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]]