Psychiatry and History

Biology vs. Psychology in the 1920s

2012-01-10T10:26:00.000-05:00

Some years ago, while rummaging around in a room full of psychiatric hospital records from the 1920s, I ran across the verbatim typescript of a memorable case conference. During this period two perspectives on understanding patients were actively competing. Psychoanalytic ideas were still relatively new and attempting to explain all sorts of phenomena that had previously been explained biologically. At the same time new biological treatments were infusing biologically oriented psychiatrists with new confidence. At this hospital the ambitious medical director had recruited a number of young clinicians from each of these perspectives. The case presented on that day was a middle aged man who had been treated with mercury some ten years earlier for symptoms of general paresis of the insane. Now he was admitted to the hospital for symptoms of depression with some suspicion that his general paresis had returned. In the days before penicillin, general paresis, which is a form of tertiary syphilis was a common frightening cause of madness and death. Its early psychiatric manifestations were quite variable, though most often they were mood related--mania and depression. While severe dementia eventually dominated the clinical picture, symptoms of dementia were, in the early stages, often subtle and easy to miss.
Why was this man depressed? The medical director posed this question to his young new staff somewhat in the manner of a professor presenting a question to a class. A lively discussion broke out. The biologically oriented psychiatrists noted that mood symptoms were common in such cases of general paresis. The psychoanalytically oriented psychiatrists argued that the sexual nature of the disorder ws producing guilt and that was leading to the symptoms of depression. The discussion went on for some time without resolution since the two perspectives were incommensurable. Eventually the medical director asked that they simply review the facts of the case. After some further discussion, he pointed out that ten years earlier the patient had thought himself cured of syphilis and free from the possibility of general paresis. Now, perhaps, the patient was able to subtle signs of dementia in himself and understood what was in store for himself. "Isn't that," the medical director concluded, "reason enough to be depressed."
Reading that case many years ago, I thought about how ideological arguments have the power to distract psychiatrists from what is staring them in the face. Over the years that I have practiced psychiatry, i have often had occasion to recall the lesson of that case conference.

Her Name is Sabine

2011-10-25T22:12:00.000-05:00

This is a beautiful, tragic documentary film directed by the actress Sandrine Bonnaire. It uses home movie footage of her sister Sabine along with footage made when Sabine was a resident of a group home for people with serious psychiatric and neurological disabilities. The contrast between the images of the hauntingly beautiful adolescent Sabine and the obese, drooling, anxiety ridden and occasionally violent woman that her sister found after her five years residence in a psychiatric hospital is profoundly moving. The film also answers a question that I have had for years since seeing Sandrine Bonnaire in the Agnes Varda film Vagabond. I wondered how Bonnaire had 'found' the hauntingly beautiful character she plays. Her Name is Sabine certainly gives a clue to an answer to that question.
I should add that Sabine is described in publicity for the film as 'autistic.' As I recall, someone who I took to be a psychiatrist in the film describes her as a 'psychoinfantile character with autistic features.' [I may not remember this exactly] While I thought that schizophrenia was a reasonable diagnosis for Sabine [especially as she seems to be receiving clozapine treatment], I found it interesting that schizophrenia is not mentioned in the film. I wondered if this was due to stigma or diagnostic peculiarities in France.

Teenager’s Path and a Killing Put Spotlight on Mental Care

2011-08-03T18:45:00.000-05:00

I suppose this article got to the first page of the New York Times today to give us a preview of what this era of more budget cuts and no new taxes will be like. There are, of course, many unfortunate consequences of lowered funding for mental health services. It takes stories like this to bring attention to the situation. What will it take to produce better services? During the late nineteenth and early twentieth centuries mental health services for the seriously mentally ill deteriorated for nearly a century.

Sigmund Freud’s Cocaine Years

2011-07-25T17:39:00.000-05:00

This New York Times review by Sherwin Nuland of Howard Markel's book titled AN ANATOMY OF ADDICTION: Sigmund Freud, William Halsted, and the Miracle Drug Cocaine sound as though Markel's book manages to treat the cocaine addiction of two famous people with both clinical and historical intelligence -- a remarkable achievement. I look forward to reading the book.

Ugandans with Mental Illness Learn to Fit In

2011-05-15T09:02:00.003-05:00

This story reported by Joanne Silberner and funded by a Rosalynn Carter Fellowship for Mental Health Journalism describes a program for helping people in Uganda with mental illness find employment. In a market economy, community acceptance is based on the ability to work and bring money home to the family. This story focuses on community efforts in Africa to supplement psychiatric treatment with vocational programs. The emphasis of this story is on how programs that promote work for the mentally ill are especially important in African communities. The suggestion seems to be that things are different in the United States. In my experience, however, all that seems different in this country is that vocational programs for the mentally ill have a very low priority. Would that there were more effective programs promoting work for the mentally ill in the United States.

Blackwell's Island Lunatic Asylum

2011-05-14T17:26:00.001-05:00

Years ago I enjoyed discovering this 1866 Harpers Weekly article. When I was developing my History of Psychiatry website, I imagined typing it out and posting it, but laziness overcame me. Now I have found that Nadia Borisova has taken the trouble to do just that.

It's all in the Head

2010-12-13T18:22:00.000-05:00

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.

Face Blind

2010-08-30T07:26:00.000-05:00

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 http://www.newyorker.com/reporting/2010/08/30/100830fa_fact_sacks#ixzz0y5e1A8DW

Spinal-Fluid Test Is Found to Predict Alzheimer’s

2010-08-09T20:24:00.023-05:00

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.

