Ryssia Wolfsohn's 1907 dissertation on "the heredity of dementia praecox".

In the 19th century, psychiatric genetic studies typically utilized a generic category of "insanity." This began to change after 1899, with the publication of Kraepelin's 6th edition containing, among other disorders, his mature concept of dementia praecox (DP). We here review an article published by Ryssia Wolfsohn in 1907 from her dissertation at the University of Zurich entitled "Die Heredität bei Dementia praecox" (The Heredity of Dementia Praecox). This work, performed under the supervision of E. Bleuler, was to our knowledge the first formal genetic study of the then new diagnosis of DP. She investigated 550 DP probands admitted to the Burghölzli hospital with known information about their "heredity burden." For most probands, she had information on parents, siblings, grandparents, and aunts/uncles. Of these patients, only 10% had no psychiatric illness in their families. In the remaining probands, she found rates of the four major categories of psychopathology she investigated: mental illness-56%, nervous disorders-19%, peculiar personalities 12% and alcoholism 13%. Her most novel analyses compared either total familial burden or burden of her four forms of mental disorders on her DP probands divided by subtype and outcome. In neither of these analyses, did she find significant differences.

The examination of Kraepelin's diagnoses of dementia praecox and manic-depressive insanity in pedigrees: Studies of Schuppius in 1912 and Wittermann in 1913.

In the first two decades of the 20th century, a new approach to psychiatric genetics research emerged in Germany from three roots: (i) the wide-spread acceptance of Kraepelin's diagnostic system, (ii) increasing interest in pedigree research, and (iii) excitement about Mendelian models. We review two relevant papers, reporting analyses of, respectively, 62 and 81 pedigrees: S. Schuppius in 1912 and E. Wittermann in 1913. While most prior asylum based studies only reported a patient's "hereditary burden," they examined diagnoses of individual relatives at a particular place in a pedigree. Both authors focused on the segregation of dementia praecox (DP) and manic-depressive insanity (MDI). Schuppius reported that the two disorders frequently co-occurred in his pedigrees while Wittermann found them to be largely independent. Schuppius was skeptical of the feasibility of evaluating Mendelian models in humans. Wittermann, by contrast, with advice from Wilhelm Weinberg, applied algebraic models with proband correction to DP in his sibships with results consistent with autosomal recessive transmission. While he had less data, Wittermann suggested that MDI was likely an autosomal dominant disorder. Both authors were interested in other disorders or traits appearing in pedigrees dense with DP (e.g., idiocy) or MDI (e.g., highly excitable individuals).

Classic Text No. 135: 'On inheritance of the insanities', by Jens Chr. Smith (1924).

Serious and realistic research into the inheritance of the psychoses started in earnest at the beginning of the twentieth century. This was encouraged by both the acceptance of the Kraepelinian classification and the rediscovery of the Mendelian model of inheritance. The application of Mendelian rules to the very complex genetics of the psychoses led to agonizing debate. The Classic Text is a translation of the introduction of the doctoral thesis of Jens Chr. Smith, a little-known Danish psychiatrist who was able to summarize, with the enthusiasm typical to his youth and with surprising accuracy, the early stages of the debate mentioned above.

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.

Uma relação possível entre os inclassificáveis e a modernidade líquida / A possible relationship between the unclassifiable and liquid modernity / Una posible relación entre los inclassificables y la modernidad neta

A psicanálise muito se ocupou de compreender as sociedades e sujeitos que a compõem, e, disto, Freud desenvolveu as três estruturas clínicas. Contudo, foi com Lacan que a psicose foi mais explorada teórica e clinicamente. Depois, com Miller e a "formalização" do termo "psicose ordinária", em 1998, há também os "inclassificáveis", que escapam destas estruturas. Na sociologia, Bauman cria o termo "Modernidade Líquida", para se referir a este tempo de desbussolamento do sujeito, de escape e perda de referencial, que nos motivou a discutir, teoricamente, quais as relações entre essa modernidade e as estruturas psíquicas existentes e reconhecidas pela psicanálise Freud-lacaniana. Tal discussão foi realizada através de revisão bibliográfica das obras de Freud, Lacan, Miller e Bauman, resultando no entendimento de que as formas de gozo se multiplicaram e seu valor simbólico para o sujeito se estilhaçou; aquilo que era a regra, hoje é mais um dos desvios dos sintomas.

