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Living with Dementia

Dementia during the nineteenth century

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  • Jun 20, 2011
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The same concepts are found in German-speaking nations and the views of Heinroth, Feuchtersleben, Griesinger and Kahlbaum were influential until the beginning of the second half of the nineteenth century. Heinroth (1818/1975) used the term dementia in a very broad sense to refer to a state of mind that might accompany or follow other mental disorders, i.e. ‘vesanic dementia’, a term that late in the century was to become very popular, particularly in France. This concept, which is not related to age, is redolent of the later notion of secondary dementia, i.e. the state of psychosocial and cognitive incompetence that might follow a functional psychosis.

Feuchtersleben’s usage (1845/1847) is even more general. In his work he uses dementia as a synonym of madness and may refer to forms of acute madness with and without accompanying idiocy. There is only one form of dementia, which he refers to as moria and considered as more or less chronic and more or less cognitive. Although possibly ending up in a state of idiocy, the patient can also show lucid intervals. Once again, age is of no relevance to moria and hence one must conclude that Feuchtersleben is referring to a form of vesanic dementia.

Griesinger’s nosology is not altogether clear and has often been interpreted as being based on the belief that there is only one form of madness (unitary psychoses concept), which may go through at least three stages: depression (as in melancholia), exaltation (as in mania) and weakness (as in chronic madness and dementia). In the second edition of his great work, Griesinger (1861/1867) insists that the states of mental weakness ‘do not constitute primary but consecutive forms of insanity’ (p. 319). This suggests that he is also referring to a form of vesanic dementia, although he includes under this large class all the forms of mental handicap where no preliminary ‘primary’ forms of madness can be recognized. Under the heading ‘dementia’, Griesinger includes mental disorders fundamentally caused by a ‘general weakness of the mental faculties’ including loss of emotions. Age is not a factor in the development of dementia or apathetic dementia and hence it must also be concluded that Griesinger is referring to vesanic dementia.

The work of Kahlbaum, particularly his important book of 1863 on the definition and classification of mental disorders, mark the beginning of a new era in psychiatry. His incorporation of time as a variable in the analysis of madness (longitudinal definition) and his view that period of life is relevant to the form of the disease remain the pillars of psychiatric nosology to this day. The concept of ‘Dementia’ is dealt with in the third section of Kahlbaum’s book (1863) under the name of aphrenia. This clinical category refers to states of mental impotence (Zustand geistiger Impotenz) (p. 153), which Kahlbaum equates to the old German notion of Blodsinn.

After complaining that neither the Greeks nor Latin writers managed to specify a term for this condition, he insists that a word is needed to refer to states of cognitive and behavioural incompetence such as those seen in dementia terminalis (Berrios, 1996).

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Edited by

Alistair Burns MPhil, MD, FRCP, FRCPsych
Professor of Old Age Psychiatry,
Wythenshawe Hospital,
Manchester, UK

John O’Brien MA, DM, FRCPsych
Professor of Old Age Psychiatry,
Institute for Ageing and Health,
University of Newcastle upon Tyne,
Newcastle upon Tyne, UK

David Ames BA, MD, FRCPsych, FRANZCP
Professor of Psychiatry of Old Age,
University of Melbourne, St George’s Hospital, Melbourne,
Victoria, Australia

###


Author:

GERMAN BERRIOS
German Berrios BA (OXFORD), MD, DM H.C. HEIDELBERG, FRCPsych, FBPSS
Professor,
University of Cambridge Department of Psychiatry,
Cambridge, UK


References

  1.   Alzheimer A. (1907) Uber eine eigenartige Erkrankung der Hirnrinde.
  2.   Allgemeine Zeitschrift fur Psychiatrie und Psychisch-Gerichtlich Medizine 64: 146-148
  3.   Alzheimer A. (1911) Uber eigenartige Krankheitsfalle des spateren Alters. Zeitschrift fur die gesamte Neurologie und Psychiatrie 4: 356-385
  4.   Anderson EW, Threthowan WH, Kenna JC. (1959) An experimental investigation of simulation and pseudodementia. Acta Psychiatrica et Neurologica Scandinavica 34 (Suppl. 132)
  5.   Anonymous (1832) An exposure of the unphilosophical and unchristian expedients adopted by antiphrenologists, for the purpose of obstructing the moral tendencies of phrenology. A review of John Wayte’s book. The Phrenological Journal and Miscellany 7: 615-622
  6.   Baillarger J. (1883) Sur la theorie de la paralysie generale. Annales Medico-Psychologiques 35: 18-52; 191-218
  7.   Baillarger J. (1889) Doit-on dans la classification des maladies mentales assigner une place a part aux pseudo-paralysies generales? Annales Medico-Psychologiques 41: 521-525
  8.   Ball B and Chambard E. (1881) Demence. In: A. Dechambre and L. Lereboullet (eds), Dictionnaire Encyclopedique des Sciences Medicales. Paris, Masson, pp. 559-605
  9.   Barrett AM. (1913) Presenile, arteriosclerotic and senile disorders of the brain and cord. In: WA White and SA Jelliffe (eds), The Modern Treatment of Nervous and Mental Diseases. London, Kimpton, pp. 675-709

Full References  »

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