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

2010-07-09T09:18:00.000-05:00

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.

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

2010-06-18T08:07:00.000-05:00

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

Released

2010-06-13T22:48:00.000-05:00

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.

Social Tensions Stoke School Attacks, China's Premier Says

2010-05-16T07:07:00.000-05:00

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.

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

2010-04-19T09:49:00.001-05:00

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].

Mental Health and Illness at the Science Museum London

2010-04-13T06:39:00.000-05:00

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.

Disabled Immigration Detainees Face Deportation

2010-03-29T17:27:00.000-05:00

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.

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

2010-03-28T08:53:00.000-05:00

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.

Büchner and Madness

2010-03-24T09:29:00.000-05:00

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.

In Haiti, Mental Health System Is in Collapse

2010-03-21T09:33:00.000-05:00

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.

h-madness

2010-03-19T17:00:00.000-05:00

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:

Greg Eghigian (Penn State University)
Eric J. Engstrom (Humboldt Universität)
Andreas Killen (City College of New York)
Benoît Majerus (Université libre de Bruxelles)

To contact us: hpsychiatry@gmail.com

Canton Asylum for Insane Indians

2010-03-19T09:26:00.000-05:00

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

2010-03-19T08:55:00.001-05:00

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.

Against Freud: Critics Talk Back by Todd Dufresne

2010-03-08T09:26:00.003-05:00

	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.

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.

Revising the book on Disorders of the Mind

2010-02-10T07:04:00.007-05:00

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.

Post Traumatic Symptoms in the Civil War

2010-02-09T07:31:00.003-05:00

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.

Wittgenstien's Nephew by Thomas Bernhard

2010-02-08T22:05:00.003-05:00

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.

Lenz by Georg Büchner

2010-02-03T08:08:00.002-05:00

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

2010-02-03T07:48:00.002-05:00

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.

American Melancholy by Laura D. Hirshbein

2010-01-22T17:58:00.005-05:00

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.

The Yellow Wallpaper

2009-12-26T15:51:00.002-05:00

Thanks for your comment Praymont. I will look for Lenz. As for the The Yellow Wallpaper it is a wonderful nineteenth century instance of madness used for polemical purposes, that I have used in teaching about the history of psychiatry. Charlotte Perkins Gilman said, as I recall, that she wrote this story as a satire of the treatment, known as the 'rest cure' that she received from the illustrious Philadelphia neurologist S. Weir Mitchell. Anyone interested in the history of psychiatry in the late nineteenth century should read this. The link above is to a free online version of the story. For more background on this period you might read my article "Neurology's Influence on American Psychiatry:1865-1915."

Lowboy

2009-12-21T23:01:00.002-05:00

I would love to find a history, or even a list, of novels, short stories etc with mentally ill protagonists. Such a history would trace the changing ways the mentally ill have been portrayed and the ways such portrayals reflect the ideas current at the time. One of my favorites was Frank Norris' McTeague, where, as I recall, the protagonist commits senseless violence and is described as an instance of hereditary degeneration. Now we have John Wray's Lowboy, where the protagonist is a sixteen year-old schizophrenic boy know as "Lowboy." Lowboy is a Holden Caulfield type character whose quest to lose his virginity is shown as refracted through his delusions. While the depiction of Lowboy seems true to what one might read in twenty-first century textbooks, it seemed that the author was taking advantage of contemporary fascination with psychotic people "off their meds" and roaming the streets, or in this case haunting the New York subway system. I couldn't help feeling that it was the latest edition to a genre that I might call "madsploitation."

Joy Luck Club

2009-12-20T09:57:00.005-05:00

I haven't read The Joy Luck Club by Amy Tan, but I had the pleasure the other evening of seeing the film version directed by Wayne Wang with a screenplay by Ms. Tan [and someone else]. It is a beautiful film that my wife, who has read the book, says does justice to the book. What struck me was the way it showed relationships changing. As so much of my psychotherapeutic work focuses on people stuck in relationships, often influenced by ghosts from their past, it can seem that such circumstances are diseases like and in need of treatment. In the Joy Luck Club, however, we see four mothers and four daughters knotted up in their relationships with each other [and others] and we also see knots become undone and relationships change. I found it refreshing to see a portrayal of the normal processes in relationships at work. It left me thinking again about what a feeble tool psychotherapy is compared to the good fortune of having relationships that allow for revision. I have included a link to Janet Maslin's review, which will give you a fuller sense of the film.

AstraZeneca Pays Millions to Settle Seroquel Cases

2009-10-31T20:09:00.002-05:00

This Times articles discusses AstraZeneca's settlement over off-label promotions. It got me wondering whether off-label prescribing is greater in psychiatry than in other specialties. Given the extreme flexibility of psychiatry's diagnostic system it would seem that practically all prescribing in psychiatry is "off-label." Yes, we may give people the diagnosis for which the studies on a particular drug were done, but how closely do the symptoms most of the people given these diagnoses match the symptom picture of the people in the study? Of course such prescribing is not truly off-label, but….

More on Atpicals and Children

2009-10-27T15:44:00.002-05:00

This New York Times article provides the latest on the continuing saga of the misuse of atypical antipsychotics. It will be interesting to track how long it will take until we are thoroughly chastened about the use of atypicals, especially in children. A comparative study of the histories of the rise and fall of various wonder treatments would be of interest-- insulin coma, focal infection etc.

