History of Psychiatry: Madness,Science,Culture

This paper will examine changes made to diagnoses of patients admitted to Valkenberg Asylum, Cape Colony, during the period 1891-1920, in order to illustrate the ambiguous and shifting relationship between psychiatric theory and practice, in this colonial setting. The diagnostic profiles of Valkenberg patients make clear that the distinction between manic-depression and dementia praecox, established in theory by the end of the first decade of this century, was by no means clearly perceived by asylum practitioners. Racial attitudes affected diagnostic practice; these will be outlined. Valkenberg's case records will be used to illustrate interactions between the patient's history, race and gender, classi ficatory changes, and ambiguous presentation of symptoms. These records add an important diachronic perspective to the synchronic perspective contained in annual reports and lunacy registers. The implications of diagnostic changes for research which attempts retrospective diagnosis will be explored.

Background. The term and concept of 'anhedonia' refer to a group of clinical phenomena whose common denominator is the complaint of a putative incapacity to 'experience pleasure'. Linked to disorders such as schizophrenia and depression, anhedonia remains difficult to define and measure.

Method. This paper explores the historical frames in which anhedonia was originally constructed; and is fully based on primary sources. It makes use of the 'conceptual method', i.e. it differentiates the history of the word from that of the behaviours and concepts involved.

Results. Historical analysis shows that the boundaries of 'anhedonia' have been fuzzy since the time of Ribot, and that this has made it conceptually unstable. One reason for this instability pertains to the fact that from the start its definition has been parasitical upon the (itself evolving) concept of 'pleasure'. Another that it is defined negatively, i.e. as a reduction or abolition in a putative unitary function. Yet another, that there is little evidence that anhedonia itself is a unitary phenomenon.

Conclusions. It is concluded that at this stage it might be advisable to refer to the concept in the plural (the anhedonias); that a definition should be formulated that it is less dependent upon the ongoing concept of pleasure; and that far more empirical research is needed to find out whether anhedonia is more than a final common pathway.

Modern French psychiatry was born at the end of the eighteenth century. This medical speciality, which was separating from general medicine, had a foundation in ancient medicine. Ancient theories died slowly but not so surely. These strange theories will be considered useless and even dangerous by the modern reader but they enabled modern psychiatry to understand that madness existed, that it was a disease and a subject for research. So the insane person was no longer considered a criminal or possessed by the devil: he was, at last and at least, a patient.

The research processes in the elucidation of the causes of general paresis, the first slow infection in psychiatry, and of Kuru, the first slow virus infection in man, were considered. The errors and difficulties encountered may contribute to the formulation of research strategies for contemporary work on possible persistent infections with unknown viruses as a cause of psychiatric disorders. Clinical observation, bold hypotheses and method ological advances appear more valuable than diagnostic categorization in etiological research into psychiatric disorders. The low heuristic value of diagnosis is due to the lack of specificity of psychiatric symptoms and syndromes, especially in low grade organic disturbances.