Monday, December 13, 2010

It's all in the Head

The Neue Galerie in New York currently has a wonderful exhibition of twenty busts by the 18th century sculptor Franz Xaver Messerschmidt (1736–1783). The article "It's all in the Head" by 
Willibald  Sauerländer  in the New York Review both places Messerschmidt's work in its historical context [to the extent that such strange and original work can be placed] and offers a well placed jab at the psychoanalytic reductionism that presumed  [and perhaps still presumes] to explain everything. 

Monday, August 30, 2010

Face Blind

Discovering Oliver Sacks's Awakenings many years ago has had a great influence on my thinking about psychiatry. Over the years I have tried to keep up with Sacks' work, though he seems to write faster than I read. Having recently enjoyed reading his  Uncle Tungsten, which is part autobiography and part history of chemistry, this piece on face blindness in the current issue of the New Yorker [August 30, 2010]  caught my eye. It is also part autobiography, -- Sacks suffers from face blindness-, part review of high points in the history of the neurosciences and part report on recent  research developments on this condition. It is also, poignantly, part advocacy, as Sacks makes a plea for considering face blindness with the kind of concern that we now give to dyslexia. In addition to the article you can also listen to Sacks talk about living with face blindness.

ABSTRACT: A NEUROLOGIST’S NOTEBOOK about prosopagnosia, or the inability to recognize faces and places. Writer describes his own difficulties recognizing and remembering faces. He also has the same difficulty with places and often becomes lost when he strays from familiar routes. At the age of seventy-seven, despite a lifetime of trying to compensate, he has no less trouble with faces and places than when he was younger. He is particularly thrown when seeing a person out of context, even if he was with that person five minutes before. Writer gives several examples of his inability to recognize familiar people out of context, including his therapist and his assistant. After learning that his brother suffered from the same problem, the writer came to believe that they both had a specific trait, a so-called prosopagnosia, probably with a distinctive genetic basis. Mentions several other people who have the same trait, including Jane Goodall and the artist Chuck Close. Face recognition is crucially important for humans, and the vast majority of us are able to identify thousands of faces individually, or to easily pick out familiar faces in a crowd. People with prosopagnosia need to be resourceful, inventive in finding strategies for circumventing their deficits: recognizing people by an unusual nose or beard, or by their spectacles, or a certain type of clothing. Describes research done on the way the brain recognizes faces. Tells about the work of Christopher Pallis, Charles Gross, Olivier Pascalis, Isabel Gauthier, and other scientists. Above all, the recognition of faces depends not only on the ability to parse the visual aspects of the face—its particular features and their over-all configuration—and compare them with others, but also on the ability to summon the memories, experiences, and feelings associated with that face. The recognition of specific places or faces goes with a particular feeling, a sense of association and meaning. Briefly discusses déjà vu and Capgras syndrome. Considers the difference between acquired prosopagnosia—through stroke or Alzheimer’s for example—and congenital prosopagnosia. Discusses the work of Ken Nakayama and Brad Duchaine, who have explored the neural basis of face and place recognition. They have also studied the psychological effects and social consequences of developmental prosopagnosia. Severe congenital prosopagnosia is estimated to affect two to two and a half per cent of the population—six to eight million people in the United States alone.

Read more

Monday, August 09, 2010

Spinal-Fluid Test Is Found to Predict Alzheimer’s

Gina Kolata seems to grow more enthusiastic and less critical with each article she writes about recent advances in the diagnosis and treatment of Alzheimer's Disease. It is hard not to hope that progress is being made. I do have my concerns, however, about the blessings of knowledge. Advances, such as she describes, in diagnosis, without comparable advances in treatment remind me of poignant episodes in the history of General Paresis of the Insane. This disease, which we now know is caused by syphilis, was, in some ways, the Alzheimer's of the nineteenth century. In an article on General Paresis I wrote that, "General paresis most often struck people (men far more frequently than women) between twenty and forty years of age. Within a matter of months to a few years after the appearance of the first symptoms, it reduced its victims to a state of dementia and profound weakness. No treatment was known, and patients uniformly died." In doing my research I ran across a number of cases where people learned that a loved one would become demented and die from  this incurable disease. As Joel Braslow has shown doctors' attitudes towards these patients, when they were thought to be incurable, were sometimes less than charitable. While I wouldn't argue against people being able to learn what they want about the illnesses that afflict them, I do hope that physicians will be able to help with the emotional aftershocks of such knowledge.