Grrr, Sniff, Arf

2009-09-16T07:34:00.002-05:00

This book reviewed in the Times gives a neuroscience perspective on the umwelt [life-world] of dogs. Aside from the inherent fascination with what the experience of sniffing reveals to a dog, it also reminded me of how difficult it is to think of people in terms of their differing umwelt's. The act of diagnosing, with its essentially reductive method, runs counter, for me at any rate, to efforts to get into the experience of others. The more remote a person's life-world is from our own, it seems, the easier it is to imagine. Hallucinating people, like dogs, are clearly living in another world. But when people resemble us, it is very difficult not to assume that their world is like our own. Perhaps neuroscience as an alienating way of talking about human experience will actually make this easier. A patient recently said to me that she felt something limbically. Will it be easier to understand human experience when we stop using words that we assume are common to all human experience?

When does realism prevail?

2009-07-03T08:16:00.003-05:00

Reading Owsei Temkin's book Galenism, I came upon an interesting paragraph on Vesalius the great 16th century anatomist. In a 1538 publication Vesalius attempted to represent traditional Galenic physiological concepts in visual form. In a drawing of the liver and portal system of veins carrying the caption: "The liver, workshop of sanguification…," the liver is represented with its traditional five lobes. On the other hand, in an illustration of the "organs of generation," where the liver does not play a central role, the liver is sketched incompletely, yet correctly, with two lobes. It was Temkin's conclusion to this observation that caught my attention. It seemed to resonate so well with my experience of practicing psychiatry in a world of distorting theories. "Where realism was of little consequence," he writes, "it could be allowed to prevail." And how are we to know, I thought, when, in our experience, realism does prevail?

Practice, Practice

2009-06-27T07:58:00.004-05:00

After reading this review, I probably won't read Masters of Sex By Thomas Maier , but the review colored in a little patch of my memory. I felt embarrassed reading it and thinking back to the seriousness and enthusiasm with which I read Masters and Johnson. Liberal self-objectification may not be as vicious as the objectification of others but it is perhaps as pernicious.

Moral Treatment and the Personality Disorders

2009-05-20T07:33:00.003-05:00

A few comments on one article of particular interest to me, "Moral Treatment and the
Personality Disorders" by Louis Charland in The Philosophy of Psychiatry: A Companion, Jennifer Radden [3d], [Oxford Universit Press, 2004] [pp64-77].
I became interested in Charland because of what he has written about Philippe Pinel, whose work I have been researching for a few years. His thoughts about Personality Disorders are of more general interest. His argument is that Cluster B personality disorders [Anti-social, and Borderline] are not medical kinds but what he calls interactive kinds and should not be within the purview of medicine. His argument is that the treatment of Axis I disorders as well as Cluster A and Cluster C disorders do not require "the sort of moral willingness and effort required by
Cluster B disorders." While "the dependent individual," he notes, "may annoy others … [he/she] does not necessarily intend to annoy them for the sake of it." Charland suggests that people with Cluster B disorders do intend the annoying [harmful] effects they have on others and therefore require a moral treatment, not a medical one, that will help them to intend otherwise. I find his distinction between moral and medical treatments unsatisfactory, to say the least. My own experience with people with Antisocial and Borderline diagnoses is that they like people with any disease, pursue treatment [if we must use that term] to diminish their own personal suffering and not to be be better people [more thoughtful of others feelings]]. The threat of jail is modestly good "treatment" for some people with an Antisocial diagnosis and when Borderlines benefit from treatments [like DBT], it is because help them feel better. It seems to me that the whole
discussion of "kinds" is as misguided when it is pursued by critics of psychiatry like Charland, as it is when it is done by the authors of the DSM.
..........
Charland reveals himself to be a dualist, identifying a realm of
actions that one intends and one that one does not intend. While this
is not the cartesian dualism of substances, it serves the same
function--to distinguish that which we are responsible for--mind,
intention, from that which we are not responsible for--body, cluster A
syndromes. Psychotherapy as inspired by Freud [and Pinel, I would
argue] in contrast is based on a monist principle. Psychoanalytic
discourse does not make a distinction between the intended and the not
intended, or perhaps I should say that the concept of unconscious
motivation is a a concept that joins the intentional and unintentional
in a way that allows one to talk about the intentional in a non
judgmental way. It makes moral therapy as Charland uses it obsolete. I
think that Charland is thinking in pre-Freudian terms and from reading
his work on Pinel, he is also thinking in eighteenth-century dualist
[though obviously not about substances] terms as well.

Waterboarding as Psychotherapy

2009-05-15T12:34:00.004-05:00

While we are properly horrified to learn about the use of deliberate near-drowning (waterboarding) as an interrogation technique, it is worth noting that for a period of nearly two hundred years the same procedure was regarded as a form of psychotherapy. The influential seventeenth century physician Jan Baptiste Van Helmont (1580-1644), originated this treatment after observing that a madman, who was revived following an accidental near-drowning, was relieved of his mental symptoms. The most influential eighteenth century physican Hermann Boerhaave. (1668-1738) mentions the use of submersion in the treatment of insanity but recommends it for only the most desperate cases. Boerhaave's student Jerome Gaub also discusses the treatment and attributes its efficacy to anxiety. "The most deeply seated mental defects and the most incurable forms of madness" he writes, "may sometimes be rooted out by anxiety." Perhaps, he speculates, this is "because the tormented and frightened mind is revived by the terrible punishment of her greatly depressed senses…." He cites "men with minds held captive by the violence of love or grief," who recovered their soundness of mind when revived after accidental near-drowning. He insists that the cause of this recovery is the "frightful torment that near loss of life from suffocation inflicts on the mind." Gaub acknowledges that "submersion therapy" is "a terrible remedy" but adds that it is "one hardly to be exceed in efficacy." Gaub took the trouble to attempt a medical explanation of "submersion therapy." He argued that "submersion therapy" worked by provoking anxiety, which he understood as a powerful emotion caused by bodily changes. The most frequent cause of anxiety, he felt, is interference with respiration, which hinders the passage of blood through the lungs and thus places life in jeopardy. These bodily events affect the "common sensorium" [where mind and body meet] so as to excite ideas in the mind that cannot be contemplated without horror and cannot be dispelled. The value of such shock therapy was widely recognized in the eighteenth century. “In mania,” a Montpellier doctor wrote in Diderot and D'Alembert's encyclopédie, “therapy is directed to the body, in which it aims to produce a shock and a deep disturbance .” Such ideas even influenced Philippe Pinel, who cites Van Helmont. Although Pinel did not use "submersion therapy," he did include the role of powerful emotions like fear in dispelling fixed ideas as a component of his moral therapy.

