‘My insanity in the year 1783’,by C.S. Andresen (1801)

The author

Christopher Schroeder Andresen was born in 1760 in Rønne, on the Isle of Bornholm. He was the son of Christian Andresen, a general auditor, and Michella Ottilia Schroeder, also a daughter of a public servant. His father died in 1777, leaving 10 of 15 children, who were then raised by their mother and maternal grandmother. He attended school in Rønne and Elsinore, and at the age of 15 he was enrolled at the University of Copenhagen. In 1787, in rapid succession, he passed the examination for the theological degree, became Master of Arts (philology), and was appointed headmaster of Rønne school. He occupied this post for 11 years. In 1800, he was appointed titular professor, and from 1806 until his death in 1832 he held various benefices (Funen 1806–32; Vissenbjerg 1806–20; Kerteminde and Distrup 1820–32). According to the district surgeon, K.G. Harder, the cause of death was ‘nerve feber og Brysttilfælde’ (chest illness).

The self-report

In May 1783, Andresen (aged 23) became insane, and was admitted to the Frederiks Hospital in Copenhagen where he spent six weeks. ¹ Eighteen years later, in 1801, he published the story of his illness: My Insanity in the Year 1783, which he had written in 1800 and 1801.

Eventually, in 1925 the medical historian Vilhelm Maar reissued Andresen’s important autopathography, which he prefaced with a comprehensive genealogical sketch of Andresen and his family (Maar, 1925). Furthermore, he had sought a diagnostic opinion from his colleague, the psychiatrist Hjalmar Helweg, who found that Andresen, in current terminology, suffered from a ‘typical case of manic-depressive psychosis’. According to Maar, Andresen’s medical case record was not extant.

An article based on Andresen’s self-report was written by S. Rasmussen and published in Dansk Medicinhistorik Årbog in 2003. Whereas Maar did not enter into the substance of Andresen’s ‘manic-depressive psychosis’, Rasmussen re-wrote it as a current case record and reached the following conclusion:

[based on] the presumably normal premorbid psyche, the sudden onset with the massive symptomatology, especially the pronounced depressive affect, one must assume that it is a benign illness, likely an endogenous depression with the somewhat changing and colourful symptomatology that one can encounter in young manic-depressives.

Further, Rasmussen suggested that Andresen,

almost twenty years after his recovery was made to suffer the humiliation that he – a true representative of the Age of Enlightenment and rationalistic theologian – was suspected to have invited his insanity by a sinful life in his youth.

Thus, according to him, Andresen’s ‘work may be regarded as a defensive pamphlet written at a time when a neutral and clinical view of mental diseases had given way to a moralistic and religious concept’. Finally, Rasmussen suggested that the pamphlet is ‘worthy of a translation’.

From Andresen himself and from Maar’s genealogical sketch, we know that several of Andresen’s family members had also suffered from mental illnesses. His mother, Michella Ottilia Schroeder, suffered from prolonged phases of mental illness. He was married to Louise Catharina Nansen, and their only child was Michella Ottilia Andresen, who married Lars Larsen. They had five children; two of them died in early infancy, and the other three lived into their adult years and were unmarried. One of them, Vibeke Elisabeth, suffered from serious insanity, and the other two, Hans Nansen and Christopher Schroeder, according to people who had known them well, had also suffered from insanity.

Inheritance of mental illness appears to be traceable from Andresen’s mother (Michella Ottilie), Andresen himself and three of his grandchildren. However, in their case, collateral inheritance cannot be excluded as there was a history of insanity in the family of their father, Lars Larsen’s. Among Andresen’s nine siblings, no history of mental illness was reported by Maar.

