Friday, December 26, 2008

First Lines of the Practice of Physic By William Cullen, Peter Reid

First Lines of the Practice of Physic By William Cullen, p. 306. "There have occurred so many instances of this kind that I believe physicians are generally disposed to suspect organic lesions of the brain to exist in almost every case of insanity 1553 This however is probably a mistake for we know that there have been many instances of insanity from which the persons have entirely recovered and it is difficult to suppose that any or g nic lesions of the brain had in such case taken place Such transitory cases indeed render it probable that a state of excitement changeable by various causes had been the cause of such instances of insanity"

First Lines of the Practice of Physic By William Cullen, Peter Reid

First Lines of the Practice of Physic By William Cullen, Peter Reid: "1541 Upon the other hand it is very probable that the state of the intellectual functions depends chiefly upon the state and condition of what is termed the Nervous Power or as we suppose of a subtile very moveable fluid included or inherent in a manner we do not clearly understand in every part of the medullary substance of the brain and nerves and which in a living and healthy man is capable of being moved from every one part to every other of the nervous system OP PHYSIC 297"

Sunday, December 07, 2008

David Hume attempts to do psychotherapy

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."

Friday, October 31, 2008

Before Prozac

Edward (Ned) Shorter, an historian who has written a number of books
on the history of psychiatry, has now thrown his opinions into the
growing debate on the influence of antidepressants and the concept of
depression on psychiatry in particular and on American life in
general. His new book Before Prozac:: The Troubled History of Mood
Disorders in Psychiatry is in some ways a companion to Wakefield and
Horwitz's The Loss of Sadness. Both attack the DSM category of Major
Depression--though for somewhat different reasons-- for dumping too
many different states into the same pot. Shorter also takes aim at the
FDA's process for vetting antidepressants, where his central critique
is that the FDA refused to allow head to head comparisons between
newer antidepressants and older ones, leading to a deterioration in
the pool of antidepressants. As in his other books, Shorter is never
short on indignation. In this book his primary complaint is that
psychiatry has failed to evaluate its treatments with sufficient
rigor. This line of attack is, however, somewhat muddled by his lack
of regard for Randomized Clinical Trials and his willingness ot accept
almost anyone's opinion that older drugs like meprobamate were really
quite wonderful. Whatever the shortcomings of this book, it is an
important one, both for giving a detailed overview of the history of
the mood disorders in the second half of the 20th century and for
setting out a framework in which this period in the history of
psychiatry can be discussed.

Saturday, October 25, 2008

Joseph Delboeuf and the History of Psychotherapy

I stumbled upon Joseph Delboeuf while doing research on Pierre Janet. Delboeuf was a nineteenth century Belginan philosopher who was a friend of William James and a minor influence on Freud. I found his ideas about psychotherapy fascinating , admirably tough minded and worthy of consideration in the twenty-first century. The link is to a paper I wrote about Delboeuf in 2002.

Wednesday, September 17, 2008

Charles S. Peirce

My interest in the pragmatist philosopher Charles S. Peirce, reawakened recently by reading Louis Menand's Metaphysical Club, drew me to Joseph Brent's fine 1993 biography of Peirce. While Brent gives a moving depiction of Peirce's tragic life and helped me better understand his ideas, I was struck by Brent's need to somehow explain Peirce's failure to understand the motives of others and poor judgment. He implicates his left handedness, his trigeminal neuralgia and the narcotics and cocaine that he took for the pain, as well as the influence of his father, the mathematician Benjamin Peirce, who worked quite hard to train the young Charles to be a great man. Not quite satisfied with these influences, Brent turns to the notion of the Dandy, that is a person determined to live by his own rules, to make sense of his erratic behavior. While I didn't find any of these efforts very satisfying, I was quite surprised, when reading a 2000 biographical essay by Brent, to find that the scales had fallen from Brent's eyes and he finally realized that everything could be simply explained by the fact that Peirce suffered from Bipolar Disorder. All the symptoms were lined up like ducks in a row. How wonderful it is for us to have the DSM to help us understand difficult people. Then, of course, there are Peirce's ideas. I find them both quite challenging and resonant with my way of thinking about people.

