LETTERS
TO
thought
THE
EDITOR
by many of us to be the heart of hysteria,
disturbance,
with
a set of surrounding
the nuclear
spread
that
have
phenomena
are
more or less related. As a member of the APA and Statistics, I can comment in a generic
dude
sense
Task
of hysterical
a number
Force
on Nomenclature
that we have chosen to speak disorders. These disorders in-
offragmentary
clinical
states,
many
of which
poorly understood. Briquet’s disorder, identified by the eponym and by a lengthy literature, is central. There was considerable discussion within the task force are
about
what
Briquet’s
disorder
should
be called.
The
by vote, with Dr. Spitzer, the chairman, voting adopting the eponym. Dr. Spitzer’s view may have to carry because no acceptable alternative to Bridisorder’ was found. ‘Polysomatizing disorder’ was ‘ ‘
quet’s
‘
suggested,
but
‘
it was
rejected
‘
because
of its confusing
impli-
cations. Admittedly,
the history
ofthe
term
“hysteria”
is the histo-
ry ofa problem, although the major disorder has been clearly defined. Dr. Margetts suggests that we all know what hysteria means. That may be true. Each of us knows; unfortunately,
few
of us agree. ROBERT
A.
WOODRUFF,
JR.
,
pendent Each
with
the
view
that
and
poor
physical
symptoms.
Since
the
essence
of
that somatizing involves multiple organ “poly’ is necessary to avoid confusion
with
‘
lions
in which
somatizing
may
which were
child
Then,
who
condition
is
the prefix other
condi-
be involved.
I was unable to convince the force of the wisdom of this view. conference to critically evaluate sue to a group of distinguished ment.
the
systems,
other
method
might
understanding
of
and
EEG
with
some
hyperactivity,
assessments. kind
of CNS
aggressive
out-
autistic behavior. They had significant and tended to show large discrepancies
coordination
which
be made to find a noneponymic term for the category that is now refeired to as Briquet’s disorder. I believe that “polysomatizing disorder” conveys the essential notion, namely, that Briquet’s disorder involves somatizing, the expression of emotional conflict or problems by medically unexplained
the
were
learnbe-
scores and impairment EEGs were markedly
generalized and focal electrichildren had positive neurosigns” such as awkward gait
present.
A control
group
children not
were
presumably
brain
damaged
and
(the
brain-damaged group, however, rethe procedure first). Results of the scan in 3 of these were interpreted as entirely within normal limits.
further
studies
could
in the brain-damaged
be accomplished,
group
developed
the fourth an acute
myas-
thenic crisis that established the neurological diagnosis without need for further investigation. At this point, the study was terminated without scanning the children assumed to have no CNS disorder because of the negative results in the other group as well as the expense of the procedure. This pilot experience suggests that the CAT scan is unlikely to provide additional evidence about a neuropathological basis for severe learning and behavior problems of child-
hood.
members
However, DSM-III,
of the task
at a forthcoming
JOYCE
we will put the isfor their assess-
nosologists
G.
DONALD VICTOR
knows?
M.D. M.D.
SMALL, A.
DIAN,
MILSTEIN,
TAKUYA
PH.D.
M.D.
SATO,
Indianapolis,
L.
ROBERT
SPITZER,
N.Y. Art
Scans
SIR:
in Children
with Behavior
Computerized
markably
axial
versatile
intracranial
contents.
The
Disorders
tomography
and accurate
(CAT
new
technique
scan)
method is rapid,
is a re-
of examining entirely non-
invasive, and can detect a wide variety of lesions, plasm, hemorrhage, edema, cysts, calcifications, and abnormalities), often with greater sensitivity than either ography or pneumoencephalography. Moreover the
scan system
affords (CNS)
an opportunity
to evaluate
in individuals
who
when there is too little likelihood fy diagnostic
procedures
that
the
may
have
ofpositive entail
central
any
(neoother angi-
CAT
nervous
brain
disease
findings
tojusti-
risks.
Such
a situ-
ation prevails in children with learning and behavior problems that are often ascribed to underlying brain damage. although the evidence of CNS impairment is mostly presumptive. The high cost of CAT scans prohibits wide584
Am J Psychiatry’
133:5,
Ma)’ 1976
md.