Psychoanalysis was very concerned with understanding the societies and subjects that compose it, and, from this, Freud developed the three clinical structures. However, However, with Lacan psychosis started to be more explored theoretically and clinically. Then, with Miller and the "formalization" of the term "ordinary psychosis", in 1998, there are also the "unclassifiable", who escape these structures. In sociology, Bauman coined the term "Liquid Modernity", to refer to this time of subject disbussing, of escape and loss of reference, which motivated us to discuss, theoretically, which relationships are between this modernity and the existing psychic structures and recognized by Freud-Lacanian psychoanalysis. Carried out through a bibliographic review from Freud, Lacan, Miller and Bauman's work, which results in the, resulting in the understanding that the forms of jouissance multiplied and their symbolic value for the subject shattered; what used to be the rule, today is yet another symptom deviation.

El psicoanálisis se preocupó mucho por comprender las sociedades y los sujetos que lo componen y, a partir de ello, Freud desarrolló las tres estructuras clínicas. Sin embargo, fue con Lacan que la psicosis se exploró más teórica y clínicamente. Luego, con Miller y la "formalización" del término "psicosis ordinaria", en 1998, también están los "inclasificables", que escapan a estas estructuras. En sociología, Bauman acuñó el término "Modernidad líquida", para referirse a este tiempo de discusión de sujetos, de escape y pérdida de referencia, que nos motivó a discutir, teóricamente, cuáles son las relaciones entre esta modernidad y las estructuras psíquicas existentes y reconocido por el psicoanálisis freud-lacaniano. Dicha discusión se llevó a cabo mediante una revisión bibliográfica de las obras de Freud, Lacan, Miller y Bauman, dando como resultado la comprensión de que las formas de goce se multiplicaron y su valor simbólico para el sujeto se hizo añicos; lo que solía ser la regla, hoy es otra desviación de síntoma.

Julius Wagner von Jauregg, Otto Diem and research methods for assessing the contributions of hereditary burden to mental illness risk: 1902-1906.

After decades of methodological stasis in 19th century psychiatric genetics, when uncontrolled studies reported high rates of hereditary burden in hospitalized patients, Koller completed the first controlled study in 1895. We pick up this narrative 7 years later when the well-known Julius Wagner v. Jauregg published a biting critique of the then current psychiatric genetics' literature. In 1905, partially in response to Wagner v. Jauregg, Otto Diem attempted to replicate and extend Koller's study. Wagner v. Jauregg then wrote a follow-up to his earlier critique in 1906, commenting on Diem's investigation. Themes discussed in this point-counterpoint included the necessity of statistical methods to draw meaningful conclusions about the impact of hereditary burden on mental illness, the required sample size and proper selection of controls, the classes of relatives which should optimally be studied, the problems of obtaining accurate information on familial illnesses, the nature of the disorders in families which contribute to mental illness risk and the common unquestioned dogmatic belief that insanity is very often due to hereditary causes. Both Wagner v. Jauregg and Diem spoke out forcefully against the common assumption that hereditary burden operated in a deterministic fashion and emphasized the need to consider other causes of illness.

The staff of madness: the visualization of insanity and the othering of the insane.

In this article I trace a history of the most ubiquitous visual symbol of madness: the staff. First, I argue that the staff, in its variants (such as the pinwheel) and with its attachments (such as an inflated bladder), represents madness as air. It thus represents madness as an invisible entity that must be made visible. Secondly, I claim that the staff - being iconic of other 'unwanted' categories such as vagabonds - represents the insane as outsiders. Also in this case, the staff serves the purpose of making madness visible. Through this interpretation I show that the urge to make madness visible outlives icons of insanity such as the staff, making it a constant presence in popular culture and medical practice.

'Psychosis of civilization': a colonial-situated diagnosis.

In the late 1930s, when colonial psychiatry was well established in the Maghreb, the diagnosis 'psychosis of civilization' appeared in some psychiatrists' writings. Through the clinical case of a Libyan woman treated by the Italian psychiatrist Angelo Bravi in Tripoli, this article explores its emergence and its specificity in a differential approach, and highlights its main characteristics. The term applied to subjects poised between two worlds: incapable of becoming 'like' Europeans - a goal to which they seem to aspire - but too far from their 'ancestral habits' to revert for a quiet life. The visits of these subjects to colonial psychiatric institutions, provided valuable new material for psychiatrists: to see how colonization impacted inner life and to raise awareness of the long-term socio-political dangers.

[The stigma of mental illness: Α historical overview and conceptual approaches].

