Hektoen International

A Journal of Medical Humanities

Enlightenment from Sherlock Holmes on COVID-19 associated perilous boredom

Daniel Gelfman
Indianapolis, Indiana, United States


Sherlock Holmes, a good example of dealing with boredom
Evening silhouette of Sherlock Holmes’s statue at Baker street, the real place where he never lived. Photo by dynamosquito. Taken January 11, 2010. Via Wikimedia

Boredom can useful. It can motivate people to do great things. It can also be dangerous by increasing the risk of depression and the risk of participation in unhealthy activities.1 It is an emotional state of weariness through lack of interest that can result in the “pursuit of novel (even negative) experiences.”2 There is indeed truth in the old adage that one can be “bored to death,” but it is mostly the reaction to avoid boredom and the associated depression that is perilous.1 The recurring lockdowns and isolation experienced during the COVID-19 pandemic has resulted in widespread boredom and this has had negative consequences.3 To appropriately approach this issue, we need to recognize the problem, understand it, name it, and attempt to treat it.

We must first differentiate “perilous” boredom from simple boredom. A well-known example of perilous boredom can be observed in the fictional character, Sherlock Holmes. A recent article discusses the diagnostic process used by Dr. Joseph Bell, the acknowledged role model for Arthur Conan Doyle’s character, revealing his observational and deductive skills that could be followed by today’s students of medicine.4 However, the article is about Dr. Bell, not about the fictional character Holmes, and therefore does not discuss the effect of perilous boredom. Doyle must have observed this pernicious behavior in other people, as he describes it so clearly. Dr. Bell himself may have been too busy to get bored because he never retired (maybe to avoid “perilous” boredom). He left the practice of medicine only when he became seriously ill and died in 1911.5 The following is a short illustrative passage where Holmes is discussing and justifying his cocaine use to Dr. Watson, who has been trying to disabuse him of the habit:

“My mind,” [Holmes] said, “rebels at stagnation. Give me problems, give me work, give me the most abstruse cryptogram, . . . and I am in my own proper atmosphere. I can dispense then with artificial stimulants. But I abhor the dull routine of existence. I crave for mental exaltation.”6

Doyle is describing a variant of the unnamed but recognizable syndrome of perilous boredom. It is not a clinical diagnosis but more of a state of mind or possibly a period of transition. It can be characterized by the loss of meaningful, enjoyable, and purposeful activity resulting in boredom, a sense of emptiness, depression, and anxiety. It can occur after different life events and may result in unhealthy or self-destructive behavior.1,2 Variations of this affliction are well known by their triggering events, such as the “empty nest syndrome” that some parents experience when children leave the home. Retirement may also be a trigger. Many people have postponed or avoided retirement (possibly like Dr. Bell) for fear of falling into perilous boredom. No wonder that up to one-third of physicians who have retired go back to work.7 Worse still is being cognitively stable but unable to take care of oneself. Many people would rather die than end up in a nursing home alone and bored to death.

Unfortunately, countless people are undergoing life-changing events related to COVID-19 that leave them perilously bored. Some of these events are traumatic, such as the loss of employment, loss of business or financial security, loss of health, or even the loss of loved ones. Where we saw an occasional patient in a state of perilous boredom, we are now seeing many people affected, and some of these patients are also dealing with a traumatic triggering event. In these stressful situations, patients will perform worse in regards to diet, exercise, and tobacco avoidance. Some will also have issues with excessive alcohol use8,9 or drug abuse. Inevitably, there will be an increase in modifiable cardiovascular risk factors and in mental health issues, especially anxiety and depression.3

We need a way to assist people in adapting to this situation. De Jong et al discuss the use of grief counseling techniques such as “life crafting intervention” in patients suffering from the more traumatic changes.10 Less intense means would be appropriate for those undergoing a less severe form of transition. Using techniques that are useful for retirement could be helpful. Doyle himself illustrates this by having Holmes retire successfully to become a beekeeper and producer of honey. Key to this productive avocation is that it can offer enthusiasts something they find missing from their lives; it can give life purpose. Purpose has been called the third requirement of successful retirement, beyond funds and activity.7 Thus, we can empathetically discuss this syndrome with our patients while encouraging them to use this time to pursue meaningful activities they never had time to do, to exercise, to continue virtual interactions, minimize alcohol consumption, possibly try meditation, and maintain some structure in their daily activities.

