Pain and Attention-Deficit/Hyperactivity Disorder: The Case of Margaret Mitchell

The article by Wu et al. (1) that appeared in the June 2018 issue of Psychosomatic Medicine reported the results of a meta-analysis of cognitive impairment in fibromyalgia (FM). In this article, it was shown that patients with FM have cognitive impairment in learning/memory, attention/psychomotor speed, executive function, and working memory. Given the findings of this meta-analysis, it is of interest to note that Pinals (2) has suggested that Margaret Mitchell (1900–1949), author of Gone with the Wind (GWTW), “the world’s best-selling novel,” had chronic widespread pain for many years and suffered from what appears to be FM and associated cognitive impairment. Her widespread pain was reported to have played an important role in writing the novel, as stated in one of her biographies, “She never thought of writing without pain” (3). The various medical issues associated with her pain began in 1920 with lower backache originating from the sacroiliac joint, which caused her pain throughout her life. Her bouts of pain became repeated and intermittent and spread to the abdomen, neck region, both shoulders, both hip joints, and both lower limbs, ultimately spreading throughout her entire body with severe intensity. As her husband stated, “I could not rub her at all from the back of her head to her toes—the slightest pressure was too painful” (4). Furthermore, Mitchell reportedly experienced a high degree of fatigue, lower abdominal pain, depression, and headaches. According to the current guidelines of the American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia (2011) (5), FM is diagnosed when the total widespread pain index + symptom severity score is 13/31 or higher. Based on her aforementioned symptoms, it can be inferred that Mitchell’s total widespread pain index + symptom severity score would be at least 26, and thus, she would probably have met the diagnostic criteria for FM according to the current guidelines (2). Moreover, as this article indicates (2), she was particularly accident-prone, sustaining serious leg burns and having two horse-riding accidents during childhood, and was involved in three separate motor vehicle accidents as an adult, indicating that inattention was also a consistent feature throughout Margaret Mitchell’s life. She died at the age of 48 years after being hit by a taxi. Upon close reading of her biography (6), we noted many descriptions of events where Margaret Mitchell possibly exhibited features of attention-deficit/hyperactivity disorder (ADHD). Attentiondeficit/hyperactivity disorder is a developmental disorder associated with central nervous system dysfunction; it is classified into predominantly inattentive, predominantly hyperactive-impulsive, and combined types (7). Using the writings in her biography, we searched the literature to identify potential psychiatric diagnoses for “Peggy,” as she called herself, including that of ADHD. This biography was written on the basis of the discovery of a large number of her publisher Macmillan Inc’s valuable documents regarding the history of the editing and publication of GWTW, which were thought to have been lost. Furthermore, this biography is also based on the individual interviews of the author Anne Edwards with more than 500