American Madness: The Rise and Fall of Dementia Praecox by Richard Noll (review)

Richard Noll provides a detailed, well-documented review of a critical period in European and American psychiatry. In describing the story of the now defunct psychiatric diagnosis, dementia praecox, Noll deftly portrays the scientific and medical world of the late nineteenth and early twentieth centuries. He provides ample evidence distinguishing Kraepelin's concept of "dementia praecox," a progressive, degenerative, biological disease, from later diagnostic classifications of "schizophrenia," which were influenced by psychoanalytic ideas and allowed for treatment and remission. Noll clearly presents this period as a time of great scientific advancement and discovery, as well as of confusion, discouragement, and tension in the clinical and scientific communities on both continents. Clinician scientists struggled to apply new knowledge and innovative laboratory science to solve the most perplexing of clinical dilemmas, mental illness. Professional tensions abounded as American psychiatry developed into a respected profession and attempted to create a place for itself among the European elite. Noll accurately and poignantly details this clinical-scientific world, while integrating the great social, economic, and political chaos that was ongoing in the background.

Noll develops the dementia praecox narrative through the story of its founder, Emil Kraepelin, and those who scientifically and clinically shaped and changed it. He pays particular attention to the contributions of Adolf Meyer, who is responsible for introducing Kraepelin's diagnostic categories in the United States and then rejecting them. Noll's text examines in great detail the personal stories and controversies surrounding these important figures, and traces the development of biological psychiatry in Europe through its passage to America. This includes the interchange that follows as America builds its research enterprise through wealthy philanthropies that were eventually as much desired by Europeans, such as Kraepelin, as Americans. Thus, the story of Kraepelin's disease, its American conception, and eventual conflation with the term "schizophrenia" is explored through a weaving of the social, political, professional, and personal struggles taking place between important scientific and clinical figures and their greater communities. Noll does this in the context of the challenges clinical psychiatry faced as leaders attempted to make sense of poorly understood laboratory results, biological mechanisms, and popular clinical theories, as well as the clinical, social, and political struggles of asylums that were filled with incurable cases. Noll's views are influenced by the work of medical historians, especially Gerald Grob, Charles Rosenberg, and Edward Shorter. The integrated ideas of these scholars provide validity to Noll's claims.

Of particular note is Noll's fascinating chapter on a forgotten American figure, Bayard Taylor Holmes. Holmes is distinctly absent in many historical texts and Noll spends an extensive chapter on Holmes's contributions. A surgeon by training, Holmes turned his intellectual and academic energies toward the quest to find a cure for dementia praecox when his son fell victim to the disease. A mind akin to Kraepelin's in his belief in a biological etiology and with early twentieth-century biological knowledge and surgical tools, Holmes pressed forward to develop a research program to find a cause and cure. In doing so, he ran against the tides of politics and money, finding himself within an American psychiatric community so shaped by Freudian psychoanalytical views that it was unwilling to listen to him. This chapter is crucial, not only because it tells a powerful, untold story, but also because it speaks to current dilemmas and controversies in psychiatry.

Occasionally, Noll makes statements that are superficial or broader than his evidence supports. This is particularly true in his chapter on "The Lost Biological Psychiatry" where depth is lost in some of his analysis. While he gives a fairly lengthy description of the Harvard-trained neuropathologist Elmer Ernest Southard, it is unclear, aside from his early death, why Southard's career and projects do not amount to more. His statement that Southard's rather eclectic interests in activities such as Vedic philosophy and poetry were...