Philosophy 2044F/G Lecture Notes - Lecture 8: Folie À Deux (Album), Philippe Pinel, Forensic Psychiatry
13 Jun 2018
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What is Esuiol’s otiutio to ou udestadig of delusios?
Explai Esuiol’s oept of ooaia.
(3) What is a delusion according to Jaspers?
(4) What kinds of delusions are there according to DSM 5?
Video:
- #1: Chronic simple schizophrenia, Vague, empty, childish manner, reaction emotionally is
inappropriate (smiling when asked about loneliness), impoverishment of personality but
memory and orientation are not impaired, hallucinations
o Patient is 40, lives quietl i hospital, doest i ith othe patiets, have strange
feeligs of eig otolled, doest talk if ot talked to, likes uite eioet,
heas oies talkig to he, oies take aa he talkig, haet see fail fo
quite some time,
- #2: patients have schizophrenia catatonic type:
o Leading symptom is lack of activity and immobility, totally oblivious of environment,
changes of expressions is usually due to fantasies, negativism, mutism, automatic
obedience,
- #3: FOLIE A DEUX:
o 2 patients suffering from induced insanity or folie a deux, develops in one person
and then communicated to another person, parent and child or husband and child
can become patients,
o In this case, mother and daughter were separated but mother became very
depressed so they had to be brought together
o Witchcraft believed by mother
o Daughter claims that some people to be criminals that hurt her
o Daughter primarily effected, mother relies/depends on daughter
o Paranoid delusions
o Delusions are a form of belief to which people hold on to besides everything else no
matter what, even if there is contrary evidence
- Schizophrenia has both symptoms, positive and negative
o Positive signs-symptoms: delusions, hallucinations, disorganized speech, grossly
disorganized or catatonic behaviour
o Negative signs-symptoms: diminished emotional expression or avolition (no volition
is avolition)
- Karl jasper general psychopathology: the theory of the different illnesses of the soul or the
mind
o Form signs or symptoms: form is derailment or the way she was expressing her
belief, was thought insertion for e.g. daughter thought beliefs were put in her mind,
whispering vs screaming to explain (how its said)
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o Content signs or symptoms: content was persecuting in the video we watched of
mother and daughter (what is being said)
o Form in which the content is presented matters, if content is normal but you explain
that in tears then you may have a problem,
DSM 5 Schizophrenia reading:
- Delusion: not the same as delirium, these are fixed beliefs that a person has, these are
maintaianed without any reasonable evidence, in mental illness we are looking for bizarre
delusions
- Hallucinations: perception-like experiences that occur without an external stimulus
- sig a e patiets lood pessue fo istae is ojetie ake ut sptos is
subjective being expressed in behaviour example in talking, gestures, sign and symptom
used interchangeably
- Esquiral: turning point in the establishment of psychiatry, first attempt to define the word
hallucination, tried to successfully distinguish it from illusions, (look for definition of these
terms in readings),
- Delia is another term highlighted by Esquiral
Jean-Etienne Esquirol (1772-1840) by Louis Charland:
- Born in Toulouse, France, died in Paris aged 69
- One of the founders of psychiatry as a scientific, clinical discipline along with Philippe Pinel
- After studding medicine in Toulouse, he moved to Paris where in 1802 he opened one of the
first private medical establishments in France devoted to care of mentally ill under the
direction of a medical doctor
- Studied under Pinel at Salpetriere hospital for women in Paris, while being here he launched
a series of clinical education courses specifically directed to the study of mental disease and
pathology that reformed Faculty of Medicine in Paris → now psychiatry has its own distinct
academic curriculum and specialized clinical training
- Contributed to nosology and therapeutics too
- Pioee alog ith Piel to oal teatet the fist eidee ased pshotheapeuti
approach to treatment of mental illness
- Believed passions were central in etiology of mental illness
o Passions were among the leading causes and symptoms of mental illness and also
significant in its cure acc. to Esquirol
- Played important role in development of govt policies and programs about distribution and
administration of mental health treatment facilities in France
- Pioneering role in establishment of forensic psychiatry as a professional domain of expertise
- Published one of the first official clinical textbooks of psychiatry
- Oe of the fist edial thike to liiall defie halluiatio i a a that it diffeed
fo illusio
o Hallucination relied heail o the oept alled delie
o Delire is one of the most important yet hard to explain and translate terms in
psychiatry
o He said hallucination is symptom of delire or delirium (English translation
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o But delire could also be translated to the English word of delusion. Both these
translations differed greatly
▪ Delusion: thought of as a purely intellectual phenomenon e.g. a belief or
judget thats pesistetl held despite stog ota eidee eist
▪ For Pinel and Esquirol, delire was not restricted to intellect only rather it
could also include pathological symptoms
o Although hallucination may be a frequent cause or symptom of delire, they are
clinically distinguishable from delire as hallucinations may persist even when delire
has ceased and vice versa
o Proposed that hallucinations may take various sensory forms may be visual,
auditory, tactile, olfactory etc. → they form a homogenous class and exhibit a
set i thei aious aifestatios. Hoee, at the sae tie he states
that halluiations are a cerebral or mental phenomenon which is produced
idepedetl of the seses → this makes them very different from illusions who
are errors of the senses
o Hallucinations begin and reside in brain while illusions involve errors or distortions
of information that originates at the sensory periphery
o Heaig loks tikig he its ot is halluiatio ut seeig a suae toe as
round is illusion
- So what is delire? For French thinkers delire is a general term of art that designates a kind of
mental disturbance that can take various forms, ranging from delusions to delirium, which is
a mixed mental disturbance where volitional and affective features are primary
- Aothe ajo otiutio is the oept of ooaia, a liial oept ad disease
atego had to eplai, still used toda o alled phoaia
o Became infamous quickly as it was very widely overused
o With the additio of the pefi aia, it as used to ultipl etal aladies
indiscriminately e.g. erotomania, dipsomania, lypemania, nymphomania,
kleptomania etc.
o Aothe ipotat oept is aie plaig a etal ole i ooaia. Esuiol
states that it is a species of insanity where intellectual, affective, and volitional
lesions cause a rupture in mental functioning that leads to a suspension or
alienation from reason → disorganization, agitation, fury hallmarks of manie,
individual here is totally alienated from reason
o In monomania, delire is not total or general rather its partial and fixed
o Monomaniacs often reason but they typically reason in a manner that adheres to a
fied, elusie idea thats usuall false o deluded → its a kid of elusie
delusion
o Lypemania is the most popular and convincing example of monomania
▪ Monomania is primarily an affective form of mental disturbance
▪ Delirium of monomaniacs is fixed and permanent
▪ 2 varieties of monomania:
• One indicated by partial delirium and a gay or excited passion
• 2nd monomania signalized by partial delirium and a sad or
depressing passion → also called melancholia
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Document Summary
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