Sunday, November 19, 2006

Body Dysmorphic Disorder circa 1808

Recently while reading an article by Philippe Pinel on melancholia in the Encyclopedie Méthodique of 1808 I ran accross a description of a treatment for what we might call Body Dysmorphic Disorder.
"Other… [melancholics] imagine having a nose or lips of immense size. We have been able to cure them by making an incision from which the patient sees blood run, and then showing them a great piece of flesh that we say we have removed." Not exactly "moral treatment!"

Tuesday, November 14, 2006

David Hume attempts to do psychotherapy

While I'm on the subject of philosophers, here is an anecdote that I ran accross in Paul Laffey's "Two registers of madness in Enlightenment Britain," History of Psychiatry 13(2002) 367-80. The philosopher "David Hume was hired to provide tutelage for the increasingly insane Lord Annandale in the mid 1740s, and began this period convinced that Annandale needed moral guidance from a 'friend' upon whose 'conduct and discretion' hopes for recovery depended. Hume found it 'strange [that] so considerable sums shoul'd be lavisht on apothecaries and physicians, who perhaps do hurt, and a moderate sum be grudg'd to one who sacrifices all his time to him.' However, if Hume was indeed experimenting with a moral account of insanity, experience soon set set him to rights, and not three weeks later he conceded that Annandale's 'caprice came from nobody, and no cause, except physical ones.' This story does serve to imply that some thinkers were prepared to assay moral models of mental derangement, but Hume's rapid abandonment of this progect shows, …that insanity's somatic substrate remained firmly entrenched as the dominant framework. And notably, Hume wrote nothing further on madness as a philosophical problem."

Thursday, November 09, 2006

Descartes Self-Analysis

Here is a sweet litle anecdote that I ran accross in Geneviève Rodis-Lewis' book Descartes: His Life and Thought. Descartes wrote:"I loved a girl of my own age, who was slightly cross-eyed; by which means, the impression made in my brain when I looked at her wandering eyes was joined so much to that which also occurred when the passion of love moved me, that for a long time aftersward, in seeing crooss-eyed women, I felt more inclined to love them than others, simply because they had that defect; and i did not know that was the reason. In contrast, since I have reflected on it, and recognized it as a defect, I have no longer been so moved." Descartes made this very personal confidence to Chanut, to transmit to Queen Christina of Sweeden, who asked what "causes…often incite us to love one person rather than another before we know their merit."

Monday, November 06, 2006

The air loom gang: the strange and true story of James Tilly Matthews and his visionary madness. Mike Jay

This is an extraordinary book. James Tilly Mathews, whose involvement in the French Revolution, may have led to his incarceration at Bethlem Hospital, that is Bedlam, developed an elaborate delusional system about the Air-loom Gang while there. This delusion was then the subject Illustrations of Madness, written by Mathews' psychiatrist John Haslam. Jay's book sensitively analyzes Mathews' delusions, his involvement in the French revolution and his relationship with Haslam. Since Haslam's career and the fate of Bedlam in the early nineteenth century are central to understanding the development of psychiatry in Great Britain in that period, Jay's book is also a readable and reliable introduction to that chapter in the history of psychiatry.

Tuesday, October 24, 2006

Man Unable to Remember Is Reunited With Fiancée

Dissociative fugue states are rare, rare enough so that diagnosing a case is reported in the New York Times. If you want to learn about an "epidemic" of this disorder, read Ian Haking's Mad Travelers: Reflections on the Reality of Transient Mental Illnesses. Hacking does more than describe a cluster of cases. He also suggests a way of understanding why certain psychiatric disorders are frequent at certain times and in certain places and then disappear.

Sunday, October 22, 2006

Living With Love, Chaos and Haley

This is a moving article which shows that while there are many treatments for serious mental illness, there is often not much help. It is refreshing to read a front page article in the New York Times that neither demonizes psychiatry or suggests that it has much to offer. The history of psychiatry could be written as a series of oversold panaceas --from moral treatment through psychoanalysis and now to the new psychopharmacology--followed by periods of disillusionment. This article is more evidence--along with all the news about antidepressants and suicide and the metabolic syndrome--that we are well into a period of disillusionment.