The present article explores the concept of stigma from a historical and theoretical perspective. At first, the conceptual origin of the term "stigma" is presented as well as its subsequent course and incorporation in the scientific field. The term stigma originates from ancient Greek language and in particular from the verb «στίζω¼, which means "to carve, to mark as a sign of shame, punishment or disgrace". In contemporary thinking about stigma, the work of Erving Goffman is seminal. According to him, stigmatization is elicited by the presence of a socially undesirable characteristic, which signals otherness. When this characteristic becomes conspicuous during a social interaction, it may act in a disqualifying manner for the identity of the person who bears it. One of the first theories on social stigma which attracted increased scientific attention is labeling theory by Thomas Scheff. Later on, the conceptual model of Corrigan and Watson underscored the main constituents of stigma, namely stereotypes, prejudices and discrimination; whereas the theoretical framework of Link and Phelan stressed labeling, stereotyping, separation, status loss and discrimination as interconnected components in a power situation. During the last half of the previous century, the concept of stigma came to the fore and gained growing research attention, especially due to shedding light on the ways whereby people with mental disorders were treated socially. Most of the literature has focused on recording the general population's level of knowledge and lay beliefs about mental illness as well as on exploring social attitudes and desired social distance from people with mental disorders. Converging evidence indicates that stereotypical beliefs and discriminatory attitudes against people with mental illness prevail worldwide; while illness severity, poor therapeutic outcome, disturbances in patients' emotional expression during a social interaction, incidents of violent or dangerous behaviours and labeling have all been shown to influence public stigma. Regarding lay respondents' correlates of public stigma; male gender, older age, lower socio-economic status, lower educational attainment and residence in semi-urban or rural areas have been linked to unfavourable attitudes towards people with mental disorders; while of outmost importance is personal experience/ familiarity with mental illness.

Just the Basic Facts: The Certification of Insanity in the Era of the Form K.

This paper investigates the certification of insanity through a standardized template called Form K which was used in Ontario between 1873 and 1883. My main thesis is that the introduction of the Form K had profound and long-lasting effects on the determination of insanity. In particular, it created a unique case in the history of certification, it grounded civil confinement on a strategy of consensus, and it informed mental health documentation for more than a century. As the result of a transnational mediation from Victorian England, the Form K prescribed an examination setting which involved a high number of participants, including three physicians and several witnesses. By comparing this case with other jurisdictions of the time, this paper shows how Ontario became a distinctive case worldwide. In order to get a closer look at this medico-legal procedure, I consider the archival records of the Toronto asylum and conclude that the certification of insanity relied on a strategy of consensus. While the Form K proved quite successful in preventing legal actions, it produced financial, logistic, and bureaucratic issues. The Form K was thus discontinued after a decade, yet its structure influenced Ontario's mental health documentation throughout the twentieth century. This paper shows the relevance of the certification of insanity for transnational history and for understanding contemporary issues of involuntary confinement and stigma in mental health.

The development of Kraepelin's mature diagnostic concept of hebephrenia: a close reading of relevant texts of Hecker, Daraszkiewicz, and Kraepelin.

In developing his mature concept of hebephrenic dementia praecox (DP) in his 4th (1893) through 6th textbook editions (1899), Kraepelin worked from the hebephrenic syndrome first described by Hecker (1871) and then carefully studied by his student Daraszkiewicz (1892). Working under Kraepelin's supervision, Daraszkiewicz followed Hecker in emphasizing several key features of hebephrenia (distinctive deteriorative course, importance of silliness and minimal positive psychotic symptoms) but expanded the syndrome to include cases developing severe dementia, rejected the link to prodromal depressive and manic phases, and reduced the emphasis on thought disorder. Daraszkiewicz proposed a soft subtyping of hebephrenia based on level of deterioration, which Kraepelin adopted in his 4th edition with an additional emphasis on severe positive psychotic symptoms. In his 5th edition, Kraepelin created a third subform with even more pronounced and bizarre delusions and hallucinations. In his 6th edition, which contained his first articulation of DP, Kraepelin eliminated his hebephrenia subforms presenting a single syndrome, which, compared to Hecker, included more emphasis on positive psychotic and catatonic symptoms and severe dementia. Kraepelin's paths to hebephrenic and paranoid DP differed in important ways. Paranoid DP was a de novo syndrome created by differentiation from paranoia. Hebephrenia, by contrast, evolved from a disorder created in the Kahlbaum/Hecker paradigm of the iterative study of clinical features, course and outcome. Kraepelin further implemented this approach in substantially reworking, over several drafts, the hebephrenic syndrome to fit into his emerging construct of dementia praecox.

