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listen upon. Calf sure do, and one thing that's going on this march is the tide casts in general- are all trying to get people interested in part casting as a general thing. So all this month we asking you to tell somebody that you love about upon cast. You think, though, of a dozen hath br cast I love my big progress. Will right now is how to be amazing, with Michael in Black. I have said it amongst friends I will save here. I think he has the best interview In any medium right now, she's amazing, and I am sure that there is someone out there that you know or lovely girl your best friend or someone in your family, that using a web, this progress to be perfect for them, something like how to be amazing or some other podcast and recommend it so go tell them about these things because everybody should be listening upon casts a medium that is, has some

truly for everyone, and we want you to also share with us in the world. Do what you recommended that friend by posting on social media and using the hashtag tripod, which is t r? Why p o d so spread the word about supply gas? It will only make us all smarter and more interested in the world. So thanks for that, and now we're gonna happen to you our topic for today, which is another question, Tracy Tracy you have her. Retards delusion or Qatar syndrome before right, and usually probably, if you ve seen it. It comes up on frequently online on lists of you know, world strangers at ease, or You know lists of of sort of disturbing or unsettling mental disorders, because in those lists it's usually just characterized as a patient believing themselves to be deceased, it is sometimes called walking corpse syndrome because of that, and while they can certainly be part of it, it is a lot more

like the man, so Qatar syndrome is quite rare. It involves both a negation delusion, so the individual feels a major change in their body or they deny the existence of one or several parts of their organs or bodies like they will sometimes think that they no longer have this or that their blood is gone or some other variation on a theme, and it also has an illicit delusion elements. So in that in that part of it, the individual also the day or are all people are dead, that they are somehow comporting themselves around the earth in a state of non living this. So it is very complex and additionally, the work of jewels. Qatar is much debated even today, and part of that is because it was unfinished which really talk about so really the story of this syndrome. That's named for him in many ways, is the story of psychiatry and how I d is our challenge and then shift and change through interpretation, as well as accumulation of data,

passage of time, so we're gonna start about Jewels Qatar, his work in this area and this sort of how things played out later on in terms of using his work to address issues, patients for having jewels Qatar was born on June, first eighteen, forty in eastern dawn in Central France and the young man, he became a medical student in Paris where he studied under several prominent and trailblazing physicians of the day. The youth included Pierre POP Ok, you have a portion of the frontal lobe in the brain named after him, because it has worked studying that area and then also establishing the concept of brain function being associated with specific areas is also Alfred Vulpine, who is credited with the discovery of Randal in being made by the adrenal. Glam am Zalm our time. Shockoe is considered the

father of Modern Neurology and has more than a dozen medical conditions or discoveries named for him, in short, a kind of an incredible How do we studying medicine in Paris? It really was There was also a lot going on, of course, in Vienna in Germany. At the time, the Paris had some really interesting neurological in psychiatric culture growing up around it. So initially Qatar was on the same path is the neurologist that he had been studying under his first significant paper was titled physiological and the logical studies on cerebral softening, exploring how inflammation and hemorrhaging damages brain tissue and then his doctorate paper in eighteen. Sixty eight was titled study on partial atrophy of the brain, one

though, would really significantly change the course of got arts career. He witnessed the psychiatrist, Charles Le Sig, interviewing a patient, and he was in broad based on watching with men at work. Began to shift his focus away from neurology and into psychiatry. The two men would eventually become colleagues, and I Phillip we should say that this was it was not uncommon for people going into psychiatry at this time to have started out in neurology. Alot of people did in eighteen, seventy four, say you introduce juice, guitar Jews, foul play two jewels. Is would go on to become research partners, working side by side in the middle of the Sunday? That's the asylum advances in Paris in the south, western suburbs and, incidentally, families, other actually owned that asylum. Qatar gave a presentation, Paris's medical cycle.

Article society on June, twenty eighth eighteen eighty, he read a case report. He and I had assembled titled of the hypochondriac delirium and a severe form of anxious melancholy. In this case, the patient was a woman who was forty three in shadow. The set of symptoms, so this woman who is referred to in the paper is Madame acts, thought that she was made of nothing but skin and bone. But she had no brain nerves, chest or entrails. Finally, she had come to the conclusion that God did not exist, nor did the devil, but she would live forever. She had made several attempts on her own life and requested of her doctors others that she be burned alive. Ass got tired, presented. He reference, similar cases that had been on the record going as far back as twenty years. He specifically mentioned summit.

