Fairy tales as practice in reality testing

dults tend to forget the amount of effort children must spend on separating reality from fantasy. Basic skills like understanding object permanence—the idea that objects continue to exist when we can't see them—are not innate but must be learned. Children also need to disentangle the mysteries of cause and effect. That's where fairy tales come in.

In 2019, Dr John Massie of the Dept of Paediatrics at University of Melbourne wrote a paper ^[1] about how fairy tales reveal medical conditions. Sleeping Beauty, for instance, may have been infected by the protozoan Trypanosoma brucei. Rapunzel may have had a combination of trichotillomania (hair-pulling) and gastric bezoar, which often occur together in a condition known as Rapunzel syndrome. Little Red Riding Hood clearly had a vision problem, while Snow White's apple probably was contaminated with Listeria cytomonogenes, a bacterium that can induce coma. The Wicked Witch probably had aquagenic urticaria, making her susceptible to water. And if only Tiny Tim had obtained adequate blood levels of vitamin D, he might never have needed a crutch.

Dumbledore in a previous incarnation

Immunologists have asked what vampires in folklore can teach us about immunology. The answer seems to be: not very much.

But for neurologists and psychiatrists, fairy tales are a gold mine. A common characteristic is the presence of magical phenomena: animals and inanimate objects talk, wear clothing, and carry pocket watches; paintings give advice and people change into animals or vice versa. Improbable astronomical events occur. The reason these are so enjoyable to children is that one of the primary tasks a child faces is to learn to distinguish reality from fantasy. This is called reality testing, which is the ability to monitor and assess the validity of beliefs and suppositions via reference to external sources of information.^[2]

Psychiatry researchers have found evidence that failures of reality testing may underlie delusional beliefs that occur in schizophrenia ^[3]. Seabury et al. ^[4] found that early SZ patients were more confident about errors they made, indicating deficient reality testing that leads to impaired belief formation—falsely concluding, for example, that internal voices are coming from outside. The authors speculated that this may explain the genesis and maintenance of delusions and hallucinations.

By captivating the child's imagination, the mixture of realistic and unrealistic phenomena in fairy tales challenges their minds, giving them practice in distinguishing reality from fantasy.

To see this, let's look at two recent fairy tale movies with a view to seeing the similarities with drug-induced hallucinations and psychotic delusions: The Secret of Moonacre and Harry Potter (warning: spoilers ahead [sort of]).

The Secret of Moonacre

On the surface, the 2008 movie The Secret of Moonacre seems like an endearing children's fairy tale:

A teenage girl falls upon hard times and is forced to move to her uncle's luxurious castle in the countryside. On waking up after her first night there, she discovers a gingerbread cookie next to her bed. Apparently unaware of the long history of bad things happening to fairy tale characters who fail to inspect food wrappers for possible tampering, she takes a bite of the cookie and notices a strange taste. After ingesting more carbohydrates later on, her glycogen levels are restored and like a typical teenager she makes a beeline for the forbidden forest.

By now, whatever was in those cookies has started to take effect. She discovers that she is a princess and that the community is embroiled in a feud, which is a violation of the laws of nature. This has led to a curse whereby the Moon is about to crash into the town, killing everyone. Failing to propitiate Nature by giving up a magical totem, she has no choice but to jump into the ocean and sacrifice herself to save the community. However, instead of drowning, the girl suddenly finds herself riding on a unicorn with an expression of utter bafflement as to how she got there. Her hallucinations have stopped . . . mostly . . . .

It turns out that the magic talisman caused the feud in the first place by forcing everyone to tell the truth. When she got rid of it, people were able to lie to each other again. Peace was restored and they all lived happily ever after. Or so they said.

To an adult, the story is preposterous. But the story has examples of object impermanence, where a character jumps magically from one location to another, as well as improbable astrophysical phenomena, which would challenge a child's mind.

Harry Potter

The most famous modern-day fairy tale is, of course, Harry Potter. It's a classic what-if story: what if medieval magic was real? It's a wonderful, uplifting, and charming story of likeable characters bonding, growing up, and overcoming a terrifying threat to their world. But it could also be read as the depiction of a child's descent into madness and his eventual recovery:

After years of starvation and mistreatment, Harry's mind snaps like a dry twig and he enters a world of unreality and magic. At first it's new and exciting: magical creatures and the ability to fly. His new friends treat him as their savior and call him the ‘chosen one.’ Then, just as in The Wizard of Oz, where a little girl gets a concussion and hallucinates a world where there is a magical thing called “color film,” problems start cropping up. Harry tells everyone the scar on his forehead wasn't caused by a botched frontal lobotomy, but by an evil wizard who tried to kill him. Snakes start speaking to him, though no one else can hear. He starts experiencing terrifying hallucinations which increase in frequency and severity as his enemy Voldemort grows stronger. Snape tries to stop them by teaching him to strengthen his mind. With another teacher's help, Harry eventually discovers that his affliction, which his friends are afraid to mention by name, is inside his own head and he must fight it to the death, if necessary, to overcome it.

The events in the story would cause anyone to question their sanity, as Harry does on several occasions. Now, HP is no more a depiction of schizophrenia than The Princess and the Pea is a depiction of fibromyalgia. But the world J.K. Rowling created is scary because it draws on the similarity. In doing so, the story stretches the imagination and strengthens our ability to distinguish truth from fantasy. Many of us remember the struggle we experienced as children in reasoning whether objects continue to exist when we don't see them. The challenge of distinguishing reality from fantasy is just as important. Perhaps the reality-testing skills children gain from fairy tales inoculate them from more serious challenges they may face in late adolescence, when schizophrenia typically manifests itself.

Maybe over-interpreting silly children's stories is one reason people hate psychiatrists. But it's also possible that the bizarre things that happen in fairy tales are not just cuteness, but a way for children to practice their skill at reality testing. That's the beauty of these stories: they can be both. And maybe it wouldn't hurt us adults to practice a little reality testing once in a while as well.

jan 21 2022, 7:35 pm. updated jan 22 2022, 6:09 am