Edward Shorter - Böcker

Psychotic depression is a distinct and acute clinical condition along the spectrum of depressive disorders. It can manifest itself in many ways and often induces very violent and suicidal behavior. This book aims to help clinical practitioners and trainees describe their observations of psychotic depression, formulate treatment, and express expectations of recovery from illness. It focuses on all facets of the disorder, from clinical history to coverage of diagnostic and treatment protocols. Medical readers of this book will come away able to diagnose and readily treat psychotic depression and thus will be able to serve their patients better. Non-physician readers will come away with the message that this is a terrible illness, but there is hope.

Shock therapy is making a comeback today in the treatment of serious mental illness. Despite its reemergence as a safe and effective psychiatric tool, however, it continues to be shrouded by a longstanding negative public image, not least due to films such as the classic One Flew over the Cuckoo's Nest, where the inmate of a psychiatric clinic (played by Jack Nicholson) is subjected to electro-shock to curb his rebellious behavior. Beyond its vilification in popular culture, the stereotype of convulsive therapy as a dangerous and inhumane practice is fuelled by professional posturing and public misinformation. Electroconvulsive therapy, or ECT, has in the last thirty years been considered a method of last resort in the treatment of debilitating depression, suicidal ideation, and other forms of mental illness. Yet, ironically, its effectiveness in treating these patients would suggest it as a frontline therapy, bringing relief from acute symptoms and saving lives. In this book, Edward Shorter and David Healy trace the controversial history of ECT and other "shock" therapies. Drawing on case studies, public debates, extensive interviews, and archival research, the authors expose the myths about ECT that have proliferated over the years. By showing ECT's often life-saving results, Shorter and Healy endorse a point of view that is hotly contested in professional circles and in public debates, but for the nearly half of all clinically depressed patients who do not respond to drugs, this book brings much needed hope.

"PPPP . . . To compress 200 years of psychiatric theory and practice into a compelling and coherent narrative is a fine achievement . . . . What strikes the reader [most] are Shorter's storytelling skills, his ability to conjure up the personalities of the psychiatrists who shaped the discipline and the conditions under which they and their patients lived."--Ray Monk The Mail on Sunday magazine, U.K. "An opinionated, anecdote-rich history. . . . While psychiatrists may quibble, and Freudians and other psychoanalysts will surely squawk, those without a vested interest will be thoroughly entertained and certainly enlightened."--Kirkus Reviews. "Shorter tells his story with immense panache, narrative clarity, and genuinely deep erudition."--Roy Porter Wellcome Institute for the History of Medicine. In A History of Psychiatry, Edward Shorter shows us the harsh, farcical, and inspiring realities of society's changing attitudes toward and attempts to deal with its mentally ill and the efforts of generations of scientists and physicians to ease their suffering. He paints vivid portraits of psychiatry's leading historical figures and pulls no punches in assessing their roles in advancing or sidetracking our understanding of the origins of mental illness. Shorter also identifies the scientific and cultural factors that shaped the development of psychiatry. He reveals the forces behind the unparalleled sophistication of psychiatry in Germany during the eighteenth and nineteenth centuries as well as the emergence of the United States as the world capital of psychoanalysis. This engagingly written, thoroughly researched, and fiercely partisan account is compelling reading for anyone with a personal, intellectual, or professional interest in psychiatry.

This fascinating history of psychosomatic disorders shows how patients throughout the centuries have produced symptoms in tandem with the cultural shifts of the larger society. Newly popularized diseases such as "chronic fatigue syndrome" and "total allergy syndrome" are only the most recent examples of patients complaining of ailments that express the truths about the culture in which they live.

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.