Cases handled by doctors, fuelled by our say, as some of the oldest he's reconsidered part of a diagnosis of general paralysis and in this context, the paralysis. Referred to is a failure of the brain characterized by a loss. Innovations and the exhibition of delusional thinking. So not a lack of physical movement or an inability to move your body right when we think of paralysis and usually what comes to mind, but that's not the application of the word here so yeah this. These similar cases that had been steady today, its earlier had kind of got lumped in as general paralysis, but Qatar felt like there was something a little more specific about them and he thought there what his patient was ignored. Was actually a form of what was at the time called Romania or like Romania, and that term eventually was planted by melancholy. Basically, he thought he had identified a specific form of Melancolia, and this was in his opinion and

just Melancolia with delusions that could include religious, miss beliefs of damnation or demon, possession. The perception that more of the body, had ceased to exist, inability to perceive physical pain, mortality, delusions and suicidal behaviour. Jewels Qatar also drew possible connections in this presentation from the symptoms he had observed in the patient to similar historical events, including various cases of reported demon fashion. He suggested that the idea of the wandering Jus Legend, which was a man who had taunted price on the cross and then was doomed to wander earth until the world ended. He thought that may have had routes and the observation. A person with a similarly delusional state yeah he was making this case that it could be that that whole legend grew out of someone's speaking with a person who actually have this delusion that he was too

to identify a guitar continued to develop his research on this topic in eighteen. Eighty, two, he expanded on it by introducing the term delete, didn't, I guess, young and that's realistic delusions in an article that he published at the archives didn't apology. Patients with such delusions, he said had a tendency to deny everything leading in extreme cases to denial of the self. You separated the delusions of mitigation clinically from delusions of persecution. Article you characterized persecution, delusions as exhibiting mistrust paranoia, ways: an ailing delusions of grandeur and acoustic verbal hallucinations that would sometimes be homicidal encounter. He was too anxious monologue, deep melancholic, depression, refusal to eat visual hallucination,

and suicidal behaviour as characteristics of the delusion of negation four years after Qatar initial presentation on the symptoms of Madame acts, He wrote about another patient this one in adult man who said that he could no longer see his children's features in eighteen, eighty Qatar still trying to build up a unified theory of what he believed to be related. Symptoms came to the conclusion that this was a loss of mental vision and that this was actually the root of the problem when patients exhibited nihilistic, delusion, The mind in his estimation, was simply unable to process visual representation of objects. He would later refine this concept by describing the problem as a loss of quote psychomotor energy, causing the patient to lose visual representation into experience, psychomotor impairment, it's entirely likely. They attired, would have continued

Refine has work on a topic had he not met an untimely end in eighteen, eighty, nine, it just forty nine years old, he contract he contracted dip, which he caught from his daughter. He never recover and he died on eight August nineteen of that year at his funeral, his partner far, I spoke calling him quote a profound and original thinker given to paradox, but guided by a robust sense of reality and mixed up we're gonna talk about what the rest of Paris's psychiatric community did with Qatar work after his death, but first we're gonna pause, have a word from one of our sponsors

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yah. Almost immediately after jewels, Qatar, death debate began about his work and where he had been headed with it and what his intentions actually were. One of the ongoing themes of Qatar work was the struggle to develop terminology for psychiatric humans, and he had also champion this idea of using symptomatic classification for psychiatry, so, of course, with his work in this state of arrest of developments and when he had been rating updates to his ideas, days before his death, there was a lot of room for interpretation, while some of his contemporaries thought he had been cut, logging an entirely new disease. Others thought his work had always been focused on exploring a severe and specific form of Melancolia. Others thought that he merely sought to catalogue and describe a symptom cluster that could be found in other diseases, in addition

in Korea in August of eighteen. Ninety two: the issue was hotly debated at the Mental Medicine Congress in Blue or France, Qatar partner Falco. I advocated for the idea that his. We have identified a new disease and, to argue the case, he claimed that there was an essential form of Qatar, Delille, Dana Guess, young stood on its own and also in this a secondary form of it. That could be part of other melancholy. And even non Melancolia disorders. Others and attendance argued that the specific cluster that far I was advocating as of guitar newly identified disorder included elements that were so rare, specifically those waiting, see religion based concepts of demonic possession, damnation and eternal wife, but there was no validity to calling at its own, singular syndrome to support this view was pointed out

virtually all patients with melancholy. I had a tendency toward negation and guilt so that cases in Qatar writings words extreme examples of this Additional arguments against this being a standard. Disorder or disease. Identification included claims that Qatar was met merely listing a random assortment of symptoms that could be found in any number of mental disorders. So good bring them together was essentially meaningless, aside from any one specific patient having them cases. Also brought into the discussion to illustrate the rather common occurrence of needless delusions in cases of chronic melancolia. Why mental health Congress came to no clear conclusion as to whether retards work was describing a specific syndrome or common elements of multiple mental disorders. There was some agreement on how to define realistic delusions syndrome.

