Physicians, the Spanish Inquisition, and Commonalities With Forensic Psychiatry.

The Spanish Inquisition was founded in 1478 by the Catholic monarchs and operated with the goal of controlling heresy in society. Religion was omnipresent, and Jewish conversos (Jews who had converted to Christianity) who continued to observe Jewish practices were many of the accused. In cases in which the defendant was thought to have mental illness, the Inquisition's physicians were to evaluate the person and provide reports and expert evidence. Those defendants who were found to have genuine mental illness were generally freed or transferred to specific hospitals for those with mental illness. Case examples elucidate the methods used by the Spanish Inquisition physicians to differentiate mental illness from malingering and heresy. Physicians also treated inmates and participated in evaluations regarding the appropriateness of torture. Understanding the events of the Spanish Inquisition and the role of physicians holds relevance for contemporary forensic psychiatry.

Medicalizing delinquents or turning the mad into criminals?: Practices of alienation and legal medicine in Colombia in the early the 20th century. / ¿Medicalizar al delincuente o hacer del loco un criminal?: Prácticas de alienismo y medicina legal en Colombia a comienzos del siglo XX.

This article analyzes medical-legal associations between madness and criminality in department of Antioquia (Colombia) during the three first decades of 20th century. The analysis was oriented by two overlapping axes: discourses and practices. The ideas of four doctors, generated between 1917 and 1925, were examined in order to identify the theoretical debates that delimited and defined mental illnesses in legal cases. The use of qualified knowledge and their place as experts were analyzed in a judicial case, initiated in 1921, in which theoretical confrontations surfaced among the doctors that debated the possible insanity of the defendant.

Este artículo analiza algunas asociaciones médico-jurídicas entre locura y criminalidad en el departamento de Antioquia (Colombia), en las primeras tres décadas del siglo XX. El análisis se orientó por dos ejes imbricados: el de los discursos y el de las prácticas. Se examinaron las ideas de cuatro médicos, planteadas entre 1917 y 1925, para identificar los debates teóricos desde los cuales se delimitaban y definían las enfermedades mentales en casos judiciales. La puesta en escena del saber de los peritos y su lugar como expertos se analizaron en un caso judicial, que inició en 1921, y en cuyo desarrollo afloraron las confrontaciones teóricas entre los médicos que debatieron sobre la posible locura del acusado.

The Dancing Manias: Psychogenic Illness as a Social Phenomenon.

The dancing mania erupted in the 14th century in the wake of the Black Death, and recurred for centuries in central Europe - particularly Germany, the Netherlands, and Belgium - finally abating in the early 17th century. The term "dancing mania" was derived from "choreomania," a concatenation of choros (dance) and mania (madness). A variant, tarantism, was prevalent in southern Italy from the 15th to the 17th centuries, and was attributed at the time to bites from the tarantula spider. Affected individuals participated in continuous, prolonged, erratic, often frenzied and sometimes erotic, dancing. In the 14th century, the dancing mania was linked to a corruption of the festival of St. John's Day by ancient pagan customs, but by the 16th century it was commonly considered an ordeal sent by a saint, or a punishment from God for people's sins. Consequently, during outbreaks in the 14th and 15th centuries, the dancing mania was considered an issue for magistrates and priests, not physicians, even though the disorder proved intractable to decrees and exorcisms. However, in the 16th century Paracelsus discounted the idea that the saints caused or interceded in the cure of the dancing mania; he instead suggested a psychogenic or malingered etiology, and this reformulation brought the dancing mania within the purview of physicians. Paracelsus advocated various mystical, psychological, and pharmacological approaches, depending on the presumptive etiologic factors with individual patients. Only music provided any relief for tarantism. Later authors suggested that the dancing mania was a mass stress-induced psychosis, a mass psychogenic illness, a culturally determined form of ritualized behavior, a manifestation of religious ecstasy, or even the result of food poisoning caused by the toxic and psychoactive chemical products of ergot fungi. In reality, dancing manias did not have a single cause, but component causes likely included psychogenic illness, malingering, and ritualized behaviors.

The simulators: truth and power in the psychiatry of José Ingenieros. / Los simuladores: verdad y poder en la psiquiatría de José Ingenieros.

