The Madness of Fear: A History of Catatonia

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.

“Some phrases are so literary that one cannot resist the temptation to read them aloud repetitively making one’s family members frown…Not only do the authors unfold the history of catatonia…They also offer the reader a clinical lesson. Fink and Shorter want the reader to recognize the clinical picture of catatonia, to detect a severe condition that is fairly easy to cure.”

Pascal Sienaert, 

Journal of ECT 

Oxford University Press World English June 2018

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.