An overview on Hebephrenia, a diagnostic cornerstone in the neurodevelopmental model of Schizophrenia

Pre-Kraepelinian observations converged in Kahlbaum’s and Hecker’s description of Hebephrenia. For Kraepelin, Hebephrenia was an ‘idiopathic incurable dementia whose onset is in adolescence’. It became the core of ‘Dementia Praecox’, and then Bleulerian ‘Schizophrenia’. In recent decades, the resurgence of the ‘late neurodevelopment’ hypothesis of schizophrenia has brought into focus Hecker’s clinical reports of adolescents who, as a result of a putative loss of psychic energy, showed a rapidly progressive cognitive impairment leading to functional and behavioural disorganization. This paper summarizes the nineteenth-century conceptualization of Hebephrenia as a developmental illness.

‘A landmark in psychiatric progress’? The role of evidence in the rise and fall of insulin coma therapy

This paper examines the evidence behind the use and decline of insulin coma therapy as a treatment for schizophrenia and how this was viewed by the psychiatric profession. The paper demonstrates that, from the time of its introduction, there was considerable debate regarding the evidence for insulin treatment, and scepticism about its purported benefits. The randomized trials conducted in the 1950s were the result, rather than the origins, of this debate. Although insulin treatment was subsequently abandoned, it was still regarded as a historic moment in the modernization of psychiatry. Then, as now, evidence does not speak for itself, and insulin continued to be incorporated into the story of psychiatric progress even after it was shown to be ineffective.

The Goldwater Rule: a bastion of a bygone era?

In tandem with the changing political landscape in recent years, interest in the Goldwater Rule has re-emerged within psychiatric discourse. Initiated in 1973, the Goldwater Rule is an ethical code specific to psychiatry created by the American Psychiatric Association in response to events surrounding the USA presidential election of 1964, in which the integrity of the psychiatric profession was challenged. Current detractors view the rule as an antiquated entity which obfuscates psychiatric pragmatism and progression. Proponents underscore its role in maintaining both respectful objectivity and diagnostic integrity within the psychiatric assessment process. This essay aims to explore the origin of the rule, and critique its applicability to modern-day psychiatric practice.

Ludwig Binswanger’s Comments on Hermann Rorschach’s Psychodiagnostik

This article presents an introduction to Ludwig Binswanger’s Comments on Hermann Rorschach’s Psychodiagnostik, published in the International Journal of Psychoanalysis in 1923, after Rorschach’s death in 1922. Binswanger, one of the most distinguished psychiatrists of the twentieth century and a close professional colleague and compatriot in the Swiss Psychiatric and Psychoanalytic Societies, was blazing new trails by incorporating turn-of-the-century phenomenology and experimental psychology into Swiss psychiatry. His comments, which have been noted for over 100 years but never before translated, are a critical review of Rorschach’s monograph, highlighting the undeveloped status of the test theory and philosophical foundations. Binswanger’s comments illuminate philosophical, conceptual and scientific pathways not taken in the development of the test following Rorschach’s untimely demise.

Aboriginal Australian mental health during the first 100 years of colonization, 1788–1888: a historical review of nineteenth-century documents

Past histories charting interactions between British healthcare and Aboriginal Australians have tended to be dominated by broad histological themes such as invasion and colonization. While such descriptions have been vital to modernization and truth telling in Australian historical discourse, this paper investigates the nineteenth century through the modern cultural lens of mental health. We reviewed primary documents, including colonial diaries, church sermons, newspaper articles, medical and burial records, letters, government documents, conference speeches and anthropological journals. Findings revealed six overlapping fields which applied British ideas about mental health to Aboriginal Australians during the nineteenth century. They included military invasion, religion, law, psychological systems, lunatic asylums, and anthropology.

Elton Mayo and Thomas Henry Reeve Mathewson: the forgotten Australian pioneers of the treatment of patients with shell shock, neurasthenia and nervous breakdown

The contributions of Australians on shell shock are absent from the literature. However, two Australians were pioneers in the treatment of shell shock: George Elton Mayo (1880–1949) and Dr Thomas Henry Reeve Mathewson (1881–1975). They used psychoanalytic approaches to treat psychiatric patients and introduced the psychoanalytic treatment of people who suffered from shell shock. Their ‘talking cure’ was highly successful and challenged the view that shell shock only occurred in men who were malingering and/or lacking in fortitude. Their work demonstrated that people experiencing mental illness could be treated in the community at a time when they were routinely treated as inpatients. It also exemplified the substantial benefits of combining science with clinical knowledge and skill in psychology and psychiatry.

Symonds on fear and Post Traumatic Stress Disorder (PTSD)

Prominent English neurologist Sir Charles Symonds, during World War II service with the Royal Air Force, published a series of articles emphasizing the role of fear initiating psychological breakdown in combat airmen (termed Lack of Moral Fibre). Having served in a medical capacity in the previous war, Symonds re-presented the phylogenetic conceptualizations formed by his colleagues addressing ‘shell shock’. In 2013, the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) re-classified Post Traumatic Stress Disorder (PTSD), removing the diagnosis from the category of Anxiety Disorders. This was the view introduced a century ago by the trench doctors of World War I and affirmed by Symonds’ clinical experience and studies in World War II.