Thomas A. Ban
Neuropsychopharmacology in Historical Perspective.
Education in the field in the Post-Psychopharmacology Era
Thomas A. Ban: The Year 1845
Thomas A. Ban July 26, 2015 Ernst Feuchtersleben’s separated
psychosis (psychiatric disorders) from
neurosis (neurological disorders)
(Lehrbuch der Aerztlichen
Thomas A. Ban August 2, 2018 Wilhelm Griesinger’s developed
his diagnostic concept of Unitary
Psychosis and postulated that mental
activity is reflex
activity based on psychic reflex
actions (Die Pathologie und Therapie
Thomas A. Ban August 16, 2018 Jaccques-Joseph Moreau de Tours’ set
the foundation for what was to
(Du hachisch et de Alié nation
Publication of Ernst Feuchtersleben’s Lehrbuch der Aerztlichen Seelenkunde Separation of psychiatry (psychoses) from neurology (neuroses)
The term “psychosis” was introduced in 1841 by Karl Friedrich Canstatt (1807–1852) in his Handbuch der Medizinische Klinik (Bürgy 2008).
In 1845 the term was adopted by Ernst Feuchtersleben (1806-1849) for the separation of mental illness from William Cullen’s (1712-1790) “neurosis” that referred to a “disease which is assumed to have its seat in the nervous system and which constituted a functional disorder with no palpable lesion in the structure of the parts” (Cullen 1777; Feuchtersleben 1845; Littre 1877). In Feuchtersleben’s formulation, “Every mental disorder implies the existence of a disease in the nervous system, but every defect of the nervous system, is not necessarily accompanied by mental disorder” (Pichot 1983).
In its original definition, the term “psychosis” was vaguely defined with changing criteria and fluid boundaries (Ban and Ucha Udabe 1995). However, with the publication of Karl Jaspers’ (1983-1969) classic paper, Eifersuchtswahn: Entwicklung einer Persoenlichkeit oder Prozess, and the conceptual separation of developmental anomalies from the effects of disease process, the scope of psychosis was unambiguously restricted to mental illness (Jaspers 1910).
For Jaspers (1913), “psychosis” was “the result of a disease process which seizes upon the individual as a whole, regardless whether it is a hereditary disease beginning at a certain time of life, or a non-hereditary disorder which called into being by an exogenous lesion.” To qualify for “psychosis” the pathologic process has to be sufficiently strong to override normal development and the behavior displayed sufficiently different that it could not be understood as an extension of the normal and/or an exaggerated response to ordinary experience.
Jaspers (1913) concept and criteria of “psychosis” was adopted by Kurt Schneider (1887-1967) who, in his Klinische Psychopathologie (Schneider 1950), separated “anomalies of development” or “abnormal variations of psychic life, from “psychosis,” i.e., “effects of illness.”
During the second part of the 20th century Frank Fish, in his 1967 Clinical Psychopathology, defined psychosis as a distortion of the whole personality with lack of insight, construction of false environment out of subjective experiences, gross disorder of basic drives, including self-preservation, and inability to make a reasonable social adjustment” (Hamilton 1985). In contrast, in the Encyclopedia of Psychiatry for General Practitioners, edited by Leigh, Pare and Marks (1972), “psychosis” refers to “mental illness which is severe, produces conspicuously disordered behavior that cannot be understood as an extension or exaggeration of ordinary experience and whose subject is without insight.” Somewhat similar to Leigh, Pare and Marks’ definition is the that of the World Health Organization in the 9th edition of its International Classification of Diseases (ICD), presented in 1977, in which “psychoses” are defined as “mental disorders in which impairment of mental functions has developed to the degree that it interferes grossly with insight, ability to meet some ordinary demands of life or to maintain adequate contact with ordinary demands of life or maintain adequate contact with reality.”
In both the DSM-III and DSM-III-R of the American Psychiatric Association (1980, 1987), “direct evidence of psychotic behavior is the presence of either delusions or hallucinations without insight into their pathological nature.” However, it is noted that “the term psychotic is sometimes appropriate also when a person’s behavior is so grossly disorganized that a reasonable inference can be made that reality testing is markedly disturbed.”