Wednesday, June 04, 2008

Johann Christian Reil

Johann Christian Reil (1759-1813), one of the most famous medical theorists of his time. Born in an East Frisian parish house, he studied medicine rather than theology, against his father's wishes, and received his medical degree in 1782. He had a private practice until 1788, when he was then appointed professor of medicine at Halle, where he became one of the most sought-after physicians. His wide ranging research activities brought him a chair at the new Univeristy of Berlin in 1810. He knew Fichte, Schleirmacher, Goethe, Humboldt and Gall and was an enthusuastic disciple of the philosopher Shelling. During the Napoleonic war he was in charge of army hospitals on the left bank of the Elbe, where he died of typhoid in 1813.
Reil intended physiology to serve as the foundation of medicine and in 1795 he founded the Archiv für Physiologie and remained its editor until his death. He used this journal to promote the reform he felt was necessary in physiology. Following Kant, he argued that physiology had failed to observe the boundaries of human knowledge. Specifically he thought the problem lay with the concpet of Lebenskraft or life force. He offered his monograph "Von der Lebenskraft," as the lead article in his new journal to discuss just this problem.
His first systematic consideration of various forms of psychological disturbance came in his book Fieberhaste Nervenkrankheiten (Feverish nervous illness, 1802), where his interest in mental illness was due to the fact that derangement often accompanied fevers. At this point Reil thought of mental illness as a disruption of the normal functioning of the powers of the soul: consciousness, understanding, reason, imagination, and sensibility, which he glossed explicitly in Kantian fashion. He accorded the soul, however, only phenomenal existence-- what it really might be remaining totally unknown. The entire direction of his analysis of the powers of the soul implied that though they were called psychic they could ultimately be reduced to forces of the nervous system. The powers of the soul, he insisted, stood in an exact relationship to the operations of the nervous system.
In 1803 he published Rhapsodien über die Anwendung der psychischen Curmethode auf Geisteszerrüttungen (Rhapsodies on the Application of Psychological Methods of Cure to the Mentally Disturbed), perhaps the most influential work in the shaping of German psychiatry before Freud. The model of mind that he developed in the Rhapsodieen went considerably beyond Kantian boundaries. With the Rhapsodieen,Reil dramatically shed his materialistic interpretation of living nature and adopted a radically contrary stance. According to Robert Richards Reil's introduction to the philsopher Friedrich Schelling's romantic idealism fundamentally reoriented his understanding of the root causes of mental illness. In the light of this new philosophical conception, Reil came to regard insanity as stemming from the fragmentation of the self, from an incomplete or misformed personality, and from the inability of the self to construct a coherent world of the nonego-all of which resulted from the malfunctioning of self-consciousness, that fundamentally creative activity of mind postulated by the romantic philosophers.
In the Rhapsodieen, Reil again proposed a medical and quasi-physiological interpretation of mind, identifying mental powers quite closely with underlying forces of the brain and nervous system. "The brain," he argued, "may be conceived as a synthetic product of art, composed of many sounding bodies that stand in a purposeful relationship (that is, in rapport) with one another" (RU, p. 46). Any change in the brain's components from external sources would then change the orchestration of the whole. The ordering of these relations of the parts of the soul's organ is grounded in a determined distribution of forces in the brain and the whole nervous system. If this relationship is disturbed, then dissociations, volatile character, abnormal ideas and associations, fixed trains of ideas, and corresponding drives and actions arise. The faculties of the soul can no longer express the freedom of the will. This is the way the brain of a mad person is produced.
Reil now conceived of the nervous system as an integrating force designed to achieve a "natural purpose," precisely the conception of organic activity rejected in his earlier "Von der Lebenskraft."If psychological manipulations were successful, then the underlying nervous connections would be properly readjusted and the rational operations of
mentality restored (see RU, p. 150).It would be a mistake, though, to think of Reil as introducing, via the mind, an indirect means of altering the pathological brain. In his construction, brain and mind became inextricably joined. Indeed, not
worrying about theoretical problems of the mind-body relationship, he treated them as virtually identical, as if mind were completely instantiated in the nervous system. Hence, an altered mind was an altered brain.
In the Rhapsodieen, Reil distinguished three chief forces of the soul, whose disruption could produce pathology. These were self-consciousness,prudential awareness,and attention. He devoted most of his effort in the Rhapsodieen to the analysis of a force now considered the most crucial for understanding pathologies, that of self-consciousness. "The essence of self-consciousness," Reil held, "seems chiefly to consist in joining the manifold into unity and assimilating the representations as one's own." When self-conscious action falters, when pathology of the ego strikes, then personality fragments and the world becomes incoherent. Some people will not be able to distinguish real objects from phantoms of their imaginations.When the faculty of prudential awareness, which keeps mental focus fixed on an object or project, becomes weakened, then attention shifts with the wind and patients live in another world. As the quote accompanying the Katzenclavier indicates Reil as drawing the patient's attention back from that other world, by mobilizing his/her prudential awareness.
(This note is derived from Robert Richard's The Romantic Conception of Life: Science and Philosophy in the age of Goethe, (University of Chicago Press, 2002)251-288.

Monday, June 02, 2008

Katzenclavier


I can't resist sharing an
account of what is one of the most bizarre treatments I have read about. Johann Christian Reil (1759-1813), the very influential German psychiatrist, who first used the word psychiatry in 1808, describes the use of the Katzenclavier-- a piano made of cats. After voicing the instrument with suitable animals, they would "be arranged in a row with their tails stretched behind them. And a keyboard outfitted with
sharpened nails would be set over them. The struck cats would provide the sound. A fugue played on this instrument--particularly when the ill person is so placed that he cannot miss the expressions on their faces and the play of these animals--must bring Lot's wife herself from her fixed state into prudential awareness." We have made progress
in the last two centuries!

Wednesday, May 14, 2008

A Major Swing in Diagnosing Bipolar Disorder

Mark Zimmerman's recent presentation at the American Psychiatric Association meeting of his study showing that, looked at rigorously, less than half of a series of patients presenting with the diagnosis of Bipolar Disorder meet criteria for that diagnosis reminded me of Pliny Earle's nineteenth century demonstration that the high cure rates claimed by asylum superintendents were due to counting every discharge from an asylum as a cure. Psychiatry's "low epistemological profile," as Michel Foucault referred to it, again allows its judgments to be influenced by social, economic and political forces.

Sunday, May 11, 2008

Dr. Heidenhoff's Process

This short novel by Edward Bellamy was published in serial form in 1878 and 1879 and in book form in 1880. It revolves around the notion that even when you have repented a sin, its memory may yet torment you. The protagonist dreams that a Dr. Heidenhoff has an electro-therapy process that can destroy specific memories and thereby liberate his lover from her torment. Reading it reminded me of Ian Hacking's Rewriting the Soul, where he argues, as I recall, that it was just at this time that secular ideas about memory were replacing religious notions about what was central to a person's identity. I found it interesting that Bellamy, in a very different social and intellectual context, was exploring similar ideas about the place of memory. Incidentally it was also at this time that George Miller Beard, who like Bellamy was from Connecticut, was exploring the psychotherapeutic benefits of electro-therapy in the treatment of [indeed, in the conceptualization of] neurasthenia.