'Brain Disorders', by Henry Calderwood (1879).

Henry Calderwood, a nineteenth-century Scottish philosopher interested in madness, published in 1879 an important work on the interaction between philosophy of mind, the nascent neurosciences and mental disease. Holding a spiritual view of the mind, he considered the phrase 'mental disease' (as Feuchtersleben had in 1845) to be but a misleading metaphor. His analysis of the research work of Ferrier, Clouston, Crichton-Browne, Maudsley, Tuke, Sankey, etc., is detailed, and his views are correct on the very limited explanatory power that their findings had for the understanding of madness. Calderwood's conceptual contribution deserves to be added to the growing list of nineteenth-century writers who started the construction of a veritable 'philosophy of alienism' (now called 'philosophy of psychiatry').

The 'Preliminary Discourse' to Methodical Nosology, by François Boissier de Sauvages (1772).

The eighteenth century witnessed an intense drive to classify diseases as natural kinds. Together with Linné, Macbride, Cullen, Sagar and Vogel, François Boissier de Sauvages, Professor of Medicine at Montpellier, was an important player in this process. In his monumental Nosologie Méthodique, Sauvages based his nosological system on the more botanico view proposed by Thomas Sydenham, namely, that human diseases (including mental ailments) should be classified in the same way as were plants. Classic Text No. 104 is an abridged translation of the Preliminary Discourse to the Nosologie Méthodique.

David Hartley's views on Madness: With an introduction by GE Berrios.

The psychiatric aspects of David Hartley's writings have received less attention than the rest of his work. This Classic Text deals with Section VI of his Observations on Man …, namely, the 'Imperfections of the rational Faculty'. Hartley defines madness as an imperfection of reason that can be temporary or enduring. He makes use of his model of mental functioning to differentiate between eight clinical categories of madness, each representing a different pattern of vibrations of the nerves. Hartley developed this model based on Newton's theory of vibrations and, to explain the complexity of mental acts and entities, he combined it with his own version of the mechanism of Association of Ideas borrowed from John Locke. Much work needs to be done to identify the provenance of Hartley's nosology and nosography.

J.H. Pons on 'Sympathetic insanity': With an introduction by GE Berrios.

The ancient concept of 'sympathy' originally referred to a putative affinity or force that linked all natural objects together. This notion was later used to explain the manner in which human beings related and felt for each other. A large literature exists on both the physical and psychological definitions of sympathy. Until the nineteenth century the conceptual apparatus of medicine preserved the view that the organs of the human body had a sympathetic affinity for each other. In addition to these 'physiological' (normal) sympathies there were morbid ones which explained the existence of various diseases. A morbid sympathy link also explained the fact that insanity followed the development of pathological changes in the liver, spleen, stomach and other bodily organs. These cases were classified as 'sympathetic insanities'. After the 1880s, the sympathy narrative was gradually replaced by physiological, endocrinological and psychodynamic explanations. The clinical states involved, however, are often observed in hospital practice and constitute the metier of 'consultation-liaison psychiatry'. Hence, it is surprising that historical work on the development of this discipline has persistently ignored the concept of 'sympathetic insanity'.

'Febrile anxiety', by Robert James (1745): with an introduction by.

The current class of psychiatric conditions called 'Anxiety Disorders' was constructed during the 20th century. Before 1900, its clinical components were conceptualized differently: some were not considered as diseases at all and others were looked after by physicians (not alienists). Whether it can be claimed that the complaints included under the 'Anxiety Disorders' have always existed, that is, constitute a form of 'natural kind', is a moot point that needs further historical investigation. This is because psychiatric complaints (mental symptoms) are no more than culturally configured segments of biological or symbolic information. Therefore, symptom-invariance or -perdurance can be explained by either biological or cultural factors. This can only be resolved by studying symptoms individually. Classic Text No. 97 shows how 'Anxiety' was conceptualized during the 18th century.

Ecologically valid cognitive tests and everyday functioning in euthymic bipolar disorder patients.

BACKGROUND: In euthymic bipolar disorder patients, scores on the Mini-Mental State Examination (MMSE) are not abnormal but general functioning remains impaired. Recent studies provide ample evidence that euthymic patients show significant impairment on more comprehensive neuropsychological test batteries. There is no definitive relationship between performance on neuropsychological test batteries and the ability to cope in everyday life. Ecologically valid tests of cognitive function aim to bridge this gap as they use everyday tasks to explore cognitive function. The aims of the study were to examine if euthymic bipolar disorder patients were impaired on ecologically valid tests of cognitive function and measures of general, social and occupational function. We examined the relationships between cognitive impairment and residual symptoms, clinical history, general functioning and employment. METHOD: Cognitive tasks, functional assessments and mood scales were administered to 29 euthymic bipolar disorder patients and 29 matched controls. RESULTS: Patients were impaired on ecologically valid tests of attention, memory and executive function. Patients showed impairment in general, social and occupational functioning. Unemployment was associated with impairment in attention. Memory impairment correlated with number of previous manic episodes. LIMITATIONS: All patients were on psychotropic medication, which may affect cognition. Traditional neuropsychological tests were not performed concurrently with ecologically valid tests. CONCLUSIONS: Ecologically valid tests of cognitive function are sensitive in detecting cognitive impairment in euthymic bipolar disorder. Clinicians should consider using these tests in the recovery phase of bipolar illness, as they may be particularly helpful in showing where rehabilitation should focus.

