The psychopathology of affectivity: conceptual and historical aspects

The disorders of affect have not contributed much to the diagnostic definition of mental disease, and their phenomenological description has never achieved the richness of the psychopathology of perception or cognition. This paper shows how the subordinate role played by affectivity in the Western concept of man led to the early and enduring view of mental illness as an exclusive disturbance of intellect. Attempts by nineteenth-century alienists to challenge this notion were only partially successful, due to the conceptual unmanageability of most forms of affective behaviour and the terminological redundancy that this engendered. These efforts were frustrated by the rebirth of Associationism, the rise of brain localization experiments, the peripheralist definition of the emotions and, finally, by the unfolding of Darwinism. As a result, no autonomous psychopathology of affectivity was ever developed. The eventual recognition of the so-called 'primary' disorders of mood has not led, however, to a refinement in the semiology of the experiences themselves. This has been impeded by the use of descriptive behavioural surrogates or by metapsychological accounts of affect as a form of energy or as a driving force. None of these developments has contributed to the clinical description of the mood disorders.

Psychiatric morbidity following total and partial thyroidectomy

Thirty subjects were screened for psychiatric morbidity approximately 7 years after they had undergone a thyroid operation. Thirteen were identified as "cases" by the General Health Questionnaire. Total and partial thyroidectomy subjects were compared. The total thyroidectomy patients identified as "cases" showed lower values of plasma calcium and higher values of inorganic phosphate than the partial thyroidectomy "cases", but the difference failed to reach statistical significance. No clinical or biochemical differences were found between cases and non-cases, irrespective of the type of operation.

Delusions and the psychopathology of the elderly with dementia

Thirty-seven, out of a sample of 100 elderly subjects, all suffering from dementia, were found to have delusions. The delusions were more common in women, in patients with a history of psychiatric illness, and amongst those with higher information subscores (Blessed Scale); and were less common in patients suffering from apraxia or severe psychosocial incompetence. Amongst the deluded patients the simultaneous presence of disorientation, hallucinations and hyperactivity often signified the diagnosis of delirium, but on follow up it was not correlated with death within 18 months. The same symptoms in the non-deluded patients were correlated with severe social incompetence and death within 18 months. It is concluded that the presence of delusions in subjects over 75 years old suffering from dementia is related, to certain extent, to previous or concomitant psychiatric illness, and that it reflects a relative preservation of mental function amongst those without such history.

Presbyophrenia: clinical aspects

Fifteen cases meeting the diagnostic criteria for presbyophrenia are reported and compared with a control sample of patients suffering from dementia. The presbyophrenic patients exhibited more elevated mood, more hyperactivity, more disorientation, and had lower information scores than the controls. Traditional explanations of 'presbyophrenic behaviour' such as delirium, pathoplastic effect of personality, or superimposed cerebrovascular disease are not adequate. Instead, presbyophrenia may constitute a sub-type of dementia characterised by severe atrophy of the locus coeruleus, marked impairment of noradrenergic transmission, and uninhibited behaviour.

"Depressive pseudodementia" or "Melancholic dementia": a 19th century view

Nineteenth century views on the interaction between dementia, depressive illness, general paralysis and brain localisation are discussed in the context of a book by A Mairet entitled: Melancholic Dementia. It is shown that by 1883 there was already awareness of the fact that severe affective disorder could lead to cognitive impairment. General paralysis was the commonest diagnosis put forward to account for patients with depression who went on to develop dementia. Patients so diagnosed, however, often recovered and clinical and statistical analysis of Mairet's case histories suggests that some were in fact suffering from depressive pseudodementia. Evidence is marshalled to show that during the 19th century there was wide disagreement concerning the clinical domain, course and even histopathology of general paralysis. This casts doubt on the traditional view that this condition served as "a paradigm" for other psychiatric diseases during this period. It is shown that by the turn of the century these difficulties led to a redefinition of the concept of dementia and to a marked narrowing of the clinical bounds of general paralysis.

Positive and negative symptoms and Jackson. A conceptual history

The old distinction between positive and negative symptoms has of late been reclaimed to describe the symptomatology of schizophrenia. The commonly held view that it originated with J. H. Jackson is inaccurate. This distinction should be attributed to J. R. Reynolds; current usage is reynoldian in that it does not presuppose the complex theoretical model that characterized the jacksonian view.

Koro-like symptom in a non-Chinese subject

‘KORO’ (head of turtle) or ‘suk-yeong’ (shrinking penis) names a symptom characterized by the belief that: 1. the penis is shrinking; 2. it will disappear into the abdomen; 3. it will cause death. It is usually accompanied by intense fear and by preventive manoeuvres such as tying or clamping or grasping the penis. It tends to be short-lived and may affect single individuals or groups.