Friday, July 09, 2010

Room for Debate: Should More Veterans Get P.T.S.D. Benefits?

This debate in the Times shows that while the legitimacy of the PTSD diagnosis may now be almost universally accepted, the implications of the diagnosis are still controversial. I believe that considering the history of the idea of psychological trauma lends perspective to contemporary controversies. During the 1980s I researched the history of this idea. For those who are interested, here is a copy of one paper I wrote on the subject: Emotional Trauma and the Development of the Idea of Neurosis in the United States: 1865-1930.

Friday, June 18, 2010

Iraq ill-equipped to cope with an epidemic of mental illness

I am pleased that at least this sad, but not surprising, story is getting some coverage in the U.S.

Sunday, June 13, 2010


This 2009 Frontline program, a sequel to The New Asylums, follows several mentally ill inmates in an Ohio prison as they are released on medication, without obvious symptoms and guardedly optimistic. Due to a lack of mental health services they soon stop taking their medications, reoffend and are confined again.  As a critique of our failure to provide adequate care for the mentally ill in the era of deinstitutionalization it is gives the impression that Ohio offers absolutely no services. This seemed like polemical overkill. [Talking with a former Ohio caseworker I learned that at least some areas of Ohio provide reasonably adequate care.] What made this program worth watching, however, was not the polemic, but the contrast in the clinical state of when they are released and after they stop taking their medications. Even after all the years I have spent working with people suffering from schizophrenia seeing this portrayal of several men losing their minds was very powerful and disturbing. I hope that medical students will get a chance to see this program as a part of their training.

Sunday, May 16, 2010

Social Tensions Stoke School Attacks, China's Premier Says

That the way people explain acts of violence is a marker of cultural differences is shown in this article. What jumped out at me in the article was the fact that the Prime Minister in discussing the "social tensions" that may lay behind the recent spate school attacks "did not address the possibility that some of the attackers might have been mentally ill." The article goes on to note that the most recent attacker "was an unbalanced person--he had tried to commit suicide twice in the past month and believed that the kindergarten administrator … had put a curse on him to prevent his diabetes from improving." It is striking that in the U.S. mental illness is often the first thing that comes to mind to explain an act of brutality, that can't be attributed to terrorism, while in China it appears to be the last.

Monday, April 19, 2010

A Double Life; A Biography of Charles and Mary Lamb, Sarah Burton (Viking, 2003)

This thoughtful and well told biography of a brother and sister, whose lives spanned the  late eighteenth and early nineteenth centuries,  is quite moving.  Throughout her life Mary Lamb had many episodes of what today would likely be diagnosed as Bipolar Disorder. These episodes occurred almost yearly, lasted from weeks to months and grew more frequent as she grew older. During the first episode, when she was 32, she killed her mother and injured her father. She was not tried, but simply declared insane and released to the custody of her 21 year-old brother. She stayed in a "madhouse" for six weeks and then returned home. Between episodes she was reported to have been a sensible, sensitive woman who was responsible for writing much of the Lambs' most enduring literary work "Tales from Shakespeare." Mary never harmed anyone else during her episodes, but both Mary and Charles were sufficiently concerned about her violence that they purchased a straitjacket that they kept with them even while traveling and used on occasion to assist in getting Mary to a madhouse. These madhouses were run by laypeople and Mary apparently only received medical treatment on one occasion. Charles appears to suffered from chronically from depression, having spent at least one period of time in a madhouse himself. His drinking was excessive and daily throughout most of his adult life, though he was able to hold a job at the East India Company for forty years. As their lives were well documented through their writings and comments of friends {Coleridge, Wordsworth etc] this dual biography provides a remarkable glimpse into the course of these psychological disorders. I was especially moved by the beautiful descriptions of what it was like for friends to listen to Mary as she entered an episode of illness. They are of particular interest as they seem not to have been influenced by medical theories. Here are two examples:
Charles Lamb wrote of his sister that: "When she is not violent, her rambling chat is better to me than the sense and sanity of this world. Her heart is obscured, not buried; it breaks out occasionally; and one can discern a strong mind struggling with the billows that have gone over it. I could be nowhere happier than under the same roof with her. Her memory is unnaturally strong; and from ages past, if we may so call the earliest records of our poor life, she fetches thousands of names and things that never would dawned on me again, and thousands from the ten years she lived before me. What took place from early girlhood to her coming of age principally lives again (every important thing and every trifle) in her brain with the vividness of real presence. For twelve hours incessantly she will pour out without intermission all her past life, forgetting nothing, pouring our name after name to the Waldens [the keepers of the madhouse, where they both lived at this time in their lives] as if in a dream; sense and nonsense; truth and errors huddled together; a medley between inspiration and possession." [Burton, 2003, 370-371]

