Authors: Dr. Edward Shorter and Dr. Max Fink
Oxford University Press
catatonia? Is it a symptom of schizophrenia? Can it be treatable and
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.
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.
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%.
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
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
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.
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
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.