This is the first historical dictionary of psychiatry. It covers the subject from autism to Vienna, and includes the key concepts, individuals, places, and institutions that have shaped the evolution of psychiatry and the neurosciences. An introduction puts broad trends and international differences in context, with an extensive bibliography for further reading. Each entry gives the main dates, themes, and personalities involved in the unfolding of the topic. Longer entries describe the evolution of such subjects as depression, schizophrenia, and psychotherapy. The book gives ready reference to when things happened in psychiatry, how and where they happened, and who made the main contributions. In addition, it touches on such social themes as "women in psychiatry," "criminality and psychiatry," and "homosexuality and psychiatry." A comprehensive index makes immediately accessible subjects that do not appear in the alphabetical listing. Bringing together information from the English, French, German, Italian, and Scandinavian languages, the dictionary rests on an enormous base of primary sources that cover the growth of psychiatry through all of Western society.

Psychiatry today is a barren tundra, writes medical historian Edward Shorter, where drugs that don't work are used to treat diseases that don't exist. In this provocative volume, Shorter illuminates this dismal landscape, in a revealing account of why psychiatry is "losing ground" in the struggle to treat depression.Naturally, the book looks at such culprits as the pharmaceutical industry, which is not inclined to market drugs once the patent expires, leading to the endless introduction of new--but not necessarily better--drugs. But the heart of the book focuses on an unexpected villain: the FDA, the very agency charged with ensuring drug safety and effectiveness. Shorter describes how the FDA permits companies to test new products only against placebo. If you can beat sugar pills, you get your drug licensed, whether or not it is actually better than (or even as good as) current medications, thus sweeping from the shelves drugs that may be superior but have lost patent protection. The book also examines the FDA's early power struggles against the drug industry, an influence-grab that had little to do with science, and which left barbiturates, opiates, and amphetamines all underprescribed, despite the fact that under careful supervision they are better at treating depression, with fewer side effects, than the newer drugs in the Prozac family. Shorter also castigates academia, showing how two forms of depression, melancholia and nonmelancholia--"as different from each other as chalk and cheese"--became squeezed into one dubious classification, major depression, which was essentially a political artifact born of academic infighting.An astonishing and troubling look at modern psychiatry, Losing Ground is a book that is sure to spark controversy for years to come.

The Age of Psychopharmacology began with a brilliant rise in the 1950s, when for the first time science entered the study of drugs that affect the brain and mind. But, esteemed historian Edward Shorter argues that there has been a recent fall, as the field has seen its drug offerings impoverished and its diagnoses distorted by the "Diagnostic and Statistical Manual of Mental Disorders." The new drugs, such as Prozac, have been less effective than the old. The new diagnoses, such as "major depression," have strayed increasingly from the real disorders of most patients. Behind this disaster has been the invasion of the field by the pharmaceutical industry. This invasion has paid off commercially but not scientifically: There have been no new classes of psychiatry drugs in the last thirty years. Given that psychiatry's diagnoses and therapeutics have largely failed, the field has greatly declined from earlier days. Based on extensive research discovered in litigation, Shorter provides a historical perspective of change and decline over time, concluding that the story of the psychopharmacology is a story of a public health disaster.

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 argues that psychiatry's love affair with the diagnosis of depression has become a death grip. Depression is a real illness, especially in its melancholic form. But most patients who get the diagnosis of 'depression' are also anxious, fatigued, unable to sleep, have all kinds of physical symptoms, and tend to obsess about the whole thing. They do not have a disorder of 'mood'. It is a travesty to call them all 'depressed.' How did this happen? How did everyone become depressed? A well-known historian, the author describes how in the 19th century patients with those symptoms were considered 'nervous,' and when they lost control it was a 'nervous breakdown.' Then psychiatry turned its back on the whole concept of nerves, and - first under the influence of Freud's psychoanalysis and then the influence of the pharmaceutical industry - the diagnosis of depression took center stage. The result has been a scientific disaster, leading to the misdiagnosis and inappropriate treatment (with antidepressants) of millions of patients. Urging that the diagnosis of depression be re-thought, the book turns a dramatic page in the understanding of psychiatric symptoms that are as common as the common cold. The book makes an immediate contribution to the debate about DSM5, which is due to be released very soon, in terms of discussing the diagnosis of depression. The author controversially proposes replacing the diagnosis of 'major depression' with 'melancholia' and 'nonmelancholia'; he argues that depression and anxiety usually occur together and are really the same disease; and he says that patients with so-called mood disorders really have a disorder of the entire body. The author's ability to make use of the enormous well of psychiatry's past history in several languages make this a unique book that contributes to the important discussions today of diagnosis and treatment.

