symptoms and disability are common in patients with mental illness, can complicate the diagnosis and treatment of mental disorders, and predispose patients to future psychiatric morbidity (5). However, the syndromes of TBI are given little attention in most psychiatry residency training curricula. For practitioners not formally trained in behavioral neurology and brain circuitry, it can be challenging to relate to and retain specific information about these syndromes. The three characters of the Scarecrow, the Tin Man, and the Cowardly Lion as exemplars of dysexecutive confusion, apathy, and disinhibition, fit naturally with our human tendency to retain information in triads, and provide an animated resource on which to hang a description of these presentations that most psychiatrists will encounter in some context. Teaching and describing these syndromes is simple, but developing a teaching method that enlivens the information and provides a mechanism to store the information is another matter altogether. We believe that “The Wizard of Oz,” as ametaphor for brain injury, is quite powerful in this endeavor, and is easily used in didactic settings for residents and medical students to educate them about the sequelae of TBI. Received January 27, 2011; revised August 10, 2011; accepted August 26, 2011. From the Dept. of Psychiatry, University of NewMexico, Albuquerque, NM. Send correspondence to Dr. David Quinn, Dept. of Psychiatry, University of New Mexico, Albuquerque, NM; e-mail: dquinn@salud. unm.edu Copyright © 2012 Academic Psychiatry