Exciting causes of insanity

My good and true friend, Ray Barillaro (who is our resident audio-visual guru at the Douglas) took time out of his busy schedule to send me the table above. It’s from the 1893 annual report of the Douglas (in those days called the Verdun Protestant Hospital for the Insane). It shows the best guesses of the M.D.s of that time as to the “exciting causes” directing folk into our kind and enlightened care. Click on the thumbnail above and then have a gander yourself, I find it quite informative and revealing, but it would be best for you to form your own opinion on the matter before I opine on it.

Back? Great! What’d'ya think? Looks pretty Victorian, right? I especially like the entry suggesting that 58 individuals fell into the pit of lunacy as the result of masturbation. I mean, my Mom always warned me that it might impact negatively on my visual acuity, but she never mentioned anything about its’ potential for mental derangement! “Vicious indulgences” is another one of my favorites, although I sometimes shudder at the thought of what this might possibly mean. Jokes aside, you can find additional evidence for the argument that this document was written by people from a long time ago. You might think that the identification of “heredity” anticipated modern genetics, until you realize that these folk knew nothing about genes. True, the father of modern genetics, Gregor Mendel, was working on the issue around that time, but it wasn’t until after the turn of the 20th century that anyone paid any notice to what he was finding (incidentally, were you aware that Mendel probably fudged some of his data? Bad enough for a scientist, but Mendel was a monk!). No, in those days heredity did not mean genes, but rather the fact that if you were in an insane asylum, you probably had one or more parents, siblings, aunts, uncles or cousins who were at some point in time also incarcerated in the Douglas or another institution with the same purpose.

Even the use of the term “insanity” is Victorian. No modern day mental health professional (or researcher) would claim that insanity is synonymous with mentlal illness. Insanity is no longer (if it ever was) a psychiatric term, it is a legal term, and only a legal term, addressing the question of whether someone who committed a crime knew he was committing a violation at the time of the crime. You sure as hell won’t see the term insanity in any patient chart or annual report these days!

Before you think I am being too harsh on scientists who did not have the benefit of modern scientific tools and analytical techniques, let me tell you that I am not. As I look at the list in its entirety, there were some remarkably insightful observations, observations supported by contemporary scientific results: “intemperance to alcohol” might be a Victorian term, but we now now that there is strong comorbidity between alcoholism and mental illness. Same can be said for opiate abuse. Entries such as “disapointed affection” (Victorian, again, but so elegant!), “domestic trouble”, “excessive study” and “isolated life” attest to the recognition that stresses of every-day life can accumulate to the point where coping becomes impossible. And although they did not know the exact mechanism, even in those days experts recognized that a lot of our mental baggage can get passed on from one generation to the next. All this is remarkable given the intellectual framework of the day. We have, in our archives, a newpaper article from the same era describing a protest by the local farmers around the hospital. They did not want the hospital to open for fear that the “inmates” would somehow transmit their symptoms to the live stock! So, the founders of the hospital were faced with some pretty heavy stigma.

It is easy for us to look back and be amused at how naive these people were. But the more difficult question is: Have we really advanced that much? What has modern science revealed about the true causes of mental disorders? We have made some pretty good (but not perfect) advances in identifying and classifying symptoms, and also made some interesting discoveries with respect to some of the brain changes that MIGHT be associated with those symptoms. We have also been able (mostly through chance and luck) to develop some reasonably effective pharmacological interventions for different disorders. But the problem here is that although we know that they work, we don’t really know WHY they work! So present-day psychiatric science has not proceded in the manner we all think is ideal: identify the cause of a problem, discover something that will destroy the cause , and then see if that works in people afflicted with the problem. In fact, it has kind of been the other way around: the discovery of effective interventions has been used to guide our search for cause. An example: we know that most (but not all) antidepressants increase the function of of a neurotransmitter known as serotonin. This has led to what is known as the serotonin hypothesis of depression: Depression results when this transmitter is not functioning at optimal capacity.

We are now in the process of trying to test this theory, for example by looking to see whether artifical and temporary reduction in serotonin might provoke depressive-like symptoms. So far, the evidence looks OK (not perfect, but OK), and so we need to look for additional lines of research to assess the hypothesis more fully. And, even if we think we are proceeding in the right direction, there are additional questions that need to be looked at. Most importantly, what might provoke serotonin under activity in the first place? We don’t really know that just now. And until we do, we are pretty much in the same boat as those people from 1893 who speculated that excessive indulgence in sexual self-gratification can cause you to see or hear things that aren’t really there.

Tagged as cause, insanity, mental illness, neurotransmitter, symptoms classification.

Posted in Brain, Mental health.

Posted on 09 Nov 2007