Anxiety-Panic History
c. 1850Biological psychiatry is actually closer to mainstream medicine than other branches, because it is scientific in its foundations. This approach originated in Germany and France in the mid-nineteenth century but, while striving to attain scientific validation, lost ground to Freud's psychoanalytical theories, which seemed new, fresh, and fraught with promise. (48)
c. 1850Heinrich Neumann (1814 - 1884) spoke of sexual (and other) "drives," which, if not satisfied, could generate "anxiety." The same assumptions were echoed in the writings of Karl Ideler (1795 - 1860), who recognized the importance of the emotional life and that unfulfilled sexual longings could serve as a source of mental disturbance. (36)
c. 1850At mid-century Otto Domrich became the first in the field of medical psychology to write about "anxiety attacks." This term replaced earlier notions of "neurocirculatory neurasthenia," "soldier's heart," and "hyperventilation syndrome" that dated back to the French Revolution (Angst, 1995) and depicted the state of combined anxiety and cardiopulmonary symptoms that might be induced by the terrors of the battlefield. (36)
1850In Japan, Dr. Gen'yu Imaizumi treats a case of panic disorder using a psychological technique called the "persuasion" method which is apparently similar to CBT. (18)
1857Bromine entered mainstream medicine in 1857, when Charles Locock, a London internist with a Mayfair practice, was commenting on a paper about epilepsy at a medical meeting. Locock happened to mention that he had given 10 grains of potassium bromide three times a day over a period of two weeks to a patient with "hysterical epilepsy," suppressing the epilepsy. He had also given it "in cases of hysteria in young women, unaccompanied by epilepsy," finding it, "of the greatest service." He implied that it sedated them. Away bromium went on its career as a sedative. (31)
1857In 1857, Benedict-Augustin Morel launched the concept of degeneration. ... All psychiatrists of Morels's day believed mental illness to be directly inheritable. ... And not only was it bad for the family, it was harmful to society. Morel wrote, "The degenerate human being, if he is abandoned to himself, falls into a progressive degradation. He becomes... not only incapable of forming part of the chain of transmission of progress in human society, he is the greatest obstacle to this progress through his contact with the healthy portion of the population." Happily, "The span of his existence is limited as is that of all monstrosities." (31)
1859What we currently call "somatization disorder" was referred to earlier as "hysteria" or "Briquet's syndrome." The latter takes its name from P. Briquet (1796 - 1881), whose monograph, Traite de l'Hysterie [Treatise on Hysteria], appeared in 1859. The syndrome consists of multiple, vague, or exaggerated somatic complaints for which no physical cause can be found. The accompanying symptoms are often gastrointestinal or sexual; the latter might include sexual indifference or vomiting during the whole of pregnancy. ... Through his methodical observations, Briquet was able to correct the old prejudices, stating that married women were only slightly less prone to hysteria than unmarried women, that a fifth of the cases occur even before puberty, that having a sexual life is no guarantee against developing hysteria, and perhaps more importantly, that men could also develop the syndrome (as LePois had mentioned years before [in 1618]). (36)
c. 1860Outside of the spas, wealthy nervous patients might land in the hands of society doctors. In London, that meant the members and fellows of the Royal College of Physicians, who after the 1860s, would cluster increasingly on Harley Street and nearby West End addresses. (31)
c. 1861Military psychiatry is a recent development, dating only from the Civil War, when neurologists made a systematic attempt to link damage to the brain to emotional behavior. In a strict sense, however, military psychiatry did not emerge as a separate discipline until the Russo-Japanese War. (30)
1863the first military hospital in the United States devoted to the treatment of psychiatric casualties was founded. The most common psychiatric condition with which medical officers had to deal was nostalgia. ... Moreover, they also began to encounter a range of symptoms which mimicked different diseases but for which any sound physical cause was lacking. Thus, for every hundred soldiers discharged for "nervous disease," 28.3 manifested a condition that mimicked epilepsy and 20.8 a condition that mimicked paralysis. (30)
1865Although the problem of psychiatric breakdown reached major proportions by [the Civil War's] end, not a single article or book on the subject was published in the post war years. The military psychiatric hospital was closed, and the government made no effort to deal with the psychiatrically wounded by involving the doctors who treated mental illness in the civilian community. (30)
