American Madness: The Rise and Fall of Dementia Praecox

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Overview

In 1895 there was not a single case of dementia praecox reported in the United States. By 1912 there were tens of thousands of people with this diagnosis locked up in asylums, hospitals, and jails. By 1927 it was fading away . How could such a terrible disease be discovered, affect so many lives, and then turn out to be something else?

In vivid detail, Richard Noll describes how the discovery of this mysterious disorder gave hope to the overworked asylum doctors that they could at last explain—though they could not cure—the miserable patients surrounding them. The story of dementia praecox, and its eventual replacement by the new concept of schizophrenia, also reveals how asylum physicians fought for their own respectability. If what they were observing was a disease, then this biological reality was amenable to scientific research. In the early twentieth century, dementia praecox was psychiatry’s key into an increasingly science-focused medical profession.

But for the moment, nothing could be done to help the sufferers. When the concept of schizophrenia offered a fresh understanding of this disorder, and hope for a cure, psychiatry abandoned the old disease for the new. In this dramatic story of a vanished diagnosis, Noll shows the co-dependency between a disease and the scientific status of the profession that treats it. The ghost of dementia praecox haunts today’s debates about the latest generation of psychiatric disorders.

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Editorial Reviews

Nature
Between 1895 and the 1930s, tens of thousands of Americans were diagnosed with dementia praecox--an "incurable" psychosis described by German psychiatrist Emil Kraepelin. The diagnoses then petered out. Psychologist Richard Noll traces the trajectory of this near-forgotten disorder, showing how it became the first specified disease of psychiatry, legitimizing that field's place in medicine. Noll also shows how the debates today around the successor to dementia praecox, schizophrenia, are leading to a trend in psychiatry towards diagnoses that could fit better with genetics.
New Scientist

The wonderful book, American Madness, [is] an artful analysis of the rise and fall of the label "dementia praecox" from its promising birth in 1896 to its unlamented death in 1927...Though set in the past, the lessons of this book are as fresh as the controversies over the new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) and the very future of psychiatry.
— Allen Frances

Bookslut

Noll is adept at portraying both the human and sociological sides of this story...[A] capacious narrative.
— Evan McMurry

Times Higher Education

There is something about the U.S. mania for madness that needs understanding, as it imperils us all. Noll clearly had to write this book.
— David Healy

H-madness

In this richly detailed book, Richard Noll explores the historical predicament of psychiatry through the efforts of America's early twentieth century psychiatric elite to integrate their field with the main currents of an emergent scientific medicine by creating a scientific classification of mental illness...Historians of American psychiatry, pulled toward the historiographical black hole of conflicts between partisans of Freudian psychoanalysis and the bio-pharmacological turn of the past few decades, have paid far too little attention to the influence of German psychiatrist Emil Kraepelin in the first four decades of the twentieth century. Noll's book goes a long way toward remedying that...The great strength of this book is that it invites intellectual engagement. Noll does not allow his own interpretive commitments to overwhelm the narrative; his representation of the world of American psychiatry during this critical period is so rich and nuanced that readers are able to develop alternative interpretations even as they consider his. In other words, it generates much more light than heat and should be widely read by historians, neuroscientists, clinicians, social scientists and educated general readers interested in understanding medicine's efforts to come to terms with mental illness. Given the issues at play in the upcoming revision of the DSM, a work of mature, responsible historical scholarship is a timely and valuable contribution to the broad discussion we need to be having about what is at stake in psychiatric classification.
— Jesse Ballenger

