The Madness of Fear offers a fresh perspective on a misunderstood psychiatric challenge.
People may think they know what catatonia is, but they are probably wrong. That’s the first of many surprises in the scholarly but fascinating The Madness of Fear from Edward Shorter and Max Fink, two professors of psychiatry and medicine.
The common view of catatonia as a sort of living slumber or rigid, head-to-toe paralysis is only part of the story. There is no one symptom of catatonia; sufferers are just as likely to be agitated, run high fevers, or show signs of extreme fear and agitation or a host of other behaviors. The first section of the book provides a historic overview of catatonia, beginning in the late eighteenth century and examining the disorder through practitioners in the nineteenth and early twentieth centuries. Middle chapters track efforts to classify and treat catatonia, while a third section shifts the focus to contemporary understanding and treatment.
Though scholarly, the writing throughout is clear and accessible, with a knack for avoiding dry discussions. Views and definitions are seen in the context of their time, place, and culture, showing, for example, that nineteenth-century France viewed catatonia as a hysteria-linked disorder, while German psychiatrist Emil Kraepelin saw it as a variant of schizophrenia, and in America, it was so rare it aroused little interest at all.
The book makes clear that the road to understanding catatonia was, and remains, a bumpy one. Individual cases and clinical studies are used to illustrate that the insistence on viewing it in tandem with other disorders led to ineffective and even lethal treatment. Anecdotes drawn from case studies move the history forward, sometimes tragically; it was only when patients died after being treated with a drug used for schizophrenia that catatonia’s link to schizophrenia was finally broken. This had the effect of a dam bursting, opening a path for new exploration.
Amplifying the text is a sense of the larger psychiatric community and the never-ending effort to create a common framework for sharing knowledge across continents. Key to the effort was the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, a widely used reference that was updated at irregular intervals. The third section of the book uses one such updating to present a detailed picture of how the committee on catatonia worked through the process. There is as yet no “carved in stone” definition of catatonia or its causes.
The book ends with a concise recap of the progress made, including the success of the drug lorazepam in achieving complete recovery within a few days. Notes and citations are arranged by chapter and follow the text, along with a detailed index.
The Madness of Fear is a fresh perspective on a misunderstood and overlooked problem that accounts for ninety thousand hospital visits a year in the US alone.
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