Military Mental Health

2009-05-13T05:41:00.004-05:00

The complexities of providing mental health services to soldiers was suggested by the recent case of the soldier who shot and killed five of his fellow soldiers at a military mental health center in Iraq. Although he managed to find a gun to use, it seems that his commanding officer was alert to his problems. He had the soldier turn in his gun and referred him for counseling. But that apparently isn't the way the soldier experienced it. In an interview, the soldier''s father said that his his son had recently angered a commanding officer, who had "threatened" him. When the officer ordered the soldier to undergo counseling and relinquish his weapon--a major rebuke in the military-- he became nervous that the Army was "setting him" up to be discharged. Having recently built a new home, he was deeply anxious that he could loose not only his steady paycheck but also his military pension, his father said.“If a guy actually goes to the clinic and asks for help, they think of him as a wimp and he’s got something wrong with him and try to get rid of him,” Mr. Russell said. “Well, he didn’t go and ask voluntarily for help. They scheduled him in, and they set him up. They drove him out. They wanted to put as much pressure on him as they could to drum him out.”

He added: “I think they broke him.”

A General in charge of the soldier's unit, however, said that, “The tools were all being used. They thought that he needed a higher level of care than the unit could provide, so they sent him to the clinic. I mean, you see, all the kind of things that we’re taught to do were in place.”

Psychiatry without Psychotherapy

2009-05-11T07:22:00.005-05:00

An article in the August 2008 issue of the Archives of General Psychiatry noted not only a significant decrease in the number of psychiatrists practicing psychotherapy, but a lack of interest in learning psychotherapy among psychiatric residents in the United States. A letter in the April 2009 issue of the same journal notes that a survey among Canadian residents showed that 84% "anticipated practicing psychotherapy and viewed it as an important component to their work and identities." For those who are inclined to see the rise of biological psychiatry as portending the inevitable decline of psychotherapy, this survey strongly suggests that economic and cultural factors are at work as well.

Looking for the Pineal

2009-03-13T16:38:00.002-05:00

Under the rubric of saving a good theory from the data, I read that in 1637 Descartes went to the anatomical theater in Leiden to observe a dissection performed by Adriaan van Valkenburt (1581-1650) hoping to see the pineal gland in man. It must have been a great disappointment to him that the professor could not show him the gland and even had to confess that he had never found it in a human subject. Descartes saved his theory by using the fact that the skull was opened some days after the beginning of the dissection. [Lindeboom, Descartes and Medicine, p.37]

More poison in the well

2009-01-14T21:09:00.003-05:00

It seems about weekly that one can read about another scandal involving the manufacturers of psychotropic medications. It does not surprise me that companies will market their drugs in whatever way they can. It does sadden me that doctors in general, and psychiatrists in particular, seem to have been complicit in poisoning the well. I have prescribed zyprexa for schizopherneic patients for years and sadly watched some of them get fat. I have switched as many as I have been able to switch back to first generation medications, usually without difficulty or apparent harm. given how little trouble I have had over the years with tardive dyskinesia due to first generation medications and the amount of metabolic side effects I have observed with second generation medications, I would say that the profession has allow a great harm to occur. Why was this? It seems to me ironic that one of the reasons is the critique of psychiatry for neglecting the epidemic of tardive dyskinesia produced by first generation medications. That I believe made us quite uncritical of the marketing of second generation drugs like Zyprexa.

Reanimating Nature

2009-01-13T22:45:00.002-05:00

As I was reading Steven Shapin's wonderful little book 'The Scientific Revolution,' and thinking about psychotherapy I came upon the following paragraph [p37]: "It must, however, be pointed out that there is nothing, so to speak, 'in the nature' of machines to prevent them from being regarded as mysterious, and a strand of thought going back to the Hellenistic period accounted machines something more than the sum of their material parts. Boyle, for example, wrote about the cultural variability of the appreciations of machinery. He related a --probably apocryphal-- story about the Jesuits "that are said to have presented the first watch to the king of China, who took it to be a living creature." Boyle himself accepted the adequacy of an account wholly in terms of "shape, size, motion &c. of the spring-wheels, balance and other parts of the watch," while recognizing that he "could not have brought an argument to convince the Chinese monarchs, that it was not endowed with life." A mechanical metaphor for nature meant, as all metaphors accepted as legitimate do, that our understanding of both terms changes their juxtaposition. The rightness of a metaphor is not subject to proof."
As someone who sees psychotherapy as fundamentally about trying to persuade people that they are not machines, but living creatures, this little story had great resonance. I realized that psychotherapy aims to reanimate nature, through whatever metaphors are at hand.