Monday, October 09, 2006

Famine: the distant shadow over French psychiatry

Reading about French anti-psychiatry I ran into a reference to a book by Max Lafont titled l'Extermination douce. It is an account of conditions in psychiatric hospitals in Vichy France, where it is estimated that some 48,000 mental patients starved to death. There is apparently no book on this subject in English, but the article "Famine: the distant shadow over French psychiatry" give a chilling summary of what is known and also asks why, when so much attention has been paid to German atrocities, there has been nothing written in English about this tragic story.

Monday, October 02, 2006

Changing Minds: Area 25

I saw this piece on 60 minutes. It struck me as another expensive partial treatment, like vagus nerve stimulation and transcranial magnetic stimulation. When these genies get out of the box they will probably proliferate in our market economy and who knows how many desperate people will seek them out. Even without doubting that they provide significant help for a core group of people, in the way that pre-frontal lobotomy did [according to Jack Pressman's account], they are likely to be advocated and sought after for many other desperate people. Having researched the history of treatments for General Paresis of the Insane, I am reminded of the many invasive and problematic partial treatments that were advocated for it before penicillin was found to kill the organism that caused the disease....And then I happened to watch a 1966 documentary called Schizophernia: the Broken Mirror, produced by the NIH, where we were shown schizophrenics being given deep brain stimulation with electrodes and encouraged to think that the cure for schizophrenia was around the corner. Around and around it would seem.

Wednesday, September 20, 2006

Lucia Joyce: To Dance in the Wake

Having an interest in learning about the history of psychiatry through biographies of famous people, I was drawn to Carol Loeb Shloss's book on the life of James Joyce's daughter Lucia Joyce. Lucia was in and out of psychiatric hospitals from her mid-twenties on and was treated by many psychiatrists including Jung. Unfortunately almost all of the documentary material about her life was destroyed, and although Shloss is an assiduous researcher, she could come up with virtually nothing about her medical records. Consequently although people seemed to agree that she needed hospital level psychiatric care, it is hard to learn much more about her psychiatric symptoms other than that she had tantrums, and lit fires. Joan Acocella has has written a thoughtful review of Shloss' book, which spells out some of the shortcomings, that I noticed as I was reading it.

Monday, August 21, 2006

Shot at dawn, pardoned 90 years on

As someone who has written about Shell Shock during World War I, I was particularly interested to see that the injustice done to those who were shot for cowardice and desertion during that war is finally being redressed. For a good general review of the subject on the web try Simon Wessely' Lecture " Risk, Psychiatry and the Military." You might also try my article "Emotional Trauma and the Development of the Idea of Neurosis in the United States: 1865-1930."

Saturday, August 12, 2006

What is Tom saying to Maureen?

Ian Hacking's review article from the London Review of Books gives a good summary of what we know and don't know about autism. I was particularly interested in the fact that he puts autism in historical context and asks why we see so much more autism now than people once did. Hacking who did such a fine job of putting multiple personality disorder in historical context in his Rewriting the Soul, brings the same sharp eye and tongue to this short piece.

Wednesday, August 09, 2006

My Husband Survived; the Man I Married Didn’t

This very moving account of the struggles of Abigail Thomas to do the right thing for her husband and still preserve her life and I imagine her sanity reminded me of another account of the impact of caring for a mentally disabled spouse. In the second edition of his Treatise on Insanity, published in 1809, the French psychiatrist Philippe Pinel reported both on the condition of the husband and separately on the wife's struggles.

"A man raised with the prejudices of ancient nobility, and hardly at his fiftieth year, proceeded before the revolution, in a great leap,, towards … psychological disorganization. Nothing could equal his lability and the aberrations of his childish effervescence. He was endlessly agitated at home, babbling, crying and flying into rages for the slightest reason. He tormented his servants with trivial orders, and his neighbors with his inconsistences and abupt lapses, of which he preserved no memory, not a trace after one minute. He spoke in turn with the most extreme versatility, of his court, his wig, his horses, his gardens, without expecting any response and without giving the time to follow his various incoherent ideas. A very spiritual wife, that convenience of rank had associated with his destiny, fell as a result of this marriage into the most profound and despairing hypochondria."

