Abstract
There is considerable confusion in the field of research on the history of psychiatry as to who created the term anancasm. This article seeks to clarify that the term was coined by the Hungarian psychiatrist Gyula Donáth, who was born in Baja, on the Danube, and worked mainly in Budapest. Donáth’s publications reveal that his predominant sphere of interest and research was neurology and psychiatry. A number of his publications deal with epilepsy and obsessive-compulsive disorders. After a period of intensive research, during which he spent some time in Berlin at the clinic of neuroscientist Carl Westphal, Donáth proposed the term ‘anancasm’ in 1895 to describe compulsive mental processes.
An error and virtual obscurity
In 2003, History of Psychiatry featured the English translation of ‘Zur Kenntnis des Anancasmus (psychische Zwangszustände)’ [Our knowledge of anancasm (psychic compulsive states)] as Classic Text No. 53 (Berrios, 2003). The manuscript that served as the basis for this translation had initially been published in the first issue of the 1897 volume of Archiv für Psychiatrie und Nervenkrankheiten which was officially released in November 1896 (Donath, 1897). Donáth’s paper is important for having brought the term ‘anancasm’ to the international psychiatric literature. The English translation of Donáth’s text was introduced by the editor of History of Psychiatry, German E. Berrios, who made the mistake of misidentifying the work’s author and hence the creator of the term anancasm. Despite his admission that he had been ‘unable to ascertain whether the author of this paper is the same Julius Donath (1870–1950) who graduated MD in Vienna in 1895’, he presented biographical information on the Austrian Julius Donath and referred to further studies by this author, which featured a striking number of psychiatric and neurological pieces (Berrios, 2003). This reference to an author based solely in Vienna is particularly curious in view of the fact that the German version of the publication clearly identifies Julius Donath as a ‘university teacher in Budapest’ and the article as being based on and adapted from a ‘presentation given at the Royal Society of Medical Professionals in Budapest on 23 November 1895’ (Donath, 1897). In fact, Donáth’s talk given there had already been published as a separate booklet in Hungarian in 1896 (Donáth, 1896), yet the existence of this original publication has been little known until today. If mentioned at all, reference is made to the more widely known German version of 1897; this was a translation of the Hungarian original to make his ideas available to a broader public (German being the language of science at that time). In his introduction to the English translation of the text, Berrios was evidently misled by the confusion of names and likewise by the fact that both had worked as doctors in the Austro-Hungarian Empire.
Yet it is still true, and this should be emphasized, that in the historiography of psychiatry it had long remained unknown who had introduced the term anancasm. A closer look at German publications up to the year 2014 revealed that before the study by Steinberg (2014) no one else had tried to find out who first used the term, nor was there any conceptual history of anancasm. This incongruity increases in light of the considerable extent of German research on the topic and the fact that, apart from the original Hungarian booklet, the term was first used in a German psychiatric journal and by an author who published in German.
On an international level, Burno’s (2006) ‘Short historical sketch on the concept of psychasthenic psychopathy and pathological scepticism’ in Russian acknowledges a Budapest-based individual named Donath as being the first to use the word in 1895. Burno then refers to German psychiatrist Kurt Schneider (1887–1967) and his Die Psychopathischen Persönlichkeiten (Burno, 2006). Apart from the name Donath, no other information is given, such as local or institutional affiliation. The name is also mentioned by Naranjo (1994), who makes repeated references to Schneider’s monograph. In other publications, merely the name is given, with occasional incorrect date information (see López Ibor, 1966; López-Ibor Alcocer, 1994). The short monograph by Schneider, mentioned above, had been re-edited nine times by 1950 and was notably ground-breaking in that it set standards for the conceptualization of personality disorders. As for the question of anancasm, it is evident that Schneider merely gives the name of Julius Donath as the ‘creator’ of the term. On reading the passage, which had not been changed throughout the nine editions, one cannot help but feel that Schneider, who worked mainly in Cologne, Munich and Heidelberg, was insinuating that everyone knew who Julius Donath was (Schneider, 1923: 51), although one may assume that he did not even put the question to himself. Subsequently, no one else took the trouble to pursue this question thoroughly. The merit of being the first to identify the correct author for this first text on anancasm must be given to the Canadian researcher on the history of medicine, Edward Shorter, who in his Historical Dictionary of Psychiatry included three lines on the classificational affiliation of anancasm in the various editions of DSM (Shorter, 2005: 201). In short: there is an evident need to clarify who published this 1897 study using the term ‘anancasm’ for the first time, and to present this person and his work to an international audience.
