! ! Blind!to!Their!Blindness:!A!History!of!the!Denial!of!Illness! ! ! A!dissertation!presented! by! Scott!Douglas!Phelps! to! The!Department!of!the!History!of!Science! ! ! in!partial!fulfillment!of!the!requirements! for!the!degree!of! Doctor!of!Philosophy! in!the!subject!of! History!of!Science! ! ! Harvard!University! Cambridge,!Massachusetts! ! ! April!2014! ©!2014!Scott!Douglas!Phelps! All!rights!reserved. Dissertation!Advisor:!Professor!Anne!Harrington!! Scott!Douglas!Phelps! ! Blind!to!Their!Blindness:!A!History!of!the!Denial!of!Illness! ! ! Abstract! ! For!many!historians,!sociologists,!and!anthropologists!of!medicine,!“disease”!and! “illness”!are!not!equivalent.!Whereas!“disease”!denotes!the!physician’s!ostensibly! objective!criteria,!“illness”!emphasizes!the!patient’s!subjective!experience.!This! dissertation!examines!that!distinction!precisely!at!a!point!where!it!breaks!down,!in!the! history!of!a!diagnosis!called!“anosognosia,”!also!known!as!the!denial!of!illness.! In!the!1890s,!Austrian!psychiatrist!Gabriel!Anton!observed!a!number!of!patients! who!denied!being!blind,!deaf,!or!paralyzed.!“That!is!just!how!it!is,”!a!patient!demurred,! “one!sees!better!in!youth.”!The!question!to!Anton!was,!were!such!patients!truly! unaware!of!their!loss!or!did!they!sense!it!on!some!level,!if!only!to!deny!it?!! The!history!of!Anton’s!syndrome,!later!named!“anosognosia”!by!the!French! neurologist!Joseph!Babinski,!spans!more!than!a!century!and!a!half!across!two!continents! and!through!both!world!wars.!I!treat!its!history!as!a!special!type!of!lens!to!focus!on! some!of!the!broader!intellectual!and!professional!differences!between!neurology!and! psychiatry.!I!argue!that!the!clinical!perception!and!portrayal!of!this!apparent!loss!of!the! patient’s!experience!depended!on!historical!patterns!of!thinking!about!the!distinction! between!conscious!and!unconscious!perception!as!well!as!categories!of!health!and! disease.!To!think!about!the!denial!of!illness!was!to!think!about!the!very!meaning!of! illness!and!awareness,!and!the!difference,!if!any,!between!the!mind!and!the!brain.! ! ! iii! Abstract…………………………………………………………………………………………………………………..…....iii! Table!of!Contents..………………………………………………………………………………………………………..iv! Acknowledgements…………………………………………………………………………………………..…………..vi! ! Introduction……………………………………………………………..…………………………………………………..!1! ! Chapter!1…………………………………………………………………………………………………………………..…23! On!a!Certain!Blindness:!The!Making!of!Anton's!Syndrome! Out$of$Confusion$and$Into$Awareness$ The$Doctrine$of$Cerebral$Localization$ The$Rise$of$Academic$Psychiatry$ The$Question$of$the$Soul$and$Scientific$Materialism$ A$Symptom$of$the$Times?$ $ Chapter!2…………………………………………………………………………………………………………............!84! The!Revolution!of!Indifference,!or!How!One!Half!of!Hysteria!Became!Two!New!Brain! Diseases! “Une$indifférence$particulière”$ $ The$Unity$of$the$Self$ The$Dismemberment$of$Hysteria$ Was$It$Real?$ ! Chapter!3……………………………………………………………………………………………………………...……127! The!Paradox!of!Health:!Wartime!Lessons!from!the!BrainIInjured! “The$Double$Way”$ “Organic$Repression”$ A$New$Anna$O.$ The$Case$of$MerleauMPonty$ $ ! ! iv! Chapter!4……………………………………………………………...