The lingering presence of psychoanalysis

2009-01-11T18:32:00.003-05:00

As I was reading C.U.M. Smith's "Brain and Mind in the 'Long' Eighteenth Century" I was thinking about psychoanalysis' lingering presence in the 21th century. Smith writes that "one important reason for the lingering of the old neurophysiology [ie. the one based on animal spirits] was the difficulty of knowing with what to replace it. The traditional understanding of the human being was at least a consistent system. Alexandre Koyré," Smith goes on to point out, said] "… the same of Aristotelian physics. … [Koyré] remarks that it '…forms an admirable and perfectly coherent theory which, to tell the truth, has only one flaw (besides that of being false)… that it is contradicted by the everyday practice of throwing.'"

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

2008-12-26T16:39:00.000-05:00

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

2008-12-26T16:06:00.000-05:00

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"

David Hume attempts to do psychotherapy

2008-12-07T10:25:00.001-05:00

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."

Before Prozac

2008-10-31T09:35:00.000-05:00

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.

Joseph Delboeuf and the History of Psychotherapy

2008-10-25T11:59:00.004-05:00

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.

Charles S. Peirce

2008-09-17T09:56:00.001-05:00

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.

Johann Christian Reil

2008-06-04T07:21:00.001-05:00

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.

Katzenclavier

2008-06-02T14:05:00.006-05:00

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!

A Major Swing in Diagnosing Bipolar Disorder

2008-05-14T09:28:00.003-05:00

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.

Dr. Heidenhoff's Process

2008-05-11T15:54:00.004-05:00

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.

The Cobweb

2007-12-29T09:52:00.000-05:00

William Gibson, who was married to the psychoanalyst Margaret Brenman-Gibson, spent some time in Topeka, Kansas, while she was associated with the Menninger Clinic in the early 1950s. The Cobweb, published in 1954, is a novel set at a psychiatric hospital located in a mid-western town. In this novel Gibson, who won fame for writing plays such as The Miracle Worker, tells a tale of institutional politics and infidelity that reads somewhat like the script for a 1950s B movie. His descriptions of clothing and cars as well as drinking and smoking habits create a vivid sense of the period. Attitudes towards race and gender are painfully, but not judgmentally, presented. What I enjoyed most, however, is the snapshot that Gibson takes of hospital based psychiatry at that moment when psychoanalytic treatment and milieu therapy were on the cutting edge. Seen from the 21st century optimism about the therapeutic value of patient government seems quaint. I think it is important, however, to revisit all those moments of false optimism that litter the history of psychiatry. Gibson's book provides an enjoyable way to visit at least one of them.

Menninger Madhouse

2007-12-16T18:05:00.000-05:00

Lawrence J. Friedman's 1990 book Menninger: The Family and the Clinic is an absorbing tour through much of twentieth century American psychiatry. Personally it connected the dots between many of the names that were floating around when I was doing my psychiatric training in the early 1970s. What struck me reading this book was the extraordinary hubris involved in the creation of hospital based psychoanalytic treatment facilities. I was reminded of Andrew Scull's book Madhouse with its caustic treatment of Henry Cotton's focal infection theory and incredible damage that resulted from its arrogant application. One of the most moving parts of Scull's book were the vignettes that allowed one to imagine what it was like for families to have someone treated by Cotton. While I do not want to draw too close a comparison between the Cotton's often lethal methods and the Menningers' subtler mind games, they do have one thing in common: psychiatrists claiming great expertise with very little evidence to back it up. If only Friedman had been given access to case records so that one could have a more vivid sense of what being subjected to treatment at the Menninger Clinic was like. I wonder if ther are first hand accounts.

Spikes in the Brain, and a Search for Answers

2007-09-14T14:29:00.000-05:00

William Grimes review of the book My Lobotomy by Howard Dully and Charles Fleming is well worth reading even if you don't plan to read the book. Grimes uses the narrative of the book to point to the ambiguities and complexities of recalling a life, particularly a life marked by a dramatic traumatic experience.

Surprise Visit

2007-09-14T14:10:00.001-05:00

I had a chance to read a story titled "Surprise Visit" by Antonia White. As fiction it recounts the story of a 38 year old woman who visits Bethlem Hospital after its conversion into a war museum. Having been a patient in that hospital 15 years earlier, she re-experiences her feelings from that time in a way that allows the reader to experience something of what a flashback must be like. The story appears in the book Strangers by White. In the introduction to that book Hermione Lee compares "Surprise Visit" to "The Yellow Wallpaper," which seems an apt comparison to me. White had indeed spent much of her 23rd year in a psychiatric hospital and the story has the quality of a memoir. For more on White try the link to the Wikipedia article on her.

Diseases of the Mind: Highlights of American Psychiatry through 1900

2007-05-18T14:53:00.000-05:00

Diseases of the Mind: Highlights of American Psychiatry through 1900

Here is an interesting new site from the National Library of Medicine.

Stella Chess, 93, Psychiatrist and Author

2007-04-08T06:55:00.000-05:00

The New York Sun
March 20, 2007 Tuesday

BYLINE: STEPHEN MILLER - Staff Reporter of the Sun

Stella Chess, who died Wednesday at 93, devoted her long
career in child psychiatry to challenging the notion that
children's personality problems are caused by bad parenting.
Together with her husband and research partner, Alexander
Thomas, she used a groundbreaking decades-long study of
children to show that mental health is the result of a
complicated interplay between an infant's inborn temperament
and parenting style. The result was an important challenge
to the earlier orthodoxy, which held that an infant at birth
was a blank slate and that mental problems could be chalked
up to defective parenting; for instance, autism was blamed
on "icebox" mothering.