A short biography
Strictly speaking, the Donáth in question and the Vienna-based Professor of Internal Medicine Julius Donath do not have identical names. The former had the Hungarian first name Gyula; Julius was only the Germanized version that he used when publishing in German medical journals. This explains why the name given for the author of the 1897 article on anancasm is Julius Donath (Donath, 1897). At this time, when, as mentioned above, German was the leading language in sciences, the Germanization of foreign and in particular of Eastern European personal, institutional and place names in international communication was rather common, similar to today’s Anglicization of names for institutions outside English-speaking countries. It is difficult to ascertain, however, if Gyula Donáth adapted his name of his own free will or whether the decision was taken elsewhere; one may assume it was done in the interests of international communication and in order to advance his participation in it. It is conceivable that this even proved beneficial to his prospects of seeing his articles published.
Information on Gyula Donáth can be found in some contemporary encyclopaedias of well-known doctors, Hungarians and Jews, for example in the Biographisches Lexikon der hervorragenden Ärzte (Fischer, 1932: 243) and the renowned Große Jüdische National-Biographie (Wininger, 1927: 69). Moreover, there are some short commemorative articles in Hungarian medical literature (Emed, 2008; Szállási, 1984). The most detailed information, full of descriptions of personal living conditions and local colour, can be found on the website of the Endre Ady Library in his hometown Baja (Anon., 2014). Unfortunately, however, both this and the two articles are only available in Hungarian. The following short biography is based on the Hungarian and the other sources mentioned above. However, the information provided by these sources is at times insufficient for a comprehensive understanding of what led to crucial decisions by Donáth concerning the direction his life took.
Baja is a little town in Hungary, near the Hungarian-Croatian-Serbian border triangle, with about 40,000 inhabitants, located on the Danube. Until the beginning of the twentieth century the German name of the town, Frankenstadt, was also quite commonly used, since about one-fifth of the population in the region, the so-called Danube Swabians, spoke German as their mother tongue and therefore Donáth also learnt German as his first foreign language at school.
Born on 23 December 1849 as the first son of a retailing couple (a brother born later died young), Donáth spent his childhood years in Baja, attending the local catholic grammar school, which he left with excellent results. In 1867 he started his medical studies at Vienna University, and then went to Innsbruck, where he graduated. Donáth’s acquaintance here with chemist and physician Richard Maly (1839–91) and Franz von Schneider (1812–97) appears to have influenced his new focus on medical chemistry; he became an assistant at Maly’s Institute of Physiology and Chemistry at Innsbruck University. While here, he defended his MD thesis before moving to Schneider’s Institute of General and Medical Chemistry in 1874. Three years later he was transferred to Graz Technical University, where Maly had meanwhile been appointed Professor of General Chemistry, and Donáth became university lecturer for general and physical chemistry and head of the laboratory. In order to gain medical experience, he accepted an invitation from the Turkish army to become head physician and surgeon at a military hospital during the Russian-Turkish war of 1877/78. He subsequently opened his own private medical practice in his home town of Baja. No information has been found that shows why he chose to do this rather than resume his academic career. It seems, however, that despite the responsibility of his medical practice, Donáth continued to perform research, including with animals, which also led him to publish a few articles on fever therapy and ophthalmology.