Charles Lamb's friend and biographer said of Mary that "Though her conversation in sanity was never marked by smartness or repartee; seldom rising beyond that of a sensible quiet gentlewoman appreciating and enjoying the talents of her friends, it was otherwise in her madness... She would fancy herself  in the days of Queen Anne or George the First; and describe the brocaded dames and courtly manners, as though she had been bred among them, in the best styhle of the old comedy. It was all broken and disjointed, so that her hearer could remember little of her discourse; but the fragmets werre like jewelled speeches of Congeve, only shaken from their setting. Thjere was sometimes even a vein of crazy logic running through them, associating things essentially most dissimilar but connecting them by a verbal association in strange order. As a mere physical instance of deranged intellect, her condition was, I believe, extraordinary; it was as if the finest elements of mind had been shaken into fantastic combinatiions like those of a kaleidoscope... [Burton, 2003, 241-2].

Tuesday, April 13, 2010

Mental Health and Illness at the Science Museum London

The new history of medicine website of the Science Museum London has now been completed. In all it now presents 4000 new images of artefacts from the collections linked to 16 specialised themes on medicine across time, written by staff and other professional historians of medicine. Each theme is associated with bibliographies and interactives suitable for teaching at several levels. The link above takes you to the mental illness and health page.

Monday, March 29, 2010

Disabled Immigration Detainees Face Deportation

As someone who works closely with people suffering from schizophrenia I found this New York Time article quite disturbing. It seems "The Great Confinement" of the seventeenth century has returned in the twenty-first century as "The Great Deportation." In both cases the issue is the failure of governments to recognize the significance of mental disability. It is sad that the knowledge acquired over the last three plus centuries hasn't had more influence on power.

Sunday, March 28, 2010

Nominee to Disability Council Is Lightning Rod for Dispute on Views of Autism

As diagnostic categories get expanded to include less disabled people, it seems that there will be more examples of people advocating that their condition be de-medicalized. This New York Times article describes a 22 year old man diagnosed with Asperger syndrome wants autism to be considered as a form of "neurodiversity"  and funds devoted to finding its cause and cure be spent on providing accommodations. In the past I've run into people diagnosed with Multiple Personality Disorder making similar arguments.  When I imagine our society becoming thoroughly medicalized, with the concept of the normal losing its meaning, I imagine that the process of de-medicalization will grow dialectically.  I am wondering if there is a literature on the process of de-medicalization.

Wednesday, March 24, 2010

Büchner and Madness

Thanks to GEB for suggesting James Crighton's book Büchner and Madness: Schizophrenia in Georg Büchner's Lenz and Woyzeck. [see the comments after the post "Lenz by Georg Büchner."]  Crighton's book is quite remarkable. Starting from an appreciation of the insightful and empathic descriptions of psychotic disorders in Büchner's Lenz and Woyzeck, Crighton asks whether factors in Büchner's personal life or knowledge of contemporary psychiatry contributed to his ability to create these works. Because Crighton is meticulous in his attempt to answer these questions the reader is guided through an era of German history and the history of psychiatry in Germany that was quite unfamiliar to me. I found his presentation of case histories of psychotic disorders in this period of particular interest. In the end Crighton acknowledges that he can't explain Büchner's genius, but it is the journey through this book, not the conclusion, that is so enriching.