Using Michel Foucault's lectures on "Psychiatric power" as its starting point, this article analyzes the book Simulación de la locura (The simulation of madness), published in 1903 by the Argentine psychiatrist José Ingenieros. Foucault argues that the problem of simulation permeates the entire history of modern psychiatry. After initial analysis of José Ingenieros's references to the question of simulation in the struggle for existence, the issue of simulation in pathological states in general is examined, and lastly the simulation of madness and the problem of degeneration. Ingenieros participates in the epistemological and political struggle that took place between experts-psychiatrists and simulators over the question of truth.

Los simuladores: verdad y poder en la psiquiatría de José Ingenieros / The simulators: truth and power in the psychiatry of José Ingenieros

Resumen Tomando como punto de partida el curso de Michel Foucault “El poder psiquiátrico”, se analiza el libro Simulación de la locura, publicado en 1903 por el psiquiatra argentino José Ingenieros. Foucault afirma que el problema de la simulación recorre transversalmente toda la historia de la psiquiatría moderna. Inicialmente se analizan las referencias que José Ingenieros dedica a la cuestión de la simulación en la lucha por la vida, para luego abordar la temática de la simulación en los estados patológicos en general y, por fin, la simulación de la locura y la problemática de la degeneración. Ingenieros participa de esa lucha epistemológica y política que se establece entre peritos-psiquiatras y simuladores en torno a la cuestión de la verdad.

Abstract Using Michel Foucault’s lectures on “Psychiatric power” as its starting point, this article analyzes the book Simulación de la locura (The simulation of madness), published in 1903 by the Argentine psychiatrist José Ingenieros. Foucault argues that the problem of simulation permeates the entire history of modern psychiatry. After initial analysis of José Ingenieros’s references to the question of simulation in the struggle for existence, the issue of simulation in pathological states in general is examined, and lastly the simulation of madness and the problem of degeneration. Ingenieros participates in the epistemological and political struggle that took place between experts-psychiatrists and simulators over the question of truth.

Neuropsychiatric Disturbances, Self-Mutilation and Malingering in the French Armies during World War I: War Strain or Cowardice?

Between 1914 and 1918, war strain appeared under a number of guises and affected, to varying extents, the majority of French soldiers. The most frequent form of war strain was war psychoneurosis, but war strain also induced more paroxystic disorders, such as acute episodes of terror, self-mutilation, induced illnesses and even suicide. Fear was the constant companion of soldiers of the Great War: soldiers were either able to tame it or overwhelmed by an uncontrollable fear. Nonetheless, over the course of the war, some aspects of fear were recognised as syndromes. The French health service poorly anticipated the major consequences of war strain, as with many other types of injuries. After the establishment of wartime neuropsychiatric centres, two main medical stances emerged: listening to soldiers empathetically on the one hand and applying more repressive management on the other. For many physicians, the psychological consequences of this first modern war were synonymous with malingering or cowardice in the face of duty. The stance of French military physicians in relation to their command was not unequivocal and remained ambivalent, swaying between medico-military collusion and empathy towards soldiers experiencing psychological distress. The ubiquity of suspected malingering modified the already porous borders between neuropsychiatric disorders and disobedience. Several war psychoneurotic soldiers were sentenced by councils of war for deserting their posts in the face of the enemy and were shot. Many soldiers suspected of self-mutilation or suffering from induced illnesses were also sentenced and executed without an expert assessment of their wound or their psychological state.

["Simulanten des Irrsinns auf dem Vortragspult": dada, war and psychiatry--'active dynamics of trauma']. / "Simulanten des Irrsinns auf dem Vortragspult": Dada, Krieg und Psychiatrie, eine, Aktive Traumadynamik'.

This paper relates stage performances of dada artists to war neurosis and shell shock as sociocultural phenomena. The leitmotif of this investigation is the notion of simulation, as dada artists were referred to as malingerers (simulators) of madness by the press at the time. I hypothesize that the performers imitate/simulate with drums, shouting and 'bruitist' sound poems, the noises of war, staging themselves as war neurotics in a kind of shocking clinical demonstration. Both discourses intersect in the fact that many dadaists try to dodge the draft by simulating madness. The scandalizing anti-art of dada will be understood as contagious anti-pedagogy, trying to vaccinate against the madness of the era.

