Manon Eileen – a Writer's Blog

For this week’s Top 10 I’m sharing ten Mental Illnesses (as listed in the DSM-IV) that I think you have not heard of before. Let’s get started!

10. Somatization Disorder

Somatization disorder is a long-term (chronic) condition in which a person has physical symptoms that involve more than one part of the body, but no physical cause can be found. The pain and other symptoms people with this disorder feel are real, and are not created or faked on purpose.

9. Pavor Nocturnis (a.k.a. night terror)

Night terrors are a sleep disorder in which a person quickly awakens from sleep in a terrified state. Night terrors occur during deep sleep, usually during the first third of the night. The cause is unknown but night terrors may be triggered by fever, lack of sleep, or periods of emotional tension, stress, or conflict. In contrast, nightmares are more common in the early morning. A person may remember the details of a dream upon awakening, and will not be disoriented after the episode, which is not the case for night terrors.

8. Transient Tic Disorder

Transient tic disorder is a temporary condition in which a person makes one or many brief, repeated, difficult to control movements or noises (tics) and is most common in children. Examples of tics are reoccurring motions without rhythm, brief and jerky movements like blinking, kicking, grimacing, clenching fists and opening the mouth. Vocal tics include clicking, grunting, moaning and hissing.

7. Schizoaffective Disorder

Schizoaffective disorder is a psychotic illness with both schizophrenic and affective (mood) symptoms. While symptoms vary greatly, they may include depression, poor temper control, racing thoughts (affective), and delusions and hallucinations (schizophrenic).

6. Rett Syndrome

Rett syndrome is a rare inherited disease that causes developmental and nervous system problems, mostly in girls and it is related to autism. Babies with Rett syndrome seem to grow and develop normally at first, though between three months and three years of age, they stop developing and even lose some skills. Symptoms include loss of speech, compulsive movements such as hand wringing, balance problems, learning problems or mental retardation.

5. Trichotillomania

Trichotillomania is hair loss from repeated urges to pull or twist the hair until it breaks off. Patients are unable to stop this behavior, even as their hair becomes thinner. The person may pluck other hairy areas, such as the eyebrows, eyelashes, or body hair. It may affect as much as 4% of the population and women are four times more likely to be affected than men.

4. Obsessive-Compulsive Personality Disorder

Obsessive-compulsive personality disorder (OCPD) is a condition in which a person is preoccupied with rules, orderliness, and control. OCPD has some of the same symptoms as obsessive-compulsive disorder (OCD). However, people with OCD have unwanted thoughts, while people with OCPD believe that their thoughts are correct. A person with this personality disorder has symptoms of perfectionism that usually begin in early adulthood. This perfectionism may interfere with the person’s ability to complete tasks or have relationships, because their standards are so rigid.

3. Depersonalization Disorder

Depersonalization disorder is a dissociative disorder in which the sufferer is affected by persistent or recurrent experiences of feeling detached from one’s mental processes or body. The symptoms include a sense of automation, going through the motions of life but not experiencing it, feeling as though one is in a movie, loss of conviction with one’s identity, feeling as though one is in a dream, feeling a disconnection from one’s body, a detachment from one’s body, environment and difficulty relating oneself to reality.

2. Pica

Pica is characterized by an appetite for substances largely non-nutritive (e.g., metal, clay, coal, sand, dirt, soil, feces, chalk, pens and pencils, paper, batteries, spoons, toothbrushes, soap, mucus, ash, lip balm). For these actions to be considered pica, they must persist for more than one month at an age where eating such objects is considered developmentally inappropriate. Pica is seen in all ages, particularly in pregnant women, small children and those with developmental disabilities.

1. Shared Psychotic Disorder

Shared psychotic disorder is also known as folie a deux (“the folly of two”). It is a rare condition in which an otherwise healthy person shares the delusions of a person with a psychotic disorder, such as schizophrenia, who has well-established delusions. For example: A person with a psychotic disorder believes aliens are spying on him or her. The person with shared psychotic disorder will also begin to believe in spying aliens. The delusions usually disappear when the people are separated.

