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PubMed1976

More on pseudoscience in science and the case for psychiatric diagnosis. A critique of D.L. Rosenhan's "On Being Sane in Insane Places" and "The Contestual Nature of Psychiatric Diagnosis".

Rosenhan's 1973 article, "On Being Sane in Insane Places," was pseudoscience presented as science. Just as his pseudopatients were diagnosed at discharge as having "schizophrenia in remission", so a careful examination of this study's methods, results, and conclusions leads to a diagnosis of "logic in remission." Rosenhan's study proves that pseudopatients are not detected by psychiatrists as having simulated signs of mental illness and that the implementation of certain invalid research designs can make psychiatrists appear foolish. These rather unremarkable findings are irrelevant to the real problems of the reliability and validity of psychiatric diagnosis and only serve to obscure them. A correct interpretation of his own data contradicts his conclusions. There are purposes to psychiatric diagnosis that Rosenhan's article ignores. His more recent suggestion that certain requirements be met prior to the adoption of a new psychiatric classification system is unrealistic.

Auditory Perception↗
PubMed1987

Exploitation of the insane in the New World. Benoni Buck, the first reported case of mental retardation in the American colonies.

Documenting the early history of mental illness in North America is complicated by the absence of colonial institutions specializing in the care or management of the insane. However, during the first half of the 17th century, a single authority existed in England, the Court of Wards and Liveries (1540-1660), with responsibility for appointing guardians for the mentally disabled. In 1637, Benoni Buck, a man with severe mental retardation, was referred to this court from Jamestown, Va. The ensuing conflict over Benoni's custody exposed a contradiction between the economic and political exigencies of a new order and the social obligation to protect the mentally ill. Benoni Buck is almost certainly the first case of mental disability reported from the English colonies. The case thereby represents a minor landmark in the history of mental illness in America; May 1987 marks the 350th anniversary of the first petition for guardianship.

England↗
PubMed2000

Food refusal and insanity: sitophobia and anorexia nervosa in Victorian asylums.

Although anorexia nervosa emerged as a new syndrome in the second half of the 19th century, this clinical picture seemed to be unknown in the psychiatric hospitals or asylums. In asylum medicine, the commonly used concept of sitophobia to designate food refusal in the insane covered a wide variety of mental disturbances and cannot be plainly equated with anorexia nervosa. A major difference is the occurrence of hallucinations and delusions specifically centered around religion and digestion. Most probably, anorectic patients were not treated in asylums, but at home, in the doctor's office, or in general hospitals. This pattern may be partly attributed to the fact that both patients and doctors were focusing on symptoms of self-starvation like emaciation, constipation, and amenorrhea, which were primarily interpreted as referring to somatic diseases. Additionally, wealthy families probably preferred private care in water-cure establishments, sanatoria, and rest homes to the stigmatizing referral of their anorectic daughter to an asylum. Hence, the fact that late 19th-century institutionalized psychiatry was only incidentally confronted with anorexia nervosa may explain its lack of interest in the emerging syndrome.

Feeding Behavior↗
PubMed1998

General paralysis of the insane and AIDS in old age psychiatry: epidemiology, clinical diagnosis, serology and ethics--the way forward.

While the incidence of general paralysis of the insane (GPI) has declined, AIDS (acquired immune deficiency syndrome) has emerged as a new illness. Today, in England and Wales, as many elderly people die from AIDS as from neurosyphilis, although both diagnoses are rare in this age group. Both are serious medical conditions with psychiatric manifestations. For both, serological tests may identify the disease, and treatment may be of benefit, but there is considerable social stigma attached to the diagnoses. Ethical guidelines for serological testing for HIV (human immunodeficiency virus) have been available for over a decade. In view of the similarities between the diseases, it may be unethical to test patients for syphilis routinely. Epidemiology, risk factors, neurological and neuropsychiatric features and ethics must be considered before testing for both syphilis and HIV.

Acquired Immunodeficiency Syndrome↗
PubMed1979

Darwin sees the insane.

Charles Darwin's work on human and animal expression introduced this age-old problem into psychological study. Darwin's interest in the expression of the mentally ill led him to correspond with J. Crichton Browne, a young psychiatrist, who supplied him with detailed materials concerning the insane as well as photographs of them.

Famous Persons↗
PubMed1983

Melancholia and partial insanity.

