Polite Dissent

Chapter Four of Naoki Urasawa’s Monster only has two brief medical scenes in it, but it is a key chapter with a murder (or two, or three).

In the previous chapter, Dr. Tenma found himself demoted from Head of Neurosurgery for choosing to operate on a young boy rather than the mayor. In this chapter, the police try to question Anna, the boy’s twin sister, but with no results. Meanwhile, the Hospital Director, his crony, and the recently promoted Head of Neurosurgery decide to milk the situation for all the PR they can, and decide to stage a photo-op with the two siblings, even though disturbing the boy is contrary to what his physician — Dr. Tenma — has ordered. The boy wakes up, the sister screams and collapses, and Tenma is forced off the case. This combined with seeing his ex-fiancee Eva going out with one of his colleagues drives Tenma to a long night of drinking. That same night, three of his superiors are found dead.

• Medical annotations of the previous chapters of Monster

I disagree with the doctors here: dissociative hysteria is an incorrect diagnosis. First, it is an out-of-date (and somewhat sexist) term. Second,it applies to people with dissociative identity disorder (formerly called multiple personality disorder). Anna simply has none of the symptoms of identity disorder.

I agree that she is suffering from some form of dissociation. In dissociation, a person who has suffered some form of trauma mentally distances themselves from their own body and personality. The Mayo Clinic describes it well: “People with dissociative disorders chronically escape their reality in involuntary, unhealthy ways ranging from suppressing memories to assuming alternate identities. These dissociative patterns usually develop as a reaction to trauma and function to keep difficult memories at bay.”

Anna is suffering from dissociative amnesia and what appears to be a dissociative catatonia (a state of limited — if any — motor activity and no response to external stimuli)

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Anticonvulsives (more commonly called anticonvulsants) are medications used to prevent seizures. They are given to people who have a history of seizures (as in epilepsy), but are also sometimes given to people who do not any prior history of seizures but are at risk of developing them in the near future. Brain trauma, brain tumors, and other brain injuries can cause seizures, so these patients are sometimes placed on medication to prevent them, just in case. Some neurosurgeons place their patients on anticonvulsants after brain surgery for six to twelve months because seizures are more likely while these people are healing from their surgery (though still rare).

Hypotensive is another term for blood pressure medicine (“hypo” = low, “tensive” = pressure). Dr. Tenma wants to keep Ms. Hankel’s blood pressure low. This will put less strain on the blood vessels in her brain. He is most likely concerned about a stroke or aneurysm. I suspect Mrs. Hankel had an aneurysm that bled. He managed to repair it, but wants to keep her blood pressure low so it is unlikely to bleed again, and wants to keep her on seizure medications while her brain heals, just in case.

Tags: comics medicine amnesia catatonia dissociation seizure blood pressure naoki urasawa monster