Parkinsons' Disease, biomarkers, talking points related to ME and psychosomatic diagnoses

understood

i do not understand

 

Parkinson's treatment involves modulation of dopamine. As dopamine rises and falls, there are natural psychological consequences. So I saw that being discussed, but not the idea of Parkinson's itself being psychosomatic... and I searched around quite a bit.

 

Yes thats true. In late stages patients often end up on drugs to deal with cognitive issues caused by the increased Dopamine, i was just referencing this the other day
http://www.parkinson.org/understand.../What-are-the-Treatment-Options-for-Psychosis

Also the dementia (a separate issue) can often be treated with anticholinergics such as Aricept.

Not to mention the stereotypy or erratic or obsessional behaviours such as gambling or addictive behaviours that can be caused by Dopamine agonists like Mirapex or Requip.

 

.....mostly what I was reading about

 

Yeah, i wonder if anyone saw that coming when these drugs were being conceptualized.
It probably seemed like an ideal solution at the time, if the Dopamine producing neurons die take this pill instead and function like normal...

 

I refer to Germany, where during the "Action T4" also people with Parkinson's and epilepsy were killed, and if you look into the lists, Parkinson's must have been replaced (e.g. idiocy, imbecility - you don't find Parkinson's very often) or such a diagnosis was added. Epilepsy was viewed as an inherited disease and "bad genes" that needs to disappear; the entire context shows it was viewed as psychiatric. Often, "diagnoses" like idiocy, imbecility and so on were added later. It must have been very common in those times to get an encephalitis due to an infection, and several children and grown-ups remained disabled afterwards. Their diagnosis often was "encephalitis", with idiocy, embicility and/or madness being added at some point.
All these cases were treated in Psychiatries; special "units" for brain diseases didn't exist.

One example of a man with Parkinson's due to an encephalitis that was killed in Grafeneck is Martin Bader. Here is a German link: https://www.t4-denkmal.de/Martin-Bader. (I think you will find something in English, too.)

I would be interested in the US history here, since, as far as I know, forced sterilization came from the US. If anyone knows more, please PM me.

 

I have found no information that Parkinson's was viewed as psychosomatic, only that it was viewed as psychiatric. I understand that brain/psyche weren't differentiated. (Something some psychiatrists want to have today again; also, "research" on the genetic background of "psychiatric illnesses" is quite present, something that rings a bell in the past.) I would like to know more, maybe I can find something.

 

The following may give a hint that Parkinson's, like Chorea Huntington, was viewed (at least in Germany) as an inherited nervous disorder:

"Grundriß der menschlichen Erblichkeitslehre und Rassenhygiene, by Erwin Baur, Eugen Fischer, Fritz Lenz" (p. 221).

So not psychosomatic, and not psychological, it seems (but psychiatric would be correct).

The degenerative process led to "idiocy" (which was a psychiatric/psychological diagnosis).

They say, Parkinson's is inherited in a recessive manner, Chorea in a dominant one.

Quite "interesting" what else they say...

 

Egads

For many purposes thats about the same thing.
There are some differences which are not important to get into here.

Much of human "knowledge" before the age of enlightenment either came from the church or serendipity. Since then Science became dominant but serendipity is still with us in smaller forms.

 

Sorry, @Inara, but I don't think that is the case. The fourth edition of Osler (the standard medical textbook) in 1901 quotes Dubief earlier. "Parkinson's disease has no characteristic lesions but on the other hand it is not a neurosis. It has for an anatomical basis the lesions of cerebra-spinal senility, and which only differ from those of true senility in their early onset and greater intensity". By 1912 Lewy bodies had been found and by 1919 pathology in the substantial nigra was documented. One of the classic features of PD is that the patient has a tremor when not thinking about the hand but the tremor disappears when they use it. I am not sure where this psychiatric story comes from. There may have been one or two crackpot neurologists who put this about but it was not the general view as far as I can see.

Similarly epilepsy was not thought to be psychiatric. Again in the nineteenth century, and I suspect in Roman times, it was well known that epilepsy was a sign of brain tumour or brain abscess or meningitis. Status epileptics was a well recognised mode of death in infantile meningitis. The idea that this was thought to be a psychiatric conditions is just not right. Certain forms of epilepsy can be confused with attention seeking behaviour but they are very much the exception.

These conditions are completely different from the ME situation.

Edit: As you say in the second post Parkinsonism may have been considered neuropsychiatric to the extent that in some cases it is associated with dementia. That was entirely appropriate, although we now know that true idiopathic Parkinsonism is not associated with dementia in its own right.

But that seems to be quite unrelated to the situation with ME.

 

@Jonathan Edwards, I was referring to Germany because I have no detailed info about other countries. But since forced sterilization came from the US, these views might haven been more widely shared.

Psychiatry was mental illnesses plus nervous disorders. I forgot the year - when it was separated into neurology, psychology and psychosomatic medicine. Before that, psychiatrists were also called "Nervenarzt" ("nerves doctor").

Maybe it's a bit like today: There was a group of scientists. And there was a group of psychiatrists. The German government (others?) followed the psychiatrists. Also, doctors aren't necessarily scientists.

In Germany, when reading about the murder of 300.000 sick and disabled persons, I learnt that epilepsy and Parkinson's and Chorea were classified as inherited nervous disorders. They were among those diseases of a Reichsgesetz that were viewed as endangering the pureness of genes and race.

