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THÉODORE GERICAULT (1791-1824) was a French painter, draftsman, lithographer, and sculptor. In his short life—12 working years—he dramatically represented contemporary experience in a visually truthful manner, seeking a middle ground between the Romantic and Neoclassical styles. He is best known for his Raft of the Medusa (1819) in the Louvre Museum (Paris, France). This painting of the aftermath of a shipwreck depicts survivors trapped on a raft and exposed to the elements. He emphasizes not the scandal that took place there, with the outbreaks of mutiny and cannibalism, but rather the suffering, struggle, and perseverance of men abandoned to the forces of nature. Although work on the painting stimulated Gericault's interest in medicine, it was a maternal family history of mental illness and his own experience of depression with paranoid delusions in 1819 that may have motivated him to accept an invitation to paint Portraits of the Insane (1822-1823).1 These intense and spontaneously executed paintings of monomania have a powerful realism and avoid traditional stereotypes of people with mental illness.2
Théodore Gericault (1791–1824), French. The Obsession of Envy (Monomanie de l'envie),1819–1822. Oil in canvas. Copyright Musée des Beaux-Arts, Lyon, France/Bridgeman Art Library, New York, NY.
Gericault completed a series of 10 portraits of insane men and women, probably referred to him by an acquaintance, Etienne-Jean Georget (1795-1828), a student of Jean Etienne Dominique Esquirol (1772-1840) and pioneer in forensic psychiatry. The 5 surviving portraits illustrate monomanias with legal implications: Kleptomania (Monomanie du vol), Gambling Mania (Monomanie du jeu), Obsessive Envy (Monomanie de l'envie), Delusion of Military Command (Monomanie du commandement militaire), and Compulsive Kidnapping (Monomanie du vol des enfants). It is unknown whether the missing 5 paintings were of the same subjects after treatment, in keeping with Esquirol's interest in physiognomic documentation before and after illness, or 5 different subjects.
The paintings are half-length portraits of patients in their own clothing with their faces illuminated against a dark background. Thick paint accents the eyes, showing tension or uneasiness. The gaze is sideways, avoiding eye contact, instead of face-to-face, to imply mental state rather than action or behavior; the brow is contracted to illustrate preoccupation. The envious woman's eyes are reddened and her facial features sag, suggesting fatigue or stress. She seems agitated and is grimacing with resentment; her clothing is ragged, and her bonnet ties dangle. She wears an ill-fitting cap with loose stands of hair; overall she seems disheveled. At the hospital she was referred to as "the hyena."3(p237)
Esquirol proposed a classification of monomanias to describe forms of partial insanity in which reason seems preserved yet the patient performs outrageous acts. It was an effort to categorize seemingly healthy individuals with isolated preoccupations. Esquirol suggested that monomanias were chronic brain diseases unattended by fever and characterized by partial lesions of intelligence, affect, or will.4 He wrote,
In the intellectual (ideational) form the patient seizes upon a false principle, which they pursue without deviating from logical reasoning, and from which they deduce logical consequences from which they modify their affections, and the acts of their will. Aside from this partial delirium they think, reason and act like other men. In affective (volitional) monomania, they are not deprived of their reason but their affections and dispositions are perverted. By plausible motives . . . they justify the actual condition of their sentiments and excuse the strangeness and inconsistency of their conduct. In instinctive monomanias, a lesion of will exists: The patient is drawn away from his accustomed course, to the commission of acts, to which neither reason nor sentiment determine, which conscience rebukes, and which the will has no longer the power to restrain. The actions are involuntary, instinctive, and irresistible.4(p320)
Although monomania was widely diagnosed at the beginning of the 19th century, it was abandoned as a diagnostic category after Esquirol's death. Its lack of specificity and doubts that isolated mental symptoms could occur in an otherwise healthy person led to its demise, yet remnants of the monomania concept, such as irresistible impulse and fixed idea, remain in modern cultural usage. Its conceptual basis endures in certain categories of DSM-IV impulse control disorders (eg, kleptomania and pyromania), the description of certain obsessions, and behavioral phenotypes such as the compulsive self-biting in Lesch-Nyhan syndrome. Its main legacy is in forensic psychiatry. Goldstein5 suggests that monomania was a linchpin in the efforts of Esquirol and Georget to win public recognition for psychiatry in the courts. In Esquirol's description of homicidal monomania,4 he insisted that the criminally insane should be treated as though they had a brain disease. In the 1820s, Georget proposed that monomaniacal homicide should be classified not as a crime but as a medical illness.5 The term's first reported forensic use in the United States was in 1845.6
Monomania and partial insanity raised important issues about the nature of the mind. If a discrete part of the mind could be diseased while others were not, the mind was not "spiritual either"5(p388) but was localized in regions of the brain, supporting a brain-based, materialistic view of mental illness. Monomania and partial insanity were organizing concepts that linked psychiatric symptoms to brain regions: a harbinger of our current approach to studying how mental phenomenology and neuropsychology are related to brain function.
Harris JC. The Obsession of Envy (Monomanie de l'envie). Arch Gen Psychiatry. 2003;60(8):764. doi:10.1001/archpsyc.60.8.764
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