Tracing the Roots of Dementia Praecox: Charles Lasègue and his 1852 Essay "Du Délire De Persécutions" (On Persecutory Delusions).

While the evolution of our modern concepts of mania and melancholia over the 19th century is relatively well-understood, no such clear narrative exists for the nonaffective psychotic syndromes that culminated in Kraepelin's concept of dementia praecox in 1899. These narratives were relatively distinct in Germany and France. An important milestone in the French literature is the 1852 essay by the alienist and polymath Charles Lasègue which contained the first detailed modern description of a persecutory delusional syndrome. Lasègue was a careful clinical observer who emphasized a symptomatic approach to psychiatric nosology and was less concerned with course and outcome. He details the evolution of persecutory delusions from increasing referential observations of real events, to the resulting anxious confusion and then the emergence of explanatory delusional beliefs. Once formed, these beliefs, he notes, are relatively impervious to correction. Lasègue was unusual for his time in emphasizing a "first-person perspective" on psychotic experiences, and quotes from his patients in his case history, of which he presents 15. Of these, 12 had auditory hallucinations and 4 passivity phenomena. While conceptualized differently than mid-19th century pre-Kraepelinian German writing on delusional syndromes, and unique on its focus on persecutory delusions, Lasègue's important essay shared a common view on the key features of a broad nonaffective delusional-hallucinatory syndrome. It was this syndrome that Kraepelin, over multiple drafts in the first 6 editions of his textbook from 1883 to 1899, was to divide into his mature concepts of paranoia and the paranoid subtype of dementia praecox.

The Genealogy of Dementia Praecox I: Signs and Symptoms of Delusional Psychoses From 1880 to 1900.

We can trace, with high congruence, the clinical syndromes of depression and mania as described over the 20th century in psychiatric textbooks back to 1880 and to the earliest writing of Kraepelin published in 1883. However, this is not the case for Kraepelin's 2 delusional syndromes central to his overall nosology: Dementia Paranoides (later paranoid schizophrenia) and Paranoia. A detailed examination of 28 textbook descriptions of delusional psychoses from 1880 to 1900 reveals a diverse and partially overlapping set of syndromes with an admixture of symptoms and signs that would later be considered indicative of Dementia Paranoides and Paranoia. A similar pattern in seen in Kraepelin's own description of "Primäre Verrücktheit" from the first edition of his textbook (1883). No clear prototypes emerged in these textbooks or in Kraepelin's early writings for the 2 distinct delusional syndromes that would later evolve in his mature writings. Rather, the nosologic approach taken in these writings was symptom based and assumed that a viable diagnostic category could be constituted by including all delusional patients once those suffering from organic or mood disorders were excluded. While Kraepelin used the historical syndromes of mania and depression, with no appreciable change, as building blocks for his category of manic-depressive insanity, his nosologic system for the psychotic disorders-the syndromes of Dementia Praecox and Paranoia-was more innovative and without clear precedent in the prior psychiatric literature.

From Evolutive Paranoia, by August Wimmer (1902).

Literature on the history of 'paranoia' (as a clinical concept) is large and confusing. This is partly explained by the fact that over the centuries the word 'paranoia' has been made to participate in several convergences (clinical constructs), and hence it has named different forms of behaviour and been linked to different explanatory concepts. The Classic Text that follows provides information on the internal clinical evolution of the last convergence in which 'paranoia' was made to participate. August Wimmer maps the historical changes of ' Verrücktheit' as it happened within the main European psychiatric traditions since the early 19th century. After World War II, that clinical profile was to become reified and renamed as 'delusional disorder'.

The Development of Kraepelin's Mature Diagnostic Concepts of Paranoia (Die Verrücktheit) and Paranoid Dementia Praecox (Dementia Paranoides): A Close Reading of His Textbooks From 1887 to 1899.