1869Chloral became the first rehearsal of the "Prozac" scenario seen with drugs that acquire a great public following for the relief of common psychiatric symptoms. In 1869, Otto Liebreich, professor of pharmacology in Berlin, determined that chloral functioned as a hypnotic to relieve insomnia in anxious and depressed patients who were not insane. Plays and novels of the epoch often eased references to chloral into the plot, the heroine being drugged before being robbed of her virtue. (31)
1869This climate of medical uncertainty about what was really organic and what was just hypothetically organic was a mirror image of patients' uncertainty about what was madness and what was nerves. Both doctors and patients required a bridge between these two uncertainties, an organic-sounding disease term to explain psychiatric-looking illness behavior. In 1869, New York electrotherapist George Beard supplied this bridge with his announcement of the discovery of neurasthenia, a supposedly distinctive disease entity. ... Beard declared that a large number of nervous symptoms were really owing to a physical exhaustion of the nerves. ... Beard's neurasthenia did not rest on the shoulders of scientific foundations. (31)
c. 1870As late as the 1870s the American Army used tattooing and branding as punishment for cowardice. (30)
c. 1870For two decades in the late nineteenth century, the disorder called hysteria became a major focus of scientific inquiry. The term hysteria was so commonly understood at the time that no one had actually taken the trouble to define it systematically. (40)
c. 1870The hydropath's mid-Victorian patients were largely members of the new bourgeoisie - flocking to the hydros partly because they considered it the fashionable thing to do, partly to be cured as quickly as possible and at the least inconvenience to themselves. From their point of view speed was the essence. It had to be; they might be the new rich, but they were certainly not rich enough to be able to afford to undertake the cure for up to three months and certainly could not follow it up with a journey to some Continental centre. The result was that they expected too much too quickly and they could really expect none other than disappointment. ... These two factors - adverse medical opinion and a disappointed public - combined to bring the whole practice of hydropathy into disrepute. A few steadfast practitioners remained in the field, supported by a sufficient number of steadfast patients. But the quacks were driven from it, together with a large number of hydropaths whose only fault that they had called their treatment by the same name as that used by their less reputable rivals. (47)
c. 1870Another prominent psychiatrist at the Bicetre was Henri Le Grand du Saulle (1830 - 1886), an enormously prolific investigator who wrote lengthy treatises on obsessive-compulsive disorder, delusions of persecution, hereditary mental disorders, jurisprudence, epilepsy, and agoraphobia. (36)
c. 1870Jean-Martin Charcot (1825 - 1893), the preeminent French neurologist of the 19th century, he trained many of the most influential psychiatrists of the era - most notably, Freud, Bleuler, Janet, and Bechterev. Charcot's interest in hysteria, combined with his great stature as a physician, conferred acceptability on the study of related phenomena (the "unconscious," hypnosis, and the neuroses) to the conservative medical establishment of his day. ... Charcot helped greatly to "de-demonize" hysteria by showing conclusively the "demonic possession" of the late Middle Ages and pre-Enlightenment era was a variety of hysteria. (36)
c. 1870In the early 1870s, Jean-Martin Charcot became entangled in what would later constitute office-practice psychiatry, the undifferentiated mass of neurotic complaints that he termed "hysteria." Believing hysteria to be a real organic disease, transmitted genetically and associated with presumptive but unidentified changes in nervous tissue, Charcot elaborated a kind of air-castle of "iron laws of hysteria," a disease thought to follow its own rules. Thus it was from the early 1870s to his death in 1893... All of Europe came to believe in Charcot's "hysteria," which willy-nilly had become the centerpiece of French psychiatry. (31)
c. 1870The patriarch of the study of hysteria was the great French neurologist Jean-Martin Charcot. His kingdom was the Salpetriere, an ancient, expansive hospital complex which had long been an asylum for the most wretched of the Parisian proletariat: beggars, prostitutes, and the insane. Charcot transformed this neglected facility into a temple of modern science, and the most gifted and ambitious men in the new disciplines of neurology and psychiatry journeyed to Paris to study with the master. Among the many distinguished physicians who made the pilgrimage to the Salpetriere were Pierre Janet, William James, and Sigmund Freud. (40)
