In 1970 Aubrey Lewis, the past master of the Maudsley Hospital, England’s premier psychiatric facility, was 70 years old. In his long decades of experience, he was puzzled by the rise of anxiety as a popular stand-alone diagnosis. The evolution of the term, he said, had gone through two phases. The first was using anxiety “as a qualifying term for the agitated depression of melancholia.” Anxious melancholia meant melancholia out of control. In the second phase, anxiety became “a qualifying term for a neurosis in which subjective feelings of alarm are associated with visceral disturbances.” This would be Freud’s anxiety neurosis. He noted that the number of articles on anxiety in the scientific literature had increased from three in 1927 to 222 in 1960—and was still rising. As Lewis wrote in 1970, anxiety was about to undergo a third phase in its evolution: Anxiety, or panic, attacks would shortly occupy center stage. Anxiety, another part of the nervous syndrome, has a distinctive story line: For most of the history of psychiatry, it was considered part of some other disorder, or not really attended to at all. Clinicians paid no particular heed to whether their patients were worried or fearful: These emotions were part of the human condition. Augustin Jacob Landré-Beauvais, professor of clinical medicine at the Salpêtrière Hospice in Paris, in his great catalogue of signs and symptoms written in 1809, takes it for granted that anxiety will be present in infectious illnesses. “Anxiety accompanies the better part of acute illnesses and some chronic illnesses, and is produced by various causes,” he said, and considered it an advance warning of an attack among “hypochondriacs, hysterics, and epileptics.” Then throughout the nineteenth century anxiety became part of the nervous package. As the nervous syndrome disaggregated in the early twentieth century, anxiety was spun off to become a free-standing disorder, “anxiety neurosis” in psychoanalytic parlance. More recently, anxiety tout court has morphed into panic disorder, and we shall shortly watch panic stride to the center of the stage.
Altered Febrile Responses in Older Adults: A Systematic Review