"It was unprecedented, especially studying children who did
not have a disease," the director of the New York University
Child Study Center, Dr. Harold Koplewicz, who worked with
Chess over the past decade, said. "Temperament is now taken
as a normal convention."

Chess and Thomas met at the New York University College of
Medicine, were married in 1938, and soon became
collaborators.

Among the books they published were "Your Child Is a Person:
A Psychological Approach to Parenthood Without Guilt"
(1965), "The Origin of Personality " (1970), and "Know Your
Child: An Authoritative Guide for Today's Parents" (1987).
Chess and Thomas were unusual in psychiatry for publishing
popular books despite being involved in clinical research,
Dr. Koplewicz said.

In "Your Child Is a Person," they insisted, "Prevailing
psychoanalytically based theories of child care are wrong."

They went on to check off the list of Freudian pitfalls:
toilet training, thumb sucking, and weaning. Rather than
representing some kind of trauma, they wrote, each was a
normal part of childhood development. Of toilet training,
they wrote, "It seems incredible that a task accomplished
routinely in most of the civilized and uncivilized world for
a very long time could create so much worry in 20th century
Americans."

Chess was born in Manhattan to parents who were Russian
immigrants. Her father became a lawyer and her mother a
schoolteacher who was said to have helped create the concept
of maternity leave when she brought a suit against the New
York City Board of Education in 1911 for terminating her
when she was pregnant.

Chess studied at the Ethical Culture School and Smith
College before entering the NYU medical school in 1935. In
addition to a private practice in Manhattan, she held
various appointments, including psychiatrist at the
Northside Center for Child Development. In 1954, she became
the first professor of child psychology at New York Medical
College. She later founded the first pediatric psychiatry
unit at Bellevue Hospital and was a professor at NYU.

"Preventive care concentrated on changing the mother's or
father's behavior, and cultural influences were often
ignored," Chess wrote in the Harvard Mental Health Letter in
1997. "But it became clear that some children with serious
problems had adequate or excellent parents."

Begun in 1956, the New York Longitudinal Study of Child
Development followed the lives of 238 young people, just
over half of them middle-class whites and the rest poorer
Puerto Ricans.

Based on the study, Chess and Thomas delineated three basic
temperaments that were present from birth: "easy,"
"difficult," and "slow to warm up." They identified nine
temperamental qualities, such as level of physical activity
and distractibility. The trick, they said, was the "goodness
of fit" between parenting styles and the child's
temperament.

Seeking to look beyond bad parenting as a cause of autism,
Chess in 1971 published "Psychiatric Disorders of Children
with Congenital Rubella." According to Dr. Koplewicz,
rubella is no longer suspected of causing autism, but the
idea that autism might be an organic brain disorder was
"decades ahead of its time."

Chess and Thomas continued to publish well into what would
be retirement for most. Their last book was "Goodness of
Fit" (1999).

Thomas died in 2003, and Chess continued to work at NYU,
rejecting emeritus status in order to stay involved in
day-to-day research. The staff found out she had died
because she didn't show up for work last week, Dr. Koplewicz
said.

Stella Chess

Born March 1, 1914, in Manhattan; died March 14 at St.
Luke's Hospital in Manhattan; survived by two sons, Richard
and Kenneth, six grandchildren, and four
great-grandchildren.

Facing Life With a Lethal Gene - New York Times

2007-03-18T10:08:00.000-05:00

Facing Life With a Lethal Gene is a very moving story about a woman who chose to learn that she had the gene for Huntington's Chorea. While this kind of knowledge is, of course, a relatively new development, it reminded me that doctors have long had some degree of prognostic ability that they could share with patients. I always recall the story of the poet John Keats, who was a physician, coughing red blood into his handkerchief and proclaiming something like, "I see here my death warrant." It also brought to mind the following story from the history of general paresis of the insane:
J.E.D. Esquirol, one of the architects of psychiatry's early nineteenth century therapeutic optimism, as well as one of the first do describe paresis among the insane boasted that his specialized expertise allowed him to detect signs of paresis that had eluded a provincial colleague. The patient was a 'strong, robust' thirty year old man who had persuaded himself that he possessed immense fortune and had yielded 'to all the excesses of the most fashionable life.' He was brought to Paris by the ‘skillful and estimable' Dr. K., who deferentially presented the patient to Esquirol. 'I commit to your care,' Dr. K. said to Esquirol ‘a very interesting patient, who is but slightly excited, and whom I have withdrawn from scenes calculated to augment his excitement, which you will speedily cure.’ Esquirol conducted a half an hour ‘conversation’ with the patient,during which he observed ‘some hesitation in the pronunciation of certain words’ and an ‘undue readiness’ to remain in a hospital. On the basis of these findings Esquirol disdainfully told his hopeful colleague, 'I think that your patient is incurable; that he will not recover, nor survive a year. Remain in Paris, and you will see, as the malady is making rapid progress.'5 Displays of diagnostic and prognostic abilities such as Esquirol's would be repeated by others during the nineteenth century but such displays could never fully conceal psychiatry's impotence in the face of this completely devastating and extremely common disorder.

