Platzschwindel, agoraphobia and their influence on theories of anxiety at the end of the nineteenth century: theories of the role of biology and 'representations' (Vorstellungen).

During the 1860s, Berlin's exterior physiognomy transformed radically. The city eroded the surrounding rural areas, and the frontiers of the old city centre were abolished. These transformations led to the disappearance of the visible frontiers that once demarcated the limits of the old residential Prussian city. In this context, the description of the clinical picture of agoraphobia by the Berlin psychiatrist Carl Westphal in 1872 marked a turning point, not only in psychiatric theories on anxiety but also in the conceptualization of our experience of space. In this paper, the authors trace the emergence of a new psychology-neurology episteme during the last third of the nineteenth century; and they argue that such an episteme became possible once the relations between anxiety and modern city-scape had been clearly articulated.

Background and history of the interface between anxiety and vertigo.

The comorbidity of vertigo and anxiety has been an integral component of the medical literature since antiquity. In the works of Plato, the same terms were used in the context of vertigo, inebriation, height vertigo, disorientation, and mental confusion. In classical medicine, vertigo had the ambiguous status of being both a disease per se and a symptom of other diseases such as hypochondriacal melancholy. Further, two etiologies were described for vertigo: an origin in the head (brain) and an origin in the hypochondria (abdominal viscera). In the course of the development of a detailed neurologic taxonomy of vertigo in the latter half of the nineteenth century, a debate ensued whether agoraphobia was a form of vertigo or a distinct psychiatric condition. Elucidation of this forgotten debate, within its historical context, provides insights into the recent rediscovery of the balance-anxiety interface.

[Panic: attack and disorder. History of the word and concepts]. / Panique: attaque et trouble. Historique du mot et des concepts.

The history of the word panic, of the concepts of Panic attack and of Panic Disorder is a complex one. The adjective word panic, derived from the Greek, stressed initially the intensity of a feeling of unjustified, individual or collective, fear, similar to the reaction provoked, according to the mythology, by the intervention of the God Pan. In their present meanings, the concepts belong to the group of anxiety states, the Panic attack being a symptom characterized by a paroxysmal anxiety which may appear in various psychopathological states, whereas the Panic Disorder is a nosological category whose diagnostic criterium is the appearance, with a definite frequency, of Panic attacks. The disorder is frequently associated to agoraphobia considered, when it exists, as a complication. It is necessary to describe, in addition to the terms and concepts related to panic, the history of the terms angoisse and anxiété (and of the equivalent ones in English and German, since many studies dealing with the subject have been written in those languages) and the history of agoraphobia. The history of the word panic and of the psychiatric concepts to which it is applied today are partially different as are the current meanings of the adjective and the substantive (and today of the verb to panic) from their technical meanings. In the technical vocabulary the substantive word refers on the one side to an abnormal group behaviour whose mechanisms, when it appears in an army by also elsewhere, are studied by social psychopathology. On the other side it has been used until recently, but only in psychiatric texts written in English, for describing acute individual states of high anxiety, eventually associated with other symptoms, and considered as pertaining-in contrast to the Panic attack in its present meaning-to various psychiatric illnesses (melancholic panic, homosexual panic). A description of states similar in their aspects, including the association to agoraphobia, to the present Panic attack, may be found in the literature of the XIXth century. Essential in this respect is the description of anxiety neurosis which Freud isolated in 1895 from neurasthenia and defined by the coexistence of a state of moderate and permanent anxiety and of anxiety attacks, whose manifestations were identical to those of the present Panic attack. Under the influence of Klein's researches which, from 1962 on, demonstrated the differential reactivity to drug therapy of its two component parts, anxiety neurosis was divided in two distinct entities. The term Panic attack-for reasons given in detail by the paper-was proposed for the acute anxiety attack, whereas the state of moderate and permanent anxiety, considered as a completely independent disorder, received the name of Generalized Anxiety Disorder. The concept, with its corresponding nomenclature, was adopted initially in the United States by the RDC (1975), then by the DSM-III (1980). It is accepted today and has been the source of a large number of investigations about its semiological, nosological, epidemiological, etio-pathogenic and therapeutic aspects which fall outside of the scope of this paper.

[Acute anxiety attacks and phobia. Historical aspects and clinical manifestations of the agoraphobia syndrome]. / Crises aigües d'angoisse et phobies. Aspects historiques et manifestations cliniques du syndrome d'agoraphobie.

