Patriarca C, Clerici C A
Division of Pathology; Asst Lariana, Ospedale Sant'Anna, Como, Italy.
Department of Oncology and Haemato-oncology, Università degli Studi di Milano and SSD Psicologia Clinica, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
Pathologica. 2019 Jun;111(2):79-85. doi: 10.32074/1591-951X-47-18.
In the conviction that a look at the past can contribute to a better understanding of the present in the field of science too, we discuss here two aspects of the relationship between early 20 century anatomic pathology and psychiatry that have received very little attention, in Italy at least. There was much debate between these two disciplines throughout the 19 century, which began to lose momentum in the early years of the 20, with the arrival on the scene of schizophrenia (a disease histologically sine materia) in all its epidemiological relevance. The First World War also contributed to the separation between psychiatry and pathology, which unfolded in the fruitless attempts to identify a histopathological justification for the psychological trauma known as shell shock. This condition was defined at the time as a "strange disorder" with very spectacular symptoms (memory loss, trembling, hallucinations, blindness with no apparent organic cause, dysesthesias, myoclonus, bizarre postures, hemiplegia, and more), that may have found neuropathological grounds only some hundred years later. Among the doctors with a passed involvement in the conflict, Ugo Cerletti, the inventor of electroshock treatment, focused on the problem of schizophrenia without abandoning his efforts to identify its organic factors: if inducing a controlled electric shock, just like an experimentally-induced epileptic seizure, seems to allay the psychotic symptoms and heal the patient, then what happens inside the brain? In seeking histological proof of the clinical effects of electroconvulsive therapy ("the destruction of the pathological synapses"), and attempting to isolate molecules (that he called acroagonins) he believed to be synthesized by neurons exposed to strong electric stimulation, Cerletti extended a hand towards anatomic pathology, and took the first steps towards a neurochemical perspective. However his dedication to finding a microscopic explanation for schizophrenia - in the name of a "somatist" approach that, some years earlier, the psychiatrist Enrico Morselli had labelled "histomania" - was unable to prevent psychiatry from moving further and further away from anatomic pathology.
我们坚信，回顾过去有助于更好地理解科学领域的现状，因此在此讨论20世纪初解剖病理学与精神病学之间关系的两个方面，至少在意大利，这两个方面很少受到关注。在整个19世纪，这两个学科之间存在诸多争论，而在20世纪初，随着具有所有流行病学相关性的精神分裂症（一种组织学上无实质病变的疾病）的出现，争论开始失去势头。第一次世界大战也促使精神病学与病理学分离，当时人们试图为所谓的炮弹休克这种心理创伤找到组织病理学依据，但未成功。这种情况在当时被定义为一种“奇怪病症 ”，症状非常惊人（失忆、颤抖、幻觉、无明显器质性原因的失明、感觉异常、肌阵挛、怪异姿势、偏瘫等等），可能直到大约一百年后才找到神经病理学依据。在曾参与过冲突的医生中，电休克疗法的发明者乌戈·塞尔莱蒂在不放弃寻找精神分裂症器质性因素努力的同时，专注于精神分裂症问题：如果诱发可控电击，就像实验诱发癫痫发作一样，似乎能缓解精神病症状并治愈患者，那么大脑内部会发生什么？在寻求电惊厥疗法临床效果的组织学证据（“病理性突触的破坏”）以及试图分离他认为由受到强电刺激的神经元合成的分子（他称之为促兴奋素）时，塞尔莱蒂向解剖病理学伸出了援手，并朝着神经化学的方向迈出了第一步。然而，他以一种“躯体主义”方法（几年前精神病学家恩里科·莫尔塞利曾将其称为“组织狂热症”）为名，致力于为精神分裂症寻找微观解释，但这并未能阻止精神病学与解剖病理学渐行渐远。