In the ICD-10 of the World Health Organisation (1990), the term “psychosis” is retained, but it is left deliberatively without any attempt of definition.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Third Edition. (DSM-III). Washington American Psychiatric Association; 1980.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Third Edition- Revised. (DSM-III - R). Washington American Psychiatric Association; 1987.
Ban TA, Ucha Udabe R. Clasificacion de Los Psicosis. Buenos Aires: Editorial Salerno; 1995.
Bürgy M. The Concept of Psychosis: Historical and Phenomenological Aspects, Schizophr Bull 2008;34:1200-10.
Cullen W. First Lines of the Practice of Physics. Edinburgh: Kincaid; 1845.
Feuchtersleben E. Lehrbuch det Aerztlichen Seelenkunde Vienna: Carl Gerold; 1845.
Fish F. Clinical Psychopathology. Bristol: Wright; 1967.
Hamilton M, ed. Fish’s Clinical Psychopathology. Bristol: Wright; 1985.
Jasperstwicklung einer Persoenlichkeit oder Prozess. Zeitschrift fure die Gesamte Neurologie und Psychiatrie 1910;1:567 -637.
Jaspers K. Allgemeine Psychopathologie. 1 Aufl. Berlin/Heidelbeeg: Springer; 1913.
Leigh D, Pare CMB, Marks B, editors. Encyclopedia of Psychiatry. Vaureauil: Hoffman La Roche; 1972.
Littre E. Dictionnaire de la Langue Francaise. Paris: Hachette & Cie; 1877.
Pichot P.A Century of Psychiatry. Paris: Editions Roger; 1933.
Schneider K. Klinische Psychopathologie. Stuttgart: Thieme: 1950.
World Health Organization. International Classification of Diseases. 1975 Revision. Geneva: World Health Organization; 1977.
World Health Organization. International Classification of Diseases. 1989 Revision. (February 1990 Draft for Field Trials). Geneva: World Health Organization; 1990.
July 26, 2018
Publication of the first edition of Wilhelm Griesingeer’s Die Pathologie und Therapie der Psychischen Krankheiten (Development of the diagnostic concept of unitary psychosis with the postulation that mental activity is brain activity based on “psychic reflex” actions)
The concept of “unitary psychosis” (einheitpsychose) is based on the notion that different clinical syndromes of “insanity” are varieties of a single universal madness with fluid boundaries (Jaspers 1963, 1997; Noll 2007).
The roots of the concept of “unitary psychosis” are in Jesse Bayle’s (1799–1858) finding in the early 1820s that in chronic arachnitis (allegedly caused by cerebral syphilis), the dementia syndrome displayed in the final stage in the development of the disease, was preceded by other mental syndromes in the earlier stages of disease development. It was on the basis of these findings that in his Recherches sur les Maladies Mentales, published in 1822, Bayle put forward the notion that “the symptoms of chronic arachnitis can be reduced to a general and incomplete paralysis and to the derangement of intellectual faculties” (Bayle 1822). He also pointed out: “These two orders of phenomena (paralysis and intellectual derangement) proceed at an equal and proportional pace and allow the disease to divide into three periods: delire monomaniaque with exaltation in the first; delire maniaque with dominant ideas in the second; and etat demence (dementia) in the third (Bayle 1825, 1826; Pichot 1983.)
A unitary concept of madness was first presented in 1833 by Joseph Guislain (1797-1860), a Belgian physician, head of the psychiatric asylum in Ghent. In his Traité Des Phrénopathies ou Doctrine Nouvelle des Maladies Mentales, published in 1833, Guislain proposed that the origin (cause) of all of the almost 100 mental syndromes he recognized was in mental pain, which he referred to as phrenalgia (phrenalgie). It was on the basis of this etiological consideration that he perceived the various mental states (syndromes) displayed by patients as expressions of one and the same illness that unfolds along seven successive, progressive stages moving towards deterioration. The seven stages identified by Guislain were: hyperphrénie (mania); paraphrénie (paraphrenia); hyperplexie (stupidity); hyperspasmie (epilepsy); ideosynchysie (hallucinations); analcouthie (confusion); and noasthénie (dementia) (Angst 2002; Beer 1996; Guislain 1893).