M.D.
York,
New
CAT
of 4
children was chosen from the same population as having the least likelihood of CNS pathology because of the relative absence of the previously described characteristics. All children were referred for CAT scans; the radiologist did not
know
should
displayed
or severely abnormal, with both cal abnormalities. None of the logical findings, although “soft
Mo.
all efforts
compatible
tween verbal and performance WISC in measures ofvisuomotor integration.
Before to agree
but
scientific
psychological,
a history
bursts, and/or ing disabilities
ceived
I happen
had
and at times
children SIR:
children.
in increasing
psychiatric, child
M.D.
St. Louis,
of these
potential
these disorders. As a pilot approach, we selected 4 children with the greatest evidence ofCNS impairment from a population of35 children hospitalized for the treatment of severe emotional disorders. There were 3 boys and I girl between the ages of 6 and 12 years. Judgments of ‘ ‘organicity’ ‘ were based on mdc-
damage
matter
was decided against failed
screening
some
Is Not Mad
SIR: The Journal is to be commended for using as a lead article an English professor’s work, ‘ ‘The Madness of Art” by Leon Edel, D. Litt. (October 1975 issue). We have long known that artists have their own road to the unconscious, and we too often have ignored the contributions they make to our understanding of man. The poets know the sense and
beauty
ofman’s
and it is not a “tristimania,’ pression.
In his tribute procrustean strained
unconscious. our ‘
mutual
There interest
Dr. Benjamin to Dr.
Rush,
is a kinship in
Rush’s Dr.
Edel
what
term makes
between Dr.
Edel
us, calls
for agitated
de-
herculean
but
efforts to wed our field to his: as if that were not enough, he gives us the bicentennial squeeze play. Dr. Edel gives a respectable interpretation of Dr. Rush’s dream, although it is obviously and naturally retrospective. It is a dream of Dr. Rush’s impotence. Fine. Freud would go along with that. It is hard to ignore the symbols of the tri-
TO
thought
THE
EDITOR
by many of us to be the heart of hysteria,
disturbance,
with
a set of surrounding
the nuclear
spread
that
have
phenomena
are
more or less related. As a member of the APA and Statistics, I can comment in a generic
dude
sense
Task
of hysterical
a number
Force
on Nomenclature
that we have chosen to speak disorders. These disorders in-
offragmentary
clinical
states,
many
of which
poorly understood. Briquet’s disorder, identified by the eponym and by a lengthy literature, is central. There was considerable discussion within the task force are
about
what
Briquet’s
disorder
should
be called.
The
by vote, with Dr. Spitzer, the chairman, voting adopting the eponym. Dr. Spitzer’s view may have to carry because no acceptable alternative to Bridisorder’ was found. ‘Polysomatizing disorder’ was ‘ ‘
quet’s
‘
suggested,
but
‘
it was
rejected
‘
because
of its confusing
impli-
cations. Admittedly,
the history
ofthe
term
“hysteria”
is the histo-
ry ofa problem, although the major disorder has been clearly defined. Dr. Margetts suggests that we all know what hysteria means. That may be true. Each of us knows; unfortunately,
few
of us agree. ROBERT
A.
WOODRUFF,
JR.
,
pendent Each
with
the
view
that
and
poor
physical
symptoms.
Since
the
essence
of
that somatizing involves multiple organ “poly’ is necessary to avoid confusion
with
‘
lions
in which
somatizing
may
which were
child
Then,
who
condition
is
the prefix other
condi-
be involved.
I was unable to convince the force of the wisdom of this view. conference to critically evaluate sue to a group of distinguished ment.
the
systems,
other
method
might
understanding
of
and
EEG
with
some
hyperactivity,
assessments. kind
of CNS
aggressive
out-
autistic behavior. They had significant and tended to show large discrepancies
coordination
which
be made to find a noneponymic term for the category that is now refeired to as Briquet’s disorder. I believe that “polysomatizing disorder” conveys the essential notion, namely, that Briquet’s disorder involves somatizing, the expression of emotional conflict or problems by medically unexplained
the
were
learnbe-
scores and impairment EEGs were markedly
generalized and focal electrichildren had positive neurosigns” such as awkward gait
present.