E. Fuller Torrey
American Madness is an elegantly written account of American psychiatry in the early twentieth century, which shows that diagnostic wrangling one hundred years ago was just as spirited as DSM revisions today.
Gerald N. Grob
American Madness is a major contribution to both history and psychiatry. Noll discredits the widespread belief that dementia praecox was 'the old name' for schizophrenia, and that schizophrenia has always been a real, unitary, stable, and recognizable disease. Noll's book offers a warning about the dangers involved in creating diagnostic categories that have real effects on peoples' lives.
New Scientist - Allen Frances
The wonderful book, American Madness, [is] an artful analysis of the rise and fall of the label "dementia praecox" from its promising birth in 1896 to its unlamented death in 1927...Though set in the past, the lessons of this book are as fresh as the controversies over the new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) and the very future of psychiatry.
Bookslut - Evan McMurry
Noll is adept at portraying both the human and sociological sides of this story...[A] capacious narrative.
Times Higher Education - David Healy
There is something about the U.S. mania for madness that needs understanding, as it imperils us all. Noll clearly had to write this book.
H-madness - Jesse Ballenger
In this richly detailed book, Richard Noll explores the historical predicament of psychiatry through the efforts of America's early twentieth century psychiatric elite to integrate their field with the main currents of an emergent scientific medicine by creating a scientific classification of mental illness...Historians of American psychiatry, pulled toward the historiographical black hole of conflicts between partisans of Freudian psychoanalysis and the bio-pharmacological turn of the past few decades, have paid far too little attention to the influence of German psychiatrist Emil Kraepelin in the first four decades of the twentieth century. Noll's book goes a long way toward remedying that...The great strength of this book is that it invites intellectual engagement. Noll does not allow his own interpretive commitments to overwhelm the narrative; his representation of the world of American psychiatry during this critical period is so rich and nuanced that readers are able to develop alternative interpretations even as they consider his. In other words, it generates much more light than heat and should be widely read by historians, neuroscientists, clinicians, social scientists and educated general readers interested in understanding medicine's efforts to come to terms with mental illness. Given the issues at play in the upcoming revision of the DSM, a work of mature, responsible historical scholarship is a timely and valuable contribution to the broad discussion we need to be having about what is at stake in psychiatric classification.
Current Opinion in Psychiatry - Eric J. Engstrom
A pathbreaking account of the reception of Kraepelin's notion of dementia praecox in the United States.
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Product Details

  • ISBN-13: 9780674047396
  • Publisher: Harvard University Press
  • Publication date: 11/30/2011
  • Pages: 408
  • Product dimensions: 6.00 (w) x 9.30 (h) x 1.40 (d)

Meet the Author

Richard Noll is Associate Professor of Psychology at DeSales University.
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Table of Contents

Introduction 1

1 The World of the American Alienist, 1896 11

2 Adolf Meyer Brings Dementia Praecox to America 36

3 Emil Kraepelin 49

4 The American Reception of Dementia Praecox and Manic Depressive Insanity, 1896-1905 14

5 The Lost Biological Psychiatry 109

6 The Rise of the Mind Twist Men, 1903-1913 149

7 Bayard Taylor Holmes and Radically Rational Treatments 194

8 The Rise of Schizophrenia in America, 1912-1927 232

Epilogue 276

Notes 289

Acknowledgments 379

Index 383

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  • Posted April 10, 2011

    A Landmark Book!

    Richard Noll's book, American Madness, is the first to document, in a narrative style, the disease history of American psychiatry's most mystifying mental disorder. The trajectory of the rise and fall of dementia praecox, and its replacement by the new concept and term schizophrenia between 1927 and 1939, is also the story of how the marginal (and much-maligned) profession of American asylum physicians (alienists) re-entered an American medical profession engaged in a momentous laboratory-science-driven revolution circa 1900. Using historian Charles Rosenberg's model of "disease specificity" as an interpretive thread, this book argues that dementia praecox legitimized the American psychiatric profession as a branch of scientific medicine by becoming its first viable object of inquiry in biologically-based clinical and laboratory research. The disease and the profession - especially psychiatry's fragile status as a medical science, a fragility which many argue persists to this day -- were mutually dependent on one another. This book is therefore more than the biography of a disease - it is the story of the rise of American psychiatry as a recognized branch of scientific medicine during the 1890 to 1930 period. It is also the definitive story of the adoption of Kraepelinian diagnostic classification in the United States. Much of the story is vividly framed by the character arcs of the leading personalities of that time: Emil Kraepelin, Eugen Bleuler, Edward Cowles, Adolf Meyer, August Hoch, E.E. Southard, Charles W. Page, Smith Ely Jelliffe, William Alanson White, Edward Kempf, George Kirby, Charles Macfie Campbell and the long-forgotten Bayard Taylor Holmes. As the debates concerning the revision of the next edition of the DSM spill into the pages of our news media, it is clear that today's biological psychiatry is currently undergoing a paradigm shift in which the assumption of discrete categories of mental disorders (such as schizophrenia) -- a guiding principle of disease specificity that has dominated the medical sciences since the 1860s -- is being overthrown in favor of dimensional approaches to symptoms that deconstruct the integrity of disease concepts in psychiatry. As this book demonstrates, dementia praecox (and later, schizophrenia) was the battleground for similar debates throughout the twentieth century. What if dementia praecox simply does not exist? asked the German psychiatrist Oswald Bumke in 1923. Prominent American psychiatrists are debating identical questions today concerning the validity of our current DSM framing of the mental disorder we call schizophrenia.

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