Sunday, March 21, 2010

In Haiti, Mental Health System Is in Collapse

Not surprisingly the earthquake in Haiti has affected its, already fragile mental health system, disastrously. As I look at signs of our, already inadequate, mental system crumbling I feel like a man with no shoes meeting a man with no feet. This New York Times article gives a vivid picture of circumstances in Haiti.

Friday, March 19, 2010


I have just found a terrific blog on the history of psychiatry called h-madness. I will list it in my links.  Here is the "about us" section: H-Madness is intended as a resource for scholars interested in the history of madness, mental illness and their treatment (including the history of psychiatry, psychotherapy, and clinical psychology and social work).  The chief goal is to provide a forum for researchers in the humanities and social sciences to exchange ideas and information about the historical study of mental health and mental illness.  The blog, therefore, primarily serves university and college faculty, students, and independent researchers.
Subscribers are encouraged to share information about teaching and research as well as news about professional activities and events, such as job postings, conferences, and fellowships and grants.  While most postings are in English, postings in other languages are welcome.The editors are:
To contact us:

Canton Asylum for Insane Indians

Recently Carla Joinson introduced me to her blog and website on the Canton Asylum for Insane Indians (1902-1934). which showed me that there are still fascinating local stories to be told in the history of psychiatry. "If there were ever a building that ought to be haunted, Joinson tells us, the Canton Asylum for Insane Indians in South Dakota would be that place.  Native Americans were committed to its care, involuntarily, with little recourse for protest. Many remained for life…"I will list the link. 

Unholy Ghost: Writers on Depression, edited by Nell Casey

The most interesting essay in this collection was Joshua Wolf Shenk's "A Melancholy of My Own," where he argues that the introduction of the term "depression" (by Adolf Meyer in 1905 as a replacement for melancholia) into the lexicon of psychiatry has served, if nothing else, to deaden and flatten the way we use language to describe certain painful experiences. The essays in this collection are strong evidence for his argument. While some of the authors do use vivid language to describe their experiences most then seem to say that all that was 'just depression,' making reading these essays a numbing experience. I guess i shouldn't have expected more from a book with an introduction written by the apostle of Depression Kay Redfiled Jamison. Published in 2001, this book does seem to provide a useful sourcebook on the historical question of how psychiatry influenced the way people in the late twentieth century thought about themselves.

Monday, March 08, 2010

Against Freud: Critics Talk Back by Todd Dufresne

This book published in 2007 consists of nine interviews with Freud "bashers." [Wortis, Menaker, Sulloway, Crews, Cioffi, Shorter, Esterton, Borch-Jacobsen, Israëls:] The interviewers are not very probing and mostly give the critics a chance to restate their positions. Having read most of these writers works, I didn't find much new in this book. For those who haven't read these critics, this book assumes too much familiarity with their work to serve as an introduction.

Wednesday, February 10, 2010

Revising the book on Disorders of the Mind

Benedict Carey's article on DSMV makes particular note of the problems associated with the diagnosis of bipolar disorder in children. I found it a wonderful example of how psychiatric diagnoses are negotiated socially. What is a psychiatric diagnosis if its boundaries can be changed because of concerns about the side effects of the medications used to treat it? Here is an excerpt from the article.

One significant change would be adding a childhood disorder called temper dysregulation disorder with dysphoria, a recommendation that grew out of recent findings that many wildly aggressive, irritable children who have been given a diagnosis of bipolar disorder do not have it.

The misdiagnosis led many children to be given powerful antipsychotic drugs, which have serious side effects, including metabolic changes.

“The treatment of bipolar disorder is meds first, meds second and meds third,” said Dr. Jack McClellan, a psychiatrist at the University of Washington who is not working on the manual. “Whereas if these kids have a behavior disorder, then behavioral treatment should be considered the primary treatment.”

Some diagnoses of bipolar disorder have been in children as young as 2, and there have been widespread reports that doctors promoting the diagnosis received consulting and speaking fees from the makers of the drugs.

In a conference call on Tuesday, Dr. David Shaffer, a child psychiatrist at Columbia, said he and his colleagues on the panel working on the manual “wanted to come up with a diagnosis that captures the behavioral disturbance and mood upset, and hope the people contemplating a diagnosis of bipolar for these patients would think again.