Morgagni & Mid-18th Century Treatment of the Mad

2007-03-18T08:19:00.000-05:00

I recently ran into the English translation of Giovanni Battista Morgagni's [1682-1771] treatise The Seats and Causes of Diseases Investigated by Anatomy. It consists of a series of Letters, the eighth of which is on madness. This letter is a rambling affair, where Morgagni sometimes sticks to his stated task of describing dissections of brains, but often describes clinical cases in some length. I found it an intriguing window into mid 18th century clinical psychiatric practice. Here is one of the shorter cases:

A strong man, by trade a blacksmith, having been liable, from a boy, to the incubus and vertigo, which had been brought on him by a fright, fell down suddenly in the winter-time, and complain'd, in confus'd words, of an internal pain in his breast. Being immediately brought into the hospital, he answer'd scarcely any thing to those who ask'd him questions; but shut his eyes, and cover'd his face with the sheet, like a man out of his senses. He was hot at the same time, and trembl'd' nor had drunkenness, or any other cause of that kind preceded; and a fever likewise attended. On the following day, he began to leap out of bed, to cry out, to threaten, and even to strike, all about him; so that being evidently a maniac, it was necessary that he should be confin'd with bands. He cried out violently and continually; and, at the same time, his whole body was agitated with convulsive motions. Then the physician, having order'd a vein in the foot to be open'd, and a pound of blood to be taken away, also ordered the cataplasm I have told you of [fresh cheese, of the coarser sort, mix'd with oil of violets] to be laid upon his head after being shaved. Do you ask me what was the event? Why by this means, within twelve hours, he was restored to perfect sanity; but whether the cure was accidental, or the effect of blood-letting only, or in some measure owing to the assistance of the external remedy [the cataplasm], I will leave you to determine. Those who foment the heads of insane patients with milk, will readily believe, that the cataplasm contributed thereto.

Giovanni Battista Morgagni, The Seats and Causes of Diseases Investigated by Anatomy, [English edition, 1769, reprinted 1960, original 1761] v1. pp. 149-150.

On the madness of neuroscientists

2007-03-10T08:55:00.000-05:00

Pierre-Jean-Georges Cabanis [1757-1808], an advocate of a monist or neuroscientific view of mind, writing about Democritus, an ancient Greek materialist relates the following story:
Hippocrates, called by the Abderans* to heal Democritus of his supposed madness, found him dissecting animal brains, from which he was trying to unravel the mysteries of … physical sensibility and to recognize the organs and the causes that produce thought. The two wise men spoke together on the general order of the universe, and on that of THE SMALL WORLD, or of man, with which both were almost equally occupied, …. In this conversation, Democritus appears to have felt even more the close connections between … physical and … moral states. And the doctor, as he retired, judged that it was to the Abderans, and not to the supposed patient, the the hellebore* should be administered [P-J-G Cabanis, On the Relations of the Physical and moral Aspects of man, Johns Hopkins U.P., 1981, v1,p 41].
*Abderans, residents of Abdera, Democritus' home. The air of Abdera was proverbial in Athens as causing stupidity
*Hellebore, a powerful laxitive and emetic thought to cure difficult diseases such as mania, by removing black bile.

Jay D. Haley, 83, Early Advocate of Involving Family in Therapy, Dies - New York Times

2007-03-09T08:06:00.000-05:00

Learning of Haley's death brought to mind how much things have changed over the last thirty years.
I can remember when Haley's ideas about the double-bind and schizophrenia were the hottest around. Reading about paradoxical intentions in psychotherapy was both exhilarating and frightening. Having spent many years working with people suffering with schizophrenia, however, I can see clearly how wrong headed, and in the wrong hands, dangerous Haley's ideas were. Nonetheless, I can't help but admire his efforts to unravel the mysteries of this terrible affliction.
Jay D. Haley, 83, Early Advocate of Involving Family in Therapy, Dies - New York Times

Insanity vs. Malice as Motives of Rampage - New York Times

2007-02-24T16:59:00.000-05:00

Perhaps we should consider a new DSM diagnosis, say Media Crazed Disorder or MCD. It has a nice ring to it.

Insanity vs. Malice as Motives of Rampage - New York Times: "But to Mr. Hinckley, the prosecutor, Mr. Johnson’s words were evidence not of mental illness but of a widespread phenomenon familiar to anyone who watches “American Idol” on television.

Mr. Johnson was simply media-crazed, and determined to get his 15 minutes of fame, the prosecutor said.

“The defendant didn’t have any command hallucinations,” or orders from God telling him to kill white people, Mr. Hinckley said. Rather, “he knew he would create media attention” by shooting up a bar, and he wanted his family to profit from his 15 minutes of “notoriety.”

Mr. Hinckley rattled off a long list of other people he said were similarly obsessed by fame, perhaps criminal in some cases but not insane. The list included Mel Gibson, Osama bin Laden, Timothy McVeigh, abortion clinic bombers, Palestinian and Iraqi suicide bombers, members of the Aryan Nations, and any number of amateur singers competing on “American Idol.”"

A Casualty on Romania's Road Back From Atheism - New York Times

2007-02-21T09:56:00.000-05:00

This story from 2005 makes it clear that older ways of understanding madness have not altogether disappeared from the earth. Today the Times reports that Daniel Petre Corogeanu was sentenced to 14 years in prison for killing a 23 year old nun in a crucifixion exorcism ritual…The four nuns arrested with him were sentenced to terms of five and eight years. Had she died during a procedure prescribed by bio-medical science the practitioner, probably would not have faced criminal charges, but would have been liable for negligence and perhaps sued for malpractice. The dominance of a belief system matters.