……………………………………………………159! Filling!in!the!Patient's!View:!Denial!Syndromes!and!American!Neuropsychiatry!of!the! MidITwentieth!Century! A$Unifying$Concept$ Culture$and$Combat$Fatigue$ The$Genus$of$Neuropsychiatry$ ! Chapter!5……………………………………………………………………………………………………………………186! From!Denial!to!Disconnection:!Norman!Geschwind!and!the!Rise!of!Behavioral! Neurology! SplitMBrain$Syndromes$ The$Borderlands$between$Neurology$and$Psychiatry$ Historical$Neurology$and$Neurological$History$ ! Epilogue………………………………………………………………………………………………………………….....216! Insight!Out:!ReIthinking!the!Perception!of!an!Illness!of!Perception! ! Bibliography………………………………………………………..……………………………………………………..220! ! ! ! v! Acknowledgements! ! Thank!you.!There!is!no!way!to!say!it!adequately.!There!is!no!way!to!convey!the!kind!of! gratitude!I!feel!for!those!whom!I!am!about!to!“acknowledge”!in!these!ephemeral!pages.! To!Joanna,!first!and!foremost,!we!made!it!!You!have!been!there!for!me!in!ways!I! did!not!know!another!person!could!be!present!for!another.!For!years!and!years!on!end,! sometimes!seemingly!to!no!end,!you!patiently!waited!for!this!project!to!take!shape!and! come!out!from!under!my!skin!into!the!light!of!day.!Thank!you!for!your!quiet!faith.!And! thank!you!for!reminding!me!there!are!always!more!adventures!waiting!around!the! corner.! To!my!primary!advisor,!Anne!Harrington,!who!never!turned!her!back!on!me,! even!if!I!was!lost!on!a!train!to!Wales,!even!despite!shoddy!internet!connections!in! Berlin,!and!even!when!the!difference!in!time!zones!was!more!than!a!little!inconvenient,!I! thank!you.!You!introduced!me!to!the!history!of!science.!You!kept!me!focused!and!more! than!once!saved!me!from!my!own!tangle!of!thoughts.!It!has!been!an!honor!calling! myself!one!of!your!students.!And!it!will!always!be.!To!my!advisor,!Charles!Rosenberg,! thank!you!for!making!yourself!consistently!available!to!edit!my!writing!and!help!me! incubate!my!ideas.!I!hope!it!is!already!obvious!by!now!how!much!my!project!was! inspired!by!your!vast!scholarship.!To!my!advisor,!Hisa!Kuriyama,!I!am!fortunate!that!our! paths!crossed!in!Paris!four!years!ago.!You!offered!me!a!kind!of!distraction!of!the!highest! order!with!all!the!wonderful!books!and!films!you!recommended!over!the!years.!Your! sense!of!play!and!depth!of!imagination!breathed!new!life!into!my!graduate!experience! and!helped!me!keep!not!only!my!head!but!also!my!heart!in!the!game.! To!Philipp!Lehmann,!thank!you!for!all!your!help!over!the!years!with!my! translations!of!arcane!German!medical!jargon!and!your!encouragement!through!many! early!drafts.!To!Andrew!Parker,!thank!you!for!giving!me!the!chance!to!fly!to!fardflung! places!each!year!and!prodding!me!to!keep!up!my!French.!To!Beau!Bellenfant,!thank!you! for!all!the!afternoon!porch!chats!and!helping!me!stay!grounded.!To!David!Smith,!thank! you!for!being!my!first!friend!in!Cambridge!and!all!the!late!talks.!To!Justin!Valentine,! thank!you!for!keeping!me!in!shape.!To!Greg!Phelps,!I!am!lucky!to!have!always!had!such!a! friend!and!mentor!in!a!big!brother!from!day!one.! I!want!to!thank!a!number!of!folks!at!Harvard!for!being!patient!listeners!and! generously!offering!their!time:!Steve!Shapin,!Rebecca!Lemov,!David!Jones,!Sean!Kelly,! Katja!Guenther!