Vehement Experiences: The Inscription and Description of Delusion in Nineteenth-century French Asylums.

This essay explores the differences in the narrative forms of mental illness, depending on whether the sources consulted come from published medical histories or archival material. Based on the study of dozens of clinical cases contained in, above all, the institutions of Charenton and Bicêtre, from the late eighteenth century to the 1850s, I argue that the distinctive feature of the clinical case was vehemence rather than delirium. My methodological approach is based on the conceptualization of the forms of experience proposed by the philosopher of history Reinhart Koselleck.

Freud, Griesinger and Foville: the influence of the nineteenth-century psychiatric tradition in the Freudian concept of delusion as an 'attempt at recovery'.

This article aims to situate the Freudian concept of delusion in psychosis as an 'attempt at recovery', within the context of the classical psychiatric theories prevalent in the nineteenth century. Freud's theoretical thinking on the psychopathology of psychosis presents elements of continuity with, and divergence from, the psychiatric theories of his time. We will thus demonstrate the singularity of Freud's own theory. We will discuss the possible influence that the theory proposed by Griesinger, with its description of a temporal evolution in the psychotic process, may have had on Freud's thinking, and consider the theory of 'deductive logic' prevalent in nineteenth-century French psychiatry. Finally, we will discuss the vehement critique Freud made of both these theories.

Historical and clinical considerations on Ekbom's syndrome.

Ekbom's syndrome represents a relatively uncommon neuropsychiatric condition characterized by the recurrent and bizarre fixed delusional belief to be infested by small organisms or even unanimated materials ('Morgellons disease'), without any objective evidence of infestation/parasitosis. The condition, mainly diagnosed in a nonpsychiatric setting, is supposed to be largely underestimated and, hence, undermanaged. The present comprehensive review aims at investigating Ekbom's syndrome, from a historical, epidemiological, clinical and therapeutic perspective, by providing diagnostic-treatment strategies in managing this condition in routine psychiatric clinical settings. The prototypical patient is a middle-aged woman (or a younger subject in those cases in which substance and/or alcohol abuse is implicated), often single, divorced or widowed (loneliness component and social withdrawal), who has already consulted several specialists due to skin lesions associated with a firm and delusional belief to be infested. The identification and diagnosis are challenging due to poor patient's insight, poor knowledge and collaboration between specialists and differential diagnoses to be considered before asking for a psychiatric referral. Management and treatment strategies mainly derive from isolated case reports or observational studies with a small sample size. Further randomized clinical trials should be performed to evaluate the efficacy of newer antipsychotic drugs, including long-acting injectable formulations.

'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.

Esquirol's change of view towards Pinel's mania without delusion.

We recount how Jean-Étienne Dominique Esquirol (1772-1840) gradually changed his position towards what Philipe Pinel (1745-1826) referred to as mania without delusion. Between 1805 and 1838, Esquirol moved from outright rejection, questioning the very idea of insane persons committing motiveless acts of violence without delusion, to relative acceptance. He eventually incorporated the clinical characteristics of mania without delusion in his description of homicidal monomania, dividing them between reasoning monomania and instinctive monomania. We examine this change by detailing each of Esquirol's points of disagreement, which decreased sharply between the completion of his thesis in 1805 and the publication of his chapter on homicidal monomania in 1838.

His majesty's psychosis: the case of emperor Joshua Norton.

Case studies are a cornerstone of medical education and have been shown to be effective teaching tools. When teaching is entertaining, learning is enhanced and, therefore, strange and unusual cases present the opportunity to illustrate issues of disorder and illness in an engaging manner. The author illustrates this concept by presenting the life and character of Joshua Norton, who declared himself Emperor of the USA in 1859 and "reigned" until his death in 1880. Although grandiose claims are not rare among patients, Norton is unlike most self-proclaimed royalty in that his community embraced him and joined in with his fantasy. No psychiatrist or psychologist has ever opined on the matter of whether or not Norton's claims stemmed from mental disorder, and the author therefore presents Emperor Norton as a unique case in psychiatric history to explore first what diagnosis best explains his story and, second, whether he merits a diagnosis at all.

The nature of delusion: psychologically explicable? psychologically inexplicable? philosophically explicable? Part 1.

The debate about the nature of delusion has rumbled on for over a century without resolution. The current situation is a stand-off between psychologists, who propose various theories as to the psychological explicability of delusion, and psychiatrists, who generally regard delusion as inexplicable. Our main aim in this 2-part article is to reprise the intellectual atmosphere of German psychopathology in the inter-war and immediate post-war years, when the issues concerning delusion were formulated with more sensitivity to the actual delusions encountered in clinical practice. In Part 1 we mount a critique of psychological and psychiatric theories of delusion.

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.

When doctors cry wolf: a systematic review of the literature on clinical lycanthropy.

