Medical Classification Debates:
The 1800s

Nineteenth-century researchers made an intense push to identify mental illnesses. They gave many specific types of Os and Cs their own names, for instance, arithmomania (compulsive counting), mysophobia (obsessive fear of contamination), and délire du toucher (touching compulsions).1 They also debated whether Os and Cs should be considered a form of insanity or not. By the end of the century, a consensus had been reached that Os and Cs were a neurosis rather than a psychosis (those concepts themselves were in the process of developing).2 As the consensus developed, physicians began to voice opposition to institutionalizing persons with Os and Cs in asylums.3

picture of Henry Maudsley
H. Maudsley recommended opium for Os and Cs

Nineteenth-century physicians treated Os and Cs with a variety of medications, and some may have actually worked, if you don't count the damaging side effects. William Hammond (1828-1900) and others used bromides as sedatives for patients suffering from Os and Cs.4 Henry Maudsley published an 1895 psychiatric textbook that recommended prescribing such patients opium and morphine, to be taken three times a day, and suggested that adding low doses of arsenic along with these narcotics could be helpful.5 Writing at the turn of the century, Pierre Janet (1859-1947) noted that he would sometimes prescribe opium, though "the danger of addiction usually outweighs the potential benefits."6

picture of Kierkegaard's journals
Kierkegaard wrote about obsessive "bad" thoughts

An important event occurred in the mid-1890s. The journal Brain published a debate on Os and Cs. Five experts participated.7 Their exchange of ideas reflected the emerging view of Os and Cs as a neurosis. The participants also discussed neurological models of obsessional conditions.8

One other event in the 19th century deserves special mention. In 1848 Soren Kierkegaard, the Danish philosopher, wrote brilliantly about obsessive "bad" thoughts.9



1You can see these terms being used, for instance, in William Hammond (1879) and Daniel Hack Tuke (1894). See also Berrios, 1985, pp. 168-70.

2Berrios, 1985, pp. 170-6. G. E. Berrios, a historian of psychiatry, has written a number of articles about the history of obsessional disorders, focusing mostly but not exclusively on the 19th century.

3See G. H. Savage's comments in Responses to Tuke (1895).

4William Hammond (1879). See also Osborn, 1998, p. 226.

5Henry Maudsley (1895). See also Osborn, 1998, p. 227.

6Pierre Janet (1903), as quoted in Pitman synopsis, 1984, p. 312.

7The Brain debate was comprised of a paper by Daniel Hack Tuke (1894) and four responses to Tuke's paper (1895).

8For more about the history of neurological models of obsessional illnesses, see Roger K. Pitman, "Historical Considerations," in The Psychobiology of Obsessive-Compulsive Disorder, J. Zohar et al., eds. (New York: Springer Publ. Co., 1991), pp. 1-12. Also see Daniel Hack Tuke's 1894 paper.

9Soren Kierkegaard (1848).


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