Psychotic depression is a distinct and acute clinical condition along the spectrum of depressive disorders. It can manifest itself in many ways and often induces very violent and suicidal behavior. This book aims to help clinical practitioners and trainees describe their observations of psychotic depression, formulate treatment, and express expectations of recovery from illness. It focuses on all facets of the disorder, from clinical history to coverage of diagnostic and treatment protocols. Medical readers of this book will come away able to diagnose and readily treat psychotic depression and thus will be able to serve their patients better. Non-physician readers will come away with the message that this is a terrible illness, but there is hope.

Written in the Flesh is a history of sexual desire – a startling and provocative history of what people yearn to do sexually. It is the story of the whole body's need for sexual attention rather than simply the genitalia and their procreational function. The desire for sexual pleasure and total body sex – that is, the expansion of sexuality from a limited focus on the face and genitals to include the entire body – is certainly not a new phenomenon: the ancient Greeks, Romans, and Chinese, amongst others, were quite familiar with eroticism that went beyond the strictly heterosexual and procreational. In the long centuries of Christian Europe, when miserable conditions of life and religious repression conspired to minimize the expression of sexual longing, desire was driven underground. Yet in the late nineteenth century, increasing privacy, prosperity, and good health again permitted the underlying biological urge for total body sex to express itself, and encouraged a shift of erotic pleasure toward new and unexplored body zones: the mouth, nipples, anus, and further. This new work by renowned medical historian Edward Shorter demonstrates that desire is hard-wired into the brain, expressing itself in remarkably similar ways in men and women, adolescent and adult, and in gays, lesbians, and straights alike. Drawing from a wide array of sources, including memoirs, novels, collections of letters, diaries, and indeed a large pornographic corpus, Shorter explores the widening of Western society's sexual repertoire. Written in the Flesh is a history of what people like to do in bed and how that has changed. The change is relentless: human sexuality continually seeks new means of liberation in its expression of pleasure.

What has been the source of women's oppression by men? Shorter argues that women were victimized by their own bodies. Exploring five centuries of medical records and folklore from Europe and the US, he shows how pregnancy, childbirth, and gynecological disease have kept women in positions of social

With every passing year, the mutual mistrust between doctor and patient widens, as doctors retreat into resentment and patients become increasingly disillusioned with the quality of care. Rich in anecdote as well as science 'Doctors and Their Patients' describes how both have arrived at this sad shape.

With every passing year, the mutual mistrust between doctor and patient widens, as doctors retreat into resentment and patients become increasingly disillusioned with the quality of care. Rich in anecdote as well as science 'Doctors and Their Patients' describes how both have arrived at this sad shape.

This book describes how women's physical experience historically has affected the whole constellation of values that represents womanliness, and the constellation of power relationships that binds men and women together. It explores the role of herbs and of mechanical procedures for abortion.

Choice Recommended ReadWhat Psychiatry Left Out of the DSM-5: Historical Mental Disorders Today covers the diagnoses that the Diagnostic and Statistical Manual of Mental Disorders (DSM) failed to include, along with diagnoses that should not have been included, but were. Psychiatry as a field is over two centuries old and over that time has gathered great wisdom about mental illnesses. Today, much of that knowledge has been ignored and we have diagnoses such as "schizophrenia" and "bipolar disorder" that do not correspond to the diseases found in nature; we have also left out disease labels that on a historical basis may be real. Edward Shorter proposes a history-driven alternative to the DSM.

