'A disease that makes criminals': encephalitis lethargica (EL) in children, mental deficiency, and the 1927 Mental Deficiency Act.

Encephalitis lethargica (EL) was an epidemic that spread throughout Europe and North America during the 1920s. Although it could affect both children and adults alike, there were a strange series of chronic symptoms that exclusively affected its younger victims: behavioural disorders which could include criminal propensities. In Britain, which had passed the Mental Deficiency Act in 1913, the concept of mental deficiency was well understood when EL appeared. However, EL defied some of the basic precepts of mental deficiency to such an extent that amendments were made to the Mental Deficiency Act in 1927. I examine how clinicians approached the sequelae of EL in children during the 1920s, and how their work and the social problem that these children posed eventually led to changes in the legal definition of mental deficiency. EL serves as an example of how diseases are not only framed by the society they emerge in, but can also help to frame and change existing concepts within that same society.

Famous people with Gilles de la Tourette syndrome?

Virtually no neurologist nor psychiatrist today can be unaware of the diagnosis of Gilles de la Tourette syndrome (GTS). Although the eponymous description by Dr. Georges Gilles de la Tourette was published in 1885, familiarity with this syndrome has been achieved only recently. In this article, the two most renown accounts of exceptional individuals retrospectively diagnosed with GTS are critically analyzed: British lexicographer Samuel Johnson and Austrian musician Wolfgang Amadeus Mozart. In both cases, clinical descriptions have been retrieved from written documents predating Gilles de la Tourette's original publication. The case for Samuel Johnson having GTS is strong, mainly based on Boswell's extensive biographical account. Johnson was reported to have a great range of tics and compulsions, including involuntary utterances, repetitive ejaculations, and echo-phenomena. On the other hand, there is circumstantial evidence that Mozart may have had hyperactivity, restlessness, sudden impulses, odd motor behaviors, echo/palilalia, love of nonsense words, and scatology, the latter being documented in autograph letters ("coprographia"). However, the evidence supporting the core features of GTS, i.e., motor and vocal tics, is rather inconsistent. Thus, GTS seems to be an implausible diagnosis in Mozart's medical history and completely unrelated to his undisputed musical genius.

A historical appraisal of America's experience with "pyromania"--a diagnosis in search of a disorder.

When "pyromania" from 1840-1890 is reviewed, it stands out as a concept that at first found favor in an era of moral insanity and moral treatment. During this period pyromania was variously labeled as a form of monomania, moral insanity, impulsive mania, or instinctive mania. As early as 1850, and clearly after the Civil War, however, controversial arguments regarding the locus of personal responsibilty emerged. Arguments were put forward that there could be diseased brains but not diseased minds. Without the proof of an organic lesion in the brain, fire-setting became an act whose locus rested in the individual's moral fabric, and in this historical context became a nonmedical concern punishable by law. Pyromania, at the hands of those physicians who limited insanity to disorders of the brain, might have received the same fate as other diseases of the mind or will: it could have simply been dismissed. But it lingered. The period 1880-1917 witnessed professional attention directed toward prophylaxis, mental hygiene, and a reorientation of American psychiatry toward an endorsement of psychotherapy (Sicherman, 1980). Attention to pyromania was more quiescent than it had been. The development of psychoanalytic theory which followed allowed for the re-emergence of pyromania as a disease entity. The diagnosis then flourished from 1924 until 1957, with descriptions of it including: an irresistible impulse, a urethra-erotic character trait, an obsession, or a psychosexually based impulse neurosis. The period of 1924-1985 can be viewed as a repetition of the period between 1840-1890 in terms of the evolution of the place of pyromania in the lexicon of psychiatry, of its existence as a disease entity, and of its implications for personal responsibility for destructive acts. Supported at the outset of this later period as a disease, this time grounded in psychoanalytic rather than moral theories of responsibility, it loses favor as the psychobiologic position ascends. And like the preceding period, the conception of pyromania as a specific disorder wanes but never dies, as advocacy for the psychodynamic (replacing moral) approach diminishes but does not disappear. The cyclical nature of pyromania has parallels in cycles of reform in standards of civil commitment (Livermore, Malmquist & Meehl, 1958; Dershowitz, 1974), in the use of physical therapies and medications (Tourney, 1967; Mora, 1974), in treatment of the chronically mentally ill (Deutsch, 1949; Morrissey & Goldman, 1984), and in institutional practices (Treffert, 1967; Morrissey, Goldman & Klerman (1980).(ABSTRACT TRUNCATED AT 400 WORDS)