"A woman of with a very cultivated mind and endowed with rare qualities, yeilded to conveniences of rank and married a man who was in a state close to dementia. For a long time, the desire to make herself agreable to her own family, and an elevated character made her courageously put up with the difficulties of this marriage; but each day brought some new scene that required her surveillance and which saddened her. In the beginning there were the childish rages of her imbecile spouse, the threats and acts of violence against the servants, as well as all sorts of inconsistent actions. Outside of the home and in the community there were the most rambling and incoherent conversations and sometimes reckless acts of extravagance and idiotic remarks.
The physical and moral instruction of the children that she cherished tenderly, and the care she gave them, alone brought joy to her sad and insipid existence, but did not prevent the progress of her melancoly. Her imagination gave birth each day to new objects of distrust and fear. Disturbing events occuring on a certain day of the week, especially Friday, persuaded her that it was an unlucky day, and she did not dare to go out of her room on that day. If the month began on a Friday, it became the source of the most frightening terrors for many days, and by degrees even Thursday, like Friday, inspired the same fears. If she appeared at a gathering and heard the name of one of these days pronounced, she became pale, and had difficulty speaking clearly, as if her life was threatened. It was some months before the revolution that they asked me my opinion on this type of melancholic vesania, and I used some simple remedies and the moral methods that her state suggested. The events of 1789 intervened, however, and soon after that, family reverses and emigration removed the subsequent course of her illness from my knowledge. I can speculate that a new chain of ideas, a change of climate and perhaps a state of misfortune may have disipated the dark vapors of melancholia."

Who invented the straight-jacket?

The straight-jacket acquired a bad reputation in the twentieth century. With "chemical straight-jackets" like Haldol and Thorazine, the use of the cloth one seemed barbaric.Originally the straight-jacket was considered a humane advance over the chains that were used at the time to restrain dangerous patients. In a straight-jacket the patient could walk around freely without risking harm to himsellf or others. Furthermore, the anger generated by chaining people made them more dangerous and also distorted observations of their true clinical state. For anyone who is interested I might add that the straight jacket was invented in 1790 by an upholster named Guilleret at Bicêtre, an asylum for the chronically mentally ill near Paris. Known as la camisol de force it was a vest of strong cloth with long sleeves which could be attached to each other behind the back of the person one wanted to prevent from causing harm. [Funck-Brentano, F. & Marindaz, G. L'Hôpital Général Bicêtre, Lyon, 1928, p.26]]

Tuesday, July 25, 2006

‘Hitting Highs at Rock Bottom’: LSD Treatment for Alcoholism, 1950–1970

This is an abstract of a current article that discusses an interesting recent episode in the history of psychiatry. Althought it was taken seriously as a treatment a little more than 50 years ago, LSD treatment is almost as hard to imagine as the mythical Melampus' use of hellebore with milk to treat the daughters of Proetus. If your interested you can find the latter at "Case Histories from the History of Psychiatry."

Sunday, July 23, 2006

Odors, now and then

Reading in the New York Times (7/21/06) that "French psychiatrists…have found that lavender-laden air can reduce agitation among certain psychiatric patients", I was reminded of ancient beliefs about hysteria.
Regarding the various symptoms of hysteria as the result of the migration of the womb, Aretaeus of Cappadocia, an ardent second century A.D. follower of Hippocrates, explains that the womb "delights, also in fragrant smells, and advances towards them; and it has an aversion to fetid smells, and flees from them; and, on the whole the womb is like an animal within an animal." He goes on to say that the "uterus in woman has membranes extended on both sides of the flanks, and also is subject to the affections of an animal in smelling; for it follows after fragrant things as if for pleasure, and flees from fetid and disagreeable things as if for dislike. If, therefore, anything annoy it from above, it protrudes even beyond the genital organs. But if any of these things be applied to the os, it retreats backwards and upwards. Sometimes it will go to this side or to that,--to the spleen and liver, while the membranes yield to the distension and contraction like the sails of a ship."
These theraputic suggestions were criticized by Soranus if Ephesus, a leading authority on gynecology in the 2nd century A.D., in his discussion of hysteria:

"the majority of the ancients and almost all followers of the other sects have made use if ill-smelling odors (such as burnt hair, extinguished lamp wicks, charred deer's horn, burnt wool, burnt flock, skins, and rags, castoreum with which they anoint the nose and ears, pitch, cedar resin, bitumen, squashed bed bugs, and all substances which are supposed to have an oppressive smell) in the opinion that the uterus flees from evil smells. wherefore they have also fumigated with fragrant substances from below, and have approved of suppositories of spinenard [and] storax, so tht the uterus fleeing from the first-mentioned odors, but pursuing the last-mentioned, might move from the upper to the lower parts."