Choice Recommended ReadWhat Psychiatry Left Out of the DSM-5: Historical Mental Disorders Today covers the diagnoses that the Diagnostic and Statistical Manual of Mental Disorders (DSM) failed to include, along with diagnoses that should not have been included, but were. Psychiatry as a field is over two centuries old and over that time has gathered great wisdom about mental illnesses. Today, much of that knowledge has been ignored and we have diagnoses such as "schizophrenia" and "bipolar disorder" that do not correspond to the diseases found in nature; we have also left out disease labels that on a historical basis may be real. Edward Shorter proposes a history-driven alternative to the DSM.

Great innovations take place within great institutions. Founded in 1819, Toronto General Hospital (TGH) is one of Canada’s oldest hospitals and has created a nurturing environment for early Canadian innovations in heart surgery. The Heartbeat of Innovation tells the story of the brilliant surgeons who worked there and the hospital environment that provided an incubator to the many people – skilled perfusionists, dedicated nurses, and pioneering cardiologists – who participated in the revolution in heart surgery that took place along University Avenue in Toronto.Supported by historical records, hospital archives, personal memoirs, and interviews, this book is an extensive and descriptive account of the seemingly inexorable development of cardiac surgery at this leading academic health science centre. It pursues several themes: the complexity of this surgical specialty, its generally male-dominated nature, the trend toward teamwork in practice, and the evolution and incorporation of original research into this branch of healthcare. These strands are woven together to demonstrate how the TGH has evolved into such a dominant leader in the competitive and demanding field of cardiac surgery. Canadian hearts may beat with pride at the knowledge that one of the major stories in modern medicine took place here – and continues here.

The University of Toronto’s Faculty of Medicine is North America’s largest medical school and a major health consortium, boasting nine affiliated teaching hospitals and a network of research institutes. It is where insulin was pioneered, stem cells were first discovered, and famous physicians from Vincent Lam to Sheela Basrur began their careers. But despite all its major accomplishments, the faculty’s impressive history has never before been comprehensively documented.In Partnership for Excellence, senior medical historian and award-winning author Edward Shorter details the Faculty of Medicine’s history from its inception as a small provincial school to its present day status as an international powerhouse. Deeply researched through front-line interviews and primary sources, it ties the story of the faculty and its teaching hospitals to the general history of medicine over this period. Shorter emphasizes the enormous concentration of intellectual energy in the faculty that has allowed it to become the dominant force in Canadian medicine, home to a legion of medical pioneers and achievements.

According to Edward Shorter, just forty years ago the institutions housing people with mental retardation (MR) had become a national scandal. The mentally retarded who lived at home were largely isolated and a source of family shame. Although some social stigma still attaches to the people with developmental disabilities (a range of conditions including what until recently was called mental retardation), they now actively participate in our society and are entitled by law to educational, social, and medical services. The immense improvement in their daily lives and life chances came about in no small part because affected families mobilized for change but also because the Kennedy family made mental retardation its single great cause. Long a generous benefactor of MR-related organizations, Joseph P. Kennedy made MR the special charitable interest of the family foundation he set up in the 1950s. Although he gave all of his children official roles, he involved his daughter Eunice in performing its actual work -- identifying appropriate recipients of awards and organizing the foundation's activities.With unique access to family and foundation papers, Shorter brings to light the Kennedy family's strong commitment to public service, showing that Rose and Joe taught their children by precept and example that their wealth and status obligated them to perform good works. Their parents expected each of them to apply their considerable energies to making a difference. Eunice Kennedy Shriver took up that charge and focused her organizational and rhetorical talent on putting MR on the federal policy agenda. As a sister of the President of the United States, she had access to the most powerful people in the country and drew their attention to the desperate situation of families affected by mental retardation. Her efforts made an enormous difference, resulting in unprecedented public attention to MR and new approaches to coordinating medical and social services. Along with her husband, R. Sargent Shriver, she made the Special Olympics an international, annual event in order to encourage people with mental retardation to develop their skills and discover the joy of achievement. She emerges from these pages as a remarkable and dedicated advocate for people with developmental disabilities.Shorter's account of mental retardation presents an unfamiliar view of the Kennedy family and adds a significant chapter to the history of disability in this country.