Sunday, July 31, 2005

18th Century Case of Post-Partum Depression ?

In D'Almebert's Dream, the philosopher Denis Diderot presents several case histories of psychiatric disorders. Dr. Bordeu, a well known "vitalist' physician describes them to Julie de l'Espinasse. In the following Bordeu presents a case of a woman with a list of symptoms which occurred following the birth of a child. Bordeu also presents an account of how this woman recovered. In this account one sees an 18th century theory of the mind and its conflicts that that antedates [and perhaps influenced] Philippe Pinel.

Bordeu: There was a woman who had just given birth to a child; as a result, she suffered a most alarming attack of the vapors--compulsive tears and laughter, a sense of suffocation, convulsions, swelling of the breasts, menancholy silence, piercing shrieks-- all the most serious symptoms-- and this went on for several years. Now this woman was passionately in love, and eventually she began to think she saw signs indicating that her lover had grown weary of her illness and complaints and was beginning to break off their affair. That was when she decided that she must either get well or make an end of herself. In this way there began a sort of civil war inside her own consciousness. Sometimes this war would turn to the advantage of the master; sometimes the subjects would get the upper hand. Whenever the two sides were equal, so that the force exerted by the fibers exactly counterbalanced that of the center of the bundle, she would fall to the ground as though dead. Then when carried to her bed, she would lie for hours on end, entirely motionless and almost lifeless. On other occassions the effect would be only one of general lassitude or exhaustion or loss of consciousness from which it often seemed she would never recover. For six months she kept up the struggle. Whenever the rebellion began in her fibers she was able to feel it coming on. She would stand up, run about, busy herself with the most vigorouws forms of physical exercise, climb up and down stairs, saw wood or shovel dirt. She would make the center of her network, the organ of will power, as rigid as possible by saying to herself: You must conquer or die. At the end of a long succession of victoreies and defeats the head finally won out, and the conquered "subjects" had been so throuughly reduced to submission that, although this woman has had to contend with all sorts of domestic troubles and has suffered from various sorts of illness, she has never had the least tendency to the vapors since that time. .
Mlle. De'Espinasse: Good for her! But I think that in her place I could have done as well as she did.
Bordeu. Yes, I think so, because yuou have a firm disposition, and if you were in love, you would not be lukewarm about it.
Mlle. De L'Espinasse. I think I understand. A person will have a firm disposition of the center of the network is able, as a result of education, habit or irgaization, to dominate the various threads. If the center is dominated by the treads, the person has a weak disposition.
Bordeu. And from that proposition one could draw a whole series of further conclusions.
Mlle. De L'Espinasse. First tell us your other case history, and then draw your conclusions.

From Denis Diderot, Rameau's Nephew and other works. Translated by Jacques Barzun and Ralph Henry Bowen [1956] p.156.


May 29, 2005, The New York Times.
The novelist Patrick McGrath reviews the sociologist Andrew Scull's MADHOUSE: A Tragic Tale of Megalomania and Modern Medicine. In this book, Scull, who has long been interested in the abuses of biological psychiatry, presents a full account of the career of Henry Cotton at Trenton State Hospital in New Jersey between 1907 and 1930. Cotton, who believed that major mental illnesses were caused by focal infections, conducted an ambitious program of surgically removing " the infected teeth and tonsils of dozens of his patients, not to mention their stomachs, gallbladders, colons, testicles and ovaries." As a persistent critic of psychiatry, Scull has chosen an exemplary subject to show psychiatry in its worst light.

Saturday, July 30, 2005

Image of Restraint

The strait waist-coat or strait jacket was heralded in the late 18th century as an advance in the management of the insane. Here is an image of the strait jacket from that period. I will upload details about it when I get back to my notes.

Case Histories from the History of Psychiatry

This is a site that I produced a few years ago. It started with case histories that I had used in teaching, where I had asked students to discuss a case based on limited information and then gave them a follow-up. I thought that the hyperlinking capacity of the internet would allow me to present cases in this format. Some of the cases on this site are in that format. As I got going on the site, I couldn't help adding other material and links to other sites. What iscurrently on the site is rather a hodge podge of materials that I have tried to organize so that it might be useful

A collection of classics on the history of psychology and psychiatry

It is increasingly possible to find texts of useful books in the history of psychiatry. Here is a web site that offers what looks like it will be a growing collection of texts. Currently you can find the following:

Havelock Ellis (1927), The Psychology of Sex
Robert Burton (1652), The Anatomy of Melancholy
Sigmund Freud (1920), Three Contributions to the Theory of Sex
Sigmund Freud (1921), Dream Psychology: Psychoanalysis for Beginners
Clifford Whittingham Beers (1921), A Mind That Found Itself