A Casualty on Romania's Road Back From Atheism - New York Times

An Autism Anomaly, Partly Explained - New York Times

2007-02-18T08:35:00.000-05:00

An Autism Anomaly, Partly Explained - New York Times
Here is a snapshot of the emergence of a new 'epidemic' in psychiatry. The question that isn't asked is whether the definition of a 'new' disease has morphed as vigilance about it increases. My guess is that states that find more autism also use a broader definition of that disorder. This certainly seems to be the case of the definition of depression over the 'prozac years.'

U.N. Troops Fight Haiti Gangs One Street at a Time - New York Times

2007-02-17T11:07:00.000-05:00

In case you thought that the overt political use of psychiatric detention was a thing of the past:
U.N. Troops Fight Haiti Gangs One Street at a Time - New York Times: "Mr. Mulet, of the United Nations, said he believed that the gang leaders were beyond rehabilitation. “They’ve been killing people, kidnapping people, torturing people, raping girls,” he told reporters recently in Washington. “It is very difficult to reinsert into society someone like that. A psychiatric institution would be the best place to place them in the future — after we arrest them.”"

Body Dysmorphic Disorder circa 1808

2006-11-19T18:10:00.001-05:00

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!"

David Hume attempts to do psychotherapy

2006-11-14T06:26:00.000-05:00

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."

Descartes Self-Analysis

2006-11-09T06:58:00.000-05:00

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."

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

2006-11-06T07:56:00.000-05:00

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.

Man Unable to Remember Is Reunited With Fiancée

2006-10-24T21:43:00.000-05:00

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.

Living With Love, Chaos and Haley

2006-10-22T20:45:00.000-05:00

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.

Famine: the distant shadow over French psychiatry

2006-10-09T20:04:00.000-05:00

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.

Changing Minds: Area 25

2006-10-02T08:35:00.000-05:00

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.

Lucia Joyce: To Dance in the Wake

2006-09-20T06:03:00.000-05:00

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.

Shot at dawn, pardoned 90 years on

2006-08-21T08:10:00.000-05:00

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."

What is Tom saying to Maureen?

2006-08-12T21:34:00.000-05:00

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.

My Husband Survived; the Man I Married Didn’t

2006-08-09T09:24:00.000-05:00

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?

2006-08-09T09:08:00.000-05:00

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]]

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

2006-07-25T15:57:00.000-05:00

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."

Odors, now and then

2006-07-23T17:48:00.000-05:00

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

2006-07-23T08:53:00.000-05:00

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.

Psychotherapy in the twenty-first century

2006-07-15T18:04:00.000-05:00

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

2006-07-15T17:59:00.000-05:00

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.

Response to Comments

2006-07-10T11:47:00.000-05:00

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.

Mixed Result in Treating Schizophrenia Pre-Diagnosis

2006-05-06T05:08:00.000-05:00

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

Analyze These

2006-04-25T15:44:00.000-05:00

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

Witness Says Moussaoui Exhibited Mental Illness

2006-04-22T19:16:00.000-05:00

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

Arizona's Strict Approach to Insanity Defenses Gets a Hearing Before the Supreme Court

2006-04-20T16:09:00.000-05:00

This might be a truly historic decision.

Afghan Case Against Christian Convert Falters

2006-03-26T21:15:00.000-05:00

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

Midnight Conversations With a Two-Headed Mind

2006-03-18T17:56:00.000-05:00

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

2006-03-18T17:48:00.000-05:00

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?

Jury Award Is Upheld in Firing Case

2005-12-30T07:25:00.000-05:00

We continue to debate how to deal with those who have shown themselves to be dangerous and mentally ill. To some extent the Americans with Disabilities Act is leading us to changing our conception of mental illness. In this case it is argued that Mr. Josephs was not mentally ill and therefore not dangerous after treatment. Through the nineteenth and twentieth centuries we held that once a person had an illness they always had it, and presumably the risk associated with it stuck to them. But looking back to colonial times in the U. S. A. people were often locked up when they seemed dangerous, but when the episode passed (obviouslly without effective medication) they were allowed to resume their usual roles in society. As I recall this was true for James Otis one of the signers of the constitution.

Charles W. Socarides, Psychiatrist and Psychoanalyst, Is Dead at 83

2005-12-30T07:14:00.000-05:00

He was a man who stuck to his guns if not to his wives. He always seemed to me to be evidence of how one's own experience, mixed with bias, in psychoanalysis can lead to views that resist all forms of public changes in opinion. While most went along with what they knew was a political (and I would say wise) decision about homosexuality by the profession, Socarides knew what he saw through his particular lens on the world.I wonder how many other psychoanalysts in less controversial and public areas also feel that they have seen a truth that the profession denies.

Releasing McElroy a dangerous idea

2005-12-23T21:16:00.000-05:00

Here is a response to an earlier post on this issue.

What caused the Mad Hatter to go mad?

2005-12-23T20:56:00.000-05:00

I hadn't thought about this question before, but now that you mention it, here is a pretty good answer.

A Hospital is not a Prison

2005-12-17T07:19:00.000-05:00

In this op-ed piece Brandon Krupp, the psychiatrist who resigned over the state of Rhode Island's attempt to extend the incarceration of a sexual offender by placing him in a civil unit of the state hospital, argues forcefully that this is a dangerous misuse of psychiatric hospitals. Historically the inability of psychiatrists to control admissions to state hospitals has been a major factor in the deterioration of care in these facilities. In the nineteenth century, the elderly, poor and homeless were often warehoused in these facilities under the pretense that they were receiving care. Now it appears that we are in the midst of seeing state hospitals used to extend criminal incarceration, under the pretense that care is being provided.