THE MADNESS OF FEAR

The psychiatric establishment blew it on one of the most important mental illnesses, according to this academic treatise.

Shorter (What Psychiatry Left Out of the DSM-5, 2015), a psychiatrist and historian at the University of Toronto, and Fink (Electroshock, 2008), a psychiatrist at Stony Brook University medical school, investigate the vexed history of catatonia, a terrifying mental disorder with a panoply of bizarre symptoms. Catatonic patients can fall into a stupor, staring fixedly into space while frozen into rigid postures for hours on end, refusing to talk, eat, or comply with any request; make strange, repetitive motions and grimaces; or burst into violence and self-mutilation. Though outwardly uncommunicative, sufferers are often alert and feel a sense of extraordinary fear during catatonic episodes, and not without reason—in extreme cases, victims have been mistaken for corpses and buried alive. Catatonia was identified as a distinct disease in 1874, but the psychiatric mainstream during most of the 20th century, the authors contend, incorrectly characterized it as a subtype of schizophrenia, with tragic results. Schizophrenic patients with catatonia were given drugs that were ineffective or made things worse while other cases often went undiagnosed—even though successful treatments, through drugs and electroshock, had been available since the 1930s. Shorter and Fink offer a probing, well-informed, and very readable account of the arcane theorizing and factional struggles by which psychiatrists hashed out a consensus on catatonia, schizophrenia, and other psychic ailments, one that’s enriched with dozens of intriguing case studies. (One patient snapped out of his immobility only when told he was pitching a baseball game, a task he dutifully undertook in the hospital hallway; another did somersaults for weeks until she died.) Their scholarly approach doesn’t preclude colorful opinionating. They write that catatonia “was kidnapped by dementia praecox and schizophrenia, the Bonnie and Clyde of the diagnosis world”; disparage the concept of schizophrenia itself as “a wastebasket for the unclassifiable and untreatable”; and dismiss the whole of Freudian psychoanalysis as “an obscure offshoot of speculative philosophy.” The result is an engrossing portrait of a fearsome and fascinating disease and a searching inquiry into the ways in which doctors misunderstand the mind.

A fine study of desperate patients and the shrinks who failed them.