From Popular Culture: John Rambo (1982)
A move along order just after the end of the Vietnam War turns into a massacre. He obviously suffered from PTSD, but did John Rambo also have Neuropsychiatric Quinism?
Who is John Rambo?
The opening paragraph via Wikipedia.
NOTE: A Vietnam veteran has reminded me that Sylvester Stallone was allegedly a conscientious objector and didn’t serve in the Vietnam War. This article relates more to the book that was written in 1972 after three years of research by David Morrell.
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1. Does the situation meet the FDA Blackbox warning rule: ‘BEHAVIOUR THAT IS UNUSUAL?’
What caught my attention (spoiler*): An incident in a police cell leads to the death of a police officer. The ensuing massive manhunt leads to the in the deaths of more than a dozen police officers, civilians, National Guardsmen and John Rambo by suicide.
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2. Was the person(s) exposed to antimalarial quinolines. If YES…
a. Which one(s)?
b. For how long?
c. Were there multiple exposures?
YES
Most likely a combination of Chloroquine and Primaquine. According to his backstory John Rambo deployed to Vietnam twice, 1966 and 1969 so we can assume multiple exposures to quinolines.
3. How was the person(s) mental health?
Problematic. PTSD was still referred to as ‘Shell Shock’ in 1974
The book commences on the 1st day of October 1974. Although not technically diagnosed with a mental health disorder John Rambo is obviously suffering from his time in service. The Diagnostic and Statistical Manual of Mental Disorders does not formally recognise PTSD until 1980.
Screenshot of Soldier Boy responding to a question about having PTSD in 2022. If you know, you know… (Source: The Boys)
In addition to PTSD, John Rambo has a number of conditions that are linked to quinolines. As First Blood develops you get a sense of John Rambo’s paranoia and psychosis which eventually culminates in destroying the town and committing suicide.
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4. Were there any confounding variables?
YES
Complex PTSD: John Rambo suffers from undiagnosed PTSD and has been through significant trauma. Point 5# outlines the trigger brought about by memories of torture at the hands of the North Vietnamese Army (NVA).
Prisoner of War: Captured by the North Vietnamese Army, John is tortured sadistically and kept in horrible POW camp conditions over a long period of time until he escapes.
Blast Injuries: Exposed to multiple blast injuries during his service.
Poverty & Homelessness: Poor mental health can commence or be exacerbated by unemployment, poverty, and homelessness. John Rambo suffered both and the book doesn’t immediately become violent. It all starts with a move along order from a local sheriff in a small USA town.
Lack of Purpose: Some Veterans lack purpose when they leave the military.
Malaria: Did John Rambo also suffer from malaria from his time without antimalarials?
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5. Was there a specific trigger?
YES. The trigger in detail. Excerpt from the novel:
But Teasle snipped the scissors to his head again and Rambo flinched again, and hair caught in the swivel of the scissors, yanking sharply at his scalp. He could not bear it anymore. He surged from the chair and spun around to Teasle.
‘Get away.’
‘Sit down in that chair.’
‘You’re not cutting anymore. You want my hair cut, you get a barber down here.’
‘It’s after six. There aren’t any barbers working now. You’re not putting on that uniform until your hair is cut.’
‘Then I’ll stay like this.’
‘You’ll sit on the chair. Galt, go up and bring Shingleton. I’ve made as many allowances as I can. We’ll cut his hair so fast it’ll be like we used sheep shears.’
Galt looked happy to get away. Rambo listened to him unlock the door at the top of the stairs, the rattle echoing down. It was all happening even faster now. He did not want to hurt anyone, but he knew that was coming, he could feel his anger spreading out of control. Instantly a man was rushing down the stairs, Galt half a flight behind. It was the man who had been sitting by the radio in the front office. Shingleton. He seemed huge now that he was standing, his head up near the bright lights in the ceiling. The bones above his eyes and around the bottom of his face stuck out in the glare. He looked at Rambo, and Rambo felt twice as naked.
‘Trouble?’ Shingleton said to Teasle. ‘I hear you have trouble.’
‘No, but he does,’ Teasle said. ‘You and Galt sit him on the chair.’
Shingleton came right over. Galt hesitated, then he came over too.
‘I don’t know what this is all about,’ Shingleton said to Rambo. ‘But I’m reasonable. I’ll give you a choice. Do you walk or do I carry you?’
‘I think you’d better not touch me.’ He was determined to keep control. There would be just the next five and the continual touch of the scissors, and then it would be over, he would be all right.
He started toward the chair, his feet slick in the water, and behind him Shingleton said, ‘Good God, where did you get all the scars on your back?’
‘In the war.’ That was a weakness. He should not have answered.
‘Oh sure. Sure you did. In which army?’
Rambo almost killed him right then.
But Teasle took another snip at his hair and startled him. There were clumps of long hair scattered across the gray wet newspaper, some of them tangled around Rambo’s bare feet. He expected Teasle to go on snipping at his head. He braced himself for it. But then Teasle brought the scissors too close to his right eye, cutting his beard, and Rambo instinctively dipped his head to the left.