Following his father’s death in 1872, his mother moved to Budapest. Donáth followed her, but soon afterwards he went to Berlin to train as a psychiatrist with Carl Westphal (1833–90) at the Psychiatric and Neurological Clinic at Berlin’s Charité. Again there is no information about Donáth’s change in direction or what motivated it, but we must assume that there were reasons. There may have been a connection with his experience at the military hospital during the war. His time in Berlin and his acquaintance with Westphal might help to explain the clear Westphal element in his study on anancasm of 1897. Towards the end of the 1870s and in view of the trend towards studying the concept of paranoia, Westphal had dealt with obsessions (Westphal, 1877, 1878) and delivered the first precise definition of them: by separating obsessions from ‘madness’, melancholia and hypochondria he distinguished them as an illness in their own right (Westphal, 1877). During his year at Berlin’s Charité, Donáth also performed physiological studies at the laboratory of Emil Heinrich du Bois-Reymond (1818–96) and pathological studies with Rudolf Virchow (1821–1902). He also spent some time at the Institute of Physics headed by Hermann von Helmholtz (1821–94). After Berlin, Donáth – like so many neuroscientists of the time – went to Paris in order to study psychiatry at the Salpêtrière hospital headed by Jean-Martin Charcot (1825–93).
On returning to Budapest, Donáth opened a private practice for psychiatric and neurological patients. Moreover, he took on medical care and research work for private and public institutions. From 1893 he also taught electrotherapy and neurology at Budapest University. In the same year he also took on the position of head of the neurological outpatient clinic at the St Rock Hospital in Budapest. Nine years later he became head of the neuropsychiatric department of the St Stephan Hospital there. In 1908 he was appointed associate professor at Budapest University (Figure 1).
Guyla Donáth (1849–1944). Source: Courtesy Semmelweis Museum, Budapest.
During World War I, Donáth headed the neurological department of the Augusta military hospital in Budapest. After the war he became more familiar with eugenic ideas, yet proved relatively moderate. It should nonetheless be noted that along with several Hungarian colleagues he campaigned for the creation of a legal framework for voluntary sterilization (Siró, 2003).
Donáth died in Budapest aged 95, shortly after the German occupation on 11 April 1944. No information could be found on whether he was among the 500,000 Jewish victims of Nazi elimination policies in Hungary. Since none of the sources imply anything to this effect, one might assume that he died of natural causes, though Jewish life became very difficult under the collaborative Döme Sztójay (1883–1946) government, as described most notably by Nobel Prize for Literature laureate Imre Kertész (b. 1929), e.g. in his most famous novel Sorstalanság (Fateless) (Kertész, 1975).
Scientific works
Donáth’s publications cover a variety of subjects: chemistry and physics, several medical disciplines, hygiene, public health, social medicine, psychology, anthropology and natural history. Besides proving his manifold interests and research activities, they are also linguistically versatile, rich and impressive.
Donáth also published various psychiatric studies including one on forensic psychiatry (Donath, 1933) and several articles on alcohol abuse and addiction (e. g. Donáth, 1927). Within the framework of the International Organisation of Good Templars, Donáth played a leading role in the Hungarian temperance movement. Moreover, quite a number of his papers focus on obsessive-compulsive phenomena and anxieties (Donath, 1899, 1912, 1916, 1918, 1920). A recent study analysed what Donáth proposed to refer to as ‘anancasm’ (Steinberg, 2014). This has also been mentioned in a recent conceptual idea of obsessive-compulsive disorders (OCD) (Oberbeck, Stengler and Steinberg, 2013). Defining obsessive-compulsive processes and conditions as a ‘clearly circumscribed type of illness’ (Donath, 1897: 213), Donáth took a clear position supporting Westphal’s view that OCDs are an independent psychiatric illness in their own right. Developing Westphal’s idea, Donáth pointed out that, even though Westphal had only spoken of ‘obsessive ideas’, research since then had shown that there are also obsessive sensations, both physical and mental, compulsive movements, acts or speech as well as compulsive psychomotor impulses or inhibitions. Inevitably, Donáth was not the first nor the only one demanding that these phenomena should be included, but he was clearly among the first to expand the concept of obsessions beyond mere obsessive ideas. For him, obsessive memories, echolalia, coprolalia, echokinesia, echopraxia, the Gilles de la Tourette (1857–1904) syndrome and also paroxysmal dipsomania, sexual perversions that are not based on imbecility, fetishism and homosexuality were to be regarded as compulsions. Since they were all ‘compulsive mental processes’, Donáth (1897) proposed all these phenomena (excluding only phobias occurring in neurasthenia, as long as they are conditioned by the ‘primary neurasthenic anxious affection’) should be referred to as ‘anancasm’, which would be understandable internationally, since it was derived from Greek (αναγκασμος = to be under compulsion, from ανάγκη = compulsion). It is understood that with his wide understanding of compulsions, Donáth went far beyond today’s understanding of what obsessive-compulsive phenomena are. The German psychiatrist Kurt Schneider later changed this primary meaning to its current denomination of a special group of personality disorders, i.e. anancastic personalities, unsure of themselves (Schneider, 1923).
