Review: The Madness of Fear: A History of Catatonia

Authors: Dr. Edward Shorter and Dr. Max Fink
Publisher: Oxford University Press
ISBN: 978-0-19-088119-1

What is catatonia? Is it a symptom of schizophrenia? Can it be treatable and reversible?

These are the questions I asked myself when I picked up Dr. Edward Shorter and Dr. Max Fink's tome, The Madness of Fear: A History of Catatonia that explores the critical factors that have affected its recognition and treatment.

Before reading the book, I did a little research and found Batya Swift Yasgur's brief article in the August 08, 2018 edition of Psychiatry Advisor where he points out that catatonia affects 9.8% of patients admitted to psychiatric hospitals.
Unfortunately, it frequently goes unrecognized and thus leads to the erroneous belief that it is rare. Yasgur goes onto state that according to a Dutch study clinicians identified catatonia in only 2% of 139 patients, whereas a research team identified catatonia in 18%.

Dr. Shorter and Dr. Fink explain that in the same sense that we know what pneumonia is, we do not know what exactly is catatonia nor do we know its causes. Moreover, catatonia has been variously described as a distinct disease entity, as a part of schizophrenia, and as a nonspecific manifestation of many disorders. According to the authors, we can identify it and recognize its many forms, and yes, it is treatable, and there is a good prognosis for recovery. Consequently, they have written their book to help and educate doctors, their patients, and the general public to recognize and understand catatonia as a core illness in psychiatry and medicine in general.

Catatonia is a psychomotor or abnormal behavioural syndrome that is a feature of many psychiatric disorders which historically has been associated with schizophrenia. As the authors point out, “it is an identifiable and verifiable syndrome of abnormal motor and psychic changes, acute in onset, disruptive of living, often malignant, with fatal outcome, and yet eminently recognizable and fully treatable today.” In most cases, prompt treatment can produce immense improvement. It is not exclusively associated with schizophrenia and is very common in clinical practice.

Relying on their vast amount of research and experience, Drs. Shorter and Fink provide their readers with a comprehensive survey and commentary on catatonia as well as the evolution of the science of descriptive psychopathology giving us a clearer picture in its understanding.

Generally, most clinical historians agree that it was the German psychiatrist, Dr. Karl Kahlbaum who had been the first to describe catatonia in 1874 and his work was published a few years later. However, according to the authors, this is technically correct but historically wrong. Physicians for centuries had been describing the symptoms of catatonia, although it was Kahlbaum who eventually assembled them into a neat package bearing the label “catatonia.” Before Kahlbaum, it was called a different thing wherein the most common one was catalepsy.

Since Kahlbaum's description, catatonia has undergone numerous descriptions over the years reflecting several changes in psychiatric disease classification. For example, in 1893, Dr. Emil Kraepelin believed that catatonia was a subtype of dementia praecox which was later termed by Dr. Eugene Bleuler, schizophrenia. Shorter and Fink disagree with Kraepelin stating that the syndrome was co-opted and misidentified by him “as a feature of his poorly defined and poorly treatable syndrome of dementia praecox. Alas, his writings were so authoritative that for more than a century catatonia remained buried within his disorder,” and as the authors further state, “it was kidnapped by dementia praecox and schizophrenia, the Bonnie and Clyde of the diagnosis world.”In the ensuing decades the association of catatonia with schizophrenia was repeatedly endorsed, first by Eugen Bleuler, and then in the iterations of the American Psychiatric Association DSM including those in 1980 and 1994.

Insofar the treatment of catatonia, the authors indicate that two effective therapies were discovered one in 1929-30, sodium Amytal and the induction of grand mal seizures in 1934, that developed into the modern electroconvulsive therapy, the definitive treatment of catatonia. And as they further state, by the 1990s catatonia has been increasingly acknowledged as an independent and treatable syndrome and as a different disorder in the psychiatric glossary, a recognition that was finalized in the 2013 publication of the American Psychiatric Association's DSM-5.

The Madness of Fear: A History of Catatonia is an excellent well-documented book skilfully exploring critical factors that have affected the recognition, treatment, and study of catatonia. And for those who wish to pursue more extensive study and investigation, the notes at the end of the book provide readers with excellent valuable resources. Without doubt this is a book that should find a place in doctors' and health care providers' libraries.