History Revisited: Psychosis of a Psychiatrist

11/17/2011 09:02 am ET

The tendency of any generation is to imagine its uniqueness, engage in a pretense that nothing existed before it and nothing will exist after it. Of course it's a fallacy, and a fallacy that's often dangerous. No generation is alone, and many of the problems that plague us were discovered long ago and not merely yesterday. So consider a story out of 19th century psychiatry.

In the 19th century, an essential dichotomy in psychiatry was a split between understanding mental illness with an apparent biological etiology and understanding mental illness without any apparent biological etiology--with the latter case posing the question of whether a biological etiology existed undetected or did not exist at all. What caused madness? No one really knew. At the present time, more than one hundred years later, the issue is still in debate. But four generations back they knew so little compared to us that their debate was too easily clouded and distorted by smoke and mirrors. They had their confusions, particularly in the second half of the 19th century.

And yet if confusion reigned in psychiatry during the 19th century, the intellectual debate was really only a footnote to the human tragedies of mental illness. People were just as bedeviled by mental illness as we are--and with no medications that really were of any help. To twist a quip, theories come and theories go, but madness remains. Four generations ago, people had their tragedies as we do, and as in our own time the tragedies of mental illness could be the most devastating. Also as in our own time, psychiatrists then were as vulnerable as they are today to mental disorders. Of the tragedies associated with mental illness, few are more ironic than the madness of a psychiatrist.

Victor Kandinsky (1849-1889) (uncle of the painter Wassily Kandinsky) was a physician and well-known research psychiatrist who went mad in his prime. Maybe his most important contribution to neuroscience was his detailed description of his own state of mind during his mental illness.

Kandinsky was born in a small village in Siberia on March 24, 1849. His father was a merchant whose home served as a local cultural salon for musical and literary parties. Victor had two cousins afflicted with what is now diagnosed as paranoid schizophrenia, both cousins with long-term asylum residence. We know little about Victor's childhood and adolescence, except that he was an only child with a normal birth, and his mother's pregnancy was also normal. Victor had no significant physical problems during his life, and he did not smoke tobacco or drink alcohol. At the age of fourteen he left Siberia to live in Moscow, and there he gained entry into a well-known high school and graduated with honors. He then entered Moscow University Medical School. He graduated in 1872 and began practice as a general physician in one of Moscow's hospitals.

Kandinsky became a prolific researcher and published many journal papers on various medical subjects. His colleagues described him as diligent, meticulous, absorbed in his work, modest in his private life, gentle and sympathetic.

Beginning at the age of twenty-seven, Kandinsky served three years in the military as a physician, including a year during the Russia-Turkish War of 1877-1878. He served on a battleship as the ship's physician, and in that period, in May, 1877, he became mentally ill, was sent to a psychiatric hospital as a patient, and remained in the hospital eleven months. In the hospital, he fell in love with one of the nurses who treated him, and after his recovery they married. Kandinsky (with his wife) spent the next months abroad on leave, but in October, 1878 he returned to Russia to be readmitted to a psychiatric hospital with an apparent deterioration of his mental illness. In 1879 he was discharged from military service due to his mental condition, and in 1881 he moved to St. Petersburg to work as a psychiatrist in a psychiatric hospital. He worked there eight years until his suicide in 1889.

Kandinsky and his wife apparently had a good marriage. They wanted children but never had any offspring. His wife was greatly devoted to him, and after his death she arranged for the publication of his scientific papers and two books--and then she committed suicide herself.

What's there to say about the double suicide of a man and his wife barely entering maturity? Intellect seems helpless to grasp it. Madness won out.

According to the people who knew Kandinsky, his illness first appeared in 1877, when he was twenty-eight. Already that year there was a suicide attempt: on the battleship during the war against the Turks he jumped into the sea to kill himself. According to Kandinsky's own description of his illness, this first episode lasted two years. In a research paper on hallucinations after the episode, Kandinsky wrote: "To my sadness, during two years I suffered from insane hallucinations ... I felt various and abundant hallucinations in all my senses except taste. The most frequent and vivid were visual, tactile, and common sensibility hallucinations."

Kandinsky reported that in the beginning of his disorder there were only delusions, no hallucinations: "In the first months of my malady there were no hallucinations. This period was generally characterized by intense but chaotic intellectual activity ... a lot of ideas that ran speeding but not in the right course, experienced as forced and false."

Kandinsky wrote that during the acute phase of his illness he experienced the common symptoms of "mental automatism": imagined telepathy, reading and broadcasting thought, enforced speaking, and enforced motor movements. He described his disturbances in visual, auditory, olfactory, and tactile perception. His mood would vary from mania to depression, with depression predominant and often including thoughts of suicide.

On the day he committed suicide, Kandinsky went to the hospital where he worked, obtained a large amount of opium from the pharmacy, returned home and swallowed several grams of the opium--a lethal dose. He continued writing as the opium took effect, and wrote his last words describing his condition: "I'm not able to write more because I can't see. Light! Light! Light!"

Kandinsky diagnosed his own illness with the psychiatric terminology of his time: primary insanity (insanity not secondary to organic cause) and paranoid hallucinatoria--descriptive labels without biological content. As a patient, he would now be classified as afflicted with schizophrenia or schizoaffective disorder--also descriptive labels without biological content. With his illness and suicide, Kandinsky illustrated the vulnerability to madness of even the people who studied it--and their ignorance of causes. When Kandinsky died, the human brain was an enigma--and the enigma is still with us.

We like to think we know so much, but we really don't know much at all. We remain children in the garden of knowledge. One hundred and twenty years after the death of Victor Kandinsky, mental illness still confounds us, a continuing and devastating plague. We are not alone in history.