Guislain’s concept of “unitary madness” was adopted by Ernst Albrecht von Zeller (1804-1877), the medical director of a private asylum in Winnenthal in Wurttenburg, Germany. He translated Guislain’s treatise to German from the French original and, in 1938, published it with a foreword (Beer 1996; Berrios and Beer 1994, 1995; Engstrom 2003; Guislain 1838).
Wilhelm Griesinger (1817-1868) adopted the diagnostic concept of “unitary psychosis” without its theoretical underpinnings while working as a medical assistant to Zeller in the early 1840s. Griesinger, a German physician who was to become director of the medical and psychiatric clinics of Charite Hospital in Berlin, perceived mental pathology as diseases of the “nerves” and believed, with consideration of Bayle’s (1822) findings, that “in the mental syndromes in which neuropathological changes are absent, they will become detectable at a later stage of disease development” (Ban and Ucha Udabe 1995).
In the first edition of his textbook, Pathologie und Therapie der psychischen Krankheiten, published in 1845, Griesinger (1845) postulated that mental activity is brain activity based on "psychic reflex action” (psychische Reflexaktion) in which “stimuli of representations” (Vorstellungen) based on the individual’s life experience play a similar role to environmental stimuli in the physiological reflex action (Berrios and Beer 1994; Engstrom 2003). He argued that both physiologic and psychic reflexes have the same mode of action and obey the same physical laws. He also contended that abnormal psychic reflex activity signals mental pathology; diminished activity leads to melancholia; and accelerated activity leads to mania.
After setting the conceptual foundation for a psychiatry that was to provide the functional underpinning on which neuropsychopharmacology was to be built upon in the second part of the 20th century, Griesinger (1861), in the first edition of his text in its second edition, elaborated his “unitary concept of psychosis.” It was based on recognition of three types of mental anomalies: one characterized by emotional disturbances; another by disturbances in intellectual and volitional functions; and a third by mental deterioration with a trajectory from “states of mental depression – melancholia” through “states of mental exaltation” to “states of “mental weakness.” Further, on the basis of cross (trans) sectional clinical manifestations within the “states of mental depression – melancholia,” he distinguished hypochondriasis; melancholia; melancholia with stupor; melancholia with suicidal or murderous tendencies; and melancholia with persistent excitement of the will. Among the “states of mental excitement” were mania and monomania; and within the “states of mental weakness” were chronic mania, dementia, apathetic dementia, idiocy and cretinism (Menninger, Mayman and Pruyser 1969).
It was in 1859, between the publication of the first and second edition of Griesinger’s text, that Heinrich Neumann’s (1814-1888) Lehrbuch der Psychiatrie appeared. Neumann, the most vocal advocate of unitary psychosis, was owner of a private psychiatric clinic at the time his book was published. In 1874 he became the medical director of a university-based clinical ward in the Breslau city hospital (now Wroclaw, Poland). Neumann believed: “There is only one type of mental disorder. We call it madness (irresein). Insanity does not possess different forms but different stages; they are called insanity (wahnsinn), confusion (verwirrheit) and dementia (blödsinn).” He also extended the concept of einheitpsychose from a continuum between diseases to a continuum between diseases and health by arguing that "sleeplessness, illusions, exaggerated sensitivity... cause illness, then madness, confusion and dementia” (Beer 1996).
