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The Neurological Patient in History

The Neurological Patient in History

L. Stephen Jacyna
Stephen T. Casper
Volume: 20
Copyright Date: 2012
Published by: Boydell and Brewer,
Pages: 276
  • Book Info
    The Neurological Patient in History
    Book Description:

    Parkinson's, Alzheimer's, Tourette's, multiple sclerosis, stroke: all are neurological illnesses that create dysfunction, distress, and disability. With their symptoms ranging from impaired movement and paralysis to hallucinations and dementia, neurological patients present myriad puzzling disorders and medical challenges. Throughout the nineteenth and twentieth centuries countless stories about neurological patients appeared in newspapers, books, medical papers, and films. Often the patients were romanticized; indeed, it was common for physicians to cast neurological patients in a grand performance, allegedly giving audiences access to deep philosophical insights about the meaning of life and being. Beyond these romanticized images, however, the neurological patient was difficult to diagnose. Experiments often approached unethical realms, and treatment created challenges for patients, courts, caregivers, and even for patient advocacy organizations. In this kaleidoscopic study, the contributors illustrate how the neurological patient was constructed in history and came to occupy its role in Western culture. Stephen T. Casper is assistant professor in Humanities and Social Sciences at Clarkson University. L. Stephen Jacyna is reader in the History of Medicine and Director of the Centre for the History of Medicine at University College London.

    eISBN: 978-1-58046-770-4
    Subjects: History

Table of Contents

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  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. Preface
    (pp. vii-viii)
  4. Acknowledgments
    (pp. ix-x)
  5. Introduction
    (pp. 1-18)
    L. Stephen Jacyna and Stephen T. Casper

    The essays in this volume deal with the construction of the “neurological patient” as a category in Western medicine. They therefore touch upon how doctors have constructed categories of nervous disease over the past two centuries, and on how medicine has viewed and treated those it has diagnosed as suffering from these complaints. This volume is therefore concerned with one particular version of the clinical gaze. These essays proceed from the premise that neurological disease is not an essence waiting to be discovered but rather a construct with a discernible historicity. But this collection is also concerned with the experience...

  6. Part One: Medicine Constructs the “Neurological Patient”

    • Chapter One The Patient’s Pitch: The Neurologist, the Tuning Fork, and Textbook Knowledge
      (pp. 21-43)
      Stephen T. Casper

      In 1946, British neurologist and clinical neurophysiologist Gordon Holmes wrote in his Introduction to Clinical Neurology:

      There is perhaps no branch in practical medicine in which the help and cooperation of the patient is so essential as in the approach to a neurological disorder. For, in the first place, it is on the patient we must mainly rely for an accurate history of the development of his illness, and such a history is often extremely valuable in determining its nature. . . . In the second place, many neurological symptoms are purely subjective; they are abnormalities experienced by the patient,...

    • Chapter Two Neurological Patients as Experimental Subjects: Epilepsy Studies in the United States
      (pp. 44-60)
      Ellen Dwyer

      For almost one hundred years in the United States and elsewhere, researchers, regulatory agencies, and the public have argued about what constitutes the ethical use of human subjects in biomedical experiments. Yet despite its continuing importance, much of this discussion has been forgotten. Few histories reach back further than the Nuremberg Code of 1946. In neglecting the lively early debate, truncated accounts limit our understanding of the development of research ethics in the United States.

      According to Susan Lederer, during the first three decades of the twentieth century, and thus well before the horrors of Nazi Germany, biomedical researchers began...

  7. Part Two: Public and Private Constructions of the “Neurological Patient”

    • Chapter Three Speaking for Yourself: The Medico-Legal Aspects of Aphasia in Nineteenth-Century Britain
      (pp. 63-80)
      Marjorie Perlman Lorch

      Throughout the eighteenth and early nineteenth century there was consideration of the status of persons deemed insane. Two legal issues were relevant: acts of criminal behavior such as violent attack or murder leading to the possibility of prison or the death sentence, and more general aspects of social functioning and the question of confinement in asylums. With the emergence of the concept of a disorder of expression due to specific brain damage and the coining of the term “aphasia” in the second half of the nineteenth century, a new group of people whose civil rights required protection was identified: those...

    • Chapter Four The Spouse, the Neurological Patient, and Doctors
      (pp. 81-106)
      Katrina Gatley

      The period spanning the late nineteenth and early twentieth centuries might be described as the age of the “specialist patient,” if only in response to the emergence of institutions and specialist doctors that required such bodies. In the case of nervous disorders, the Great War aided and abetted this development.¹ The neurological patient of this paper—the Anglophile Frenchman Jacques Raverat (1885–1925)—and his illness narrative are also intertwined with the Great War. It was his failed attempt to enlist in the armed forces that precipitated his diagnosis by a specialist in nervous diseases of a central nervous system...