Dexamethasone suppression test in acute grief reaction

The authors report a study on the response to the dexamethasone suppression test of bereaved first-degree relatives. Of the 21 subjects who took part two were non-suppressors (plasma cortisol greater than 138 mmol/l), but their grief scores were no higher than the suppressors. Both subjects showed a suppressor response 3 months later.

Epilepsy and insanity during the early 19th century. A conceptual history

During the first half of the 19th century, epilepsy and the insanities were considered as closely related "neurotic" disorders. Under the influence of factors such as the decline of the 18th-century Cullean concept of neurosis, the development of the new descriptive psychopathology, the introduction of statistics, and the availability of longitudinal observations of hospitalized cohorts, epilepsy was redefined as a "neurological" disease by the 1850s. The reaction of psychiatry to the exclusion of the mental disorder as a defining feature of epilepsy manifested itself in the creation of the "masked epilepsy" concept. This notion is behind the later development of categories such as "borderland" and "equivalent," which are still of some relevance to 20th-century views of epilepsy.

Visual hallucinations and sensory delusions in the elderly

One hundred and fifty successive referrals to a psychogeriatrician were assessed for visual hallucinations. Forty-four (29.33 per cent) patients reported visual perceptual disturbances. No differences between hallucinators and non-hallucinators were found in terms of sex, age, length of illness, underlying psychiatric diagnosis or cognitive score. There was a significant correlation between presence of hallucinations and eye pathology (less than .001) and delusions (less than .001). The phenomenological characteristics of the visual hallucinations are analyzed. The "picture" sign is described in 7 patients and the Charles Bonnet syndrome in two. The significance of these findings is discussed.

Descriptive psychopathology: conceptual and historical aspects

This paper offers a conceptual and historical analysis of descriptive psychopathology. The first section defines it as a cognitive system constituted by terms, assumptions and rules for its application. It traces the conceptual implications of this definition and relates them to clinical practice. The second section contains an up-to-date assessment of current historical work on descriptive psychopathology and offers a new hypothesis to account for its development during the nineteenth century. It is suggested that the work involved in the testing of the hypothesis should be carried out by psychiatrists with historical training and as a separate speciality. It is concluded that the historical calibration of psychiatric symptoms must be considered as an essential stage in the construction of a viable descriptive psychopathology.

Tactile hallucinations: conceptual and historical aspects

A brief historical analysis of the general concept of hallucination is presented and the suggestion is made that it emerged as the unwarranted generalisation of a perceptual model that was meant to apply only to vision and the "distance senses". Against this background the evolution of tactile hallucinations is considered and its interaction with 19th century psychological theory explored. It is concluded that tactile hallucinations are sui generis phenomena which do not fit the conventional model and whose clinical identification rests on criteria so far unclear. A brief review of their taxonomy and diagnostic usefulness is presented. Some wider implications are drawn which should be relevant to the general concept of hallucination.

The Charles Bonnet syndrome and the problem of visual perceptual disorders in the elderly

The literature, classical and modern, on visual perceptual disturbances in the elderly is reviewed. The utility of the concept of the Charles Bonnet Syndrome, an eponym originally coined to describe visual hallucinations in the elderly in the absence of cognitive impairment and peripheral ophthalmopathy, is challenged, particularly as the syndrome has become progressively enlarged. Three representative cases of elderly patients who have developed different types of visual perceptual disturbances are described. It is proposed to undertake a systematic study of the frequency of such disturbances in the elderly and of what other pathologies, particularly cognitive and visual, may be associated with them.

Delirium and confusion in the 19th century: a conceptual history

Delirium remained a stable psychiatric category until the early 19th century when it underwent aetiological and phenomenological redefinition, precipitating the transformation of the functional insanities into psychoses. Confusion, introduced by French workers during the second half of the century, referred to a syndrome wider than (but including) delirium. It emphasized chaotic thinking and cognitive failure. The notion of clouding of consciousness (and temporo-spatial disorientation) established a common denominator for the two concepts, while Chaslin and Bonhoeffer redefined confusion and delirium as the stereotyped manifestations of acute brain failure.

Stupor: a conceptual history

The concept of ‘stupor’ is subjected to historical analysis. Particular attention is given to the nineteenth-century, during which three evolutionary stages are identified. During the first stage stupor is considered as a simple state of non-responsiveness. The second stage recognizes that some stupors are accompanied by rich subjective experiences and separates them as ‘psychiatric stupors’. During the third stage some of its symptoms are reinterpreted as resulting from an interaction between patient and environment. A number of historical sources are reviewed in an attempt to illustrate the evolution of the concept and its association with cognate behavioural states.