And that was that it included two specific elements: anxious melancolia and systematized ideas of negation. So, as an aside to clarify what that means, systematized delusion indicates that a patient has developed a consistent, complex system of beliefs associate with their condition, which often fit together perfectly in a really elaborate narrative. So, for example, if you think that you died in an accident where you did not die that all of the strange things that may happen to you, you will put together into a puzzle to support that conclusion, like I'm clearly dead. That is why that person never calls me back it's because I'm dead and they're not getting my call. That's a very simplify then and basic way, and I'm sure any doctor would be like Hollywood now. But that's just a kind of give you an idea of what this systematized aspect of it means. One year after that Congress and four years after Qatar death the term

hard syndrome was first introduced. That was in eighteen, ninety three by a meal raises the name, the depressive disorder that Qatar have studied and described. That then became cemented lexicon through its use by another of Qatar contemporaries who was psychiatrist jewels similar, although there were some differences and how similar in Qatar this condition, while many believe that retards work had led him to the conclusion that needlestick delusion was a separate any meat condition signal. I felt that it was an expression of an extreme state of anxious melancolia. So the case in which say, glass, first used the term Qatar syndrome to describe a patient featured a man who much like Qatar, patient. Madame acts believed himself to be immortal. Damned and without his internal organs and despite his different view,

of whether the syndrome was a unique disorder or away to identify extreme cases. Signalize diagnosis of a patient as having Qatar syndrome really popularized the terms usage with the dawn of the twin, century came many changes in the way mental health was discussed and treated and Qatar work. Heads examined in new ways as a consequence. So, firstly probably noted that leading up to this point, we exclusively used the term Melancolia that's because depression and manic depressive illness, as diagnostic terms, didn't exist until the twentieth century and those of continued to be refined. Now people generally say bipolar disorder and not manic depressive illness. Once they re It is these terms, really impacted alot of disorders and illnesses, including Qatar syndrome, so in the earth Nineteen hundreds Qatar cinder

was invoked as a systematic analysis of patients who are being treated for general paralysis, answer dementia, as it had been toward the end of the nineteenth century, been using both of those but now it was also associated with the newer terms, depression and at that point, manic, depressive, illness and so wider range of use also came with the development of a subdivision of the syndrome by some doctors into two types: the melancholic type of Qatar Syndrome and the hypochondriacal type of Qatar syndrome. Melancholic type was considered secondary and a patient with effective disorder. The mood disorders such as depression, bipolar disorder or anxiety disorder, characterized by nihilist, loose ends and the patients subjectivity the hypochondriacal type,

considered a primary manifestation of the syndrome where the patient symptoms were focused around incorrect and paranoid feelings about my body like that it was missing viscera or that it was no longer alive. And again, we should make clear that this was not a universally accepted approach to to dividing this. In nineteen o for Leonardo Bianchi and James Hog Mcdonald wrote a textbook of psychiatry for physicians and students and ended. They wrote quote Qatar and others have assigned undue import to the delirium of negation attributing to its certain clinical characters, many of which, as a matter of fact, are common to the majority of cases of depressive delirium, such as self accusation and hypochondria, of which it represents a more advanced

of evolution. It was just as a decade earlier a time when some of the medical mental health community believe that Qatar had wrongly associated a series of fairly common symptoms into one unique club, Another idea developed during this period was away Identify wirelessly The as true Qatar syndrome, this particular approach required that a patient exhibit a combination of an effective or mood component liking Eddie and an intellectual component, which was the idea of negation. This approach meant that these solutions could be read nice than acknowledged in a variety of scenarios, without the identification of Qatar syndrome and to make even more nebulous some provisions? Also cigarette suggested breaking down the syndrome and complete and incomplete versions based on variations in the patient's symptoms.

This is one of those things were the more I read the more I was like how do any doctors or clinicians ever agree on anything, but because it is so hotly debated- and I know this isn't just unique to Qatar Syndrome Others suggested that Qatar Syndrome is really a result of institutionalization and, in fact, that first patient that Qatar described back in eighteen. Eighty was a woman who had been find at the Van visas, asylum for a number of years said about things up, we're going to talk a bit about the discussion and handling of Qatar syndrome after World war. Two, but first we gonna take one last quick break for a word from a sponsor putty cleared up. Whole data LISA Car the whole day, yeah. First, we need to study. I have some flashcards here that old, releasing a vocabulary. Seclusion pies costs, money factors, disposition is