c. 1870Charcot, the son of a tradesman who had risen to wealth and fame, was a prominent member of this new bourgeois elite. His salon was a meeting place for government ministers and other notables of the Third Republic. He shared with his colleagues in government a zeal for the dissemination of secular, scientific ideas. His modernization of the Salpetriere in the 1870s was carried out to demonstrate the superior virtues of secular teaching and hospital administration. And his investigations of hysteria were carried out to demonstrate the a secular over a religious conceptual framework. His Tuesday Lectures were political theater. His mission was to claim hysterical women for science. (40)
c. 1870The study of hysteria captured the public imagination as a great venture into the unknown. Charcot's investigations were renowned not only in the world of medicine but also in the larger worlds of literature and politics. His Tuesday Lectures were theatrical events, attended by "a multi-colored audience, drawn from all of Paris: authors, doctors, leading actors and actresses, fashionable demimondaines, all full of morbid curiosity." In these lectures, Charcot illustrated his findings on hysteria by live demonstrations. The patients put on display were young women who had found refuge in the Salpetriere from lives of unremitting violence, exploitation, and rape. The asylum provided them greater safety and protection than they had ever known; for a selected group of women who became Charcot's star performers, the asylum also offered something close to fame. (40)
c. 1870Charcot was credited for great courage in venturing to study hysteria at all; his prestige gave credibility to a field that had been considered beyond the pale of serious scientific investigation. Prior to Charcot's time, hysterical women had been thought of as malingerers, and their treatment had been relegated to the domain of hypnotists and popular healers. (40)
1872In "The Expression of the Emotions in Man and Animals," [Charles] Darwin proposed that "the chief expressive actions, exhibited by man and by the lower animals, are now innate or inherited, - that is, have not been learnt by the individual." As evidence for emotional innateness, he noted the similarity of expressions both within and between species. In humans, Darwin was particularly impressed with the fact that the bodily expressions (especially of the face) occurring during emotions are similar in people around the world, regardless of racial origins or cultural heritage. He also pointed out that these same expressions are present in persons born blind, and thus lacking the opportunity to have learned the muscle movements from seeing them in others, and are also present in very young children, who also have had little opportunity to learn to express emotions by imitation. ... Darwin was able to identify some striking similarities, even within fairly dissimilar organisms. He pointed out how common it is for animals of all varieties, including humans, to urinate and defecate in the face of extreme danger. And many animals erect body hair in dangerous situations, presumably to make themselves look more vicious than they otherwise would. ... Within the general class of innate emotions, Darwin suggested that some have older evolutionary histories than others. He noted that fear and rage were expressed in our remote ancestors almost as they are today in humans. Suffering, as in grief or anxiety, though, he placed closer to human origins. (42)
1874 JanEng and Chang Bunker -- the world's most famous connected [conjoined] twins, the ones who gave us the term "Siamese twins" -- had died on a cold January night in 1874. ... After their death, one medical camp held that while Chang had died of a blood clot, Eng had died of shock. In other words, believing that the death of his brother would cause his own demise, Eng was scared literally to death. Another theory held that the five-inch-long and three-inch-wide band that connected the twins was a lifeline which, barring immediate surgical intervention, would pass death from one to the other. An autopsy found the blood clot in Chang's brain, but it couldn't resolve the debate over the cause of Eng's death. (39)
1875[American nerve doctor Silas Weir Mitchell created in 1875 a therapy called the rest cure that was designed to combat neurasthenia.] ... involving the components of seclusion enforced through bed rest, a milk diet, electrical treatments, and massage. (31)
1877In 1877, Mitchell published Fat and Blood, explaining the mechanics of [his rest] cure. The book became a sensation, and Mitchell's Infirmary for Nervous Diseases turned into a "Mecca for patients from all over the world." The rest cure required a good deal of money and was mainly restricted to an international elite of nervous patients, criss-crossing the oceans in search of relief. Physicians would ship patients far afield to a spa clinic for a rest cure of typically six weeks to three months. (31)
1879Psychology is first established as an academic discipline when Wilhelm Wundt opens the first formal psychological laboratory at the University of Leipzig in Germany. (31)
c. 1880Karl Westphal (1833 - 1890) wrote about the neuroses, including phobias, sexual disorders, and what would now be called "obsessive-compulsive disorder." (36)
