The Madness of Fear: A History of Catatonia

Shorter Fink The Madness of Fear Cover

Edward Shorter is a medical historian who has written and published widely about psychiatry. Among his many published works is Endocrine Psychiatry, written with Max Fink and published by Oxford University Press. 

Dr. Max Fink is a clinician whose writings on melancholia, catatonia, and convulsive therapy have been internationally recognized.

The Madness of Fear: A History of Catatonia 

 This important book is the first history of the psychiatric illness called catatonia, a disease that has been virtually forgotten by medicine, with dangerous consequences. 

The main symptoms of catatonia affect movement and thought, including staring, stupor, mutism, food refusal, negativism and even psychosis. During a stupor, patients often experience terrifying images and thoughts. In 1874, these age-old symptoms were brought together in the single term “catatonia” by German psychiatrist Karl Kahlbaum. 

Thirty years later, catatonia disappeared from view as an independent illness, and was turned into a “subtype” of dementia praecox (schizophrenia). There, catatonia remained submerged from view for almost a century. It was rediscovered as a disease of its own only in the 1990s. 

Today, catatonic symptoms are seen in ten percent of admissions to psychiatric emergency departments. It is relatively easy to treat but untreated, catatonia can have a fatal outcome. 

Unlike schizophrenia, catatonia responds readily to therapy and symptoms vanish without a trace. Those afflicted sometimes have been described as “Lazurus patients.” They may have languished for years or even had “hospice papers on their bed stands.” But since the 1960s, with lorazepam or electroconvulsive therapy, even those in long-term catatonic stupors can be given new lives, often without relapse, or residual symptoms. It is a kind of miracle. This book is about that miracle. 

What triggers catatonia? In this fascinating history, replete with dramatic case studies, the authors argue that it may be a complex response to fear and alarm, or trauma. Increased awareness is essential. 

Edward Shorter, American-born, who earned his PhD at Harvard is a renowned scholar and author. His plethora of books include the classic work A History of Women’s Bodies (Basic), A History of Psychiatry from the Era of the Asylum to the Age of Prozac (Wiley) a new works, The Historical Dictionary of Psychiatry (Oxford University Press), Written In The Flesh: The History of Desire (University of Toronto Press), and Shock Therapy with David Healy (Rutgers University Press).  He is a professor of history at the University of Toronto.

How Everyone Became Depressed

The Rise and Fall of the Nervous Breakdown

 This book argues that psychiatry’s love affair with the diagnosis of depression has become a death grip. Depression is a real illness, especially in its melancholic form. But most patients who get the diagnosis of ‘depression’ are also anxious, fatigued, unable to sleep, have all kinds of physical symptoms, and tend to obsess about the whole thing. They do not have a disorder of ‘mood’. It is a travesty to call them all ‘depressed.’ How did this happen? How did everyone become depressed?

Before Prozac

The Troubled History of Mood Disorders in Psychiatry

An unsettling look at modern psychiatry, revealing how greed, lax regulation, and academic infighting have set the field back fifty years.

 Psychiatry today is a barren tundra, writes medical historian Edward Shorter, where drugs that don’t work are used to treat diseases that don’t exist. Based in part on unprecedented access to federal archives and on extensive interviewing, Shorter illuminates this dismal landscape in a revealing and provocative account of why psychiatry is losing ground in the struggle to treat depression.

The book looks at such culprits as the pharmaceutical industry, which is not inclined to market drugs once the patent expires, leading to the endless introduction of new – but not necessarily better – drugs. 

 But at the center of the story is an unexpected villain: the FDA, the very agency charged with ensuring drug safety and effectiveness. Shorter describes how the FDA permits companies to test new products only against placebo.  Beating sugar pills can ensure a license – whether or not a drug is actually better than (or even as good as) current medications. Drugs that may be superior but have lost patent protection are thus swept from the shelves.

 The book also examines the FDA’s early power struggles against the drug industry, an influence-grab with little concern about science, and which left many effective drug classes under-prescribed, despite the fact that under careful supervision they are better at treating depression, with fewer side effects that the newer drugs in the Prozac family.

