Allan Beveridge

Abnormal cerebral asymmetry and schizophrenia in a subject with Klinefelter’s syndrome (XXY)

BACKGROUND A high incidence of schizophrenia has been reported in individuals with sex chromosome aneuploides (SCAs), and extra-X aneuploidy appears to adversely affect neurodevelopment. We previously examined neurodevelopment in SCA subjects with structural magnetic resonance imaging (MRI) of the brain. We present an XXY subject who subsequently developed schizophrenia. Further examination of the MRI data was undertaken. METHODS Graphs of MRI-determined regional brain to whole brain volume proportions and cerebral asymmetry indexes were generated for Klinefelter (n = 10) and male control subjects (n = 25) to allow inter-individual comparisons. RESULTS The index case had reversed prefrontal and temporal lobe asymmetries, and these findings were more marked than in any other subject. CONCLUSIONS It has been suggested that a genetic locus for schizophrenia may be found on the X chromosome and that the gene(s) concerned are implicated in the development of normal cerebral asymmetries. This case supports these arguments.

Madness in Victorian Edinburgh: a study of patients admitted to the Royal Edinburgh Asylum under Thomas Clouston, 1873-1908 Part II

The classification of mental disease preoccupied Victorian alienists and many systems were proposed throughout the nineteenth century. In his review of the subject, in the Dictionary of Psychological Medicine, Daniel Hack Tuke (1892) admitted that ’The result has been disappointing.’ The Edinburgh contribution to the classification debate was the system outlined by Skae (1863) and extended by Clouston (1873a, 1876a). The system claimed to be based on aetiology, but it also took account of other factors such as the natural history of the disease. Skae’s classification was criticized by many writers (e.g. Tuke 1870, Crichton-Browne 1875, Journal of Psychological and Mental Pathology, 1877), sometimes with great hostility, and it was never seriously adopted by any asylum outside Morningside. Nevertheless, Clouston (1895) continued to defend Skae’s classification which he found to be clinically valuable:

Life in the asylum: patients' letters from Morningside, 1873-1908.

I feel I cannot stand this place a minute longer and soon I shall lose the brains I had, and not be able to interest myself in others and everything that goes on in the world. The monotony and routine simply drives me wild ... I feel I shall go on degenerating in this environment into an animal, that only lives to eat as we do here! and has not thought beyond. For really that is all the ’treatment’ consists of/ 1

Mental illness and the late Victorians: a study of patients admitted to three asylums in York, 1880–1884

The case histories of the patients newly admitted to the Retreat Asylum in York between 1880-1884 were examined. Most patients were aged under 50 years, single and non-Quaker, and a majority satisfied the Research Diagnostic Criteria for a diagnosis of schizophrenia or affective disorder. It was found that 72.9% of the patients were deluded, the most common delusions being of persecution, grandeur and guilt; in 34.9% of the deluded patients, the delusion had a religious content. Suicidal ideation was recorded in the case records of 31.4% of the patients. Drug therapy was commonly prescribed, a history of assault on other patients or asylum staff was recorded in 38.1% of the patients, and 11% of patients were force fed at some stage during their illness. Within a year of admission 49.1% of the patients were discharged, the prognosis being better for patients with an affective illness than for schizophrenia, but 31.4% remained in the asylum for five or more years. The characteristics, alleged causes of mental illness, and treatment and outcome of the Retreat patients were compared with those of patients admitted during the same period to the two other York asylums which served different socio-economic groups of the population. Mortality rates were higher in the asylum admitting mainly pauper patients, and possible reasons for this are explored.

The madness of King George III: a psychiatric re-assessment

This research, based on a study of King George III’s medical records and of contemporary diaries of his courtiers and equerries, further confirms the considerable doubt on the claim of Richard Hunter and Ida Macalpine that the King suffered from recurrent attacks of acute porphyria. The present study examines the above records from a psychiatric viewpoint, together with some additional reports, to re-assess the nature of the King’s maladies. It concludes that he suffered from recurrent mania (four episodes), with chronic mania and possibly a degree of fatuity during the last decade of his life. This is in agreement with previous reports that he suffered from manic-depressive psychosis.

A disquieting feeling of strangeness?: the art of the mentally ill.

