Max Fink: Reconceptualization of Catatonia

            INHN posts on schizophrenia, depression and schizoaffective disorder are surely relevant.  These matters have been subject to controversy for decades, especially after the arbitrary posturings and decisions in DSM-III. I see a serious omission, a whiff of truth, that you omit the remarkable victory in the delineation of catatonia.

            First, in my training days in 1950s at a 200-bed psychiatric facility, the Hillside Hospital in Queens, NY, we residents learned that when presenting a new case to one director (Simon Kwalwasser) we were praised when we identified "schizophrenia"; when the same case was presented to Joseph Miller, "manic-depression" received approval.   The treatments were the same, although insulin coma was favored for schizophrenia and ECT for the mood disordered.

            In your comment on Foucher et al.’s essay you properly credit Mickey Taylor (1990) with the recognition of the failure to differentiate identifiable syndromes, but fail to cite his recognition of catatonia as a definable (and treatable) entity.  As we describe in Madness of Fear: A History of Catatonia (Shorter and Find 2018), this syndrome, first described in 1874, was then buried for a century in "schizophrenia" until the recognition and effective treatment of malignant catatonia (neuroleptic malignant syndrome) led to today's recognition of catatonia as a verifiable and treatable syndrome.  Not "schizophrenia," as conjured by DSM-I to DSM-III, but an independent systemic identifiable and treatable entity (Fink and Taylor 2003).

            Defining catatonia using the guidelines of the medical model of diagnosis is a model path to discard DSM labels and ineffective criteria.  A place to start is to re-examine the melancholia of Bernard Carroll, identify with the Hamilton Depression Scale, verify with the dexamethasone suppression test and successfully treat with ECT (and for the better educated and experienced, treat with the tricyclic antidepressants).

References:

Fink M, Taylor MA. Catatonia: A Clinician's Guide to Diagnosis and Treatment. NY: Cambridge University Press. 2003. 

Shorter E.  Comment on Jack R. Foucher et al.’s paper on  Wernicke-Kleist-Leonhard phenotypes of endogenous psychoses: A review of their validity. inhn.org.perspective. May 7, 2020.          

Shorter E, Fink M. The Madness of Fear: A History of Catatonia. Oxford University Press. 2018.   

Taylor MA. Catatonia: A review of a behavioural neurologic syndrome. Neuropsychiatry Neuropsychol Behav Neurol. 1990;  3:48-72. 

Taylor MA, Fink M. Melancholia: The Diagnosis, Pathophysiology and Treatment of Depressive Illness. NY: Cambridge U Press, 2006.

December 10, 2020