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Affiliation
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EA 4050, laboratoire de recherches en psychopathologie : nouveaux symptômes et lien social, université de Rennes 2, 35043 Rennes cedex, France. |
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Abstract
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OBJECTIVE: The aim of this work is to give a new anchorage for the initial concept of pseudodementia, its basic definitions and actual clinical implications. The original definition and framework of the concept are misidentified and therefore need to be reintroduced and analysed here. This approach, beyond its heuristic and epistemological goal, has a practical aim: to adjust the psychopathological point of view on pseudodementia.
METHODOLOGY: In addition to a conventional survey based on search engines (Medline, PsychINFO and google book), we conducted a systematic review of the concomitant papers related to the rise of the concept.
RESULTS: Three moments of conceptualization are identified and linked to Wernicke's successors at the university of Breslau. Firstly, Stertz (1910) has described pseudodementia as a psychogenic illness that could occur after any trauma. According to our research, it is probably the first written use of the term pseudodementia in its psychogenic meaning. Secondly, we present Bonhoeffer's approach based on psychogenic reactions (1911). Finally, the views of Alzheimer and his student Schuppius are described: their understanding of pseudodementia is open to psychoanalytic concepts (1914).
DISCUSSION: The concept of pseudodementia (Pseudodemenz) takes shape in a particular period of German history: the promulgation of laws settling railway (1871) and industrial accidents (1884) but also the law of compensation of the traumatic neurosis (1889), the nosological specificity of which was debated. German psychiatry of the beginning of the 20th century was strongly imbued with a moralizing sense of national duty. The disqualification of traumatic neurosis has been followed by a unanimous recognition of traumatic hysteria and its psychogenic hypothesis. As a consequence, traumatic events were rarely taken into consideration and the issue was moved into the private sphere (Privatsache) by questioning patients' morbid wishes. Breslau's psychiatrists analyzed the cognitive disorders of pseudodementia with regard to an ideogenic model of the trauma, which emphasized the subjectivity but which was still facing the primacy of the consciousness. It is in this context, and by reducing the question of the pseudodementia to the situations of detention (Gansersche Syndrom) and pension neuroses (Rentenneurosen), that Bonhoeffer promoted the notion of "wishing to be sick" (Wille zur Krankheit). This conception gave a social component to mental disorders but placed in the foreground a suggestive phenomenon, which Raecke included as secondary to the primary symptom of hysterical inhibition. Thus, Schuppius's article under the tutoring of Aloïs Alzheimer offers a double testimony. On one hand, it shows how neuropsychiatry was, by then, at least partially open to the notion of an unconscious causality. On the other hand, it exposes a hidden aspect of Aloïs Alzheimer: a brilliant histopathologist capable of interest for psychodynamic mechanisms.
CONCLUSION: In his famous study of 1961, Leslie Gordon Kiloh argues that the concept of pseudodementia does not belong to any nosological system, is purely descriptive and does not imply an accurate diagnosis. The present work shows a very different conclusion. Initially, the term was introduced in German psychiatry to describe cases of hysterical psychogenic illness after trauma (psychogene Erkrankungen nach Trauma) in which the mechanism of inhibition was discussed. Topologically, we can even define its emergence in the Breslau's university and psychiatric clinic in which Wernicke, Stertz, Bonhoeffer and Alzheimer himself, promoted it. One should also note that the category of hysteria referred to an array of functional mental disorders, including "hysterical psychosis" (hysterische Psychosen).
Language: fr |