À propos du centenaire de la psychasthénie (1903): Les troubles obsessionnels-compulsifs dans la psychiatrie française : revue historique

Abstract

During the time of unitary mental alienation, the history of obsessive disorder begins with Esquirol’s famous observation of Miss F., published in the chapter “Monomania” of his treatise (1838). It his for him an affective (reasoning or without delusion) monomania, with consciousness, in which emotional and behavioral symptoms (compulsions) prevail on intellectual disturbances. Between 1850 and 1861, several pupils of Esquirol at the Salpêtrière hospital in Paris publish clinical cases of obsessive disorders: pseudomonomania (Delasiauve), fixed ideas (Brierre de Boismont), lucid madness (Trélat), monomania with consciousness (Baillarger, who uses for the first time about it the word neurosis in 1861). But these descriptions are not yet autonomous in the psychiatric nosology. During the time of the mental illnesses, after 1865, clinical course and differential diagnosis allow the description of several entities, separated from hysteria and fixed ideas, by J. – P. Falret’s pupils: (1) the “emotive delusion” (Morel, 1866), neurosis including anxious, phobic and obsessive manifestations; (2) the “doubt madness” (J. Falret son, 1866), in which intellectual disturbances prevail, like later the first German descriptions (Krafft-Ebing, 1867; Griesinger, 1868); (3) the “doubt madness with touch delusion” (Legrand du Saulle, 1875), remarkable synthesis of all former works, which insists about ambulatory cases and previous personality disorders. During the decade 1880, the word obsession (already used occasionally by Esquirol) becomes usual, at first to designate some “episodic syndromes” of the mental degeneracy (Magnan, 1882), then to classify the “obsessions with consciousness” (J. Falret, 1889). The cases described at this time are generally observed in the hospital practice. The obsessions are therefore often correlative to a heavy mental pathology, in a “transnosographic” approach: degeneracy, delusions and hallucinations (Séglas, 1895), impulsions (Pitres and Régis, 1902), constitutional psychoses (Arnaud in G. Ballet's treatise, 1903). At the beginning of the 20th century, French descriptions are fixed around two wide and competitive entities, including most neurotic disorders beside hysteria (like Morel and Legrand du Saulle), therefore, of more extensive clinical signification than Freud’s obsessional neurosis (1895): (1) The psychasthenia (P. Janet, 1903), of psychological genesis, involving obsessional ideas, forced agitations (compulsions, phobias, panic attacks) and stigmas (personality disorders), correlative to a reduction of psychological tension, an incompletion and a loss of reality function (theoretical notion which would influence Bleuler’s conception of autism in 1911). (2) The anxious (or emotive) constitution (E. Dupré, 1909), endogenous, hereditary, inspired by Kraepelin’s model, in which obsessions represent the transition between anxiety, cyclothymia and heavy mood disorders (melancholia). French alienists will prefer it to psychasthenia for a long time, whereas obsessive manifestations are described in the limits of chronic delusional disorders (Sérieux and Capgras, 1909; Clérambault, 1923; Ceillier, 1924). Between 1945 and 1980, Freud’s obsessional neurosis prevails in French textbooks and classifications, while psychasthenia is reduced to a simple personality disorder, beside “anal” character. Since 1980, in contrast, contemporary international classifications (DSM-III, DSM-IV, CIM-10) and comorbidity studies of obsessive disorders (with other anxiety disorders, depressive disorders, cyclothymia and obsessive–compulsive personality) seem to validate Janet’s clinical views, but without take again his theoretical approach.