Extremes of Normal: Status Lymphaticus and DSM-5 by Dr Claire Hilton

By Dr Claire Hilton, Historian in Residence at the RCPsych.

Little more than a century ago, physical disorders of status lymphaticus, fragile bones and haematoma auris, were ‘invented’ to fulfill social needs. All crept into the culture of the lunatic asylums. Status lymphaticus was a supposedly pathological explanation for sudden death which occurred during treatment. Fragile bones allegedly predisposed psychiatric patients to fractures in scuffles with staff who were over-zealous in manually restraining them. Haematoma auris is still recognised, as ‘cauliflower ear’, a result of trauma, linked to the expression to give someone a ‘thick ear’. Asylum patients were considered to have an inherent predisposition to develop them. All three disappeared from psychiatric text books, as they never were intrinsic to mental disorders. They were socially constructed, to protect the reputation of doctors and asylums from accusations of neglect and cruelty.

Psychiatric diagnoses have also been created to define behaviours as pathological outside an arbitrarily created framework of social acceptability. Drapetomania, from the ancient Greek drapetes for a runaway slave, was a ‘disease’ that caused African-Caribbean slaves to run away. ‘Absconding from service’ was the main symptom, with associated sulkiness just prior to flight. Running away was a sane and brave course of action, not psychopathology. More recently, mid-20^th century socially constructed diagnoses included homosexuality, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM), and ‘sluggish schizophrenia’, used to justify mental hospital detention in the USSR for those who criticised the authorities.

Hopefully all these socially constructed medical and psychiatric diagnoses are now confined to the dustbin of medical history. Yet the habit of pathologising – characterizing aspects of normal as abnormal – goes on: one wonders whether some DSM 5 diagnostic categories such as ‘hoarding disorder’ will suffer a similar fate. Some people whom I know quite well, saved from the diagnostic label by having a minimalist partner, hope that it will.