  8. Part Three: Patient Groups Construct the “Neurological Patient”

    • Chapter Five Disappearing in Plain Sight: Public Roles of People with Dementia in the Meaning and Politics of Alzheimer’s Disease
      (pp. 109-128)
      Jesse F. Ballenger

      One of the most striking aspects of the rise of Alzheimer’s disease (AD) since the 1970s has been the emergence of people with dementia publicly speaking for themselves about their illness and about the meaning of dementia. Of course, exemplary disease victims have been part of the modern cultural landscape throughout the twentieth century, both reflecting and shaping the development of medicine and the experience of illness.¹ But the nature of AD and other age-associated progressive dementias, which in the dominant trope of the AD advocacy movement destroyed the very selfhood of its victims, for a long time suggested that...

    • Chapter Six The Cursing Patient: Neuropsychiatry Confronts Tourette’s Syndrome, 1825–2008
      (pp. 129-164)
      Howard I. Kushner

      I first met Michael (a pseudonym), a neighbor in his early teens, in 1980. Michael periodically would blurt out what sounded like barks and often ask inappropriate questions. He informed me that these behaviors were caused by an affliction called Tourette’s syndrome (TS). When Michael was about eight years old he had developed uncontrolled eye blinking; soon after he developed more pronounced facial and body tics accompanied by vocalizations that at first sounded as if he was muttering to himself. When he approached his late teens he began to curse, regularly shouting out a series of obscenities, most often “fuck...

  9. Part Four: The Patient Constructs the “Neurological Patient”

    • Chapter Seven The Psychasthenic Poet: Robert Nichols and His Neurologists
      (pp. 167-183)
      L. Stephen Jacyna

      This chapter is concerned with a particular neurological patient, the poet, dramatist, and self-confessed neurasthenic Robert Nichols (1893–1944).¹ Nichols can be seen as representative of the functional cases that still fell within the purview of British neurologists in the early decades of the twentieth century.² Because Nichols’s first contacts with these neurologists came in the aftermath of his experience of modern warfare, his case may be seen as an aspect of the history of traumatic neurosis.³ Above all, however, Nichols provides a particularly rich instance of how an immersion in the language and practice of psychology provided the means...

    • Chapter Eight The Encephalitis Lethargica Patient as a Window on the Soul
      (pp. 184-212)
      Paul Foley

      The adoption of the neurobiological approach to psychiatric disorders was excited in 1845 by the German internist Wilhelm Griesinger (1817–68)—“We must in each case recognize that psychic disorders are disorders of the brain”¹—and by the Austrian physician Ernst von Feuchtersleben (1806–49)—“Every psychosis is at the same time a neurosis, because without mediation of nervous activity no psychic change is manifested.”² This physiological view dominated psychiatric thought until the end of the nineteenth century, substantially sustained by the golden age of neuroanatomy that began in the 1860s. Technical developments allowed ever finer investigation of brain structure,...

  10. Part Five: Historians Construct the “Neurological Patient”

    • Chapter Nine Neuropatients in Historyland
      (pp. 215-222)
      Roger Cooter

      If the patient is the hole at the center of the history of the neurological patient, it is only in the sense of an invisible performing subject. The concept of the patient has never been missing. It is implicit to the history of neurology, as it is to the rest of the history of medicine. Like all concepts and categories, however, it is a shifting product of its historical times. It moves with its historiography. In illustration of this, we need look no further than the contributions to this volume by Stephen Casper and Jesse Ballenger. Like other chapters, their...

    • Chapter Ten The Neurological Patient in History: A Commentary
      (pp. 223-230)
      Max Stadler

      On the evening of Tuesday, December 2, 2009, at 5:05 pm, Henry Gustav Molaison, aged eighty-two, died of respiratory failure in a nursing home in Connecticut; his death almost coincided, fortuitously, with a workshop on the neurological patient in history some three days later in London, the papers of which comprise this volume. This brief commentary will offer some reflections on the workshop papers, but it begins with Mr. Molaison, known to the world only by his initials, H. M.

      Not coincidentally, of course, does this commentary focus on H. M., for H. M. was a historic neurological patient: having...

  11. Bibliography
    (pp. 231-252)
  12. List of Contributors
    (pp. 253-256)
  13. Index
    (pp. 257-264)
  14. Back Matter
    (pp. 265-265)