In the past, fewer people were undergoing life-transforming events. Now many more people are affected and are predicted to suffer significant consequences for mental and physical health.3 We need to recognize this issue, name it, and offer treatment. We could call it the “Sherlock Holmes boredom syndrome” or the “COVID-19 syndrome” and use the example of Doyle’s character, Holmes. By naming it, destigmatizing it, and by associating it with a respected fictional character, we can reveal the danger of the syndrome, assuage any associated guilt or shame, offer hope coupled with additional suggestions discussed above including purposeful activities as a means to fill the void. Recognizing and understanding this syndrome can empower practitioners to effectively address this important emerging syndrome using a kind, empathetic approach coupled with thoughtful therapeutic directions.



  1. Britton A, Shipley MJ. Bored to death? Int J Epidemiol. 2010;39(2):370-371. doi:10.1093/ije/dyp404
  2. Bench SW, Lench HC. Boredom as a seeking state: Boredom prompts the pursuit of novel (even negative) experiences. Emotion. 2019;19(2):242-254. doi:10.1037/emo0000433
  3. Schippers MC. For the Greater Good? The Devastating Ripple Effects of the Covid-19 Crisis. Front Psychol. 2020;11. doi:10.3389/fpsyg.2020.577740
  4. Patel SR, Best SL, Rabinowitz R. Sherlock Holmes and the Case of the Vanishing Examination. Am J Med. 2018;131(11):1270-1271. doi:10.1016/j.amjmed.2018.05.015
  5. JOSEPH BELL, M.D., F.R.C.S.E., F.R.S.E., J.P. BMJ. 1911;2:954-956. doi:10.1136/bmj.2.2650.954
  6. Doyle A. The Sign of Four. Lippincott’s Mon Mag. 1890.
  7. Cronan JJ. Retirement: It’s Not About the Finances! J Am Coll Radiol. 2009;6(4):242-245. doi:10.1016/j.jacr.2008.12.001
  8. Grossman ER, Benjamin-Neelon SE, Sonnenschein S. Alcohol Consumption during the COVID-19 Pandemic: A Cross-Sectional Survey of US Adults. Int J Environ Res Public Health. 2020;17(24):9189. doi:10.3390/ijerph17249189
  9. Strauss A. ‘Vodka in Your Coffee Cup’: When Pandemic Drinking Goes Too Far. The New York Times. https://www.nytimes.com/2020/12/25/nyregion/pandemic-drinking-alcoholism.html. Published December 25, 2020. Accessed December 27, 2020.
  10. de Jong EM, Ziegler N, Schippers MC. From Shattered Goals to Meaning in Life: Life Crafting in Times of the COVID-19 Pandemic. Front Psychol. 2020;11:1-6. doi:10.3389/fpsyg.2020.577708



DANIEL M. GELFMAN, MD, FACC, FACP, is a Clinical Professor Emeritus of Medicine (Cardiology) at The Marian University College of Osteopathic Medicine. He remains active teaching clinical medicine and pursuing scholarly activities at Marian University. His research interests currently include developing effective teaching methods and combining the humanities with medicine. Recent publications include, “The David Sign,” published in JAMA Cardiology, and “The importance of ‘The David Sign,’” published in Hektoen International, which reveal and discuss previously unrecognized illustrations of cardiovascular physiology in Michelangelo’s sculptures.


Highlighted in Frontispiece Volume 13, Issue 2– Spring 2021
Winter 2021  |  Sections  |  Covid-19

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