In the literature of the seventeenth and eighteenth centuries (and indeed of earlier periods), it is possible to recognize behaviours that nowadays we may wish to refer as dementia being reported under different rubrics. For example, in relation to ‘Stupidity or Foolishness’, Thomas Willis (1684) wrote:
although it chiefly belongs to the rational soul, and signifies a defect of the intellect and judgement, yet it is not improperly reckoned among the diseases of the head or brain; for as much as this eclipse of the superior soul proceeds from the imagination and the memory being hurt, and the failing of these depends upon the faults of the animal spirits, and the brain itself (p. 209).
Willis suggested that stupidity might be genetic (‘original’, as when ‘fools beget fools’) or caused by ageing (‘Some at first crafty and ingenious, become by degrees dull, and at length foolish, by the mere declining of age, without any great errors in living’) (p. 211), or other causes such as ‘strokes or bruising upon the head’, ‘drunkenness and surfeiting’, ‘violent and sudden passions’ and ‘cruel diseases of the head’ such as epilepsy.
The same is the case with Boissier de Sauvages (1771), one of the great classificators of the eighteenth century. Order 3rd (8th class) of his Nosographie Methodique encompasses delirium, paraphrosyne, imbecility, melancholia, demonomania and mania. Synonyms of ‘Imbecility are Bêtise (stupidity, foolishness), Niaiserie (silliness), and Démence; in Greek paranoia, and in Latin Dementia, Fatuitas, Vecordia. The term is used to refer to patients who are fools, (fous), imbeciles (imbécilles), mentally weak (foibles d’esprit), mad (insensés)’ (p. 723).
Boissier lists 12 subtypes of imbecility of which the first one is the imbecility of the elderly (L’imbécillite de vieillard), also known as puerile state, drivelling or senile madness, and which he explains thus: ‘Because of the stiffness of their nervous fibres, old people are less sensitive to external impressions …’ (p. 724).
In the Nosographie (1818; first published 1798), Pinel dealt with cognitive impairment under amentia and morosis, which he explains as a failure in the association of ideas leading to disordered activity, extravagant behaviour, superficial emotions, memory loss, difficulty in the perception of objects, obliteration of judgement, aimless activity, automatic existence, and forgetting of words or signs to convey ideas. He also referred to démence senile (para 116). Pinel did not emphasize the difference between congenital and acquired dementia (Pinel 1806).
The above entries summarize well views on dementia before the nineteenth century. There was, first of all, a ‘legal’ meaning according to which dementia was a state of non-imputability.
In France, this was enshrined in Article 10 of the Napoleonic Code: ‘There is no crime when the accused is in a state of dementia at the time of the alleged act’ (Code Napoléon, 1808).
Second, there was a clinical meaning. This could be very general (i.e. a synonym of madness) or specific, i.e. a clinical condition that was differentiable from mania (which, at the time, described any state of acute excitement, be it schizophrenic, hypomanic, or organic) and delirium (which referred, more or less, to what goes on nowadays under the same name).
Although chronic, dementia could still be reversible, affect individuals of any age, and be a final common pathway, i.e. the end deficit for many other mental disorders. This created a template for the alienists of the nineteenth century.
Alistair Burns MPhil, MD, FRCP, FRCPsych
Professor of Old Age Psychiatry,
John O’Brien MA, DM, FRCPsych
Professor of Old Age Psychiatry,
Institute for Ageing and Health,
University of Newcastle upon Tyne,
Newcastle upon Tyne, UK
David Ames BA, MD, FRCPsych, FRANZCP
Professor of Psychiatry of Old Age,
University of Melbourne, St George’s Hospital, Melbourne,
German Berrios BA (OXFORD), MD, DM H.C. HEIDELBERG, FRCPsych, FBPSS
University of Cambridge Department of Psychiatry,
- Alzheimer A. (1907) Uber eine eigenartige Erkrankung der Hirnrinde.
- Allgemeine Zeitschrift fur Psychiatrie und Psychisch-Gerichtlich Medizine 64: 146-148
- Alzheimer A. (1911) Uber eigenartige Krankheitsfalle des spateren Alters. Zeitschrift fur die gesamte Neurologie und Psychiatrie 4: 356-385
- Anderson EW, Threthowan WH, Kenna JC. (1959) An experimental investigation of simulation and pseudodementia. Acta Psychiatrica et Neurologica Scandinavica 34 (Suppl. 132)
- Anonymous (1832) An exposure of the unphilosophical and unchristian expedients adopted by antiphrenologists, for the purpose of obstructing the moral tendencies of phrenology. A review of John Wayte’s book. The Phrenological Journal and Miscellany 7: 615-622
- Baillarger J. (1883) Sur la theorie de la paralysie generale. Annales Medico-Psychologiques 35: 18-52; 191-218
- Baillarger J. (1889) Doit-on dans la classification des maladies mentales assigner une place a part aux pseudo-paralysies generales? Annales Medico-Psychologiques 41: 521-525
- Ball B and Chambard E. (1881) Demence. In: A. Dechambre and L. Lereboullet (eds), Dictionnaire Encyclopedique des Sciences Medicales. Paris, Masson, pp. 559-605
- Barrett AM. (1913) Presenile, arteriosclerotic and senile disorders of the brain and cord. In: WA White and SA Jelliffe (eds), The Modern Treatment of Nervous and Mental Diseases. London, Kimpton, pp. 675-709