It was just about the same time that Neumann (1859) and Griesinger (1861) put forward their “unitary concept” that the first set of drugs was introduced – morphine and hyoscine for the control of excitement agitation and aggression (Wood 1855; Shorter1997); potassium bromide for relieving restlessness, anxiety and tension (Lockock 1857; Bettany 2004); and chloral hydrate and paraldehyde for calming and inducing sleep (Cervello 1883,1884; Liebreich 1869) – that profoundly affected the future course of psychiatry. Their effect provided the necessary changes for the collection of information and study of patients throughout their illness. With the information collected, by the 1920s psychopathology, the discipline that deals with the symptoms and signs of mental illness, and nosology, the discipline that deals with the rules of separating subpopulations and classifying these subpopulations, provided a foundation for psychiatry with sub-populations which arguably have predictive validity. Yet, the concept of “unitary psychosis” lingered on.
Angst J (2002). Historical aspects of the dichotomy between manic–depressive disorder and schizophrenia. Schizophrenia Research 2002;57:5-13.
Ban TA, Ucha Udabe R. Clasificacion de los Psicosis. Buenos Aires: Editorial Salermo; 1995.
Bayle ALJ. Recherches sur L’Arachnitis Chronique Considerees Comme Cause d’Alienation. Paris: Gabon 1822.
Bayle ALJ. Nouvelle Doctrine des Maladies Mentales. Paris: Gabon; 1825.
Bayle ALJ. Traite des Maladies du Cerveau et de ses Membranes. Paris: Gabon; 1826.
Beer MD. Psychosis: A history of the concept. Comprehensive Psychiatry 1996;37:273-91.
Berrios GE, Beer MD. The notion of unitary psychosis: a conceptual history.Journal of the History of Psychiatry 1994;5;13-36.
Berrios GE. Beer MD. (1995). "Unitary psychosis concept: clinical section." In German E. Berrios and Roy Porter. A History of Clinical Psychiatry: The Origin and History of Psychiatric Disorders. London: Athlone: 1995, pp. 313-35.
Bettany, GT. Lockock, Sir Charles. Oxford Dictionary of National Biography. Oxford University Press; 2004.
Cervello V. Sull'azione fisiologica della paraldeide e contributo allo studio del cloralio idrato.
Archivio per le Scienze Mediche 1883;6:177-84.
Cervello V. Recherches cliniques et physiologiques sur la paraldehyde Archives italiennes de biologie, 1884;6:113-34.
Engstrom EJ. Clinical Psychiatry in Imperial Germany: a History of Psychiatric Practice. New York: Cornell University Press; 2003.
Griesinger W. Die Pathologie und Therapie der Psychischen Krankheiten.1 Aufl. Wreden: Braunschweig; 1845.
Griesinger W. Die Pathologie und Therapie der Psychischen Krankheiten.2 Aufl. Stuttgart: Krabbe; 1861.
Guislain J. (1835). Traité sur les phrénopathies, ou doctrine nouvelle des maladies mentales (2 ed.). Brussels: Etablissement encyclographique; 1835.
Jaspers K. General Psychopathology. Translated from the German original by J. Hoenig & Marian W. Hamilton. Baltimore: Johns Hopkins University Press; 1963, 1997.
Liebreich MEP. Das Chloral hydrate, ein neues Hypnoticum und Anaestheticum, und dessen Anwendung in die Medizin. Eine Arzneimeittel –Untersuchung. Nerlin: Muller; 1869.
Menninger K, Mayman M, Pruyser P. The VITAL Balance. The Life Process in Mental Health. New York: The Viking Press; 1968.
Neumann H. Lehrbuch der Psychiatrie. Erlangen: Enke; 1959.
Noll R. The Encyclopedia of Schizophrenia and Other Psychotic Disorders (3rd edition). New York: Infobase Publishing; 2007.
Pichot P. A Century of Psychiatry. Paris: Roger Dacosta; 1983.
Shorter E. A History of Psychiatry. New York/Chichester/ Brisbane/Toronto/Weinheim; John Wiley & Sons, Inc. 1997;190-238.
Wood A. A new method for treating neuralgia by the direct application of opiates to the painful points. Edinburgh Medical and Surgical Journal 1855;82:265-81.