A control
group
children not
were
presumably
brain
damaged
and
(the
brain-damaged group, however, rethe procedure first). Results of the scan in 3 of these were interpreted as entirely within normal limits.
further
studies
could
in the brain-damaged
be accomplished,
group
developed
the fourth an acute
myas-
thenic crisis that established the neurological diagnosis without need for further investigation. At this point, the study was terminated without scanning the children assumed to have no CNS disorder because of the negative results in the other group as well as the expense of the procedure. This pilot experience suggests that the CAT scan is unlikely to provide additional evidence about a neuropathological basis for severe learning and behavior problems of child-
hood.
members
However, DSM-III,
of the task
at a forthcoming
JOYCE
we will put the isfor their assess-
nosologists
G.
DONALD VICTOR
knows?
M.D. M.D.
SMALL, A.
DIAN,
MILSTEIN,
TAKUYA
PH.D.
M.D.
SATO,
Indianapolis,
L.
ROBERT
SPITZER,
N.Y. Art
Scans
SIR:
in Children
with Behavior
Computerized
markably
axial
versatile
intracranial
contents.
The
Disorders
tomography
and accurate
(CAT
new
technique
scan)
method is rapid,
is a re-
of examining entirely non-
invasive, and can detect a wide variety of lesions, plasm, hemorrhage, edema, cysts, calcifications, and abnormalities), often with greater sensitivity than either ography or pneumoencephalography. Moreover the
scan system
affords (CNS)
an opportunity
to evaluate
in individuals
who
when there is too little likelihood fy diagnostic
procedures
that
the
may
have
ofpositive entail
central
any
(neoother angi-
CAT
nervous
brain
disease
findings
tojusti-
risks.
Such
a situ-
ation prevails in children with learning and behavior problems that are often ascribed to underlying brain damage. although the evidence of CNS impairment is mostly presumptive. The high cost of CAT scans prohibits wide584
Am J Psychiatry’
133:5,
Ma)’ 1976
md.
M.D.
York,
New
CAT
of 4
children was chosen from the same population as having the least likelihood of CNS pathology because of the relative absence of the previously described characteristics. All children were referred for CAT scans; the radiologist did not
know
should
displayed
or severely abnormal, with both cal abnormalities. None of the logical findings, although “soft
Mo.
all efforts
compatible
tween verbal and performance WISC in measures ofvisuomotor integration.
Before to agree
but
scientific
psychological,
a history
bursts, and/or ing disabilities
ceived
I happen
had
and at times
children SIR:
children.
in increasing
psychiatric, child
M.D.
St. Louis,
of these
potential
these disorders. As a pilot approach, we selected 4 children with the greatest evidence ofCNS impairment from a population of35 children hospitalized for the treatment of severe emotional disorders. There were 3 boys and I girl between the ages of 6 and 12 years. Judgments of ‘ ‘organicity’ ‘ were based on mdc-
damage
matter
was decided against failed
screening
some
Is Not Mad
SIR: The Journal is to be commended for using as a lead article an English professor’s work, ‘ ‘The Madness of Art” by Leon Edel, D. Litt. (October 1975 issue). We have long known that artists have their own road to the unconscious, and we too often have ignored the contributions they make to our understanding of man. The poets know the sense and
beauty
ofman’s
and it is not a “tristimania,’ pression.
In his tribute procrustean strained
unconscious. our ‘
mutual
There interest
Dr. Benjamin to Dr.
Rush,
is a kinship in
Rush’s Dr.
Edel
what
term makes
between Dr.
Edel
us, calls
for agitated
de-
herculean
but
efforts to wed our field to his: as if that were not enough, he gives us the bicentennial squeeze play. Dr. Edel gives a respectable interpretation of Dr. Rush’s dream, although it is obviously and naturally retrospective. It is a dream of Dr. Rush’s impotence. Fine. Freud would go along with that. It is hard to ignore the symbols of the tri-
