The Madness of Fear: A History of Catatonia

In this post, Brenda Bogaert reviews The Madness of Fear:  A History of Catatonia (Oxford: Oxford University Press, 2018) by Edward Shorter and Max Fink.

The Madness of Fear: A History of Catatonia, by Edward Shorter and Marx Fink, aims to increase awareness about its titular disorder, which is typically characterised by an abnormality of movement or behavior brought about by disturbed mental state.  The authors try to snap readers out of apathy on the very first pages by saying that catatonia “is simply too unfamiliar to many” (xi) but also that it is one of those rare conditions where treatment is possible, and even better, fast and effective.  The idea that catatonia is at once identifiable, verifiable and treatable is intriguing, but also troubling, especially when they state that the standard treatment is benzodiazepine and electro-convulsive therapy (ECT), treatments that continue to be controversial in the medical community and among the wider public due to long-term side effects.  Is catatonia so easy to treat, as these authors suggest? In trying to gain recognition and awareness, are they inviting the patient and the family to the discussion?

 

Photo by Noah Silliman on Unsplash

 

This short book provides both a historical and current analysis of the nosology of catatonia, peppered with interesting facts and details (see Chapter 2 for incredible cases of patients “waking from the dead”). The book is co-written by a historian and a professor of psychiatry and neurology, which allows us a bridge between historical analysis and a practitioner’s understanding of the phenomenon. It will be of interest to the medical humanities as it gives a critical look into how disease classifications condition the way we see the world and how we treat disease. It is also an anthropological study, showing us how catatonia was seen and treated in different countries throughout history, mainly the United Kingdom, France and the United States.

The book largely seems intended as a historical analysis for historians and doctors, as it consists in a very detailed and largely historical analysis on the classification and treatment of catatonia.  It also brings us to up the current day, in discussion of catatonia’s place in the Diagnostic and Statistical Manual of Mental Disorders (DSM).  As the authors convincingly show us (and indeed seems to be the central message of the book), Kraepelin’s error in making catatonia a type of schizophrenia, an entanglement which lasted for over one hundred years, has prevented successful diagnosis and treatment, even today.  They call it an “a catastrophic misbelief in medical history” (156) and advocate that this miscomprehension has prevented research into the syndrome as a system bodily disorder, rather than a psychiatric emotional disorder.

The book successfully releases catatonia out of schizophrenia’s shadow.  It also sparks our interest in new research directions for the disorder outside of psychiatry. What is disappointing about the book comes from its title, “The Madness of Fear.” We are lead to believe that we will somehow understand the link between fear and catatonia, which will elucidate our understanding of the phenomena.  This is not the case.  The authors spend only a few pages of the book discussing the “possible” link between fear and catatonia with evolutionary hypotheses.  The title is a projection, showing what they hope future research will elucidate.  They “anticipate that, as catatonia is increasingly recognised as a singular entity, hormone studies that have identified changes in conditions of fear and flight will test the significance” of their theory (158). As the authors are trying to convince us that catatonia should not be regulated to psychiatry, the book would benefit from further contextualization such as on the links between mind and body (Sternberg 2001), cognitive approaches to emotions (Damasio 2006) and/or philosophical conceptions such as the idea of emotions as cognitive value judgements (Nussbaum 2001), to further interest us and elaborate on the possible link between fear and catatonia.  As written, it falls short.

The authors also do not mention the elephant in the room, namely the discussion around  the cognitive side effects (in particular memory problems) experienced by patients who undergo ECT, which is gaining increasing interest in scholarly literature in both philosophy (Seniuk 2018) and medicine (Verwijk et al. 2017). The authors make a small allusion in the conclusion of the book to “the widely stigmatized sciences that merit greater public recognition and research attention” (158) but otherwise advocate uncritically in favour of ECT throughout the book, even calling it “a kind of miracle” (3).  This suggests that the authors believe that the existing treatments for catatonia today are the “right” or “right enough” treatments for catatonia as they are effective (for discussion on the efficiency and efficacy of ECT, see LeRoy et al. 2018). After all the rich historical contextualization on how disease categories can be detrimental to patient care, I wonder why they refuse to elucidate on the difficulties of treatment for catatonia in the form of ECT, even if it is as effective as they say. Senuik (2018) for instance uses phenomenology to explore how the current informed consent model of ECT does not appreciate the full extent in which memory loss disturbs lived-experience. He argues that “it is imperative that clinical support for ECT not cast a shadow over the risk/harm profile by extoling the treatment’s virtues.” The kind of analyses given by Senuik would have helped us achieve a more nuanced view of patient care for catatonia in the book.

Gaining awareness of the signs and symptoms of catatonia, as well as rich historical detail of nosology around catatonia and schizophrenia, make the book an interesting read for the medical humanities scholar. It also has a practical use, as after reading the book, the general public and the healthcare practitioner are more likely to recognise possible cases of catatonia.  They may also lead us into further enquiries of what other so-called psychiatric conditions should be examined in other fields. However, patient and family experiences of catatonia and its treatments remains absent, showing us yet again that healthcare has not yet made a place for the patient in the discussion.

 

About the reviewer:

Brenda Bogaert is a PhD student in philosophy at the University of Lyon (France).  She is part of an innovative research chair in Philosophy and Economics on the Values of Patient Centered Care.  She is researching another disorder which suffers from troubling associations with psychiatry – epilepsy – which is weaved into this narrative in unexpected ways.

 

References

Damasio, Antonio. 2006. Descartes’ error: emotion, reason and the human brain, rev. ed. with a new preface. ed. Vintage, London.

Leroy, Arnaud, Naudet, Florian, Vaiva, Guillaume, Francis, Andrew, Thomas, Pierre, Amad, Ali, 2018. Is electroconvulsive therapy an evidence-based treatment for catatonia? A systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci 268, 675–687.

Nussbaum, Martha. 2001. Upheavals of thought: the intelligence of emotions. Cambridge University Press, Cambridge ; New York.

Seniuk, P. 2018. I’m shocked: informed consent in ECT and the phenomenological-self. Life Sciences, Society and Policy 14.

Sternberg, Esther. 2001. The balance within: the science connecting health and emotions. Freeman, New York.

Verwijk, Esmée, Obbels, Jasmien., Spaans, Harm, Sienaert, Pascal, 2017. Doctor, will I get my memory back? Electroconvulsive therapy and cognitive side-effects in daily practice. Tijdschr Psychiatr 59, 632–637.

Leave a Reply

Your email address will not be published. Required fields are marked *