Tuesday, February 09, 2010

Post Traumatic Symptoms in the Civil War

I recently came across this in Louisa May Alcott's Civil War Sketches [Dover, 2006, 34-5]. She worked as a volunteer nurse at a hospital in Washington shortly after the battle of Fredricksburg. This is a layperson's description. The role of psychological trauma was not established medically in the production of symptoms such as these until after the Civil War. I'm not sure how a Civil War doctor would have diagnosed this "… New Jersey boy, crazed by the horrors of that dreadful Saturday. A slight wound to the knee brought him there; but his mind had suffered more than his body; some string of that delicate machine was over strained, and, for days, he had been reliving in imagination, the scenes he could not forget, till his distress broke out in incoherent ravings, pitiful to hear. As i sat by him endeavoring to sooth his poor distracted brain by the constant touch of wet hands over his hot forehead, he lay cheering his comrades on, hurrying them back, then counting them as they fell around him, often clutching my arm, to Drag me from the vicinity of a bursting shell, or covering up his head to screen himself from a shower of shot his face brilliant with fever; his eyes restless; his head never still; every muscle strained and rigid; while an incessant stream of defiant shouts, whispered warnings, and broken laments, poured from his lips with that forceful bewilderment which makes such wanderings so hard to overhear." Perhaps a febrile delirium.

Monday, February 08, 2010

Wittgenstien's Nephew by Thomas Bernhard

This is a book about madness and friendship. Written as a memoir, which in part it is, it describes Bernhard's friendship with the great philosopher's mad nephew Paul Wittgenstein. What is most moving about this book is that the author, while vividly describing his friend's madness, also conveys how terribly important his friendship with this madman is to him. In the end it is not a book so much about Paul's madness as about Thomas' frailty and his sadness at the loss of a dear friend.

Wednesday, February 03, 2010

Lenz by Georg Büchner

Thanks to Praymont I have read Lenz [for more about this book see his comment on my Yellow Wallpaper post]. Büchner's descriptions of Lenz's madness were convincing and if I had the time I would love to compare them with, say, the descriptions of Lowboy's madness [see my Lowboy post] to get a better idea of how contemporary ideas about madness color our representations of the inner lives of the mad. I don't think it is possible to provide a culture free description of madness and I think all such descriptions say more about the culture and the author than about madness itself. What impressed me more than the description of Lenz was the description of Oberlin and his wife as they struggled to care for Lenz. Without a medical model to channel their feelings towards Lenz their mix of kindness and exasperation reminded of the kinds of feelings that families today have when one of their loved ones begins losing his or her mind.

The Age of Anxiety by Andrea Tone

Almost a companion piece to Hirsbein's book The Age of Anxiety traces the creation of the diagnosis of Anxiety Disorder and the production of treatments for it in the United States during the last half of the twentieth century. This book is less self-consciously constructionist and feminist than Hirsbein's, which is not to say that it does not make clear how the diagnosis of anxiety was constructed and how gender has played a role in marketing the diagnosis and its treatments. Tone is, however, more interested in changes in American culture and how this affected attitudes towards anxiety and its treatments. She does a wonderful job capturing the mood of the country during the Miltown years as well as during the ups and downs in our feelings about benzos. A particular pleasure in this book is that Tone interviewed two of the men responsible for particular medications--Frank Berger (Miltown) and Leo Sternbach (Librium)-- and puts their personal stories in counterpoint with the larger cultural story.

Friday, January 22, 2010

American Melancholy by Laura D. Hirshbein

Written by a psychiatrist/historian, this engaging book traces the growth of the diagnosis of depression in the second half of the twentieth century. Hirshbein argues that while the symptoms of depression can be found throughout history, the diagnosis of depression and its various treatments became commodities only late in the last century. What some have seen as the destigmatizing of a disease she interprets more as a marketing triumph. Her second argument is that reports that women suffer from depression much more frequently than men are not simple reports from nature but artifacts of the way depression has been studied. Her arguments about the construction of the diagnosis of depression got me thinking about the diagnoses that have come and gone--hysteria, neurasthenia-- and wondering how long the the diagnosis will retain its popularity. A particular strength of this book is that the author has not only described the psychiatric literature on depression, but also explored popular literature on the subject.