This paper provides an overview and critical reassessment of the cases of clinical lycanthropy reported in the medical literature from 1850 onwards. Out of 56 original case descriptions of metamorphosis into an animal, only 13 fulfilled the criteria of clinical lycanthropy proper. The remaining cases constituted variants of the overarching class of clinical zoanthropy. Forty-seven cases involved primary delusions, and nine secondary delusions on the basis of somatic and/or visual hallucinations which may well have affected the patients' sense of physical existence, also known as coenaesthesis. Cases of secondary delusions in particular warrant proper somatic and auxiliary investigations to rule out any underlying organic pathology, notably in somatosensory areas and those representing the body scheme.

From the Netherlands to Japan: communicating psychiatric practice in the 1830s.

This article explores an example of the transmission of Dutch psychiatric knowledge to Japan in the Edo period (1600-1868), through the translation of a case study first published by Schroeder van der Kolk in 1826. The translation appeared in an innovative new journal of Western medicine edited by the Japanese rangaku (Dutch-learning) scholar, Mitsukuri Genpo. The case study describes the symptoms and treatment of a woman who experienced delusions following an ear infection, in terms largely familiar to the Japanese doctors of the time. This translation provides opportunities to consider the globalization and localization of psychiatric knowledge, the medicalization of mental health care in Japan, and the growing interest in Western psychiatry before its official introduction to Japan after 1868.

The delusion of the Master: the last days of Henry James.

The novelist Henry James shared with his brother William, the author of the Principles of Psychology, a deep interest in the ways in which personal identity is built through one's history and experiences. At the end of his life, Henry James suffered a vascular stroke in the right hemisphere and developed a striking identity delusion. He dictated in a perfectly clear and coherent manner two letters as if they were written by Napoleon Bonaparte. He also showed signs of reduplicative paramnesia. Negative symptoms resulting from right hemisphere damage may disrupt the feelings of "warmth and intimacy and immediacy" and the "resemblance among the parts of a continuum of feelings (especially bodily feelings)", which are the foundation of personal identity according to William James. On the other hand, a left hemisphere receiving inadequate input from the damaged right hemisphere may produce positive symptoms such as delusional, confabulatory narratives. Other fragments dictated during Henry James's final disease reveal some form of insight, if partial and disintegrated, into his condition. Thus, even when consciousness is impaired by brain damage, something of its deep nature may persist, as attested by the literary characteristics of the last fragments of the Master.

What is a'mood-congruent' delusion? History and conceptual problems.

This article investigates the history of the concept of mood-congruent delusions and the problems accompanying this concept. In the late nineteenth century, there were conflicting views regarding the relationship between the contents of an individual's delusional thought and his/her affective state. The differentiation between delusion-like ideas secondary to affective state and incomprehensible primary delusions was introduced in the early twentieth century; this differentiation is the origin of the present-day distinction between mood-congruent and -incongruent delusions. Although the themes of delusions are clearly described in the operational diagnostic criteria for mood-congruent psychotic symptoms, the concept of mood congruence inevitably involves ambiguity. This article argues that a dilemma between reliability and validity emerges when diagnosing mood-congruent (and -incongruent) psychotic symptoms.

[Interpretation of writings in the psychopathologic approach to spiritualism (1850 - 1950)]. / La place de l'étude des écrits dans l'approche psychopathologique du spiritisme (1850-1950).

We propose a chronological review of the psychopathological interpretations of writings produced by spiritualists during their practices of trance or by spiritualists turned delirious. The interest is to highlight the exemplary role that psychiatrists or psychopathologists made attributed to mediumnism in the elaboration of psychiatric knowledge.

[Assassination of Henri IV, mental disorders and criminal responsibility]. / Assassinat d'Henri IV, troubles mentaux et responsabilité pénale.

On 14th May 1610, François Ravaillac, a delusional mystic, assassinated King Henri IV. Under the Ancien Regime, regicide was considered as a supreme act of patricide and received the ultimate punishment even if the perpetrator showed obvious signs of insanity. What would the situation be today? A study of this notorious historical episode provides a reflection on the way dangerousness linked to mental disorders has been viewed and treated over the last four centuries.

Tracing the Roots of Dementia Praecox: The Emergence of Verrücktheit as a Primary Delusional-Hallucinatory Psychosis in German Psychiatry From 1860 to 1880.

While the roots of mania and melancholia can be traced to the 18th century and earlier, we have no such long historical narrative for dementia praecox (DP). I, here, provide part of that history, beginning with Kraepelin's chapter on Verrücktheit for his 1883 first edition textbook, which, over the ensuing 5 editions, evolved into Kraepelin's mature concepts of paranoia and paranoid DP. That chapter had 5 references published from 1865 to 1879 when delusional-hallucinatory syndromes in Germany were largely understood as secondary syndromes arising from prior episodes of melancholia and mania in the course of a unitary psychosis. Each paper challenged that view supporting a primary Verrücktheit as a disorder that should exist alongside mania and melancholia. The later authors utilized faculty psychology, noting that primary Verrücktheit resulted from a fundamental disorder of thought or cognition. In particular, they argued that, while delusions in mania and melancholia were secondary, arising from primary mood changes, in Verrücktheit, delusions were primary with observed changes in mood resulting from, and not causing, the delusions. In addition to faculty psychology, these nosologic changes were based on the common-sense concept of understandability that permitted clinicians to distinguish individuals in which delusions emerged from mood changes and mood changes from delusions. The rise of primary Verrücktheit in German psychiatry in the 1860-1870s created a nosologic space for primary psychotic illness. From 1883 to 1899, Kraepelin moved into this space filling it with his mature diagnoses of paranoia and paranoid DP, our modern-day paranoid schizophrenia.