‘Hold still,’ Teasle said. ‘Shingleton, you and Galt hold him steady.’
Shingleton pulled his head up straight, and Rambo slammed his arm away. Teasle snipped again at his beard, catching it in the scissors, pinching his cheek.
‘Christ.’ He squirmed. They were too close. They were crowding him so he wanted to scream.
‘This could go on all night,’ Teasle said. ‘Galt, go get the shaving cream and the razor off the desk.’
Rambo squirmed. ‘You’re not shaving me. You’re not coming near me with that razor.’
Then Galt was there handing it to Teasle, and Rambo watched the long blade flash in the lights, and remembered the enemy officer slicing his chest, and that was the end. He broke, grabbing the razor and standing, pushing them away. He fought the impulse to attack. Not here. Not in the goddamned police station. All he wanted was the razor away from them. But Galt was white faced, eyes on the razor, and he was fumbling for his gun.
‘No, Galt!’ Teasle shouted. ‘No guns!’
But Galt continued fumbling for his gun, and awkwardly he had it out. He must really have been new on the job: he looked as though he could not believe he was actually raising the gun, his hand shaking, squeezing on the trigger, and Rambo slashed the razor straight across his stomach. Galt peered stupidly down at the neat deep slash across his belly, blood soaking his shirt and pouring down his pants, organs bulging out like a pumped-up inner tube through a slit in the tree. He took a finger and tried poking the organs back in, but they kept bulging out, blood soaking his pants and running out his cuffs onto the floor as he made a funny little noise in his throat and toppled across the chair, upsetting it.
Rambo was already charging up the stairs…
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6. Other considerations?
YES
One of the [not so] funny physical side effects of Quinism is Urticaria (which has been linked to Quinine) and Psoriasis (has been linked to synthetic antimalarials).
Now back to First Blood, shortly after he is arrested for vagrancy and resisting arrest John Rambo had serious skin rashes. Excerpt:
‘What I have to know, doesn’t that hair get itchy down the back of your neck?’
Always they asked the same. ‘It did at first.’
Dobzyn scratched his eyebrow and thought about the answer. ‘Yeah, I suppose you can get used to just about anything if you put your mind to it. But what about the beard? Doesn’t that get itchy in this heat?’
‘Sometimes.’
‘Then what possessed you to let it grow?’
‘I have a rash on my face and I’m not supposed to shave.’
‘Like I have a pain in my rear-end and I’m not supposed to wipe it,’ Teasle said by the door.
‘Now, wait a second, Will. It may be that he’s telling the truth.’
Rambo could not resist. ‘I’m not’
‘Then what did you say all that for?’
‘I get tired of people asking me why I grew the beard.’
‘Why did you grow the beard?’
‘I have a rash on my face and I’m not supposed to shave.’
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ASSESSMENT
PROBABLE
When I reread this book recently, I immediately thought that John Rambo most likely suffered from Neuropsychiatric Quinism as well as a range of other conditions including complex PTSD due to his war service. The skin rashes nailed it for me. David Morrell didn’t know about that in 1972 and he completed three-years of research.
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UPDATE (17.04.2024)
UPDATES
31.05.2024: Reviewed/Updated: Major rewrite utilising the Liverpool School of Tropical Medicine approach to reviewing mefloquine related deaths (2017). Poster updated from 1982 to 2008 promotion. References updated.
17.05.2024: Added correspondence by David Morrell
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REFERENCES
REFERENCES
Bunge, W (1970) Malaria Chemoprophylaxis in Vietnam and Post-Vietnam. [https://jamanetwork.com/journals/jama/article-abstract/353390] JAMA Network. Page accessed 16.04.2024
First Blood (1982) Orion Pictures. Los Angeles, California, USA
IMDb (2024) Rambo (2008) [https://www.imdb.com/title/tt0462499/mediaviewer/rm1645974529/] Page accessed 31.05.2024
Morrell, D (1972) First Blood. Rowman & Littlefield. Lanham, Maryland, USA
The Boys, Season 3 (2022) Herogasm. Amazon MGM Studios. Culver City, California, USA
Tickell-Painter M, Saunders R, Maayan N, Lutje V, Mateo-Urdiales A, Garner P (2017) Deaths and parasuicides associated with mefloquine chemoprophylaxis: A systemic review. Travel Medicine and Infectious Diseases. DOI: 10.1016/j.tmaid.2017.10.011
Wikipedia (2024) John Rambo [https://en.wikipedia.org/wiki/John_Rambo] Page accessed 16.04.2024
Wikipedia (2024) Quinine [https://en.wikipedia.org/wiki/Quinine] Page accessed 16.04.2024
Wikipedia (2024) Quinism [https://en.wikipedia.org/wiki/Quinism] Page accessed 19.01.2024