Was Insanity on the Increase?

Hare, E. H.

doi:10.1192/bjp.142.5.439

Cited by 122 publications

(47 citation statements)

References 20 publications

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“…history resources. This was especially unwelcome in a period of acute fear relating to the perceived 'remarkable increase' in the British asylum admission rate, 21 particularly of the chronic insane and the consequent 'silting up' of asylumdom. 22 Moreover, amidst widespread 'race suicide' concerns, with the British birth rate in decline and the loss of soldiers in combat, the social epidemiology of the disease was a source of further concern.…”

Section: A Complex and Cruel Diseasementioning

confidence: 99%

The most deadly disease of asylumdom: general paralysis of the insane and Scottish psychiatry, c.1840–1940

Davis¹

2012

J R Coll Physicians Edinb

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General paralysis of the insane (GPI) was one of the most devastating diseases observed in British psychiatry during the century after 1840, in terms of the high number and type of patients diagnosed, the severity of its symptoms and, above all, its utterly hopeless prognosis. With particular reference to the physicians and patients of the Royal Edinburgh Asylum, this article explores the diagnostic process and the social and medical significance of the 'death sentence' that accompanied the GPI diagnosis.KeywoRdS General paralysis of the insane, mortality, diagnosis, prognosis, postmortem, Royal Edinburgh Asylum deClARATionS of inTeReSTS No conflicts of interest declared. General paralysis of the insane (GPI) emerged as a new and devastating form of insanity during the early nineteenth century. Its identification as a distinct disease category has been credited as the achievement of a small group of French psychiatrists, or alienists, as this profession was commonly known during the nineteenth century. G Davis1 The disease was not recognised in Scotland until around 1839, 2 though clinicians on both sides of the English Channel questioned whether this was simply because British alienists had not yet 'learned to see' the disease. 3,4 There was also considerable confusion as to the causation of GPI. Although the possibility of syphilis had been suggested as early as 1857, this was not generally accepted in the nineteenth century, when the disease was thought to be multi-causal, relating largely to the destructive influences of the urban environment and in particular to the excesses of alcohol, tobacco and sex. Not until the early twentieth century did the 'syphilitic hypothesis' begin to achieve widespread acceptance, with the Japanese bacteriologist Hideyo Noguchi's demonstration of the presence of the organism, then called Spirochaete pallida, in the brain of a patient who had died of GPI.5 However, even then, Scottish asylum physicians continued to ascribe GPI to factors as diverse as 'bereavement', 'kick from a horse', and 'unknown origin '. 6 There was, however, broad agreement on the disease's symptomatology and prognosis. It was widely perceived as the most deadly disease of psychiatry. The course of GPI was one of steady and progressive mental and physical deterioration ending in death. The disease inflicted degenerative dementia upon its sufferers in tandem with the development of muscular incoordination and paralysis, hence the disease's pseudonym 'dementia paralytica'. Most of those diagnosed were middle-aged males in the prime of their working lives; the socioeconomic implications of the disease were therefore a source of significant concern. Worst of all, there appeared to be no cure, the diagnosis conferring an almost certain death sentence upon its sufferers. As a result of the type of patient diagnosed, the severity of the symptoms and the hopeless prognosis, the eminent Scottish alienist Thomas Clouston described GPI as the 'most terrible of all brain diseases '. 7 Nor was this ...

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Section: A Complex and Cruel Diseasementioning

confidence: 99%

The most deadly disease of asylumdom: general paralysis of the insane and Scottish psychiatry, c.1840–1940

Davis¹

2012

J R Coll Physicians Edinb

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“…Torrey has pointed out that no disease manifests itself with exactly equal frequency in every population (1989), assembling data (1980,1987) from over 40 studies to compare prevalence rates. Historical perspectives suggest that the condition may not have been present before about 1800 (Torrey, 1980;Hare, 1983) and that rates in developed countries may now be declining (Der et al 1990). Major differences in the manifestation of the condition in rich and poor countries have been noted (Warner, 1985).…”

Section: Schizophrenia In British Afro-caribbeansmentioning

confidence: 97%

Schizophrenia in British Afro-Caribbeans: Two Debates Confused?

Ineichen

1991

Int J Soc Psychiatry

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The concept and aetiology of schizophrenia remain controversial issues. Epidemiological studies reveal considerable variations in rates of diagnosed cases between groups. British Afro-Caribbeans show high rates. At the same time, their psychiatric experience is marked by a high level of conflict with the psychiatric services. The two debates--that surrounding the concept of schizophrenia, and that concerning the psychiatric experiences of British Afro-Caribbeans--need to be separated so that each receives appropriate consideration. Studies based on the experiences of people diagnosed as schizophrenic may confuse rather than advance the first debate if due care is not paid to the reliability of the diagnosis. The second debate has consequences for the development of psychiatric services. Further unaddressed questions referring to the mental health of ethnic minorities are suggested.

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“…The anthropoparity principle (the assumption of constancy across different societies and over time) has generally been taken for granted, but this assumption is based on limited evidence without thorough examination of its singularity. Lately, however, the principle has been challenged (10,11). This controversy stimulated a cross-cultural study of incidence conducted under the auspices of the World Health Organization (WHO) (12).…”

Section: Epidemiology Of Schizophreniamentioning

confidence: 99%

Etiopathogenesis and Treatment of Psychosis

Crow

Harrington²

1994

Annu. Rev. Med.

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Psychotic illnesses (schizophrenia and schizoaffective and affective psychosis) have a lifetime prevalence of 2-3% and probably occur at a similar rate in all human societies. No etiologically significant environmental precipitants have been identified, and this suggests that these diseases are primarily genetic. Brain studies reveal that in schizophrenic patients, development of cerebral asymmetry is arrested, which may be associated with a small reduction in cortical mass. Episodes of illness can be ameliorated by dopamine (in particular D2) antagonists, drugs that are antipsychotic rather than merely antischizophrenic. The discovery of at least five dopamine receptor subtypes and their genes paves the way for new approaches to treatment. However, whether psychotic patients undergo a primary disturbance of dopaminergic transmission remains unclear.

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Was Insanity on the Increase?

Cited by 122 publications

References 20 publications

The most deadly disease of asylumdom: general paralysis of the insane and Scottish psychiatry, c.1840–1940

The most deadly disease of asylumdom: general paralysis of the insane and Scottish psychiatry, c.1840–1940

Schizophrenia in British Afro-Caribbeans: Two Debates Confused?

Etiopathogenesis and Treatment of Psychosis

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