 Shorter also castigates academia, showing how two forms of depression, melancholia and nonmelancholia – “as different from each other as chalk and cheese” – became squeezed into one dubious classification, major depression, which was essentially a political artifact born of academic infighting.

 An astonishing and troubling look at modern psychiatry, Before Prozac is a book that is sure to spark controversy for years to come.

Shock Therapy

A History of Electroconvulsive Treatment in Mental Illness

Edward Shorter and David Healy

The electroshock story is one of the great unknown stories of modern medicine. Considered by many to be the penicillin for the severely mentally ill, it fell out favor in the 1960s for curious, cultural reasons. Only recently is it experiencing a comeback.

This book is appealing on three levels. It is a lively and evocative social history from the 1930s to today, including recent experiments in Deep Brain Stimulation.  It is illuminating on the science of the brain in mental illness. And it is a work of advocacy which will influence the thinking about shock therapy.

One of the most interesting aspects in the history of medicine and culture is how and why such an effective treatment fell out of favor when there was nothing substantially better to replace it.

Shock Therapy is still controversial. This book by two leading authors will be a major contribution to ameliorating the stigma that has been attached to it.

A Historical Dictionary of Psychiatry

Edward Shorter

This is the first historical dictionary of psychiatry. It covers the subject from autism to Vienna, and includes the key concepts, individuals, places, and institutions that have shaped the evolution of psychiatry and the neurosciences. An introduction puts broad trends and international differences in context, and there is an extensive bibliography for further reading. Each entry gives the main dates, themes, and personalities involved in the unfolding of the topic. Longer entries describe the evolution of such subjects as depression, schizophrenia, and psychotherapy. The book gives ready reference to when things happened in psychiatry, how and where they happened, and who made the main contributions. In addition, it touches on such social themes as “women in psychiatry,” “criminality and psychiatry,” and “homosexuality and psychiatry.” A comprehensive index makes immediately accessible subjects that do not appear in the alphabetical listing. Among those who will appreciate this dictionary are clinicians curious about the origins of concepts they use in their daily practices, such as “paranoia,” “selective serotonin reuptake inhibitors” (SSRIs), or “tardive dyskinesia”; basic scientists who want ready reference to the development of such concepts as “neurotransmitters,” “synapse,” or “neuroimaging”; students of medical history keen to situate the psychiatric narrative within larger events, and the general public curious about illnesses that might affect them, their families and their communities-or readers who merely want to know about the grand chain of events from the asylum to Freud to Prozac. Bringing together information from the English, French, German, Italian, and Scandinavian languages, the Dictionary rests on an enormous base of primary sources that cover the growth of psychiatry through all of Western society.

Written In The Flesh

A History of Desire

Edward Shorter

This elegant and erudite book tracing sexual desire in the western world was on the short-list for the Governor-General’s Award for Non-Fiction, a major literary prize in Canada.

Shorter, a renowned medical historian, demonstrates that the desire for sexual pleasure and what Shorter calls “total body sex” (that is, the expansion of sexuality from a limited focus on the face and genitals to include the entire body) is certainly not a new phenomenon: the  ancient Greeks, Romans, and Chinese, among others, were quite familiar with an eroticism that went beyond the strictly heterosexual and procreational. In the long centuries of Christian Europe, when the miserable conditions of life and religious repression conspired to minimize the expression of sexual longing, desire was driven underground. Yet in the late 19th Century, increasing privacy, prosperity, and good health again permitted the underlying biological urge for total body sex to express itself, and encouraged a shift of erotic pleasure toward unexplored body zones.

This classic work by renowned medical historian Edward Shorter demonstrates that desire is hardwired into the brain, expressing itself in remarkably similar ways in men and women, adolescent and adult, and in gays, lesbians, and straights alike. Drawing from a wide array of sources, including memoirs, novels, collections of letters, diaries, and indeed a large pornographic corpus, Shorter explores the widening of Western society’s sexual repertoire.

Written in the flesh is a history of what people like to do in bed and how that has changed.