c. 1880Neurasthenia, a nervous illness originally described by the New York doctor George M. Beard, made its way to the European continent in the early 1880s. According to Beard's mechanistic conception of the nervous system, modern civilization exacted an enormous drain on the individual's finite reserve of 'nerve force'; as a result, neurasthenic symptoms such as fatigue, headaches, sleeplessness, dizziness, digestive problems, irregular heart beat and impotence had begun to appear with increasing frequency. Beard conceived of neurasthenia as a purely American phenomenon which he attributed to the country's peculiar social and economic relations, but his writings had great resonance in Britain, France, Germany and Russia as well, where thinkers endowed the illness with qualities peculiar to their own social, economic and geographical milieux. (43)
c. 1880Charcot's approach to hysteria, which he called "the Great Neurosis," was that of the taxonomist. He emphasized careful observations, description, and classification. He documented the characteristic symptoms of hysteria exhaustively, not only in writing but also with drawings and photographs. Charcot focused on the symptoms of hysteria that resembled neurological damage: motor paralysis, sensory losses, convulsions, and amnesias. By 1880 he had demonstrated that these symptoms were psychological, since they could be artificially induced and relieved through the use of hypnosis. (40)
c. 1880At the Salpetriere, Charcot observed numerous cases of hysterical symptoms arising in men, including headaches, heart palpitations, chest pain, irregular pulse rate, constipation, dizziness, fainting spells, trembling of the hands and neck, emotional and sleep disorders, and mental disorientation. These symptoms closely resembled those of his hysterical female patients; significantly, they seemed to arise after traumatic events, such as work-place accidents and train crashes. In women, on the other hand, Charcot believed that hysterical attacks were generally unleashed by emotions or passions; jilted lovers and weepy, romantic girls being a highly susceptible category. Charcot developed a model to explain these symptoms in which an environmental agent provocateur, or traumatic stimulus, could act in the presence of an inherited, constitutional disposition, or diathese. He attributed the onset of symptoms to a combination of factors, but gave primacy to the pathogenic effects of the emotions unleashed by traumatic experiences, in particular, fear. Both organic and emotional factors played a role, and Charcot posited that traumatic experiences could become superimposed on physical injuries or irregularities. Although he remained convinced that hysteria could only develop when the prerequisite physical and hereditary preconditions existed, Charcot thus cautiously introduced psychological elements into his disease model. (43)
c. 1880Charcot's formulations of hysteria offered a scientific explanation for phenomena such as demonic possession states, witchcraft, exorcism, and religious ecstasy. One of his most cherished projects was a retrospective diagnosis of hysteria as portrayed throughout the ages in works of art. With a disciple, Paul Richer, he published a collection of medieval artworks illustrating his thesis that religious experiences depicted in art could be explained as manifestations of hysteria. Charcot and his followers also entered into acrimonious debates on contemporary mystical phenomena, including cases of stigmatics, apparitions, and faith healing. Charcot was particularly concerned with the miraculous cures reportedly occurring in the newly established shrine at Lourdes. Janet was preoccupied with the American phenomenon of Christian Science. Charcot's disciple Desire Bourneville used the newly established diagnostic criteria in an attempt to prove that a celebrated stigmatic of the time, a devout young woman named Louise Lateau, was actually a hysteric. All of these phenomena were claimed for the domain of medical pathology. ... Charles Richet, a disciple of Charcot, observed in 1880: "Among the patients locked away in the Salpetriere are many who would have been burned in former times, whose illness would have been taken for a crime." (40)
c. 1880The backlash [against theories of hysteria] began even before Charcot's death in 1893. Increasingly, he found himself called upon to defend the credibility of the public demonstrations of hysteria that had enthralled Parisian society. It was widely rumored that the performances were staged by suggestible women who, knowingly or not, followed a script dictated under hypnosis by their patron. At the end of his life, he apparently regretted opening up this area of investigation. ... By the end of the century, the political impulse that had given birth to the heroic age of hysteria had dissipated. (40)
1880Beginning in 1880, Breuer treated a young woman, "Anna O.," for hysterical limb paralyses as well as visual and other disturbances. (36)
