Abstract
Edward Shorter and Max Fink open The Madness of Fear by critiquing a broad range of contemporary psychiatric research. The prevailing focus on fields like neuroimaging and neurochemistry has obscured the fundamental role of the psychiatrist, they contend, which remains being able ‘to specify how . . . various diseases present clinically’ (p. ix). The Madness of Fear offers a corrective to this trajectory through the study of catatonia, a condition that has been buffeted by professional and societal trends over nearly two centuries. In doing so, Shorter and Fink have constructed a deeply contextualized insight into the condition, vividly addressing its varied forms of stupor, mutism, ‘waxy rigidity’ and debilitating fear, while simultaneously charting psychiatry’s longstanding failure to address the afflicted.
Shorter, Professor of the History of Medicine at the University of Toronto, and Fink, Emeritus Professor of Psychiatry and Neurology at Stony Brook School of Medicine, present a persuasive argument that catatonia has been neglected by psychiatry for a prolonged period, due to a combination of imprecise terminology, diagnostic challenges and historical trends. However, this is not just a warning for contemporary practitioners. The Madness of Fear instead provides a broad history, from the monk in Toulouse who became ‘stiff and immobile’ while saying Mass in 1415 to the condition’s shifting position within the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) in 2013. In between, there were varied misperceptions and false starts for catatonia, which contributed towards the condition’s neglect as a subcategory of schizophrenia.
Writing for both clinicians and historians is a sizeable challenge for any study. The Madness of Fear warrants particular praise for its deft management of both audiences, highlighting the fruitful symbiosis that can emerge where there is an engaged dialogue between the two disciplines. The text is also particularly notable for its strikingly effective use of a broad range of case studies. The sheer depth and variety of these accounts, drawn from physicians and patients in various countries across the centuries, enriches the study and provides an often shocking insight into the effect of catatonia. Underscoring its many variations, The Madness of Fear presents a compelling case for how this disease entity was subsumed under the broad umbrella of schizophrenia for more than a century.
Addressing an underdeveloped niche within psychiatric history, Shorter and Fink are not averse to attacking shibboleths. Schizophrenia, for instance, is dismissed as an ‘image in the mind of the beholder . . . a curse word applied when the patient frightens the doctor’ (p. 125), while psychoanalysis is characterized as an ‘obscure offshoot of speculative philosophy’ (p. 117). Sometimes, in their effort to find the catatonic, the authors can push a shade too far, leading to some questionable assertions – as when they cite Theresa of Avila’s ‘hysterical’ attacks as evidence of catatonia when she was a Carmelite novitiate, without including a discussion of the broader cultural tropes associated with religious mysticism in sixteenth-century Spain. Alongside these brief lapses in cultural context, the text is also let down by periodic trips into nostalgia for a period when ‘things used to be different in psychiatry’ (p. 5), as well as by the jarring use of language, such as when dementia praecox and schizophrenia are termed the ‘Bonnie and Clyde of the diagnosis world’ (p. 65).
Yet these minor quibbles should not detract from the book’s considerable achievement in illuminating catatonia through a text that can fruitfully be read by both psychiatrists and historians of medicine. The Madness of Fear offers an engaging portrait of a psychiatric disease, while vividly reflecting the importance of both psychiatry and history in understanding how broader trends can lead to failures in the care of patients. Undoubtedly, it presents a strong case for recognition of catatonia in practice, while challenging historians to address psychiatric trends with a comparable level of vigour.