Cannabis and psychosis: revisiting a nineteenth century study of 'Indian Hemp and Insanity' in Colonial British India.

BACKGROUND: In nineteenth-century British India, concern regarding large numbers of asylum patients with 'Indian Hemp Insanity' led to establishment of the Indian Hemp Drugs Commission. The exotic cannabis plant was widely used in pharmacopeia and a source of government revenue. The Commission was tasked with determining the public health risks of cannabis use, particularly mental illness. This analysis of the Commission report seeks to highlight the status of 1892 cannabis research and compare it with current evidence for medical and recreational cannabis use. METHODS: Detailed historiographic review of the Indian Hemp Drugs Commission Report (1892). RESULTS: In 1892, heavy cannabis use was considered to have been associated with severe mental illness (7.3% of asylum patients; 12.6% of patients with diagnoses). About two-thirds were children and young adults with higher relapse rates. Risk increased with early cannabis use and a family history of mental illness. Cannabis psychosis was found to have a shorter trajectory and better prognosis than other mental illnesses in the asylums. Different cannabis potency and modes of consumption had different effects. Occasional cannabis use was felt to have medicinal benefits for some. Appendices provided symptoms and demographic characteristics of cannabis-induced mental illness. CONCLUSION: This important nineteenth-century study observed frequency and dose-related effects of cannabis on mental health, particularly psychotic symptoms in young people with a previous or hereditary risk of mental illness. Pathophysiological observations were consistent with current knowledge. As one of the most systematic and detailed studies of the effects of cannabis of the time it foreshadowed contemporary cannabis issues.

[Carl Wernicke (1848-1905) and the "Wernicke-Kleist-Leonhard school". Connections to "Erlangen School" of psychiatry]. / Carl Wernicke (1848­1905) und die "Wernicke-Kleist-Leonhard Schule". Beziehungen zur "Erlanger Schule" der Psychiatrie.

BACKGROUND: To celebrate Carl Wernicke's 170th anniversary, the paper aims at analysing possible connections of Wernicke and his "Wernicke-Kleist-Leonhard (WKL) school" to the "Erlangen school" of psychiatry. METHODS: Relevant primary and secondary literature as well as archival material were examined to test the hypothesis. RESULTS: Wernicke's efforts to realise his nosological system in clinical practice were continued by his pupil Karl Kleist (1879-1960). After Wernicke's tragic early death Kleist worked under Gustav Specht's "Erlangen school of psychiatry". Karl Leonhard (1904-1988), who worked under Specht as well as under Kleist, continued Wernicke's and Kleist's research and ended up with a very differentiated classification of endogenous psychoses. DISCUSSION: Specht's "Erlangen school" of psychiatry can be regarded as a link in the development of the "Wernicke-Kleist-Leonhard school". Wernicke's description of "anxiety psychosis" motivated Specht to study the emotion of anxiety in "manic-depressive disorder". Specht's study again stimulated Leonhard's concept of "anxiety-happiness psychosis". Generally, Specht's intensive focus on bipolarity has influenced Leonhard's concept of cycloid psychoses. Specht's description of "pathologic affect" had an impact on Leonhard's concept of "affect-laden paraphrenia". CONCLUSION: Modern methods of neuro-imaging open a new perspective to Wernicke's localisation theory. The natural-scientific-philosophical "double orientation" of the WKL school motivates an increased integration of philosophical elements (ethics, religiosity, spirituality) in the field of psychiatry, psychosomatic medicine and psychotherapy.

'Close confinement tells very much upon a man': Prison Memoirs, Insanity and the Late Nineteenth- and Early Twentieth-Century Prison.

This article explores prisoners' observations of mental illness in late nineteenth- and early twentieth-century British prisons, recorded in memoirs published following their release. The discipline of separate confinement was lauded for its potential to improve prisoners' minds, inducing reflection and reform, when it was introduced in the 1840s, but in practice led to high levels of mental breakdown. In order to maintain the integrity of the prison system, the prison authorities played down incidences of insanity, while prison chaplains lauded the beneficent influence of cellular isolation. In contrast, as this article demonstrates, prisoners' memoirs offer insights into the prevalence of mental illness in prison, and its poor management, as well as inmates' efforts to manage mental distress. As the prison system became more closed, uniform and penal after the 1860s, the volume of such publications increased. Oscar Wilde's evocative prison writings have attracted considerable attention, but he was only one of many prison authors criticizing the penal system and decrying the damage it inflicted on the mind. Exploration of prison memoirs, it is argued, enhances our understanding of experiences of mental disorder in the underexplored context of the prison, highlighting the prisoners' voice, agency and advocacy of reform.