The art of the mentally ill is currently the focus of great interest. There have been numerous books on the subject, the emergence of specialized journals, international exhibitions, and the sale of work at ever-increasing prices. The creations of mentally ill patients have been given various names, such as ‘outsider art’, ‘psychotic art’, ‘art brut’ and ‘art extraordinary’. The area has attracted psychiatrists, artists and historians. Psychiatrists have been interested in what such art reveals about the mental state of the artist; for example, Sims1 used a picture by a psychotic patient to illustrate the cover of his textbook on psychopathology. Here art is being used as a visual demonstration of mental illness. Artists have claimed to find in the pictures of the psychotic a liberating disregard for cultural convention and orthodoxy, and have hailed these patient—artists as intrepid explorers of new artistic landscapes. Historians have been interested in several aspects of the art of asylum patients. Why was such work produced in the first place? What can it tell us about the asylum world? And, finally, why is such patient-work, which was initially considered to be artistically worthless, now held to possess significant aesthetic value—a process that MacGregor2 has called ‘the discovery of the art of the insane’. These disciplines bring with them contrasting perspectives, but at the core of these discussions are two questions: Is there anything distinctive about the art created by those deemed mad? If so, is it possible to recognize and describe its distinctive features? At the beginning of the nineteenth century, two major factors contributed to the awakening interest in the art of the insane—the Romantic movement, which identified madness as an exalted state allowing access to hidden realms; and the emergence of the asylum, which provided a location for the production of patient-art. Romanticism saw madness as a privileged condition: the madman, unrestrained by reason or by social convention, was perceived as having access to profound truths. The Romantics emphasized subjectivity and individualism, and hailed the madman as a hero, voyaging to new planes of reality. Although the equation of madness and genius originated with Plato, it was only in the nineteenth century that it became an important feature of cultural discourse3. From the proposition that the genius was a kind of madman it was logical to ask whether the mad themselves create works of genius. The growth of the asylum and attendant rise of the psychiatric profession has been the subject of intense debate, stimulated by Michel Foucaults ground-breaking Madness and Civilization4. While recent scholarship has painted a complex picture, which finds evidence not only of oppression but also of humanity, it is undeniable that the asylum era witnessed the creation of large, captive and often long-term populations of the mentally disturbed. It also saw the emergence of asylum doctors, some of whom began to take an interest in the artistic productions of their patients.

Madness in Victorian Edinburgh

as well as their similarities. In like manner, Trevor Turner ( 1992a) has stressed that we cannot write of ’patients’ as if they were all afflicted with the same kind of ’madness’. His own work on the Ticehurst Asylum has shown the value of a medical appreciation of the diversity of symptomatology. We now have a greater understanding of asylums in several countries. In England, there are studies of the Ticehust Asylum (MacKenzie 1985, Turner 1992a), the York Retreat (Digby 1985, Renvoize and Beveridge 1989) and the Bethlem (Allderidge 1985, Andrews 1991). In Ireland there has been work on St Patrick’s Hospital (Malcolm 1989) and general district asylums (Finnane 1981). In North America there have been studies of the Pennsylvania Hospital (Tomes 1984), the Utica and Willard Asylums (Dwyer 1987), and the London Hospital (Shortt 1986). Australian (Garton 1988) and Indian colonial asylums (Ernst 1991) have also been examined. Until recently comparably little was known about asylums in Scotland and the only guide to the field was D. K. Henderson’s (1964) The Evolution of Psychiatry in Scotland. However, the last decade has witnessed a resurgence of interest. We now possess general overviews of the area by Rice ( 1981 ) and

Metaphors of madness: Iain Crichton Smith's journey through the inferno.

accounts by the mentally ill must be added a new and significant contribution. The eminent Scottish writer, Iain Crichton Smith, has recently revealed that his 1987 novel, In the Middle of the tX~ood2 is, in fact, a description of his own mental breakdown.’ The novel provides a remarkably vivid and sensitive depiction of a mind unbalanced, and Crichton Smith has been able to achieve an extraordinary sense of objectivity about his plight: he neither sentimentalizes his ordeal, nor seeks to vindicate himself. Indeed, he frequently paints himself in an unflattering light, as a self-absorbed, arrogant intellectual who causes distress to his immediate family. The novel also recounts the author’s experience of his treatment in a psychiatric hospital, and, once again, Crichton Smith’s ability to distance himself from his material, means that this does not become a mere illustration of sociological theory about the mental institution, but rather it gives a humane evocation of

Madness and politics: French nineteenth-century alienists' response to revolution

Between 1789 and 1880 France underwent several revolutions and changes in the political system. The Great Revolution of 1789-1799 saw the French people teetering between order and disorder. The nineteenth century witnessed the reigns of Louis XVIII and Charles X as well as the two Bonapartist regimes of Napoleon I and Napoleon III. The century also experienced three revolutions: the ’bourgeois’, the ’popular’ and the ’socialist’ revolutions of 1830, 1848 and 1871 respectively. As a result of these upheavals the French people finally settled on a republican form of government and rejected a monarchy. During this period a new type of physician appeared in France. Born of Enlightenment Philosophy, these physicians were called alienists. They made lunatics as well as the general population their study, and they held that passions were the cause of madness. They felt that political changes were associated with an increasing incidence of insanity. Their views were often welcomed by the government of the day. Until the first revolutionary period, lunatics were not generally confined. In Toulouse, for example, lunatics, whether quiet or noisy, were allowed to walk about the general hospital of ’Saint Joseph de La Grave’. If they became violent they were chained and locked up in special prisons, called ’loges’, of which there were only few in number. They were subsequently dealt with in

Edinburgh's Poet Laureate: Robert Fergusson's illness reconsidered

Edinburghs Poet Laureate, Robert Fergusson died in the City Bedlam at the age of 24. Available information concerning his last months is examined and a possible explanation is offered for his early demise.