August 2, 2018
Publication of Jacques-Joseph Moreau de Tours’ Du hachisch et de l’aliénation mentale: études psychologiques (Set th foundation for what was to become psychopharmacology)
The roots of psychopharmacology are in the mid-19th century in the research of the French psychiatrist Jacques-Joseph Moreau (1804 -1884), usually referred to as Moreau de Tours after the city (Tours) in which he began with his medical studies (Ban 2004; Shorter 2005).
Moreau started his career in psychiatry with Jean-Etienne-Dominique Esquirol (1772-1840) at the national asylum in Charenton, a suburb of Paris. Esquirol used to send patients traveling abroad and entrusted some of them to the care of Moreau. This gave Moreau an opportunity to visit the “Orient” (Far East) to become acquainted with and interested in “hashish” (Collet 1952). By the 1840s his interest expanded and Moreau was intensively involved in the study and treatment of mental pathology with drugs (Pichot 1983).
Moreau’s rational for using drugs in the treatment of his patients was in keeping with the principle of homeopathy which stipulates that “a medicinal substance that can evoke certain symptoms in healthy individuals may be effective in the treatment of the illness having symptoms closely resembling those produced by the substance” (Stedman 1982). He maintained that if symptoms of mental illness could be substituted by similar symptoms induced by drugs they would become more accessible for control (Caldwell 1970). By pursuing his research within this frame of reference, in 1841 Moreau published a 43-page pamphlet on the treatment of hallucinations with Datura stramonium (Moreau 1841).
Moreu’s research culminated in 1845 with the publication of his monograph Du hachisch et de l’aliénation mentale: études psychologiques. It is based on his findings in a series of systematic studies in which he administered the substance known as a “dawamse,” a flavored paste (electuary) of hashish, or as a pure extract of hashish, together with black coffee to enhance (potentiate) and accelerate its effects and to mask its taste (Caldwell 1970). The series included self-experiments and the administration of the substance to his students (normal subjects) and to psychiatric patients with different diagnoses in escalating and diminishing doses. The findings of his research indicated that the effects of the substance were not just dose dependent but also diagnosis dependent, i.e., not just different in normal subjects from patients with mental illness, but also different in patients with different diagnoses or even with different symptoms within diagnoses.
By taking the substance himself, Moreau recognized that “by its mode of action on the mental faculties it gives to everyone who submits himself to its strange influence, the power of studying on himself the moral disturbances of mental illness, or at least the principal intellectual disorders, from which all kinds of mental disturbances originate” (Mayer-Gross, Slater and Roth 1960). Furthermore, he speculated that hashish could serve as a torchlight “in the mysteries of insanity, taking us back to the hidden source of these disorders which are so numerous and variegated and so strange” (Shorter 1997).
Ban TA. Neuropsychopharmacology and the History of Pharmacotherapy in psychiatry: A review of developments in the 20th century. Ban TA, Healy D, Shorter E, editors. Reflections on Twentieth Century Psychopharmacology. Budapest: Animula; 2004.
Caldwell AE. History of Psychopharmacology. In: Clark WG, Del Giudice J, editors. Principles of Psychopharmacology. New York: Academic Press; 1970.
Caldwell AE. Origins of Psychopharmacology. From CPZ to LSD. Springfield: Thomas; 1970.
Collet CG. Les fundateurs de la Société médico-psychologique. Ann Médicopsychol (Paris) 1952; 110:48-72.
Mayer-Gross W, Slater E, Roth M. Clinical Psychiatry. Second edition. Cassell and Company: Melbourne; 1960.
Moreau J. Mémoire sur le traitement des hallucinations par le Datura stramonium. Paris: Rouvier and LeBouvier; 1841.
Moreau J. Du hachisch et de l’aliénation mentale: études psychologiques. Paris: Fortin and Masspn; 1845.
Pichot P. A Century of Psychiatry. Paris: Roger Dacosta; 1983.
Shorter E. A History of Psychiatry New York: John Wile and Sons; 1997.
Shorter E. A Historical Dictionary of Psychiatry. Oxford: University Press; 2005.
Stedman TL. Stedman’s Medical Dictionary. 25th edition. Baltimore: Williams and Wilkins; 1982.
August 16, 2018
October 3, 2019