Jerome Nriagu, a geochemist who has studied lead’s toxic effects, attributed many of Claudius’ symptoms and negative traits to lead poisoning: “He had disturbed speech, weak limbs, an ungainly gait, tremors, fits of excessive and inappropriate laughter, and unseemly anger, and he often slobbered…his contracting of plumbism would not be surprising, since he was an intemperate glutton.”6 Nriagu also argued that the neuropsychological sequelae of lead poisoning might have clouded the judgment of many Roman emperors.6
Yet some scholars, notably Robert Graves,7,8 have argued that Claudius was highly intelligent and that his copious writing showcased his scholarly interests, hard work, and sound judgment in young adulthood. Based on Graves’ assessment, Claudius probably did not suffer severe plumbism as a child.
Birth injury or cerebral palsy might have caused Claudius’ poor gait and drooling, which were present from childhood. As his drinking and gluttony worsened later in life, alcoholism and lead poisoning could have shortened Claudius’ temper and blurred his judgment, particularly in marrying Agrippina.
Claudius’ belief that he would become a god does not strongly indicate psychosis, because his contemporaries believed that emperors could be deified after death. Opler et al,9 however, found that prenatal lead exposure, as suggested by elevated D-aminolevulinic acid, may be a risk factor for schizophrenia and other psychiatric disorders that manifest in late adolescence or adulthood.
Although we know little about Claudius’ medical problems, abdominal pain has a broad differential diagnosis. Poisoning at Agrippina’s hands or alcohol-induced gastritis, as well as lead-induced abdominal colic, could have caused his intolerable pain.
Bipolar disorder. Claudius’ unrestrained spending, irritability, impulsivity, grandiosity, and mood lability suggest bipolar disorder. Hypomania could have fueled his vast literary output, which has been lost. His belief that he would be deified could also be a manic symptom.
Hypomania was prevalent among Claudius’ family. Two close relatives—his nephew Caligula and great-nephew/adopted son Nero—had marked mood swings. These two emperors were more antisocial than Claudius and showed behavior more consistent with frank mania.
Caligula, who preceded Claudius as emperor, was well known for his excessive behaviors. He was vicious and promiscuous, having sex in public with men, wives of others, and his sisters. Most famously, he considered making his horse, Incitatus, a consul. He gave this horse a “marble stable…a house and a household of slaves and furniture.”10
Nero, who succeeded Claudius, was an alcoholic who frequently indulged his appetites. He believed he was a great singer and became infamous for playing his fiddle while Rome burned. Some of his last words are supposed to have been, “What an artist dies with me!”10
Alcoholism. Some historians have estimated that two-thirds of Roman emperors who reigned from 30 BC (Augustus) to 220 AD (Elegabalus) drank heavily.6 Claudius was reputedly a heavy drinker, and many features displayed by him and his relatives—bad temper, poor judgment, paranoia, impulsivity, violence, and sexual indiscretions—can result from alcohol abuse.
Psychosocial stressors. Claudius was raised and surrounded by malevolent people, then given almost limitless power. That mix of circumstances, plus fear fostered by persistent intrigue, may explain some of his behavior, particularly his brutality.
poll here
The authors’ observations
Had laboratories been available in ancient Rome, a blood test would have determined whether Claudius suffered lead poisoning. Diagnosing bipolar disorder and/or alcoholism is much more difficult. Differentiating these disorders from each other and from other psychiatric disorders is challenging, as no laboratory tests confirm the diagnosis. Ongoing clinical observation of the illness and response to medication are crucial.
In some cases, having the patient list his or her depressive and manic episodes on a “life chart” might clarify the diagnosis. This exercise can also help the patient recognize bipolar symptoms and accept that he or she has the illness, which is critical to ensuring treatment adherence. Also start medication at this time.
Treatment
Treat bipolar disorder and alcoholism simultaneously, as either disorder could worsen the other’s course.11,12
Lithium or valproate would be probable first-line treatments for Claudius. Discuss the medication’s risks and benefits with the patient and involved family members/caretakers. Inform them that you might have to change or add medication if the patient does not respond or experiences side effects.
Psychotherapy and/or psychoeducation are integral to treating comorbid bipolar disorder and alcoholism. Claudius also could have benefited from:
- education about healthy dieting
- counseling against high-risk behaviors associated with alcoholism, such as domestic violence and gambling
- a support group for patients with bipolar disorder or a 12-step program.