(especially!for!sharing!the!copies!of!Schilder’s!papers!and!reading!an! early!draft!of!my!first!chapter),!Chris!Phillips,!Jeremy!Blatter,!Peter!Gordon,!Jimena! Canales,!Stefan!Sperling,!Steve!Hyman,!and!Nasser!Zakariya.!Thanks!also!for!the!support! from!Robert!Martensen!(especially!in!the!early!stages!of!my!prospectus),!Constantin! Tranulis!(pour!les!randonnées),!Claude!and!Armelle!Debru!(pour!un!séjour!très! mémorable!à!Paris),!Alena!and!Frank!Lehmann!(meine!liebe!deutsche!Eltern),!Romain! and!Pauline!Schneckenburger,!Jacob!Rooksby,!and!Steven!Benyas.!I!am!grateful!to!the! Beinecke!Foundation,!Rotary!Foundation,!and!the!National!Science!Foundation!for! generously!funding!my!research.! ! Finally,!to!my!parents,!Doug!and!Peggy!Phelps,!this$one’s$for$y’all.! ! vi! Introduction! Blind!to!Their!Blindness:!A!History!of!the!Denial!of!Illness! ! “[N]o$one$is$healthy$who$knows$that$he$is$so.”1$ ! In!1899,!the!year!that!Freud!finished!The$Interpretation$of$Dreams,$Austrian! psychiatrist!Gabriel!Anton!described!three!patients!with!a!very!peculiar!type!of! behavior.!All!three!had!suffered!a!form!of!brain!disease,!and!as!a!result,!two!were!left! completely!deaf!and!the!other!blind.!When!the!first!patient!checked!into!Anton's!clinic,! she!complained!of!headaches!and!back!pain.!Within!a!month,!she!completely!lost!her! vision.!And!yet,!she!never!seemed!to!realize!it.!True,!she!admitted,!her!eyesight!was!not! as!good!as!it!used!to!be.!“That!is!just!how!it!is,”!she!demurred,!“one!sees!better!in! youth.”!But!she!denied!being!blind.!According!to!Anton,!such!patients!lacked!not!only! their!eyesight!but!also!“illnessdinsight.”!They!were,!he!wrote,!“mentally!blind!to!their! blindness.”2! A!decade!and!a!half!later,!in!the!summer!of!1914,!French!neurologist!Joseph! Babinski!reported!to!the!Société$de$Neurologie!in!Paris!two!patients!with!the!most! remarkable!“mental!trouble.”!After!suffering!what!appeared!to!have!been!a!stroke,!they! were!paralyzed!on!the!left!side!of!their!body.!Otherwise,!they!still!recognized!their! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 1!Georges!Canguilhem,!The$Normal$and$the$Pathological!(New!York:!Zone!Books,!1991),!243.! ! 2!Gabriel!Anton,!“Über!die!Selbstwahrnehmung!der!Herderkrankungen!des!Gehirns!durch!den!Kranken!bei! Rindenblindheit!und!Rindentaubheit,”!Archiven$für$Psychiatrie$und$Nervenkrankenheiten!32!(1899):!86– 127;!Gabriel!Anton,!“Blindheit!nach!beiderseitiger!Gehirnerkrankung!mit!Verlust!der!Orientierung!im! Raume,”!Mittheilungen$des$Vereines$der$Aerzte$in$Steiermark!33,!no.!3!(January!27,!1896):!41–46;!Gabriel! Anton,!“Beiträge!zu!klinischen!Beurtheilung!und!zur!Localisation!der!Muskelsinnstörungen!im!Grosshirne,”! Zeitschrift$für$Heilkunde!14!(1893):!317–319,!323–325.! ! friends!and!family!and!could!carry!on!normal!conversations.!There!was!just!one!glaring! problem.!Whenever!Babinski!asked!them!to!try!to!raise!the!paralyzed!arm,!they! completely!ignored!him.!After!repeated!requests,!one!patient!finally!replied,!“There,!it's! done,”!although!the!arm!lay!motionless!by!her!side.3! By!most!accounts,!this!marked!the!beginning!of!the!history!of!“anosognosia,”4! known!also!as!the!AntondBabinski!syndrome.5!Strictly!speaking,!it!is!true.!Anton!was!the!