This article describes the evolution of the concept of agoraphobia since its initial description in 1871 until its inclusion in the most recent american diagnostic classifications. In most cases, agoraphobia appears to be secondary to the occurrence of repeated panic attacks, that may also lead to the development of chronic generalized anxiety or hypochondriac syndromes. The main clinical, biological and therapeutic features of panic disorders, a clinical entity that is part of the previous syndromes, are reviewed and discussed according to the most recent studies. Panic disorders appear to be distinct from mood disorders but their relationship to other anxiety disorders is still a matter of controversy.

"A multidão é louca, a multidão é mulher": a demofobia oligárquico-federativa da Primeira República e o tema da mudança da capital / "The crowd is crazy, the crowd is a woman": the oligarchical-federal demophobia of the First Republic and the issue of transferring the capital

Examina as expressões de demofobia da classe política da Primeira República, em faces das manifestações do povo carioca, relacionando-as à necessidade de mudar para o interior a sede do governo federal. A literatura demófoba produzida pelos liberais europeus contrários à democratização em seus países impregnou a orientação da classe política brasileira do período. Empenhados em construir uma federação oligárquica, viam a população do Rio de Janeiro como uma ameaça. Contra um subversivo povo-multidão de uma capital cosmopolita, artificial e estrangeirada, o federalismo oligárquico valorizava um ‘autêntico' povo brasileiro que remetia ao imaginário de uma população interiorana e ordeira.

This study examines the expressions of demophobia of the political class of the First Republic, faced with demonstrations against the government in Rio de Janeiro, and relates them to the need to move to the seat of the federal government inland. The demophobic literature produced by liberal Europeans against democratization in their countries pervaded the orientation of the Brazilian political class during the period. Committed to building an oligarchic federation, they saw the population of Rio de Janeiro as a threat. Compared to a subversive crowd of people in a huge, artificial capital suffering from foreign influence, oligarchic federalism valued the ‘authentic' Brazilian people, referred to the image of a provincial, orderly population.

Agoraphobia: what Westphal really said.

In 1872 Westphal described a series of patients who experienced unexpected and situational panic attacks in squares, empty streets, on bridges and in crowds. They suffered from anticipatory anxiety and a fear of sudden incapacitation. The symptoms of agoraphobia have not changed appreciably in well over a century.

Charles Darwin and panic disorder.

Charles Darwin (1809-1882) suffered from a chronic illness that, throughout much of his adult life, impaired his functioning and severely limited his activities. The writings of this famous scientist as well as biographical materials indicate that he probably suffered from an anxiety disorder. His symptoms, when considered individually, suggest a variety of conditions, but taken together they point toward panic disorder with agoraphobia. This diagnosis brings coherence to Darwin's activities and explains his secluded lifestyle, including difficulty in speaking before groups and meeting with colleagues.

["Agoraphobia--place anxiety/place fear--place-related vertigo". The classical description of place anxiety by Carl Westphal and Emil Cordes and its significance for the history of the concept and current discussion of anxiety disorders]. / "Agoraphobie--Platzangst/Platzfurcht--Platzschwindel". Die klassischen Beschreibungen der Platzangst von Carl Westphal und Emil Cordes und ihre Bedeutung für die Konzeptgeschichte und aktuelle Diskussion der Angsterkrankungen.

We discuss the history of "agoraphobia" and related descriptions as the "Platzangst" from M. Benedikt and the artile of E. Cordes, who used the same title "agoraphobia" as Westphals original paper. It is remarkable that Westphal and Cordes recognized the psychological character of the phenomenon, whereas Benedikt in 1870 suspected a neuroophthalmological origin for his "Platzschwindel". Regarding the details of these first three descriptions one can show that the primary authorities set up a discussion, which is still going on: The relation between agoraphobia, dizziness, fear and panic is until now object of many controversies, as shown in the final chapter.

Some notes on a historical perspective of panic disorder

This article aims to describe important points in the history of panic disorder concept, as well as to highlight the importance of its diagnosis for clinical and research developments. Panic disorder has been described in several literary reports and folklore. One of the oldest examples lies in Greek mythology - the god Pan, responsable for the term panic. The first half of the 19th century witnessed the culmination of medical approach. During the second half of the 19th century came the psychological approach of anxiety. The 20th century associated panic disorder to hereditary, organic and psychological factors, dividing anxiety into simple and phobic anxious states. Therapeutic development was also observed in psychopharmacological and psychotherapeutic fields. Official classification began to include panic disorder as a category since the third edition of the American Classification Manual (1980). Some biological theories dealing with etiology were widely discussed during the last decades of the 20th century. They were based on laboratory studies of physiological, cognitive and biochemical tests, as the false suffocation alarm theory and the fear network. Such theories were important in creating new diagnostic paradigms to modern psychiatry. That suggests the need to consider a wide range of historical variables to understand how particular features for panic disorder diagnosis have been developed and how treatment has emerged.