1885Charcot was also the mentor of another important commentator on hysteria: Paul Richer, who was to dedicate his encyclopedic 976-page work on la grande hysterie, published in 1885, to his teacher. By then Richer had become the director of the clinic for nervous diseases at the Salpetriere. The terms "grand hysteria" and "hystero-epilepsy" were used to designate a severe form of hysteria of which the contortions of the body and outbursts of overwhelming emotion that characterized hysteria were accompanied by convulsions (either during the outbursts or at a separate time). ... Richer also included a long chapter on the history of the phenomenon, which previously was ascribed to the workings of the devil. The parts of the body where the devil was alleged to have taken up residence - the breasts, the heart, the forehead - were the very areas where hystero-epileptoids were wont (according to Richer) to experience their auras. Richer noted past outbreaks of what he saw as hystero-epilepsy in Aix la Chapelle in 1374, Strasbourg in 1418, and the celebrated case in 1632-33 at the convent of Loudun near Bordeaux. (36)
1886Freud's trip to Paris to study hypnotism and hysteria with Charcot. Impressed by the power of hypnotherapy to relieve hysterical symptoms (including paralyses), at least in some cases, Freud returned to Vienna after a year and formed a close friendship with physician Josef Breuer (1842 - 1925), who lent a sympathetic ear to Freud's enthusiasm for the hypnotic method. (36)
1888The water-clinic Marienberg in Boppard-on-Rhine was typical in every way of the middle-class hydro, and statistics from Marienberg show it was, without question, a primarily psychiatric facility. Of 1,185 patients seen there between 1883 and 1888, only one-fifth were somehow off the psychiatric spectrum (chest disease, anemia, overweight). Fifty-two percent of all patients at Marienberg had "neurosis" (neurasthenia, hysteria, hypochondria); 5 percent suffered from organic diseases of the nervous system such as neurosyphilis; 13 percent were alcoholics; and 9 percent had some form of what was considered "psychosis," mainly obsessive-compulsive disorders and depression. ... Places like the Marienberg hydro must be drawn into any comprehensive history of psychiatry, for it was there that the middle classes received their psychiatric care. (31)
1888Bayer founded a pharmaceutical division in 1888. (31)
c. 1890[The teachings of degeneration] were absorbed by patients and physicians alike in late Victorian England. How difficult it was, noted Samuel Strahan, senior medical officer of Berrywood Asylum in Northampton, to elicit a family history of mental illness from relatives who were all terrified at the specter of degeneration in the family tree. (31)
c. 1890The ambition of Charcot's followers was to surpass his work by demonstrating the cause of hysteria. Rivalry was particularly intense between Janet and Freud. Each wanted to be the first to make the great discovery. In pursuit of their goal, these investigators found that it was not sufficient to observe and classify hysterics. It was necessary to talk with them. For a brief decade men of science listened to women with a devotion and respect unparalleled before or since. Daily meetings with hysterical patients, often lasting for hours, were not uncommon. The case studies of this period read almost like collaborations between doctor and patient. ... These investigations bore fruit. By the mid 1890s Janet in France and Freud, with his collaborator Joseph Breuer, in Vienna had arrived independently at strikingly similar formulations: hysteria was a condition caused by psychological trauma. ... Janet called this alteration in consciousness "dissociation." Breuer and Freud called it "double consciousness." ... Both Janet and Freud recognized the essential similarity of altered states of consciousness induced by psychological trauma and those induced by hypnosis. Janet believed that the capacity for dissociation or hypnotic trance was a sign of psychological weakness and suggestibility. Breuer and Freud argued, on the contrary, that hysteria, with its associated alterations of consciousness, could be found among "people of the clearest intellect, strongest will, greatest character, and highest critical power." (40)
c. 1890While French neurologist Pierre Janet (1859-1947) formulated his theories of trauma and dissociation, or the splitting of the personality, the Austrian Sigmund Freud (1856-1939) elaborated on (but later denied) the long term effects of childhood trauma on a person's subsequent mental health. If Freud helped to propel and publicize this paradigm shift, it first found widespread acceptance during World War I. (43)
c. 1893On Charcot's death, Freud eulogized him as a liberating patron of the afflicted: "No credence was given to the hysteric about anything. The first thing that Charcot's work did was to restore its dignity to the topic. Little by little, people gave up the scornful smile with which the patient could at that time feel certain of being met. She was no longer necessarily a malingerer, for Charcot had thrown the whole weight of his authority on the side of the genuineness and objectivity of hysterical phenomena." (40)
