American Madness: The Rise and Fall of Dementia Praecox

by Richard Noll

2012 BMA Medical Book Award, Highly Commended in Psychiatry, British Medical Association

2012 Cheiron Book Prize, Cheiron, International Society for the History of the Behavioral and Social Sciences

In 1895 there was not a single case of dementia praecox reported in the United States. By 1912 there were tens of thousands of people with this diagnosis locked up in asylums, hospitals, and jails. By 1927 it was fading away . How could such a terrible disease be discovered, affect so many lives, and then turn out to be something else?

In vivid detail, Richard Noll describes how the discovery of this mysterious disorder gave hope to the overworked asylum doctors that they could at last explain--though they could not cure--the miserable patients surrounding them. The story of dementia praecox, and its eventual replacement by the new concept of schizophrenia, also reveals how asylum physicians fought for their own respectability. If what they were observing was a disease, then this biological reality was amenable to scientific research. In the early twentieth century, dementia praecox was psychiatry's key into an increasingly science-focused medical profession.


But for the moment, nothing could be done to help the sufferers. When the concept of schizophrenia offered a fresh understanding of this disorder, and hope for a cure, psychiatry abandoned the old disease for the new. In this dramatic story of a vanished diagnosis, Noll shows the co-dependency between a disease and the scientific status of the profession that treats it. The ghost of dementia praecox haunts today's debates about the latest generation of psychiatric disorders.

Genres: Psychology, History, Science, Nonfiction, Mental Health

408 pages, Hardcover

First published November 28, 2011

About the author

Dr. Richard Dean Noll, Ph.D. (Clinical Psychology, New School for Social Research, 1992; B.A., Political Science, University of Arizona, 1979), is a clinical psychologist, historian of medicine, and Associate Professor of Psychology in the College of Sciences at DeSales University (Pennsylvania). Previously, he taught and conducted research at Harvard University for four years as a postdoctoral fellow and as Lecturer on the History of Science. During the 1995–1996 academic year, he was a visiting scholar at the Massachusetts Institute of Technology and a resident fellow at the Dibner Institute for the History of Science and Technology.

Reviews

[Neal Alexander · Rating 4 out of 5]

The author's lesson from history is that disease definitions are contingent. On schizophrenia, he says “the confusion of the alienists and neurologists of the past regarding dementia praecox is precisely what historians of the future will find in the literature left behind by our own psychiatric elite when they attempt to re-create the story of our era's construction of schizophrenia.” In other words, we shouldn't think that “this time is different” when it comes to defining psychiatric conditions.

Hence the author's verb for the appearance of new diseases is “create”, e.g. “Bleuler, the creator of schizophrenia”. Bearing in mind the history laid out here, it's hard to argue that dementia praecox and schizophrenia come from anything other than an idiosyncratic and fallible process of constellating groups of signs, symptoms and behaviours.

Dementia praecox was abandoned as a diagnosis by WWII. This is not unusual. The Lancet medical journal used to run a column called Discarded Diagnoses. One example from the later 20th century would be childhood schizophrenia, which had currency for about 50 years, till the 1970s. It would be hubristic to think that all our current diagnoses will last indefinitely. Moreover, the author rejects the idea that “schizophrenia” was just a change of name over “dementia praecox”. In other words, he rejects that there is a “real, recognizable unitary and stable object of enquiry (‘RRUS’)” denoted by both terms (or by either of them, for that matter).

The author shows a degree of compassion which is rare for an academic book. He says that being an asylum alienist “was an impossible job. Over time many alienists adopted the very same sequence of behaviors exhibited by the troubled persons reacting in a natural fashion to their loss of personal liberties: confusion, fear, and anger followed by occasional rages, then resignation and withdrawal.” He calls it “learned helplessness”.

Overall the book is technical, dry at times, but insightful into the human foibles and social conditions that cause newly defined diseases to flourish and then fade away.

[Rick Sanders · Rating 5 out of 5]

This is billed as some scathing exposé, but really it's a straightforward history. The topic is arcane, but the book is very engaging, and it nicely illuminates much about turn of the century American psychiatry.

[Scott · Rating 4 out of 5]

For my LJ review check out the following:

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