This disorder usually occurs only in long-term relationships in which one person is dominant and the other is passive. The people involved often are reclusive or otherwise isolated from society and have close emotional links with each other.

Which disorders had you heard of before? What do you think of these disorders?

Please share your thoughts!

When you read this post’s title, you probably thought “Ah, lobotomy! Interesting!”. Well, while you’re right about all that. However, there is one distinction to be made: psychosurgery (also known as neurosurgery for mental illness), is what lobotomy was inspired by, or based on, if you will.

António Egas Moniz

Psychosurgery was officially introduced in 1935 by Portugese neurologist António Egas Moniz (1874-1955), but the treatment already had quite an extensive history. The very first form of psychosurgery was trepanning, which was already practiced in 5000 B.C.. The first more advanced attempt at psychosurgery was performed by a certain Swiss psychiatrist called Gottlieb Burckhardt in the 1880′s. He performed surgery on the brains of six patients; he cut out pieces of their cerebral cortex. One of the patients died only days later. He published a report and presented his findings at the Berlin Medical Congress, but the responses were adverse. Burckhardt did not perform any further psychosurgeries.

There were more attempts at psychosurgery in the early 20th century, but all had discouraging results.

The Invention of Leucotomy

Then, Egas Moniz came along. He introduced psychosurgery to mainstream psychiatric practice and gave it its name. He hypothesized that the mentally ill, particularly in “obsessive and melancholic” cases, had a disorder in their synaptic connections, which allowed unhealthy thoughts to roam their mind. He thought that if he cut these connections, they would be replaced by more healthy ones. In 1935, Moniz directed a neurosurgeon (Pedro Almeida Lima) to drill holes in a person’s skull and to inject ethanol into her brain, which would destroy small parts of white matter in the frontal lobe.

After a few of these surgeries, Moniz and Lima changed their technique and instead of using ethanol, they would now cut out pieces of brain tissue directly. They used a tool called a

An ad for leucotomes in the 1940's

leucotome and called the operation a leucotomy (which means “cutting of white matter”). After twenty of these surgeries, they reported their results and although the responses were generally hostile, it inspired a few psychiatrists, especially in Italy and the United States, to experiment with the technique themselves (which eventually resulted in leucotomy as we know it – lobotomy).

A Nobel Prize and the Rise and Decline of Psychosurgery

Psychosurgery (in any shape and form) became incredibly popular in the 1940′s. By the end of that decade, nearly 5000 operations were performed annually in the USA only, despite its significant risk of death and severe personality changes (although you might argue that those changes were not seen as damage but as repair).

In 1949, Egas Moniz received the Nobel Prize for Physiology or Medicine:

“for his discovery of the therapeutic value of leucotomy (lobotomy) in certain psychoses”

In the 1950′s, the popularity of psychosurgery declined due to the introduction of psychoactive drugs and a growing awareness of the long-term damage caused by the operation. Additionally, people began to doubt its efficacy. This doubt increased and in the 1960′s en 70′s, psychosurgery became the subject of public debate. This resulted in congressional hearings in the US. Against all expectations, in 1977 the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (quite a mouthful) allowed the continued limited practice of psychosurgery.

Psychosurgery in Recent Years

Psychosurgery is still performed on a small (and still declining) number of patients to this very day. Forms of psychosurgery in use today or in recent years all target the limbic system (in which structures such as the amygdala, hippocampus, hypothalamus are located). These structures all play a part in the regulation of emotion. An example is anterior cingulotomy, which has been the most used commonly used psychosurgical procedure in the US in recent decades. It is performed to relieve the symptoms of major depression, obsessive compulsive disorder and chronic pain. (To get all technical: it targets the anterior cingulate cortex. The operation severs the thalamic and posterior frontal regions and damages the anterior cingulate region.)

There is currently a debate going on whether or not Deep Brain Stimulation (DBS, surgical treatment involving the implementation of a brain pacemaker, sometimes used in patients that suffer from Parkinson’s Disease, major depression or chronic pain) should be categorized as psychosurgery.

What do you think of psychosurgery? Do you think DBS should be categorized as psychosurgery?

Next week I will discuss the practice of lobotomy. I promise, it’s going to get truly gruesome.