Over 12 years (1887-1899), in his second through sixth editions of his textbook Psychiatrie: Ein Lehrbuch für Studierende und Ärzte, Emil Kraepelin created, through an iterative, self-examining process, his mature concepts of Verrücktheit (paranoia) and Paranoide Formen Dementia Praecox. I seek in this essay to show this skilled nosologist at work. Four themes were prominent. First, Kraepelin used symptoms throughout, but he transitioned from superficial phenomenon (delusional themes) to those he considered more pathognomonic: disorganized fantastical delusions vs organized, nonbizarre delusions. Second, he increasingly emphasized the distinction between delusions arising from misinterpretations of real events vs delusions arising from hallucinations. Third, the putative causes of the disorder became more important as he came to understand Verrücktheit from a psychological and developmental perspective, whereas dementia paranoides (the precursor to paranoide formen dementia praecox) resulted from pathological brain changes. Fourth, Kraepelin appreciated the importance of disease course, but he initially lacked adequate data to elucidate it. As his research program developed, he used the well-recognized disease of general paralysis of the insane as a paradigm and correlated symptoms, modes of delusion formation, and presumed mechanisms of disease with course and outcome. Patients with slowly developing, referential, nonbizarre delusions without hallucinations were typically stable for years with minimal deterioration. Patients with rapidly developing, poorly organized, fantastical delusions emerging from prominent hallucinations tended to deteriorate quickly. Using conceptual tools first proposed by Kahlbaum and Hecker, Kraepelin developed his concepts of Verrücktheit and paranoide formen dementia praecox using an exploratory, conceptual, and data-gathering process in which each syndrome was defined in contrast to the other and, in addition to a core focus on disease course, multiple additional levels of clinical inquiry were included.

The Clinical Features of Paranoia in the 20th Century and Their Representation in Diagnostic Criteria From DSM-III Through DSM-5.

This review traces, through psychiatric textbooks, the history of the Kraepelinian concept of paranoia in the 20th century and then relates the common reported symptoms and signs to the diagnostic criteria for paranoia/delusional disorder in DSM-III through DSM-5. Clinical descriptions of paranoia appearing in 10 textbooks, published 1899 to 1970, revealed 11 prominent symptoms and signs reported by 5 or more authors. Three symptoms (systematized delusions, minimal hallucinations, and prominent ideas of reference) and 2 signs (chronic course and minimal affective deterioration) were reported by 8 or 9 of the authors. Four textbook authors rejected the Kraepelinian concept of paranoia. A weak relationship was seen between the frequency with which the clinical features were reported and the likelihood of their inclusion in modern DSM manuals. Indeed, the diagnostic criteria for paranoia/delusional disorder shifted substantially from DSM-III to DSM-5. The modern operationalized criteria for paranoia/delusional disorder do not well reflect the symptoms and signs frequently reported by historical experts. In contrast to results of similar reviews for depression, schizophrenia and mania, the clinical construct of paranoia/delusional disorder has been somewhat unstable in Western Psychiatry since the turn of the 20th century as reflected in both textbooks and the DSM editions.

[The nosological evolution of bipolar affective disorder]. / A bipoláris affektív zavar nozológiai fejlodése.

The nosological improvement of the bipolar disorder (manic-depression) follow the written history of psychiatry. The symptoms of manic and depressive episodes and mixed states were described in the ancient times. In my summary I accompany the taxonomic improvement, the changing of diagnostic categories and the work of the most important researchers from the beginning to these days.

'Paranoia and its historical development (systematized delusion)', by Eugenio Tanzi (1884).

This was the first paper by the Italian alienist Eugenio Tanzi (1856-1934). It surveyed existing works and provided an analysis of clinical categories such as monomania, sensory madness, moral insanity, Wahnsinn, Verrücktheit and systematized delusions, which had been used in France, Germany, Britain and Italy since the early nineteenth century to deal with paranoia. As pointed out by Tanzi, discrepancies and discontinuities in diagnostic concepts affected both psychiatric nosology and practice. Paranoia (from the Greek παρά and νοια) made for greater clarity in psychiatric terminology, and denoted a broad category, including both acute and chronic delusional states which were considered to be distinct from mania and melancholia, and usually not to lead to mental deterioration.

From paranoia querulans to vexatious litigants: a short study on madness between psychiatry and the law. Part 2.

