Today, we have made great strides in psychology and mental healthcare with new technologies such as genetic research, MRI’s, CAT scans and other ways to see ailments of the brain at a cellular level. We have developed new treatments and more enlightened approaches to caring for patients with mental disorders. However, these strides started around the turn of the century with great names such as Sigmund Freud, Alfred Binet, Henry H. Goddard, Robert Yerkes etc… These researchers and many more were some of the first pioneers into developing the foundation of our modern treatments and attitudes toward psychiatric disorders despite their sometimes now “outdated” language and theories. Interestingly, many of the works of these great researchers have survived and can be read easily by the public. It’s striking, some of the resemblance to our own methods of research and case studies. Here are some of my most favorite ones to read!:
Alois Alzheimer is the man that Alzheimers disease is named after. He conducted research into dementia disorders in the early 1900’s. Not as well known is his case study of a patient named Auguste Deter. Deter was a woman in her early 50’s who had symptoms of what is now early onset Alzheimers such as memory loss and delusions, as well as behaviors such as screaming in the middle of the night and dragging bed sheets around the house! Her husband committed her to the Institution for the Mentally Ill and for The Epileptics in Frankfurt, Germany in 1901. Alzheimer studied her for a while while she was there. He asked her questions to judge her awareness which she replied “Ich hab mich verloren”, or “I have lost myself” if she didn’t know. Alzheimer kept meticulous notes of all of their interactions and even samples of her handwriting! Alzheimer later moved on to another institution, but was kept in touch with Auguste. She died in 1906 and Alzheimer dissected her brain, revealing later hallmarks of Alzheimers as we know it today. Her medical file was found 90 years after Alzheimer’s death and contains all of the notes on Auguste and Alzheimer’s interactions! Unfortunately, it is not online and I couldn’t find any of Alzheimer’s works either :( However, there are some published extracts form that file:
Nov 26, 1901
She sits on the bed with a helpless expression. What is your name? Auguste. Last name? Auguste. What is your husband’s name? Auguste, I think. Your husband? Ah, my husband. She looks as if she didn’t understand the question. Are you married? To Auguste. Mrs D? Yes, yes, Auguste D. How long have you been here? She seems to be trying to remember. Three weeks. What is this? I show her a pencil. A pen. A purse and key, diary, cigar are identified correctly. At lunch she eats cauliflower and pork. Asked what she is eating she answers spinach. When she was chewing meat and asked what she was doing, she answered potatoes and then horseradish. When objects are shown to her, she does not remember after a short time which objects have been shown. In between she always speaks about twins. When she is asked to write, she holds the book in such a way that one has the impression that she has a loss in the right visual field. Asked to write Auguste D, she tries to write Mrs and forgets the rest. It is necessary to repeat every word. Amnestic writing disorder. In the evening her spontaneous speech is full of paraphrasic derailments and perseverations.
Extracts from Nov 29, 1901
What year is it? Eighteen hundred. Are you ill? Second month. What are the names of the patients? She answers quickly and correctly. What month is it now? The 11th. What is the name of the 11th month? The last one, if not the last one. Which one? I don’t know. What colour is snow? White. Soot? Black. The sky? Blue. Meadows? Green. How many fingers do you have? 5. Eyes? 2. Legs? 2.. . . If you buy 6 eggs, at 7 dimes each, how much is it? Differently. On what street do you live? I can tell you, I must wait a bit. What did I ask you? Well, this is Frankfurt am Main. On what street do you live? Waldemarstreet, not, no. . . . When did you marry? I don’t know at present. I show her a key, a pencil and a book and she names them correctly. What did I show you? I don’t know, I don’t know. It’s difficult isn’t it? So anxious, so anxious. I show her 3 fingers; how many fingers? 3. Are you still anxious Yes. How many fingers did I show you? Well this is Frankfurt am Main.
The patient is asked to recognise objects by touch, with her eyes closed. A toothbrush, sponge, bread, breadroll, spoon, brush, glass, knife, fork, plate, purse, Mark, cigar, key. She recognises them quickly and correctly. By touch she calls a brass cup a milk jug, a tea-spoon, but when she opens her eyes she immediately says a cup. Writing, she does it as already described. When she has to write Mrs Auguste D, she writes Mrs and we must repeat the other words because she forgets them. The patient is not able to progress in writing and repeats, I have lost myself. No disturbance in speech articulation. She frequently interrupts herself in the articulation of words during the interview (as if she did not know whether she had said something correctly or not). During physical examination she cooperates and is not anxious. When she was brought from the isolation room to the bed she became agitated, screamed, was non-cooperative; ; showed great fear and repeated I will not be cut. I do not cut myself…”
That is as much as I found on her file. The extract comes from here: Auguste D and Alzheimer’s disease. I wish there was more on her case and that they could make a movie about it. Luckily, there is a TV program on it, but it is entirely in German!
My other favorite read is an entire book online called The Intelligence of The Feeble Minded by Alfred Binet in 1916. It details extensively the studies done on multiple patients ranging from “Idiots”, to “Imbeciles” and what they are cognitively capable of doing, as well as physical sensations such as pain. Some colorful cases are Denise, a “low grade imbecile” who is always cheerful and imitated everything Alfred Binet did with her. Also this little vignette with a patient called “cretin” during a pain study:
“First notice Denise,a low grade imbecile, a short little woman of twenty-ﬁve years with small black eyes brilliant and mobile,who is extremely pleasant.The moment she enters the ofﬁce, she holds out her hand and begins to laugh, showing her beautiful white teeth. She laughs at everything and nothing; she is very docile, even affectionate.”
“Cretin, middle grade imbecile, behaved altogether differently. In order to learn her sensibility to pain, we raised her sleeve, slightly pinching her arm. At ﬁrst, she seemed amused, and smiled; indeed it was her ﬁrst smile that day. Then when we attempted a second time to pinch her, she defended herself drawing back her arm vigorously. We seized her wrist without, however, causing her pain. It was never the less the beginning of a contest; the child began to cry loudly, and to sob,hiding her face behind her sleeve. At the end of several seconds the sobs stopped of themselves. We gave her a sou which she eagerly took and pocketed. But in spite of the gift her sullen attitude only increased, she stood up and insisted upon leaving us, repeating several times, “Me go”.Q.Where?A.Eat.Q.Eat what?A.They are eating.Q.You are going to eat?A. Yes, it is time.Q. But stay just a minute, are you afraid of us?A. I go eat.”