In the medical literature of the eighteenth century melancholia came to be defined as partial insanity. Seventeenth-century English law introduced the term and influenced later forensic concerns about the concept. But the history of melancholia reveals a gradual development of such a concept of limited derangement associated with the delusions usually cited in accounts of this disease. In the early nineteenth century the relationship of melancholia and this concept weakened and was gradually abandoned, the content of the syndrome of melancholia was reduced, and out of this complex process emerged the notion of monomania.

Delusions↗
PubMed1997

Developmental insanity or dementia praecox: was the wrong concept adopted?

Over a century ago, the Scottish psychiatrist Thomas Clouston proposed the idea of a developmental or adolescent insanity. He characterised the condition as having a male predominance and a poor outcome, and noted the frequency of a family history and of minor anomalies of the palate; he considered it a disorder of cortical development and the onset of psychotic symptoms due to maturation during adolescence "of certain parts of the brain which had lain dormant before". Clouston's idea was subsequently eclipsed by the broader dementia-praecox espoused by Kraepelin and Bleuler, but recent epidemiological, neuroimaging, and neuropathological research supports the existence, within the schizophrenia syndrome of a group of patients with a severe, early onset, developmental psychosis. This disorder, re-christened as neurodevelopmental schizophrenia, is associated with childhood language and speech difficulties which render subjects more likely to later misinterpret their own inner speech as external voices; like all developmental disorders of language, it is commoner in males. Predisposing factors include the inheritance of abnormal cerebral asymmetry, and early environmental hazards of brain development such as prenatal exposure to maternal viral infection and perinatal complications.

Adolescent↗
PubMed1993

Kraepelin revisited: a reassessment and statistical analysis of dementia praecox and manic-depressive insanity in 1908.

A meta-analysis was carried out on 53 cases of dementia praecox (DP) and 134 cases of manic-depressive insanity (MDI) originally diagnosed by Kraepelin or his collaborators in Munich in 1908. The original case material was coded in terms of Present State Examination syndromes and analysed statistically for internal consistency and discrimination between the two diagnostic entities. Kraepelin's DP and MDI were found to define homogeneous groups of disorders which could be clearly distinguished from one another. A CATEGO re-classification of the cases revealed an 80.2% concordance rate between Kraepelin's diagnoses and ICD-9. Cluster analysis of the original data reproduced closely Kraepelin's dichotomous classification of the psychoses but suggested that DP was a narrower concept than schizophrenia today, while MDI was a composite group including both 'typical' manic-depressive illnesses and schizoaffective disorders.

Adult↗
PubMed1981

Insanity and the realities of history in early modern England.

This paper argues that the attack on religious enthusiasm, a campaign against popular religious radicalism, prompted the governing classes in late seventeenth- and eighteenth-century England to embrace secular explanations of the nature of insanity and to repudiate treatments which were based on religious and magical beliefs. An objection to the argument is considered, and some of its implications are discussed.

England↗
PubMed1999

[Communicated insanity, folie a deux and shared psychotic disorder. Different concepts and a case from Mallorca].

Following an earlier description of the psychopathological conceptions of "communicated insanity" we focus on a remarkable difference concerning the development of the historical terminology. The current operationalized definition is oriented at the originally French conception of the "folie à deux" which includes an adoption of certain delusional ideas by an intimate other. Compared with that, in the German psychopathological tradition those cases were also included in the conception of the "induziertes Irresein", in which the shocking experience of another's psychosis may cause a psychotic illness of somebody else. In modern psychiatric terminology this kind of "induction" is rather disregarded. We report a case of an induced psychosis in two women and give particular attention to the German psychopathological tradition because of still existing clinical relevance.

Adult↗
PubMed2005

Kraepelin and manic-depressive insanity: an historical perspective.

Since the time of the ancient Greeks, physicians have recognized a certain relatedness between the mental states of depression and mania. In the mid-Nineteenth century, French alienists proposed a 'double' or 'circular' illness consisting of alternating depressed and manic episodes and at the beginning of the twentieth century, Emil Kraepelin introduced the term 'manic-depressive insanity.' Kraepelin's broad clinical experience resulted in compelling descriptions of the symptoms of mood disorders that have arguably never been surpassed. The Kraepelinian nosology continues to provide a touchstone for modern classification systems of the mood disorders.

Bipolar Disorder↗
PubMed2005

Medical societies and insanity in late-eighteenth-century London: the fight between Andrew Marshal and John Hunter.