c. 1893after Charcot's death the whole edifice of Charcotian hysteria collapsed. The supposedly organic nervous disease called "grand hysteria" turned out to be nothing more than an artifact of suggestion, as did the presumed "stigmata" of hysteria, fixed physical signs such as supposed tunnel vision. An entire generation of physicians and patients had been gulled into believing, and reproducing in their illness behavior, the symptoms of a set of iron laws that never existed. It was a complete disaster for French psychiatry. (31)
1893Breuer and Freud's first paper on hysteria treated by psychoanalysis is published. (36)
1893"The Scream" is painted by Edvard Munch. (49)
1894William James... "Amongst all the many victims of medical ignorance clad in authority the poor hysteric has hitherto fared the worst; and her gradual rehabilitation and rescue will count among the philanthropic conquests of our generation." (40)
1895Freud's description of the "anxiety neurosis" in 1895 was a wider concept that covered milder anxiety states as well as actual panic attacks, of which Domrich's description [(c. 1850)] was the forerunner. (36)
1895In 1895, Freud and Breuer published a book together, Studies on Hysteria, containing Breuer's history of a young woman he named "Anna O," as well as Freud's account of several other cases. (Breuer's approach to the case became christened "cathartic therapy.") ... Freud theorized that much hysteria and anxiety could be explained on the grounds of patients' early experiences with sexual trauma and with adult experiences of sexual abstinence, masturbation, and such practices as coitus interuptus. (31)
c. 1895By the mid 1890s [Janet, Freud, Breuer] had also discovered that hysterical symptoms could be alleviated when the traumatic memories, as well as the intense feelings that accompanied them, were recovered and put into words. This method of treatment became the basis of modern psychotherapy. Janet called the technique "psychological analysis," Breuer and Freud called it "abreaction" or "catharsis," and Freud later called it "psycho-analysis." But the simplest and perhaps best name was invented by one of Breuer's patients, a gifted, intelligent, and severely disturbed young woman to whom he gave the pseudonym Anna O. She called her intimate dialog with Breuer the "talking cure." (40)
1895In France, Valentin Magnan became the main standard-bearer of degeneration after Morel's death in 1873. Magnan first warmed to the subject in his lectures at Sainte-Anne in 1882, producing a decade later a widely read summary of the subject. Coming as he did after Darwin, Magnan interpreted the degenerates as losers in an epochal battle for survival among the species. A society that did not wish to succumb in the "hereditary struggle for life" would trim its load of degeneration, he said in 1895 with his collaborator Maurice Paul Legrain. "Degeneracy is more than an individual disease, it is a social menace: It is important to combat it with a rigorous form of social hygiene." (31)
1896By 1896 Freud believed he had found the source [of hysterical symptoms]. In a report on eighteen case studies, entitled The Aetiology of Hysteria, he made a dramatic claim: "I therefore put forward the thesis that at the bottom of every case of hysteria there are one or more occurrences of premature sexual experience, occurrences which belong to the earliest years of childhood, but which can be reproduced through the work of psycho-analysis in spite of intervening decades. I believe that this is an important finding, the discovery of a caput Nili in neuropathology." (40)
c. 1897Within a year, Freud had privately repudiated the traumatic theory of the origins of hysteria. His correspondence makes clear that he was increasingly troubled by the radical social implications of his hypothesis. Hysteria was so common among women that if his patient's stories were true, and if his theory was correct, he would be forced to conclude that what he called "perverted acts against children" were endemic, not only among the proletariat of Paris, where he had first studied hysteria, but also among the respectable bourgeois families of Vienna, where he had established his practice. This idea was simply unacceptable. It was beyond credibility. (40)
c. 1897After 1897, Freud came to believe that it was not actual sexual trauma but fantasies of incest in childhood that opened the wellsprings of neurosis in his adult female patients. Thus in his practice, Freud began talking to his bewildered patients even more about sex. (31)
1899In the sixth edition of [Emil Kraepelin's text "Psychiatrie," his] ideas reached their definitive form, resulting in a classification of illness that provided the basis of the later Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association. (31)
Anxiety-Panic History