A review of the natural course of bipolar disorders (manic-depressive psychosis) in the pre-drug era: review of studies prior to 1950.

A review of the most important original studies describing the natural course of bipolar disorder (manic-depressive psychosis) published in the pre-drug era - before 1950 - is conducted. Discrepancies among studies are detected, most of which are likely explained by methodological differences. However, some conclusions from these old studies remain perfectly valid nowadays: mania is a chronic brain disorder, inherited in most cases, decompensation being more frequent between March and August. It is more common in males, and in some cases, is secondary to other somatic problems. Mixed states are more frequent in the elderly. The review of this type of historical studies is aimed at underscoring the importance that should be attached to the careful study of psychopathology and its recording, both in clinical practice and in psychiatry research.

'The varieties of effects resulting from such morbific causes as are capable of rendering more vivid the feelings of the mind' by S. Hibbert (1825).

The transformation of the old notion of apparition into the new concept of hallucination started in earnest at the beginning of the 19th century. Apparitions were naturalized on the argument that in no case were they a response to an external stimulus; and were secularized by challenging the very existence of external spirits or forces. Both arguments are clearly stated in the work on 'Apparitions' by Samuel Hibbert (a chapter of which has been included below as Classic Text No. 69). Although the debate on the ontology and meaning of the 'phantasms of the living' has continued to this day, it has had no influence on the medical concept of hallucination. It is likely that the latter has suffered as a result.

Confabulation in schizophrenia and its relationship to clinical and neuropsychological features of the disorder.

BACKGROUND: A form of confabulation has been documented in schizophrenia and appears to be related to the symptom of thought disorder. It is unclear whether it is associated with the same pattern of neuropsychological deficits as confabulation in neurological patients. METHOD: Thirty-four patients with chronic schizophrenia, including those with and without thought disorder, and 17 healthy controls were given a fable recall task to elicit confabulation. They were also examined on a range of executive, episodic and semantic memory tests. RESULTS: Confabulation was seen at a significantly higher rate in the schizophrenic patients than the controls, and predominated in those with thought disorder. Neuropsychologically, it was not a function of general intellectual impairment, and was not clearly related to episodic memory or executive impairment. However, there were indications of an association with semantic memory impairment. CONCLUSIONS: The findings support the existence of a form of confabulation in schizophrenia that is related to thought disorder and has a different neuropsychological signature to the neurological form of the symptom.

'The clinico-diagnostic perspective in psychopathology' by K Kahlbaum.

Karl Kahlbaum (1828-99) introduced the concept of time into European psychiatric nosology. In 1863 he first expressed the view that disease definition should take into account the course of the disease, the extension to which psychological functions were compromised, the relevance of the period of life when the mental disorder first appeared, and its primary or secondary nature. Via E. Kraepelin these ideas have moulded the way in which mental disorder has been conceived ever since. And yet Kahlbaum never made it into academic psychiatry. For reasons which remain obscure, he did not obtain a university teaching position and had to spend the rest of his life in private psychiatry. Whether the novelty of his ideas irked contemporary psychiatric officialdom needs further study.

'Mind in general' by Sir Alexander Crichton.

The history of the 'philosophies of psychiatry' can be defined as the contextualized study of past theoretical views on the nature, understanding and management of madness and related notions. The application of an hermeneutic apparatus to past psychiatric narratives gives rise to the history of psychiatry; its application to current narrative gives origin to the philosophy of psychiatry. If the latter employs off-the-shelf, ready-made, external philosophies, it follows a centripetal approach; if it starts from the inside of psychiatry and generates its own tools and meta-language, it follows a centrifugal approach. Psychiatry is burdened by intrinsic and extrinsic philosophical problems. The former result from its hybrid nature, i.e., from the fact that psychiatry unsteadily straddles the natural and human sciences. The latter are borrowed from the conceptual frames into which psychiatry has been inscribed since the 19th century. The philosophy of psychiatry may anticipate or follow empirical research. The ante rem mode is based on the idea that empirical research requires conceptual supervision, audit and guidance, for it is always ideology- and theory-laden. The post rem mode is based on the view that science is the only way to 'truth' and hence all that the philosophy of psychiatry can (or should) do is facilitate, interpret, justify, defend or glorify empirical findings. The Classic Text that follows was written by Sir Alexander Crichton at the end of the 18th century, and is a good example of the centripetal mode of philosophy-making.

