Max Fink

What are the real disease entities in psychiatry? This is a question that has bedeviled the study of the mind for more than a century yet it is low on the research agenda of psychiatry. Basic science issues such as neuroimaging, neurochemistry, and genetics carry the day instead. There is nothing wrong with basic science research, but before studying the role of brain circuits or cerebral chemistry, shouldn't we be able to specify how the various diseases present clinically? Catatonia is a human behavioral syndrome that for almost a century was buried in the poorly designated psychiatric concept of schizophrenia. Its symptoms are well-know, and some of them are serious. Catatonic patients may die as their temperatures accelerate; they become dehydrated because they refuse to drink; they risk inanition because they refuse to eat or move. Autistic children with catatonia may hit themselves repeatedly in the head. We don't really know what catatonia is, in the sense that we know what pneumonia is. But we can identify it, and it is eminently treatable. Clinicians can make these patients better on a reliable basis. There are few other disease entities in psychiatry of which this is true. So why has there been so little psychiatric interest in catatonia? Why is it simply not on the radar of most clinicians? Catatonia actually occurs in a number of other medical illnesses as well, but it is certainly not on the radar of most internists or emergency physicians. In The Madness of Fear, Drs. Shorter and Fink seek to understand why this "vast field of ignorance" exists. In the history of catatonia, they see a remarkable story about how medicine flounders, and then seems to find its way. And it may help doctors, and the public, to recognize catatonia as one of the core illnesses in psychiatry.

The riddle of melancholia has stumped generations of doctors. It is a serious depressive illness that often leads to suicide and premature death. The disease's link to biology has been intensively studied. Unlike almost any other psychiatric disorder, melancholia sufferers have abnormal endocrine functions. Tests capable of separating melancholia from other mood disorders were useful discoveries, but these tests fell into disuse as psychiatrists lost interest in biology and medicine. In the nineteenth century, theories about the role of endocrine organs encouraged endocrine treatments that loomed prominently in practice. This interest faded in the 1930s but was revived by the discovery of the adrenal hormone cortisol and descriptions of its abnormal functioning in melancholic and psychotic depressed patients. New endocrine tests were devised to plumb the secrets of mood disorders. Two colorful individuals, Bernard Carroll and Edward Sachar, led this revival and for a time in the 1960s and 1970s intensive research interest established connections between hormone dysfunctions and behavior. In the 1980s, psychiatrists lost interest in hormonal approaches largely because they did not correlate with the arbitrary classification of mood disorders. Today the relation between endocrines and behavior have been disregarded. This history traces the enthusiasm of biological efforts to solve the mystery of melancholia and their fall. Using vibrant language accessible to family care practitioners, psychiatrists and interested lay readers, the authors propose that a useful, a potentially live-saving connection between medicine and psychiatry, has been lost.

This book provides a comprehensive review of melancholia as a severe disorder of mood, associated with suicide, psychosis, and catatonia. The syndrome is defined with a clear diagnosis, prognosis, and range of management strategies, differentiated from other similar psychiatric, neurological, and general medical conditions. It challenges accepted doctrines in the classification and biology of the mood disorders and defines melancholia as a treatable mental illness. Described for millennia in medical texts and used as a term in literature and poetry, melancholia was included within early versions of the major diagnostic classificatory systems, but lost favour in later editions. This book updates the arguments for the diagnosis, describes its characteristics in detail, and promotes treatment and prevention. The book offers great hope to those with a disorder too often mis-diagnosed and often fatal. It should be read by all those responsible for the management of patients with mood disorders.

Catatonia is a syndrome of motor dysregulation (mutism, peculiar postures, repetitive speech, negativism and imitative movements), and is found in as many as ten per cent of acutely ill psychiatric inpatients. Although its classification has been controversial, the identification of catatonia is not difficult, but it is often missed, leading to the false notion that the syndrome is rare. Catatonia has various presentations, and may be caused by many neurologic and general medical conditions, most commonly mood disorder. Treatments are well defined, and when used, catatonia has an excellent prognosis. This book, by two leading neuropsychiatrists, describes the features of catatonia, teaches the reader how to identify and treat the syndrome successfully, and describes its neurobiology. Patient vignettes from the authors' practices, and many from the classical literature, illustrate the principles of diagnosing and treating patients with catatonia. It is an essential clinical reference for psychiatrists and neurologists.