["... mein Recht muss mir werden!" Hermann Bahr's tragicomedy Der Querulant (1914)]. / "[...] mein Recht muss mir werden!" Hermann Bahrs Tragikomödie Der Querulant (1914).

At the end of the eighteenth century, people who became notorious for their excessive engagement in legal proceedings started being labeled as "querulents" or "paranoid litigants". The term "querulents" first appeared in the General Order of the Court for the Prussian States (Allgemeine Gerichtsardnung für die Preussischen Staaten) from July 6, 1793. From there on, the spectrum of juridical measures undertaken against the so-labeled litigators included classifying these persons as ineligible for legal action and psychiatric hospitalization. The paper discusses to what extent Hermann Bahr rearranges psychiatric and legal knowledge about this special type of the complainer in his tragi- comedy Der Querulant, premiered in 1914. This concerns, first, the theatricality of the body and speech, secondly, the use of cultural techniques of writing and, thirdly, conflict- ing notions of justice. Therefore, the paper analyzes the aesthetic function of querulous behavior in the dramatic structure of the play from the point of view of both media theory and literary theory.

French neuropsychiatry in the Great War: between moral support and electricity.

In World War I, an unprecedented number of soldiers were suffering from nervous disturbances, known as war psychoneuroses. Mechanisms of commotion, emotion, and suggestion were defined in order to explain these disturbances. In France, emphasis was placed on the mechanism of suggestion, based on pithiatism, introduced by Joseph Babinski (1857-1932) before the war to highlight the concept of suggestion and its hazy border with simulation. As a result, many soldiers suffering from war neuroses became considered as simulators or malingerers who were merely attempting to escape the front. A medical-military collusion ensued with the aim of sending as many of these nervous cases back to the front as possible through the use of painful or experimental therapies. Aggressive therapies flourished including torpillage, a particularly painful form of electrotherapy developed by Clovis Vincent (1879-1947) and subsequently by Gustave Roussy (1874-1948). At the end of the war, some psychiatrists, such as Paul Sollier (1861-1933), Georges Dumas (1866-1946), and Paul Voivenel (1880-1975), developed a more psychological approach. In Great Britain, where Charles Myers (1873-1946) coined the term shell shock in 1915 to describe these cases, psychological theories were more successful. In Germany, aggressive therapies developed by Fritz Kaufmann (1875-1941) emerged in the second part of the war. In Austria, the future Nobel Prize winner Julius Wagner-Jauregg (1857-1940) was accused of performing violent therapies on patients with war neuroses. These methods, which now seem barbarian or inhuman, were largely accepted at the time in the medical community and today should be judged with caution given the cultural, patriotic, and medical background of the Great War.

The origins of factitious disorder.

Factitious disorder is the deliberate simulation of illness for the purpose of seeking the sick role. It is a 20th-century diagnosis, though the grounds for its introduction are uncertain. While previous authors have considered the social changes contributing to growth in the disorder, this article looks at some of the pressures on doctors that may have created the diagnostic need for a disorder between hysteria and malingering. The recent history of those disorders suggests that malingering would no longer be acceptable when applied to the potentially larger numbers involved in workers' compensation or in mass conscription. Equally, the absolution given to hysteria on the basis of the Freudian subconscious would survive only as long as that model retained credibility. Growing egalitarianism and changing doctor-patient relationships in the 20th century would no longer tolerate a sharp division between culpable malingering and exculpated hysteria, which may previously have been made on grounds of class or gender. They would contribute to the need for a mediating diagnosis, such as factitious disorder.

Feigned and factitious diseases in the British Forces c.1830-1840: a forgotton medical classic.

Soldiers and seamen were remarkably inventive in their methods of feigning disease; I know of few cases where soldiers today have gone to such determined efforts to simulate a disease. All of us have encountered malingerers in the course of our work but the extent and array to which they extend in their attempts is greatly surpassed by the tales of effort and guile reported by Gavin. Fit, content men have always been at the centre of the military capability and in the forces of the present day the driving concerns to discharge oneself from the army or navy are no longer quite as pressing. However, medical officers should always be alert to the art of feigning. I will leave the last word to Hector Gavin: "As long as soldiers have the idea that they can impose upon officers, and that the result will be for their advantage, so long will examples of imposition occur in the army. "