By calling it nervous disorder, the organic cause of Parkinson's, epilepsy and Chorea is acknowledged. I've just read a chapter in a "classic" - it was said that "imbecility, idiocy and dumbness" followed these nervous diseases, which are mental illnesses.

https://de.m.wikipedia.org/wiki/Gesetz_zur_Verhütung_erbkranken_Nachwuchses
https://en.m.wikipedia.org/wiki/Law_for_the_Prevention_of_Hereditarily_Diseased_Offspring
(The law was about forced sterilization, but these disease groups are also found in the victims lists.)

These were treated in psychiatric units by psychiatrists (Heil- und Pflegeanstalt = "Healing and Care institutions"), together with "mental illnesses". At least in Germany that was the fact.

As I said, I would like to know how psychiatry in other countries thought about this.

Indeed, I see some parallels to ME and our situation today, but not coming from Parkinson's, more from hysteria.

 

I don't really understand what you are getting at @Inara. It seems that originally psychiatrists were part of neurology - so they were neurologists or Nervenartz. That is how it was in the UK and US I think. Psychiatry split off from neurology, not the other way around.

 

Hm, I hope the following explains better what I mean:
A "Nervenarzt" explained to me it means "Doctor for Psychiatry and Neurology", and it's old-fashioned.

What I wanted to say is that - that's how I understood it - before 1945 at least (maybe before 1988) "Psychiatry" seems to have been a superset of the disciplines "psychiatry" and "neurology" and "psychosomatic medicine", and in that sense it is not incorrect, maybe not 100% accurate, to say Parkinson's was viewed or treated as a psychiatric illness (even though science was more progressed). It is also justified to say that due to the circumstances of that time: people with nervous disorders were treated in psychiatries, and 1940/1941 they were killed (children longer) along with mentally ill people, and before and after that they were sterilized. This is indeed very interesting because it seems to have been not uncommon to get an encephalitis (then it was often due to the Spanish flu) with long-term consequences (like Parkinson's), which was acknowledged, but still people with a disability due to encephalitis were killed or sterilized. One of the explanations may be - from what I have read - that the affected were seen as "weak" from birth on (which seems to have included mental weakness), because, in contrast to others, they fell sick and remained disabled. In view of the "Social Darwinism" of that time, the weak should be actively selected.

My impression was that mental and nervous disorders were all being lumped together and viewed with the same contempt (with exceptions). My feeling is that is something we can find today, too, in other areas though.

Parkinson's was not classified as psychosomatic. I have no deep understanding of psychiatry of the past, but "psychosomatic" is a modern word; it seems to correspond to hysteria, partly. And hysteria was a diagnosis of its own.

I was surprised to read all that about Parkinson's, and I didn't know that Chorea was already known then. It is "interesting".

Do you mean historically? Since I hear and read that for the first time, I kindly need to ask you for a reference so that I can check. Certainly there's something to learn.

 

It seems that neurology as a subject was first recognised with the term in the seventeenth century. 'Psychiatry' was coined either 1808 or 1846, depending on who you believe. I suspect psychiatry never really took off until the craze for psychotherapy around the time of Freud. I don't have any other sources but my understanding is that in the nineteenth century physicians with an interest in nervous diseases, i.e. diseases of the nervous system, had the job of sorting out structural neurological disorders from conditions like schizophrenia and that although there were some with a special interest in the latter (psychiatrists) most people with mental illness just got locked up and forgotten about.

But all this seems to me irrelevant because nobody would ever have put Parkinson's disease under psychiatry (disorders of the soul) even after 1846. I realise that some strange things happened in Germany in the mid twentieth century but I don't think they have much to do with medicine anywhere else.

 

If, by any chance, you come across any references, I'll be interested.

 

The English wikipedia page on the history of neurology could be helpful to start with.

It's wikipedia (no reliable source), but you might find some useful sources there.

I found the German wikipedia page on neurology rather confusing, but perhaps in Germany/ in the German states medicine was a bit special in the 18th and 19th centuries already? One linked source sounds promising:

One of the author's current foci is neuropsychiatry:
http://www.izn-frankfurt.de/web-content/memb_get.php?anzname=Pantel J.

Edit: just checked -- link doesn't work, but inserting the code in your browser will fix it:

Code:

http://www.izn-frankfurt.de/web-content/memb_get.php?anzname=Pantel%20J.

You most probably know how to search the libraries in Germany for (non-e-) journals? ( https://zdb-katalog.de/index.xhtml )

 

Booth, G. (1948). Psychodynamics in Parkinsonism. Psychosomatic Medicine, 10, 1-14.
http://dx.doi.org/10.1097/00006842-194801000-00001
Abstract

Parkinsonism is a syndrome with a specific personality pattern characterised by marked impulses toward action, motor activity, and industriousness accompanied by a striving for independence, authority, and success. Rigid and moralistic behavior patterns are present. The male sex predominates in Parkinsonism. The personality structure is developed from constitutional factors with an emphasis upon aggressiveness and a tendency to be identified with the dominant parent along with "the accident of an inferior position regarding competition in childhood." When the personality is not successfully integrated, disease symptoms appear, satisfying on a symbolic level, rigidity of behavior and compulsiveness of the motor system. 43-item bibliography.

===

i have this note: "Biomedical research did not get taken seriously until the late 1950s."

 

Thank you @MSEsperanza. My impression was after skimming the Wikipedia pages on Neurology and Psychiatry that they seem to have developed independently, which intuitively doesn't make sense.

@Samuel, great find!

 

Actually, I was surprised to find that the idea of Eugenics came from Francis Galton from the UK and was very popular in the US before it came to Germany. It makes sense that Germany was not an enclave of ideologies about sick and disabled people, but it shows very clearly what these ideologies were.

 

Egads
In the end the history of modern science is in some cases not as old as we would think.