The Diagnostic Dilemma of Psychosis: Reviewing the Historical Case of Pseudoneurotic Schizophrenia.

The term "pseudoneurotic schizophrenia" was introduced in 1949 by Hoch and Polatin to describe apparently neurotic patients showing formal thought disorders, emotional dysregulation, and transient psychotic symptoms. Even if this diagnostic entity is no longer included in modern diagnostic systems, its evolution is intertwined with the history of schizophrenia in the 20th century. This article retraces the development of pseudoneurotic (or "borderline") schizophrenia in modern psychiatry, finding it a pioneering concept in psychopathology. In particular, we demonstrate that recent findings about the positive syndrome, good-outcome, type I "distress" subtype of schizophrenia (associated with high emotionality, including anxiety, depression, and sensitivity to stress) show surprising consistency with the clinical concept of pseudoneurotic schizophrenia. Finally, we discuss the historical development of pseudoneurotic schizophrenia in modern psychiatry as a meaningful example of the difficulty of confining severe psychological disturbances lying at the edge of full-blown schizophrenia within a widely accepted diagnostic category.

'Dementia praecocissima': the Sante De Sanctis model of mental disorder in child psychiatry in the 20th century.

The aim of this article is to describe the nosographical contribution of the Italian psychiatrist Sante De Sanctis (1862-1935) to early twentieth-century child psychiatry. De Sanctis first proposed the category of 'dementia praecocissima' in 1906, and it was recognized by Kraepelin. Dementia praecocissima has its roots in a theoretical and methodological conception of mental disorder based on 'psycho-physical proportionalism' and the 'law of circle'. This article deals with De Sanctis's model, which has so far been neglected by historiographers; it shows the pioneering role that this Italian psychiatrist played in child psychiatry in Italy.

Schizoaffective disorder: A review.

BACKGROUND: Schizoaffective disorder (SAD) is a chronic, potentially disabling psychotic disorder common in clinical settings. SAD often has been used as a diagnosis for individuals having an admixture of mood and psychotic symptoms whose diagnosis is uncertain. Its hallmark is the presence of symptoms of a major mood episode (either a depressive or manic episode) concurrent with symptoms characteristic of schizophrenia, such as delusions, hallucinations, or disorganized speech. METHODS: A literature search in PubMed and Google Scholar was conducted to identify articles on SAD. We also reviewed major textbooks and DSM-5 to identify pertinent information. RESULTS: This review begins with the history and classification of SAD. Debate continues to swirl around the concept, as some experts view SAD as an independent disorder, while others see SAD as either a form of schizophrenia or a mood disorder. The disorder is more common in women and its course follows the middle ground between schizophrenia and bipolar disorder. SAD appears to have high heritability. Most patients appear to benefit from antipsychotics plus antidepressants and/or mood stabilizers, depending on whether the patient has the depressive or bipolar subtype. Electroconvulsive therapy can also be effective. CONCLUSIONS: SAD is a chronic psychotic disorder that continues to be controversial. There has been inadequate research regarding its epidemiology, course, etiologic factors, and treatment.

Neuroaesthetical Changes in Sculpture: The Case of Yannoulis Halepas (1851-1938).

The theoretical conceptualization of artistic ingenuity and creativity, as reflections of the highest-level cognitive functions in the human brain, has recently evolved from a purely philosophical pursuit to a compelling neuroscientific undertaking. Changes in artistic style have been extensively studied in association with brain dysfunction in the presence of neurological and psychiatric diseases in famous artists. This paper presents the case of Yannoulis Halepas (1851-1938), who is widely regarded as the most influential sculptor of modern Greek art. At the age of 27, already at the peak of his fame, Halepas abruptly abandoned the sculpture world after developing schizoaffective disorder, only to resurge onto the art scene after an almost 40-year-long hiatus with a fundamentally reformed artistic style. Two distinct periods have preoccupied art critics: Halepas's early premorbid years (1870-1878), which were imbued with the principles of neoclassicism, and the later postmorbid years (1918-1938), which mark the artist's transcendence to expressionism and contemporary art. From a neuroaesthetical perspective, the extensive and multifaceted oeuvre that Halepas produced in his lifetime allows a close study of his artistic development throughout and beyond mental disease. In addition, his lifework is a unique account in the history of art of the struggle of artistic genius with the limits of the rational mind and its conscious reality.