The second part of this paper examines the history of querulous paranoia and vexatious litigation in the English-speaking countries from the nineteenth century to today. This study suggests that the lack of thorough research on querulous paranoia in these countries is due to a broad cultural, legal and medical context which has caused unreasonable complainants to be considered a purely legal, rather than a medical issue. To support this hypothesis, I analyse how legal steps have been taken throughout the English-speaking world since 1896 to keep the unreasonable complainants at bay, and I present reasons why medical measures have scarcely been adopted. However, I also submit evidence that this division of responsibilities between the judges and the psychiatrists has taken a new turn since the dawn of the twenty-first century.

From paranoia querulans to vexatious litigants: a short study on madness between psychiatry and the law. Part 1.

The first part of this two-part paper presents a comparative history of paranoia querulans, also known as litigants' delusion, in German-speaking countries and France from the nineteenth century onwards. We first focus on two classic literary works which describe litigious behaviours that were later pathologized, then give an insight into the history of Querulantenwahn (litigants' delusion), a term coined in 1857 by Johann Ludwig Casper and adopted by German-speaking psychiatrists and forensic experts. The last section is devoted to its French equivalent, the delusion of the litigious persecuted-persecutors. We show how this category, widely popular among French fin-de-siècle alienists, was replaced by another: the delusion of revendication (litigious subtype). The history of the vexatious litigants in the English-speaking world will be explored in the Part 2.

[Pleasure and confusion. A footnote to Freud's translations of Mill]. / Lust und Verwirrung. Eine Fuessnote zu Freuds Mill-Ubersetzungen.

In 1863 Theodor Gomperz came to England to propose to Helen Taylor Mill, step-daughter of J. S. Mill. For several months he delayed the proposal while studying transcripts of the Philodemus papyri in the Bodleian Library. There a threatening note, supposedly left on his desk, triggered an attack of paranoia. My study of this incident, initially a mere footnote, expanded into an examination of the obscure causes of this attack. The philosophical question of the nature of desire and the researcher's passion to reconstruct a fragmented classical text are related to Gomperz's unfocussed relationship with both Mill and his step-daughter, and his ensuing confusion between reality and fantasy. The incident is considered paradigmatic of the perils of scholarly research, when the desire to possess knowledge becomes entangled with transferential relationships.

["... mein Recht muss mir werden!" Hermann Bahr's tragicomedy Der Querulant (1914)]. / "[...] mein Recht muss mir werden!" Hermann Bahrs Tragikomödie Der Querulant (1914).

At the end of the eighteenth century, people who became notorious for their excessive engagement in legal proceedings started being labeled as "querulents" or "paranoid litigants". The term "querulents" first appeared in the General Order of the Court for the Prussian States (Allgemeine Gerichtsardnung für die Preussischen Staaten) from July 6, 1793. From there on, the spectrum of juridical measures undertaken against the so-labeled litigators included classifying these persons as ineligible for legal action and psychiatric hospitalization. The paper discusses to what extent Hermann Bahr rearranges psychiatric and legal knowledge about this special type of the complainer in his tragi- comedy Der Querulant, premiered in 1914. This concerns, first, the theatricality of the body and speech, secondly, the use of cultural techniques of writing and, thirdly, conflict- ing notions of justice. Therefore, the paper analyzes the aesthetic function of querulous behavior in the dramatic structure of the play from the point of view of both media theory and literary theory.

Fixing Freud: the Oedipus complex in early twenty-first century US American novels.

Representations of Sigmund Freud in early 21st century US American novels rely on and respond to the image of Freud that emerged from investigations by Paul Roazen ("Brother Animal," 1969) and Jeffrey Moussaieff Masson ("The Assault on Truth," 1984), which cast doubt on the validity of the Oedipus complex. Relying on Roazen, Brenda Webster's "Vienna Triangle" (2009) links Freud's oedipal thinking to paranoia and male masochism. Working with Masson, Selden Edwards's "The Little Book" (2008) takes Freud to task for abandoning the seduction theory in favor of the Oedipus complex. Jed Rubenfeld's "The Interpretation of Murder" (2006) rethinks the Oedipus complex as a projection of adults onto their children. All three novels seek to celebrate Freud's understanding of the human psyche, while shifting the focus of the oedipal structure away from the murderous and lustful child toward the adult.

VladimirMikhailovic Bekhterev (1857-1927): strange circumstances surrounding the death of the great Russian neurologist.

