The Madness of Fear

This is the first history of the psychiatric illness called catatonia, virtually forgotten by medicine yet often present in severely ill patients. The main symptoms of catatonia affect movement and thought, including staring, stupor, mutism, food refusal, negativism, and even psychosis. These symptoms are age-old, but they were brought together in the single term “catatonia” by German psychiatrist Karl Kahlbaum in 1874. Yet, 30 years later, catatonia disappeared from view as an independent illness, turned into a “subtype” of dementia praecox (schizophrenia). There, catatonia remained submerged from view for almost a century, rediscovered again as a disease of its own in the 1990s. Today, catatonic symptoms are seen in around one in ten admissions to a psychiatric emergency department. Untreated, catatonia may have a fatal outcome. Interest today has been increasing because of the discovery that, unlike schizophrenia, catatonia responds readily to therapy, with the symptoms vanishing without a trace. The authors argue that catatonia may be a response to fear and alarm triggered by trauma; during a stupor, patients often experience terrifying images and thoughts. Edward Shorter is a medical historian who has written widely about psychiatry. Max Fink is a clinician whose writings on melancholia, catatonia, and convulsive therapy have been internationally recognized.