During the last half of the 18th century and the first half of the 19th century, a psychosocial approach to mental disorders called moral therapy became popular. The term moral didn’t stand so much for a code of conduct as you might expect, but instead it meant “psychological” or “emotional”. Its basic principles included treating institutionalized patients as normally as possible in a setting that encouraged and reinforced normal interaction.

How moral therapy came into existence

Moral therapy as a treatment originated with the French psychiatrist Philippe Pinel (1745-1826). A former patient, Pussin, was working in a Parisian hospital when Pinel took over. Pussin had already instituted remarkable reforms, perhaps because he remembered being shackled as a patient himself. Pussin persuaded Pinel to go along with the changes. And Pinel did. Not only did he reform this hospital, but also a women’s hospital, where a humane and social approach produced “miraculous” results.

William Tuke followed Pinel’s lead in the United Kingdom, Benjamin Rush, often considered the founder of American psychiatry, introduced moral therapy in the United States for the first time. Not long after, moral therapy became the treatment of choice in the leading hospitals.

The miraculous results of moral therapy

Worcester State Hospital

Before moral therapy came into existence, asylums were already quite common, but were more often a type of prison than not. The rise of moral therapy made asylums habitable and even therapeutic. In the US, in 1833, 32 patient were given up as incurable. These patients were then treated with moral therapy, cured, and released to their families. Of 100 patients who were highly aggressive before treatment, no more than 12 continued to be violent a year after beginning treatment.

The decline of moral therapy

Unfortunately, after the mid-19th century, humane treatment of psychiatric patients declines because of a convergence of factors. It was widely recognized that moral therapy was most effective when the number of patients in an institution was 200 or less, which allowed for a lot of individual attention.

However, patient loads in the existing hospitals started to increase; some of the hospitals grew to a 1000, 2000 and more. This was caused by the quickly growing population in the United States at the time. It was short after the Civil War and immigrants flooded to the country. These immigrant groups were thought not to deserve the same privileges as the “natives” (whose ancestors  had often immigrated only 50 or 100 years earlier!), so they were not given moral

Dorothea Dix

treatment even when there was sufficient personnel.

A second reason for the decline of moral therapy has a rather unlikely source. The great crusader Dorothea Dix (1802-1887) campaigned endlessly for reform in the treatment of the insane. She used to be a teacher who had worked in many institutions. She knew firsthand how awful the many of the insane were treated and she made it her quest to make the American population aware of this problem.

Her work became known as the mental hygiene movement. As her career drew to a close many years later, she was acknowledged as a hero of the 19th century. However, a consequence of Dix’s efforts were a huge increase in the number of mental patients. This increase led to a rapid transition from moral therapy to custodial care – hospitals became very much understaffed.

The final blow to the practice of moral therapy was the decision, in the middle of the 19th century, that mental illness was caused by brain pathology and therefore couldn’t be cured.

Please share your thoughts on this if you have any

Source: Barlow, D.H., & Durand, V.M. (2009) Abnormal psychology: an integrative approach (5th Edition). Wadsworth Cengage Learning.

For much of our recorded history, “odd” or deviant behavior was considered to be a reflection of a battle between good and evil. Where people saw inexplicable, irrational behavior, they saw evil. As a matter of fact, in the Great Persian Empire from 900 to 600 B.C. all physical and mental illnesses were thought to be the work of the devil.

Barbara Tuchman (a renowned historian) recounted the second half of the 14th century in A Distant Mirror (1978). This was a particularly rough time for humanity. In this book she describes the conflicting opinions on the origins and treatment of insanity during this dark and rowdy period.

Demons and Witches

One strong school of thought put the causes and treatment of psychological illness in the realm of the supernatural. During the last quarter of the 14th century, religious and lay authorities (who dealt with the reformation of the English church) fostered these superstitious beliefs. Society as a whole began to believe more strongly in the existence and power of demons and witches.

More and more often, people turned to magic and sorcery to solve their problems. Those with psychological disorders were thought to be possessed by demons or evil spirits and were accused to be the cause of the misfortune experienced by the townspeople. This lead to quite drastic action against the “possessed”.