The famous Russian neurologist Vladimir Mikhailovic Bekhterev (1857-1927) was ordered to examine Josef Stalin in December 1927 during the First All-Russian Neurological Congress in Moscow. Returning to the Congress after his consultation he told some colleagues that he had 'examined a paranoiac with a dry, small hand'. The next day, Bekhterev died and only his brain was examined postmortem, the body being cremated the same day.

The psychohistorical roots of the American "Tea Party" Movement.

Extreme resistance to governmental taxation and authority is derived, according to Freud's theory of anal characterology, from premature and harshly coercive toilet training, in which a child is forced unfairly and against its will to surrender the products of his eliminations (which represent money, among other things, in the unconscious) to parental authority. Among these individuals anal eroticism plays a significant role in the psychogenesis of paranoia and conspiracy theorizing, which may represent a defense mechanism erected against repressed fears of passive submission.

Ordenando a babel psiquiátrica: Juliano Moreira, Afrânio Peixoto e a paranoia na nosografia de Kraepelin (Brasil, 1905) / Bringing order to the Babel of psychiatry: Juliano Moreira, Afrânio Peixoto, and paranoia in Kraepelin's nosography (Brazil, 1905)

Investiga os significados da paranoia e de sua aplicação como categoria nosográfica. Apresenta o artigo de Juliano Moreira e Afrânio Peixoto "A paranoia e as síndromes paranoides", apontando a diferenciação que eles estabelecem entre esse constructo clínico e a demência precoce. Indica ainda que situar os limites diagnósticos da paranoia 'legítima' foi maneira de delimitar suas posições teóricas e seu alinhamento a Kraepelin, justificando a escolha da postura científica para tornar moderna a psiquiatria brasileira. Adicionalmente, discute aspectos da história conceitual da paranoia (suas relações com personalidade), quanto aos referenciais teóricos usados por aqueles autores brasileiros em seu artigo.

Ordenando a babel psiquiátrica: Juliano Moreira, Afrânio Peixoto e a paranoia na nosografia de Kraepelin (Brasil, 1905) / Bringing order to the Babel of psychiatry: Juliano Moreira, Afrânio Peixoto, and paranoia in Kraepelin's nosography (Brazil, 1905)

Investiga os significados da paranoia e de sua aplicação como categoria nosográfica. Apresenta o artigo de Juliano Moreira e Afrânio Peixoto "A paranoia e as síndromes paranoides", apontando a diferenciação que eles estabelecem entre esse constructo clínico e a demência precoce. Indica ainda que situar os limites diagnósticos da paranoia 'legítima' foi maneira de delimitar suas posições teóricas e seu alinhamento a Kraepelin, justificando a escolha da postura científica para tornar moderna a psiquiatria brasileira. Adicionalmente, discute aspectos da história conceitual da paranoia (suas relações com personalidade), quanto aos referenciais teóricos usados por aqueles autores brasileiros em seu artigo.(AU)

Kafka, paranoic doubles and the brain: hypnagogic vs. hyper-reflexive models of disrupted self in neuropsychiatric disorders and anomalous conscious states.

Kafka's writings are frequently interpreted as representing the historical period of modernism in which he was writing. Little attention has been paid, however, to the possibility that his writings may reflect neural mechanisms in the processing of self during hypnagogic (i.e., between waking and sleep) states. Kafka suffered from dream-like, hypnagogic hallucinations during a sleep-deprived state while writing. This paper discusses reasons (phenomenological and neurobiological) why the self projects an imaginary double (autoscopy) in its spontaneous hallucinations and how Kafka's writings help to elucidate the underlying cognitive and neural mechanisms. I further discuss how the proposed mechanisms may be relevant to understanding paranoid delusions in schizophrenia. Literature documents and records cognitive and neural processes of self with an intimacy that may be otherwise unavailable to neuroscience. To elucidate this approach, I contrast it with the apparently popularizing view that the symptoms of schizophrenia result from what has been called an operative (i.e., pre-reflective) hyper-reflexivity. The latter approach claims that pre-reflective self-awareness (diminished in schizophrenia) pervades all conscious experience (however, in a manner that remains unverifiable for both phenomenological and experimental methods). This contribution argues the opposite: the "self" informs our hypnagogic imagery precisely to the extent that we are not self-aware.