Making Sense of Pain: Delusions, Syphilis, and Somatic Pain in London County Council Asylums, c. 1900
During the late nineteenth century, a high percentage of male deaths in asylums was attributed to various forms of tertiary syphilis, most notably General Paralysis of the Insane (GPI) and tabes dorsalis. It was not unusual for patients to present symptoms of both conditions, the latter of which could be agonizingly painful. Some patients also suffered from persecutory delusions, believing that electricity was running through them or that their limbs were gnawed by lions and wolves at night. Drawing on a theory advanced by a number of key alienists and pathologists of the period, I suggest that these delusions were misinterpretations of felt sensations and, as such, illusions rather than delusions. Despite the well-known problems around using these historical sources, I contend that recorded delusions in asylum case notes can be treated as narratives of pain that provide invaluable insights into patients' subjective experiences.
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