One of the oldest cases of schizophrenia in Gogol's Diary of a Madman

doi:10.1136/bmj.323.7327.1475

From trainee to consultant, BMJ Group offers doctors around the world tailored information, special events, learning resources and recruitment services at every step along their career path.

... by doctors, for doctors, for patients
We are open for entries!

Online learning

BMJ Learning

High-quality CME / CPD for doctors and other healthcare professionals. BMJ Learning features hundreds of accredited, peer-reviewed learning modules in text, video, and audio formats. Find out more

Courses and Qualifications

BMJ Masterclasses

BMJ Masterclasses, led by experts, help clinicians to use the latest evidence and recent guidelines in practice and meet their CPD/CME requirements. Find out more

Exam Preparation

The leading provider of online exam preparation, helping over 167,000 healthcare professionals to pass their exams. Find out more

onExamination

Search all BMJ research articles:

From

Limit by

Access to the full text of this article requires a subscription or payment. Please log in or subscribe below.

Eric Lewin Altschuler (ealtschuler@ucsd.edu), assistant director

Brain and Perception Laboratory, University of California, San Diego, 9500 Gilman Drive, 0109, La Jolla, CA 92093-0109, USA

Besides intrinsic historical and literary interest and clinical usefulness by providing good exemplar cases, the study of the history of a disease can provide clues to its pathogenesis—it is necessary, but not sufficient, that the cause of a disease be at least as old as the disease itself. Here I note one of the oldest and most complete descriptions of schizophrenia, in Nicolai Gogol's classic short story Diary of a Madman (1834).1

Summary points

Nicolai Gogol's classic short story Diary of a Madman (1834) contains one of the earliest, and most complete, descriptions of schizophrenia

Beyond intrinsic and historical interest, this case is important because it has implications for the antiquity, and possibly the aetiology, of schizophrenia

From a literary point of view, the story can be appreciated as a sketch—albeit a most brilliant one—of the disease

History of schizophrenia

It might seem unnecessary to need to prove that schizophrenia is an old disease because “every town had a fool.” However, the only case of schizophrenia that possibly meets the diagnostic criteria for the disease (see box) much before 1800 is that of Edgar or Poor Tom in Shakespeare's King Lear.3-5 This has led to the tentative suggestion that some factor—a virus, environmental toxin, or perhaps “modernity itself”—in play since 1800 has greatly increased the incidence of schizophrenia.3 As the signs of schizophrenia can be noticed without any laboratory test or even specialised training, the extreme dearth of old cases of schizophrenia cannot trivially be due to lack of advanced diagnostic equipment or medical education in days of yore. The “mad” ravings of a local town “fool” could have been secondary to mania, temporal lobe epilepsy,6 substance misuse or withdrawal, vitamin deficiencies, or heavy metal poisoning.