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Images in Psychiatry   |    
Henri Dagonet: Lypémanie and Depression
Am J Psychiatry 1999;156:1499-1499.

In his Nouveau Traité Elémentaire et Pratique des Maladies Mentales (1876), the French psychiatrist F1 was the first physician to use photographs to illustrate a medical text. In the plate reproduced above he represented four patients suffering from various forms of what he, following his teacher Esquirol, called "lypémanie." Derived from Greek roots (for "sadness" and "madness"), "lypémanie" would appear to have been equivalent to "major depression with psychotic features" in current nosology. Dagonet was careful to differentiate it from simple "melancholia," which in his system would have been called "lypémanie sans délire," since it did not involve any cognitive disturbance. Dagonet distinguished such subsidiary forms as "lypémanie erotique" (equivalent to our "erotomania"), "lypémanie anxieuse" ("panphobic," apparently equivalent to our "major depression with comorbid anxiety disorder"), and "lypémanie religieuse" and "lypémanie hypochondriaque," defined by the patient’s predominant delusional preoccupations.

The photographs were intended to acquaint the reader with the "characteristic physiognomic features" of the disorder, consistent with Dagonet’s view, widely held at the time, that physiognomy held an essential key to clinical diagnosis. Nonetheless, his verbal descriptions of the disorder, exhaustively and meticulously detailed, would be instantly recognizable today; unfortunately, he did not have at his disposal the therapeutic resources available to modern psychiatry.

Dr. Esman, 115 East 86th St., New York, NY 10028. Photograph courtesy of Dr. Esman.




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