This book provides a comprehensive review of melancholia as a severe disorder of mood, associated with suicide, psychosis, and catatonia. The syndrome is defined with a clear diagnosis, prognosis, and range of management strategies, differentiated from other similar psychiatric, neurological, and general medical conditions. It challenges accepted doctrines in the classification and biology of the mood disorders and defines melancholia as a treatable mental illness. Described for millennia in medical texts and used as a term in literature and poetry, melancholia was included within early versions of the major diagnostic classificatory systems, but lost favour in later editions. This book updates the arguments for the diagnosis, describes its characteristics in detail, and promotes treatment and prevention. The book offers great hope to those with a disorder too often mis-diagnosed and often fatal. It should be read by all those responsible for the management of patients with mood disorders.

Few mental illness treatments are more reviled in the public mind than Electroconvulsive Shock Therapy. However, in reality, ECT is a safe and effective treatment for cases of clinical depression and catatonia that are unresponsive to drug therapy. Also, unlike drugs, ECT has relatively few side effects. The authors argue that it is time for this historically stigmatized procedure to be reevaluated. The authors make a strong case for greater professional and public attention to the procedure's benefits, offering historical coverage of ECT-related movements, legislation, public and practitioner sentiment and the introduction of competing treatments. This volume will not only garner the interest of mental health professionals, but will call on policy makers and ethicists to examine its arguments.

Electroshock therapy (ECT) has long suffered from a controversial and bizarre public image, a reputation that has effectively removed it as a treatment option for many patients. In Electroshock, Max Fink draws on 45 years of clinical and research experience to argue that ECT is now a safe, effective, painless, and sometimes life-saving treatment for emotional and mental disorders. Dr Fink discusses the development of ECT from its discovery in 1934, its acceptance and widespread use for two decades until it was largely replaced by the introduction of psychotropic drugs in the 1950s, and its revival in the past twenty years as a viable treatment now that undesirable side-effects have been largely removed. He provides case studies of actual patients and the testimonies of their family members to illuminate successful responses. Many disorders, such as depression, mania, catatonia, and schizophrenia, respond well to ECT. We learn what the patient experiences, as the author explains the whole procedure from preparation to recovery. He also shows how anaesthesia and muscle relaxation have refined ECT, minimizing discomfort and reducing its risks to a level far lower than many of the psychotropic drugs routinely prescribed for the same problems. An excellent sourcebook for patients, their families, caretakers, and mental health professionals, Electroshock clarifies misconceptions about ECT. For those who suffer from mental and emotional disorders, it offers a safe and highly effective treatment.

Electroshock therapy (ECT) has long suffered from a controversial and bizarre public image, a reputation that has effectively removed it as a treatment option for many patients. In Electroshock, Max Fink, M. D., draws on 45 years of clinical and research experience to argue that ECT is now a safe, effective, painless, and sometimes life-saving treatment for emotional and mental disorders. Dr. Fink discusses the development of ECT from its discovery in 1934, its acceptance and widespread use for two decades until it was largely replaced by the introduction of psychotropic drugs in the 1950s, and its revival in the past twenty years as a viable treatment now that undesirable side-effects have been largely removed. He provides case studies of actual patients and the testimonies of their family members to illuminate successful responses. Many disorders, such as depression, mania, catatonia, and schizophrenia, respond well to ECT. We learn what the patient experiences, as the authoer explains the whole procedure from preparation to recovery. He also shows how anesthesia and muscle relaxation have refined ECT, minimizing discomfort and reducing its risks to a level far lower than many of the psychotropic drugs routinely prescribed for the same problems. An excellent sourcebook for patients, their families, caretakers, and mental health professionals, Electroshock clarifies misconceptions about ECT. For those who suffer from mental and emotional disorders, it offers a safe and highly effective alternative to medication or psychotherapy.