You do not need to know all this to lease a car, but I gotta negotiate a good deal carelessly Yes, it's the roadmap. You go through and take the car you want. Then they give you a tailor. Price is crystal clear, I've already applied discounts, negotiated a low rate and included all taxes and pleased. Then they deliver party your house both, but what about the acquisition yes, Ryan them to do you even know what an acquisition VIII is no, but I think it's on the next card there welcome to the future of car leasing with the road a lap you can choose from hundreds of cars writing your area. We give you crystal clear, that includes discounts, taxes in fees and once you decide what cartilage will even drive it right to your house, it's easy, it's clear, its roto There were two parents was, of course occupied by the Nazis and so work on psychiatry. There certainly slowed, but

the war. Qatar work was once again examined and in some ways, history, repeated itself, various clinicians offered their interpretations based on their work with patients that had similar or related symptoms in the book. Uncommon psychiatric syndromes, writers Morgan, Enoch and William, two thousand wrote. It is quote justifiable to regard Qatar syndrome as a specific clinical entity, because it may exist in a pure, incomplete form. Even when symptomatic of another mental illness, nihilistic delusions dominate the clinical picture, and today. Of course, classification of mental disorders continues to be debated in the eighteen These many of the concepts that were being introduced for in their infancy, so things were constantly in flux,

there was ongoing debate about what various disorders should be called and even how to arrange the known disorders into a larger classification system, because the very juvenile staves of many the concepts thick attired was writing about and the fact that he was riding in French. There have been additional debates through the years about the interpretations of its work and how Inflation has affected that, for example, in a paper written and ninety ninety five by g barriers and are Luke. There is some discussion. About the use of the french word Billy, which have more complex and nuanced meaning than its usual translations of delirium or delusion The writers of the paper explain that the word is more inclusive than that and can be used to describe a syndrome with lots of different symptoms. Not just delusions. This syndrome now has three distinct developmental stages recognised within it in the work of some doctors. The germination stage is characterized by depressed

and often a fear or worry about illness in the second stage called the blooming stage. Patients exhibit anxiety and negativism and the delusions of death and immortality appear. This is what most people are describing. If you ever read like a very quick blurb about what could hardly is and then the third chronic stage of Qatar Syndrome manifest in severe depression. Tarred syndrome is not listed in the diagnostic and statistical manual of mental disorders or in the international classification of diseases as an independent disorder. Instead, it is listed as a mile is stick to lose in, which is an effective solution with an oppressive episode with psychotic features and Qatar syndrome can be treated with anti depressants anti site

headaches and mood stabilizers, either by themselves or in some combination, depending on the test that have been run and what the doctor and and patient determined to be the best course of action. Sometimes these still controversial electro convulsive therapy is also used. That is very different than it used to be a fly. The greatest risks in terms of the syndrome today, when speaking about potential mortality, are starvation and patients that refuse to eat or suicide, so patients undergoing treatment do you have to be watching very carefully, but there is treatments, and there are many cases of people who come out of this and treat it and no longer habit. So thatS Qatar syndrome, which fascinates me the US ask them snare mail. I do and it's not about psychiatric weirdness at all. This is from our listener, whose name is should ever. I hope I am pronouncing that correctly, just as high guy

I love your show, I'm an illustrator and love listening to it. When I'm working, I made a hard core heroines of history carts series. Last year, a few of the women I had heard of because of your show and the others I found three research. I recently saw that you didn't episode mony, a Louis, and I was so excited since I found her last year. It was blown away by which he accomplished in her lifetime. Also, here is the archaeology badger that came to mind from the other. Episode I laughed so hard and loved your tagline at any rate. Here is a pack of cards for fun. I've included my artist animal pon series, since I know, cats in art are also a love of one of yours, thanks for being superstars than ever, and she also rates PS. This is my first female I've ever sent. Of course, history pike, ass, moved me to embarrass myself. I loved it and I love the ship, as these are the cutest thing. So now I will describe these adorable cards, which she sat in the hot seat. Pictures and share them so

one is a hard core history of heroines, no hard core heroines of history that you ve probably never heard of it. Basically, she has incorporated animals into these portrait, so, for example, there is Caroline Herschel there an episode on as a Third and she's lovely Sojourner truth is that. I think that is a fair it, but I'm not a hundred certain they're, all very, very adorable, and this new pack, which includes artists, has some of the best things ever, including Marcel, do Chimp MARC Chagall, Leonardo Da Vinci. You tricks. Otter did take pictures of these ensure that, because they are so cute, so thank you. Thank you. Thank you should ever at these are just the most darling things I have. Maybe

receive. I love them. If you would like the right through, as you could do so at history pike after house works dot com, you can find us across the spectrum of social media as missed in history. That means were on Twitter is apt, missed in history, at Facebook, dot, com, Slash missed in history, on Instagram, as aunt missed in history, at missed in history that tumblr com, restart comes lash, MR history, you'd like to research a little bit on your own good. Our parents house works. You can type in psychiatry and find a wealth of information and interesting article to keep you occupied. You can also visit me and Tracy missed in history dot com, where we have every episode of the show that has ever existed as well, as shown us for every observed, the Tracy and I have worked together in the last four years, so we

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