In 1789, at a meeting of a small London society for the promotion of medical and surgical knowledge, Andrew Marshal (1742-1813) and John Hunter (1728-1793) engaged in heated debate regarding the association between mania and the structure of the brain. Marshal claimed to have observed abnormalities when dissecting brains of those who died insane and Hunter denied this connection. At the next meeting a scuffle between them ensued and they had to be parted. Although Marshal did not publish his observations during his lifetime, they were assembled by his assistant in 1815. Marshal's descriptions of the brains of hydrophobics and maniacs are worthy of note.

Brain↗
PubMedDate not supplied

Weygandt's On the Mixed States of Manic-Depressive Insanity: a translation and commentary on its significance in the evolution of the concept of bipolar disorder.

Wilhelm Weygandt's Uber die Mischzustände des manisch-depressiven Irreseins (On the Mixed States of Manic-Depressive Insanity) describes and conceptualizes mixed states of mood, behavior, and thinking commonly found in manic-depressive disorders. These ideas emerged from Weygandt's service in the 1890s at the Psychiatric Clinic of the University of Heidelberg, directed by Emil Kraepelin. In the sixth (1899) edition of Kraepelin's influential textbook, the concept of manic-depressive illnesses underwent a fundamental shift from a complex group of syndromal subtypes to a single integrated disorder, widely known from the 1921 English translation of the eighth (1920) edition. In the 1899 edition, Kraepelin acknowledged Weygandt for a new section on mixed manic-depressive states within the new integrated view of manic-depressive disorder. We provide biographical notes on Weygandt, a little-known but historically important figure, as well as the first English translation of his monograph and interpretive summaries of his findings. We also consider whether Weygandt's important insight that the same person could be both manic and depressed not only at different times but even at the same time served as an important stimulus to Kraepelin's unified manic-depressive disorder concept, which survives as bipolar disorder a century later.

Bipolar Disorder↗
PubMed1980

Violence in the mentally Ill.. A study of 547 patients at a French hospital for the criminally Insane.

This is a study of 547 patients hospitalized in a French hospital for the criminally insane over the past 10 years. This chart review study correlates diagnosis with criminal act and other psychological and sociological parameters. It is of note that the diagnosis of paranoia is strongly associated with violent crimes against persons, especially murder, whereas personality disorders are more associated with criminal acts involving property.

France↗
PubMed2006

Friedrich Nietzsche's mental illness--general paralysis of the insane vs. frontotemporal dementia.

OBJECTIVE: For a long time it was thought that Nietzsche suffered from general paralysis of the insane (GPI). However, this diagnosis has been questioned recently, and alternative diagnoses have been proposed. METHOD: We have charted Friedrich Nietzsche's final fatal illness, and viewed the differential diagnosis in the light of recent neurological understandings of dementia syndromes. RESULTS: It is unclear that Nietzsche ever had syphilis. He lacked progressive motor and other neurological features of a progressive syphilitic central nervous system (CNS) infection and lived at least 12 years following the onset of his CNS signs, which would be extremely rare for patients with untreated GPI. Finally, his flourish of productivity in 1888 would be quite uncharacteristic of GPI, but in keeping with reports of burgeoning creativity at some point in the progression of frontotemporal dementia (FTD). CONCLUSION: We suggest that Nietzsche did not have GPI, but died from a chronic dementia, namely FTD.

Dementia↗
PubMed1981

General paralysis of the insane associated with HLA-Aw32.

HLA-A, -B, and -C locus antigens were determined in 35 unrelated patients with general paralysis of the insane (GPI), and in 13 neurosyphilis patients without dementia. HLA-Aw32 was found more frequently (corrected p = 4.9 x 10(-2) in the GPI patients than in 1009 controls. None of the patients having neurosyphilis without dementia had HLA-Aw32. These findings indicate that genetically determined mechanisms may play a role in development of GPI. Further studies of such rare patients should be initiated to investigate whether these observations reflects a true association or whether they are due to chance. If possible other well defined groups of tertiary syphilis should also be studied.

Adult↗
PubMed2004

'Embarrassed circumstances': gender, poverty, and insanity in the West Riding of England in the early-Victorian years.

Gender assumptions in early-Victorian England held that men derived their identities from work, while women were dependent beings for whom employment was not a central component of identity. Yet just as the New Poor Law positioned women ambiguously, sometimes emphasising women's dependency and other times stressing women's ability to work, so too do asylum records reveal complicated relationships between gender, poverty, and employment. Patient case notes from the West Riding Pauper Lunatic Asylum suggest that employment was a central component of poor women's identities. Female insanity was sometimes attributed to a lack of work, and both medical practitioners and female patients expected poor women to be employed.

Employment↗