The disorder

The self-report includes Andresen’s admission to the Frederiks Hospital (1783) and his symptoms during the next decade. Notwithstanding the lucida intervalla that he mentioned, his report suggests that his condition had a more or less chronic course. Other than the intervalla, no technical terminology such as mania or melancholia is used in the text. His language is expansive, superabundant, grandiose, digressive and referential, bordering on the delusional; it shows no conspicuous melancholic features. Some of his literary style may possibly reflect the Zeitgeist. During his admission, Andresen showed uncontrollable attacks of rage, necessitating physical restraint, blood-letting and cold baths. It is unclear whether the illness interrupted or prolonged his university education. Between 1820 and 1832 he seems to have been periodically embroiled in conflict with his parishioners. In 1832, he died from ‘nerve fever and a chest disease’ (K.G. Harder, cited by Maar, 1925: x).

In the absence of Andresen’s case notes from Frederiks Hospital, any retrospective diagnosis will have to be based on his self-report, which was not written and/or put together until 1800 to June 1801, that is, 17 to 18 years after his hospital admission. A conservative diagnosis suggests a manic disorder, with a florid phase during admission and moderate recurrences during the ensuing years, some of them with mixed features. Clear depressive phases cannot be identified.

What might have been his diagnosis according to contemporary sources? One of the doctors treating him at Frederiks Hospital was its medical director, ‘Overmedicus’ Frederik Ludvig Bang (1747–1820). ² One of his publications, Selecta Diarii (Bang, 1789a), includes admissions to the Frederiks Hospital from 1782, 1783 and 1784, but none can be identified as relating to Andresen. Bang’s views on melancholia and mania can be found in his Praxis medica systematice exposita (1789b, 1818).

In this classification, in accordance with contemporaneous authors (see Berrios, 1995; Berrios and Beer, 1995; Menninger, 1963: Appendix, 430–4), Bang placed mental illnesses in classis tertia: the neuroses, which were divided into orders, of which ordo tertia consisted of paranoia s[ive] insania, an involuntary aberration of certain mental functions: judicium, affectus, and recordatio, and subdivided into 5 genera: 1) melancholia, 2) mania, 3) amentia s[ive] fatuitas, 4) amnesia, 5) hydrophobia. ³

Based on Bang’s own nosography, there cannot be much doubt that in 1783 he would have diagnosed Andresen’s insanity as mania. The treatments that Andresen describes as having received, such as the shaving of the head, are all included by Bang in his section on mania. Andresen (1801: 203, 245) also mentions his lucida intervalla, a term used by Bang (1818: 412).

The cause of death

To establish a retrospective diagnosis of cause of death (nerve fever and a chest disease), we shall refer to the section on ‘febris nervosa’ by S. de Meza (1779). ⁴ According to this author, in febris nervosa there is a lack of tone of the body and laxity with damage of the lymphatic and nervous systems. Those thus affected are debilitated either by a preceding illnesses, repeated evacuations, excessive study or work, or by long-lasting and concealed grief. ⁵

Taken in isolation, the cause of Andresen’s death does not shed clear light on his condition at that time, even when de Meza’s description is taken into account. The presence of fever would have been judged, if at all, by pulse rate, not body temperature. The term ‘nerve fever’ as such would arbitrarily imply a clouded sensorium or delirium, as mentioned by de Meza, or an excitement, agitation of the brain, for example an attack of mania.

At the time of his death, there is no information regarding Andresen’s chest illness. Special attention, however, should be paid to his account relating to his violent physical illness, to which he ‘regularly succumbed’, from 1789 to 1792: ‘a violent breast cramp’ which, at times, subjected him ‘to the most violent convulsions’ (Andresen, 1801: 247). In April 1791, he was ill in bed for three weeks, and almost every hour he expected his ‘disintegration’.

The weaker my physical strength, the stronger was that of my soul. - The whole day I was lying there most of the time feeling lonely, reading with the greatest hilarity and attentiveness. Often the attack of cramps forced me to creep out of bed in order to take [my] medicaments. (p. 247)

But during all this,

I felt an extraordinary sense of hilarity, acuity and ease even towards literary works, and at night my fantasy very often took me to the peaceful and happy land, whose inhabitant I had been before. – Thus, even in my physical weakness I had these happy and delicilucidaous hours. (p. 247)

Thus, Andresen also suffered from a recurring physical illness, asthma perhaps, Bang’s asthma convulsivum s[ive] nervosum (Bang, 1818: 358ff).