No mention of lavender.

Quotes from Ilza Vieth, Hysteria: The History of a Disease, (University of Chicago Press, 1965) 23-30.

Psychiatry in the twenty-first century: Garden State

In the film Garden State [2004], 26 year-old Andrew Largeman comes home, after nine years, from Los Angeles to New Jersey, when his mother dies. We learn that his psychiatrist father thinks that Andrew has never been able to forgive himself for causing his mother to become paraplegic when he was nine years old. In addition to sending Andrew to a boarding school at age 16, father has been prescribing and Andrew has been taking a cocktail of 3 SSRI's, lithium and depakote. When the story begins Andrew is shown as numb to all feeling, but he forgets his medications in Los Angeles, and through the four days that the film depicts we see Andrew becoming progressively more able to respond emotionally. Of course there is a plot, which gives Andrew plenty to respond to, but the film is also a, not too subtle, critique of the numbing of society by psychotropic drugs. Reference to Brave New World completes the picture. In addition to the iatrogenic effects of psychoactive drugs, the film also points to the destructive consequences of the psychiatrist-father's insistence that Andrew suffers from being "unable to forgive" himself for what we are told was just an accident. Ian Holm's portrayal of the father's solemn, but misguided, benevolence also parodies psychiatry as a profession of would-be sages.

Saturday, July 15, 2006

Psychotherapy in the twenty-first century

I recently saw a woman for a medication consultation who was quite shy about expressing her feelings directly to others. She was having difficulties with a boyfriend and had gone into therapy to discuss her feelings about this. In relating her story to me, she clearly was having a hard time talking about what she was experiencing. After a few minutes, she paused and said, "This would be easier if I could read you my texts." With that, she took out her cell phone and proceeded to read me a series of text messages that she and her boyfriend had exchanged. I was quite struck by the nuanced account of the evolution of their relationship that could be gleaned from these very short and often eliptical messages. I asked her if she had read these texts to her therapist. "Of course," she replied, with some surprise in her voice, "I read them to her at each session. It helps me understand how things are going." I could believe that, though it was not quite the psychotherapy that I was taught way back in the twentieth century.

G. W. Albee, 84, Psychologist Who Tied Poverty and Illness, Dies

I had never heard of Albee before reading this obiturary. Though he wrote in the 1960s, it sounds as if he should be read today.

Monday, July 10, 2006

Response to Comments

I've gotten two recent requests.
One person is looking for more material on famous people with psychiatric disorders. Some cases of famous people can be found on my web site "Case Histories from the History of Psychiatry." I would also suggest the recent book by Joshua Wolf Shenk, Lincoln's Melancholy: How Depression Challenged a President and Fueled his Greatness."I liked it because it tries to show how emotional distress can lead to acheivemnets, as well as suffering.
A second person asked for historical images of the mentally ill. Again there are some on my web site "Case Histories …." I would also suggest two books edited by the historian Sander Gilman. 1. The Face of madness: Hugh W. Diamond and the Origin of Psychiatric Photography; 2. Seeing the Insane. I could also suggest "Madness in America: Cultural and Medical Perceptions of Mental Illness before 1914," by Lynn Gamwell and Nancy Tomes.

Saturday, May 06, 2006

Mixed Result in Treating Schizophrenia Pre-Diagnosis

Perhaps whis could be filed in the "should we be surprised" department.

Tuesday, April 25, 2006

Analyze These

Reviews an exhibition of Freud's drawings opening at the New York Academy of Medicine on May 11.

Saturday, April 22, 2006

Witness Says Moussaoui Exhibited Mental Illness

If historians ever need an example of how socio-political storms whirl around the insanity defense, this is their case.

Sunday, March 26, 2006

Afghan Case Against Christian Convert Falters

Mental illness may yet save the day and prevent the clash of civilizations,

Saturday, March 18, 2006

Midnight Conversations With a Two-Headed Mind

In case you missed it, here is a beautiful little article by the psychiatrist Elissa Ely. Would that more psychiatrists had her narrative gift and ear for the personal. If you are lucky you can her her on NPR as well.

Sane Chinese Put in Asylum, Doctors Find

In case any thinks that political imprisonment in psychiatric hospitals is a thing of the past, here is a well documented current case. When will we adopt the diagnosis "conspicuously enhanced pathological will?" Or do we already have it and call it Oppositional Defiant disorder?