Obviously, biologically-oriented Donáth – just like most orthodox medical practitioners of the time – disapproved of psychoanalysis. One should nonetheless remember that at the same time the Budapest School led by Sándor Ferenczi (1873–1933) was about to develop into a leading European centre of the psychoanalytic movement; on the other hand, compulsive neurosis must be regarded as one of the basic and most thoroughly elaborated concepts of Sigmund Freud (1856–1939), on which he started to publish in 1894, i.e. almost in parallel to Donáth’s essay (Freud, 1894, 1896, 1909). Donáth criticized Freud’s views for being bourgeois-elitist and hence non-representative. Workers, he continued, had other things to do than to deal with sexual traumas (Dalos, 1990).
In addition, Donáth presented several remarkable studies on the therapy of progressive paralysis. In 1903 he suggested subcutaneous salt infusions, a method that met with considerable interest, but also discussion, among his colleagues. Today we are well aware of the cause of this illness and of the fact that it is a neuroluetic disease. At the time, however, the reason was not yet clear, and Donáth suggested that poisonous metabolic products played a significant, symptom-inducing role and hence that by flushing these toxic substances out, mitigation could be achieved (Donath, 1903). In 1910 he suggested injections with nucleic acid in order to induce hyperthermia without infecting the body (Donath, 1910). Donáth was aware of the works on fever therapy of neurological and psychiatric secondary diseases of syphilis that were based on an injection of infectious agents, like those by Julius Wagner Jauregg (1857–1940) (Brown, 2000; Himmerich, Kirkby and Steinberg, 2010; Himmerich, Sorge, Kirkby and Steinberg, 2012; Whitrow, 1990, 2001). Since the malaria fever therapy proved successful, Donáth’s own, and very original, experiments were no longer necessary.
In the field of neurology, Donáth published a series of studies on epilepsy. He strongly promoted the ‘saltless diet’ to enhance the effects of a potassium bromide treatment (Donath, 1913). Today potassium bromide is used in epilepsy in children who are resistant to standard therapy. His 1900 study Bestrebungen und Fortschritte in der Behandlung der Epilepsie includes his clear evaluation that ‘reproduction of those patients is unwelcome’. At the same time he clearly established that epilepsy as a result of brain trauma was not hereditary (Donath, 1900). In 1909 he was one of the co-founders of the ‘International League Against Epilepsy’, that was, coincidentally, founded in Budapest (Shorvon and Weiss, 2009), and became the first editor-in-chief of the journal Epilepsia which is still published and is the most frequently cited specialist journal (Shorvon, 2007). The founding of this epileptological journal was of key importance, since the four leading neurological journals at the time had not published works on this illness (Shorvon, 2007). Apart from this, Donáth was also one of the editors of the Hungarian monthly medical journal Klinikai Füzetek (Clinical Bulletin) (Szállási, 1984).