Book Review
History of Psychiatry 
Psychogenic Psychoses August Wimmer.1916. Translated from the original Danish by Johan Schioldann. Burnside (South Australia): Adelaide Academic Press; 2003. 264 p. CAN$47.80.
Reviewer
rating*: Not Recommended
Review by: Alistair Munro, MD, FRCPC, FRCPE, FRCPsych
Halifax, Nova Scotia
Since objective diagnostic criteria still largely elude us in psychiatry, the onset of a mental illness is often a time of diagnostic confusion. In the case of an apparent acute psychosis, the symptoms may be both protean and nonspecific, and the acuteness may sometimes be questionable because many psychiatric illnesses have quite insidious onsets. If the onset is more gradual than suspected, this may lead to faulty judgments about etiology: apparent causal factors not uncommonly turn out to be consequences of subtly disturbed mentation and behaviour in the illness’s earliest stages. Providing a prognosis is problematic, and deciding on treatment in such perplexing circumstances is often quite hit-and-miss. Nowadays (unlike the situation when this monograph was originally published), we are conditioned to think of any kind of psychosis as a candidate for neuroleptic treatment and for continuation of the neuroleptic if the patient gets better.
However, what if the patient really has a brief psychotic disorder, perhaps related to recent stress, which will—if given the chance—respond best to rest, minor sedation, and practically oriented psychotherapy? If that individual is placed unnecessarily on a powerful antipsychotic, the drug will likely be given credit for the improvement that would have occurred anyway and will be continued to no benefit and with all the dangers of severe side effects.
This is a scenario that can occur only too readily with the illnesses variously known as psychogenic psychosis, reactive psychosis, acute and transient psychiatric disorders (ICD-10), or brief psychotic disorder (DSM-IV). The psychiatrist has to be profoundly aware of the diagnostic features of this type of illness to recognize it accurately and treat it appropriately.
Whatever the nomenclature, the essence of the disorder is an acute psychotic episode (sometimes recurrent) of brief duration (if the stressor is relieved) and usually related to a combination of external stress and personality vulnerability. What constitutes a stressor is often debatable, and the significance of predisposing nonpsychotic personality factors is always difficult to place in perspective.
Scandinavian psychiatry developed the concept of reactive or psychogenic psychoses to a greater degree than most other nosological systems and allowed the period of psychosis to extend up to 2 years. Nowadays, many Nordic psychiatrists find this unsatisfactory; however, the concept of psychosis as a reaction to external or internal stress factors remains a lively topic of discussion in psychiatry generally, and assignment of causality will obviously markedly influence the direction of treatment.
The present work is the first English translation of a monograph by August Wimmer, a distinguished Danish psychiatrist, who published it locally in 1916. The translator, a present-day Danish psychiatrist who is clinical professor of psychiatry in the University of Adelaide, South Australia, has done a sterling job of translating it.
Having said that, Professor Wimmer’s prose proves to be of daunting density, and Professor Schioldann, the translator, has been forced to employ equally dense English. The subject is clearly interesting and significant, since one hopes for better definitions of the brief psychoses in future editions of the DSM and the ICD (1,2). Sadly, this volume is unlikely to help in that process because it harks so much to the past.
Only a very few specialized scholars are now able to think themselves back to a particular time when belief systems in psychiatry were so different from now and depended as much on abstract argument as on empirical observation and that belonged to a specific cultural context that could be quite parochial and to an acceptance of academic authority rather than experiment.
To me, the book only comes alive when Wimmer’s case vignettes are presented. These still represent recognizable, meaningful psychiatric disorders, indicating that the illnesses stay largely the same over time and distance but are rendered confusing for contemporary practitioners by the welter of speculation and specious word play that still characterizes too much of our specialty.
This book is a labour of love, both by the original author and by Professor Schioldann. As is obvious from the foreword by Dr Berrios, it is still of interest to the philosophers in our midst. To medical scientists, its interest must be largely historical.
Because of its contribution to one aspect of psychiatry, even if somewhat marginal in present-day terms, and because of its richness as a reference source for aspects of pre-World War I psychiatry, I suggest that the book usefully belongs in the archival section of psychiatric libraries. Sadly, I cannot recommend it to general psychiatric readers.
References
1. Munro A. Delusional disorder. Cambridge (UK): Cambridge University Press; 1999. p 197–201.
2. Singh SP, Burns T, Amin S, Jones PB, Harrison G. Acute and transient psychotic disorders. Br J Psychiatry 2004;185:452–9.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
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