Lycanthropy in Byzantine times (AD 330-1453).

In this paper, the original Greek language texts of the Byzantine medical literature about lycanthropy are reviewed. The transformation of a human being into a wolf and the adoption of animal-like behaviour, which were already known from mythology and had been presented in the scientific works of ancient Greek and Roman physicians, were examined by six Byzantine physicians and explained as a type of melancholic depression or mania. In spite of the influence of Byzantine medicine, its rationality in the interpretation of lycanthropy was forgotten in medieval and Renaissance times when it was replaced by explanations based on demonic possession and witchcraft. More recently psychiatry has treated the phenomenon as a subject of medical inquiry and has again explained the condition in terms of mental disorder.

Are Drugs Always the Proper Solution to Therapeutic Dilemmas? Non-drug Approaches to the Post-traumatic Stress "Waking Corpse" Syndrome.

Jules Cotard (1840-1889), a Parisian neurologist, described a syndrome of delirium negations which was later named after him. Some physicians in antiquity and medieval times, especially in Asia, have noticed this syndrome and categorized it as a symptom of melancholy. They have presented it as a "walking corpse syndrome", inflicting most probably veteran soldiers after suffering during ferocious battles, presenting the first cases of a post war traumatic stress disorder. Philotimus (3rd-2nd century BC) was the first to record it around 3rd century BC, and proposed a simple but pioneering treatment, by just putting a lead hat on the men's heads. Although various combined treatment strategies were proposed by modern psychiatry including pharmaceutical, electroconvulsive therapy, behavioural therapy and supportive psychotherapy, it seems that in antiquity a simple external intervention of supportive therapy was the main concept of confrontation, while drug administration was to be avoided.

Neurology versus Psychiatry? Hallucinations, Delusions, and Confabulations.

Hallucinations, delusions, and confabulations are common symptoms between neurology and psychiatry. The neurological diseases manifesting with such symptoms (dementia, epilepsy, Korsakoff's disease, brain tumors, Parkinson's disease, migraine, right hemisphere stroke and others) would be the key to understand their biological mechanisms, while the cognitive sciences, neuropharmacology and functional neuroimaging would be the tools of such researches. It is possible to understand the perceptive rules of the mind and the mechanisms of the human consciousness based on these symptoms. However, hallucinations and delusions manifest with extraordinary vehemence with psychiatric disorders such as psychosis and schizophrenia, with which there is no evidence of brain lesions. Furthermore, they are subjective symptoms, and they do not have biological markers. Hence, they are prone to high inter-individual variability and depend on other variables (such as education, history of trauma), and are therefore difficult to reduce to unequivocal constructs. Causative mechanisms are probably multiple. For understanding these symptoms, a common framework between neurology and psychiatry is still missing. The psychopathology of French alienists over the 19th century, of S. Freud, and of Henry Ey over the 20th century gave way, in the second half of the 20th century, to the adoption of the DSM and neurosciences, to pursue a pure neurological perspective. However, although psychodynamic models seem nowadays (in a technological era) less influential, detailed clinical evaluations focusing on emotional-cognitive paradigms are probably the only way to lead to new neurobiological researches.

Psychopathology of schizophrenia in Ljubljana (Slovenia) from 1881 to 2000: changes in the content of delusions in schizophrenia patients related to various sociopolitical, technical and scientific changes.

BACKGROUND: Clinical observations and research have found the content of delusions in schizophrenia to be sensitive to sociopolitical and cultural factors. AIMS: The aim of this retrospective case-note study was to determine changes in the frequencies of various contents of delusions in schizophrenia patients over time. METHODS: A total of 120 records of first-time admission schizophrenia patient at Ljubljana's psychiatric hospital in the period from 1881 to 2000 were randomly selected. Information was taken from each record to fill out a form specially created for this study. The frequencies of delusions with regard to their content in various time spans were compared. RESULTS: A marked increase in two delusional themes--persecution and self-reference--was found after the change of political regime (1941-2000) in Slovenia. After the spread of radio in the 1920s and television in the 1950s in Slovenia, there was an obvious increase in delusions of outside influence and control as well as delusions with technical themes. A striking increase in the percentage of Schneiderian first-rank symptoms was found after the spread of Schneider's ideas in the 1950s. CONCLUSIONS: Sociopolitical changes and scientific and technical developments have a marked influence on the delusional content in schizophrenia.