Treatments for possession: exorcism, shaving, binding, drilling holes…

A room where hydrotherapy was performed

“Treatment” of their possession included exorcism, in which various religious rituals were performed to rid the victim of his demons. Other ways of treating the sick included shaving the pattern of a cross in the hair of the victim’s head and securing sufferers to a wall near the front of a church so that they might benefit from hearing the Mass.

A trepanned skull

Hydrotherapy was another form of treating “possessed” patients: they were shocked “back to their senses” by being submerged in ice-cold water.

Another common type of treatment of insanity was “trepanation”. This was “release the evil spirits” taken literally. The town’s physician would drill a hole in the sick person’s skull to release the demons. Consequently, the person often died shortly afterward, or they suffered such brain damage that they remained in a vegetative state for the rest of their lives.

Trepanation is still performed to this very day, but mostly to relieve intracranial pressure when there is no other way. (There are, however, groups of people who advocate more use of trepanation.)

The conviction that demons and witches are causes of madness and other evils continued into the 15th century, and evil continued to be blamed for unexplainable behavior.

What do you think of these treatments? Please share your thoughts

Source: Barlow, D.H., & Durand, V.M. (2009) Abnormal psychology: an integrative approach (5th Edition). Wadsworth Cengage Learning.

The Greeks and Romans always thought that psychological disorders were biologically caused and so, they treated them like physical illnesses.

Hippocrates: already impressively close to the truth in 400 B.C.

Hippocrates, a Greek physician (470-366 B.C.) and many others contributed to a manual called the Hippocratic Corpus, on how psychological disorders could be treated like any other disease. However, Hippocrates and his associates didn’t stop there; they had the notion that psychological disorders might also be caused by brain pathology or head trauma and also, they had the idea that psychopathology could be influenced by genetics.

It’s quite interesting to see how close Hippocrates came to the truth. Many of his deductions have been supported in recent years. Hippocrates also recognized the importance of social contributions to psychopathology, such as the negative effects of family stress. In some cases he even removed patients from their families.

Galen: quite a humorous guy

The Roman physician Galen (approx. 129-198 A.D.) took the ideas of Hippocrates even further. He created a powerful and influential school of thought within the biological tradition of psychology that extended well into the 19th century.

Galen’s theory was the humoral theory, and perhaps the forst example of associating psychological disorders with chemical imbalance, which is a widespread theory still to this day.

It was initially assumed that normal brain functioning was related to four body fluids (or humors): blood (the heart), black bile (the spleen), yellow bile (the liver) and phlegm (the brain). Physicians believed that too much or too little of any of these humors would lead to disease. For instance, it was believed that too much black bile lead to melancholia (depression).

The four humors were related to the Greeks’ conception of the four basic qualities: heat, dryness, moisture and cold. Each humor was associated with one of these qualities. Terms derived from the four humors are still used today to describe personality traits. For example sanguine (red, like blood) describes someone who is ruddy in complexion, cheerful and optimistic. Melancholic means depressive, and a phlegmatic personality indicates apathy and sluggishness, but can also mean being calm under stress. A choleric (from yellow bile or choler) person is hot tempered.

Treatment of an excess of humors

An overabundance of any of these humors was treated by regulating environmental factors. They increased or decreased heat, dryness, moisture or cold, depending on which humor was out of balance.

In addition to rest, good nutrition and exercise, two treatments were developed. In one, bleeding, or bloodletting, a carefully measured amount of blood was removed from the body. This was often done with leeches. The other was to induce vomiting to treat depression (in Anatomy of Melancholy (1621) Robert Burton advised to eat tobacco and a half-boiled cabbage to induce vomiting).

What do you think of these theories? It’s interesting to see that these theories are already so old, but still so close to the truth. Of course, the humoral theory has become obsolete somewhere in the last two centuries, but people have always considered the theory to be true.

Also, isn’t it great that this theory had such a big influence of a part of our language, on how we describe personality traits?

Please share your thoughts!

Source: Barlow, D.H., & Durand, V.M. (2009) Abnormal psychology: an integrative approach (5th Edition). Wadsworth Cengage Learning.