On the fantastic apparitions of vision by Johannes Müller.

The history of the construction of the concept of hallucination remains biased in the favour of the French contribution. Important to this history are the first 30 years of the nineteenth century for it was then that it was decided that hallucinations were: (1) primary disorders of perception; (2) the same class of phenomena, regardless of the sense of modality in which they occurred; (3) generated by stimulation of brain regions related to perception and hence were mechanical responses with no semantic or informational import; and (4) medical problems. In 1826 Johannes Müller published a book on the fantastic phenomena of vision. Therein her proposed new rules for the description and explanation of hallucinations. Although published after Purkinje's books on an analogous theme, and after Esquirol's entry for the Panckoucke dictionary, Müller's book served as one of the foundations for the new nineteenth-century speculative physiology and physiopathology of hallucinations. This way of conceptualizing these phenomena was to culminate in the irritation model proposed by Tamburini in the 1880s. This paper justifies the choice of Müller's book as a classic text, provides biographical data about its author, and places the book in its historical context.

Excerpt from Medicinische Psychologie oder Physiologie der Seele by Dr Rudolph Hermann Lotze.

Hermann Lotze (1817-81) is a neglected figure in the history of psychiatry although it has been claimed that his early views were influential, for example, on the young Griesinger. Trained as a physician, psychologist and philosopher he saw better than many the impending epistemological crisis that was to affect disciplines such as psychology and medical psychology as they were being taken over by the natural sciences. The problem he endeavoured to resolve was double-headed. On the one hand, Lotze believed that the mechanisms proposed by physiology and other relevant natural sciences were essential to the explanation of human behaviour provided that its meaning and context were respected; on the other, he wanted to do away with the mysterious (metaphysical) explanations such as 'vital force' which in his time were still popular in biology. The solutions he eventually offered can understandably be seen as a weak compromise and one which statisfied no one. Materialists à outrance such as Vogt, Büchner, Lange and Ribot though he was too 'metaphysical'; spiritualist philosophers believed that he had surrendered too much to biology. It is likely that Lotze remained, in fact, a metaphysician as can be ascertained by studying his concept of Seele (soul, mind) into which he packed enough furniture to make many believe that he was an idealist thinker. This paper discusses some of these issues and justifies the choice of classic text, namely, Lotze's illuminating Introduction to his book Medicinische Psychologie oder Physiologie der Seele.

Formal thought disorder in schizophrenia: an executive or a semantic deficit?

BACKGROUND: It has been hypothesized that the schizophrenic symptom of formal thought disorder is linked to both executive and semantic dysfunction. METHOD: Intellectually preserved schizophrenic patients with (n = 15) and without (n = 16) formal thought disorder, plus matched normal controls (n = 17) were administered four executive and four semantic tests. Tests of verbal fluency and comprehension of grammar were also given. RESULTS: The patients with formal thought disorder were significantly impaired on all four executive tests compared to the patients without the symptom. They were only impaired compared to non-thought-disordered patients on 1 of 4 semantic tests, which probed semantic associations between concepts. Naming performance did not distinguish the two groups, nor did a previously used measure of semantic fluency controlling for phonological fluency. CONCLUSIONS: The results provide support for a dysexecutive hypothesis of formal thought disorder in schizophrenia, and, in line with other studies, suggest that there may be a restricted 'higher-order' semantic deficit which spares naming.

Phthisical insanity by T.S. Clouston.

The history of the relationship between tuberculosis and insanity has been neglected. This is surprising, for during the nineteenth century it was subject to an important medical and cultural debate and gave rise to a style of analysis which has been used ever since to study the clinical phenomenon of 'disease-coexistence' (rebaptized 'comorbidity' during the 1970s). Triggered by a perceived increase in the prevalence of tuberculosis and insanity, the debate centered around the meaning and mechanisms of disease-coexistence, techniques which may be used to rule out fortuitous associations, the comparative relevance of epidemiological, congenital, genetic and environmental factors, and the clinical effects that the members of the disease pair may have on each other. The Classic Text reprinted below provides an adequate introduction to the main issues listed above.

Of Mania: introduction (Classic text no. 57).

Classic Text no. 57 is meant to illustrate the way in which the old, pre-1800 clinical notion of mania was transformed into its current counterpart. In Classical times, the term 'mania' had been used to refer to three orders of objects: medical (as featured in this introduction and in the Classic text), theological (two Greek deities) (Smith, 1870) and epistemological. In regard to the last, a mania of 'divine'origin is mentioned by Plato in the Phaedrus, as a way to gain full knowledge, i.e., to journey from the sensible world to the ideal or intelligible world.By the end of the nineteenth century, however, the clinical category 'mania' had changed its referent completely: it now named a different symptom-cluster, was inscribed in a novel nosological frame, and was explained by new mechanisms. This metamorphosis took about sixty years to complete, and the extract reprinted below instances the way in which such a process took place within English alienism.