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Diagnose: General Paralysis of the Insane – Speilvendt
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Diagnose: General Paralysis of the Insane


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I denne utgaven var tanken å skrive om en eksisterende diagnose. Derimot, da vi kom over denne perlen av en diagnose, trumfet den av flere grunner. General paralysis of the insane (GPI) kan regnes som den aller første genuine psykiatriske diagnosen. Allan Ropper og B.D. Burrell skriver om tilstanden i boken How the Brain Lost its Mind (2020). I boken brukes denne diagnosen som en inngangsport for å forstå hvordan psykiatrien og nevrologien skilte lag. Navnet får nok ikke mange bjeller til å ringe hos de aller fleste fordi den, som mange andre diagnoser, har skiftet navn flere ganger siden den ble formulert i 1826 av Louis-Florentin Calmeil. 

Så, hva er general paralysis of the insane? Helt enkelt og helt kort, så er det en følgetilstand av ubehandlet syfilis. Syfilis er kjent som en imitator i det at sykdommen kan maskere seg i form av mani, epilepsi, hysteri og andre lidelser. 

Calmeil fant at GPI nesten alltid begynte med forstyrret tale. Etterhvert som sykdommen utviklet seg ville man se problemer med finmotorikk hos pasienten. I siste fase ville den karakteristiske maniske galskapen blomstre, før pasienten døde. Død inntraff omtrent to år etter de første symptomene på GPI. Når det gjaldt årsak, så attribuerte ikke Calmeil den til syfilis, men han noterte seg at sykdommen ikke diskriminerte etter rang. Han merket seg at den oftere rammet menn enn kvinner, og at det var en høyere forekomst blant soldater. Han lurte på om sykdommen kunne skyldes utbrenthet etter krig. 

GPI er interessant fordi den knytter seg til mange andre diagnoser, til en urovekkende teori om årsak, og til det metafysiske spørsmålet om hjerne vs. sinn. Dette var en sykdom som hadde eksistert lenge og fått flere betegnelser. Et tidligere navn er tabes dorsalis, formulert av Moritz Heinrich Romberg. Romberg utviklet en test for å diagnostisere tilstanden. Han fant ikke årsaken, men det gjorde Guillaume-Benjamin-Armand Duchenne de Boulogne, Charcots mentor. Han merket seg korrelasjonen mellom syfilis og tabes dorsalis, som han mente sammenfalt i nitti prosent av tilfellene han så. Charcot sa da “Hva med de andre ti prosentene?” Det var riktig av han å tenke at korrelasjon ikke er kausalitet, men hans egen årsaksteori var helt feil. Charcot hadde en forklaring på etiologi som var utbredt på 1800-tallet, nemlig degenerasjonsteori. Darwins teori hadde vært vanskelig for mange å svelge, da spesielt dette at alle mennesker har et felles opphav som vi er etterkommere av. Degenerasjonsteori går med på at mennesker har et felles evolusjonært opphav, men sier at enkelte blodlinjer har blitt korrumpert av miljø eller kultur. Sårbarheter (les: dårlig moral) gikk da i arv i enkelte familier. Dette ble brukt til å forklare alt fra kriminalitet til alkoholisme til hysteri. 

Calmeil tok utgangspunkt i Bayles teori om at psykiske symptomer kunne ha en materiell årsak. Bayle hadde sett at hjernehinnebetennelse sammenfalt med psykiske symptomer. Calmeil og Bayle bidro begge til å legitimere psykiatrien i en tid hvor den hadde lav status, hvor f.eks. Calmeil la vekt på de psykiske symptomene og ikke de somatiske. Dette bidro til å forankre psykiatrien innenfor medisinen. 

Syfilis ble identifisert som årsak til GPI i 1853 av kirurgen Friedrich von Esmarch og psykiateren Peter Willers Jessen og fem år etter kom en kur. 

I over fire århundrer hadde syfilis hatt et konstant tilstedeværelse som skapte skam og frykt. Syfilis var ikke tilstede periodevis som en pest eller pandemi. Noen estimater tyder på at syfilis rammet en tiendedel av populasjonen til en hver tid. Ikke alle som fikk det døde. I omtrent tjue prosent av sakene utviklet syfilisen seg til GPI. I dag kan syfilis oppdages og kureres ved første tegn til sykdom. 

Kilde: 
Ropper, A. & Burrell, B.D. (2020). How The Brain Lost Its Mind: sex, hysteria and the riddle of mental illness. S.l.: ATLANTIC BOOKS


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