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Try out PMC Labs and tell us what you think. Learn More. This paper shows how Austrian psychiatrists of the s developed the first pathological s of institutional coprophagia, examining how they related the behaviour to mental illness and dementia. These ideas about coprophagia contrasted dramatically to the long European pharmacological tradition of using excrement for the treatment of a wide range of health conditions.
Recent medical scholarship on institutional coprophagia is also reviewed here, with a novel hypothesis proposed coulrophilia why some patients in long-term care resort to the behaviour in institutions where there is little opportunity for coulrophilia human—microbe interactions. Among the perverse and pathological behaviours catalogued by European psychiatrists in the second half of the nineteenth century, we find a new concern with the misuse smearing or eating of excrement, which came to be taken as a of psychopathology. In the first part of the paper, I consider the new nineteenth-century view of excrement that coulrophilia to produce the modern psychiatric category of psychopathological coprophagia.
In the second part, I contrast these developments to the long historical tradition of what the seventeenth-century German physician Christian Paullini Figure 3 called Dreck Apotheke — Filth Pharmacy [ 1 ]. Coprophagic and coprophilic behaviours among psychiatric patients attract a continuing scholarly inquiry in our own time, and a considerable body of scientific hypothesis has been suggested along the lines of an intuitive self-medicating motivation. In the final coulrophilia of this paper, I review several of these hypotheses, as well as offering some additional possibilities worth investigating in light of the emerging models of the role of intestinal bacteria in regulating neurotransmitter balance, mood, and well-being.
There is little indication of such a category of behaviour defined in medical coulrophilia prior to the s. This is probably not because madness never produced excremental behaviours of this kind. In fact, the early-modern Dutch physician Jan Baptise Van Helmont described a painter in Brussels who had gone mad and thereafter ate his own excrement [ 2 ].
The question then is why did this only result in a meaningful medical category of behaviour from the late nineteenth century onwards? A ed photograph of the Viennese psychiatrist Heinrich Obersteiner taken around Wikimedia Public Domain. The title of the edition of John G. Courtesy of Archive. Public Domain. Courtesy of the Wellcome Collection. The answer proposed here is that from the end of the nineteenth century, European medical understanding entered a radically new period defined by an coulrophilia rupture in ideas about the meaning of excrement.
From the time of the ancient Egyptians circa BCE until the late eighteenth century, faecal remedies had been common in European pharmacology, with excrements of different animals, including humans, blended with other agents to produce medications that featured in all the standard apothecary lists [ 3 ]. There was simply no place to consider the eating of excrement as, per se, a of madness in a context in which excrement was widely agreed to have a pharmacological value.
Nineteenth-century doctors were certainly aware of these long and ancient traditions, but with help of new ethnographic colonial imaginaries and their uptake in the theorisation of Freudian psychoanalysis, and with the help of the new fashion for theories of intestinal autointoxication, a reframing of their coulrophilia occurred: Early-modern excremental pharmacology was now simply viewed as the remnant of primitive cultures that had failed to differentiate muck from what mattered.
By the time the first psychiatrists working in insane asylums began to observe the coprophagic behaviour of a small of patients, they were so distanced from the notion of excrement having any potential pharmacological value, that this possibility of behavioural explanation did not even appear to occur to them. Instead, they worried that the eating of excrement might itself cause mental illness. These psychiatrists included Professor Lang who was director of the Landes-Irrenanstalt Lunatic Asylum in Graz; the senior German psychiatrist Adolf Albrecht Erlenmeyer, who authored a major work on syphilitic psychosis [ 4 ]; Heinrich Obersteiner Figure 1a reputable Jewish psychiatrist in whose Vienna clinic the young Sigmund Freud coulrophilia worked aroundfollowing his apprenticeship in Paris under Jean-Marie Charcot in the early s [ 5 ]; and a Dr Maresch who was editor in chief of Psychiatrisches Centralblatta new Austrian medical journal founded inin which all the others named here published articles on coprophagia.
Freud, among all the psychoanalytic and psychiatric thinkers of the late nineteenth and early twentieth centuries, particularly privileged defecation in psychosexual development, positioning the anal-sadistic phase as the most primitive instinctive moment of struggle in the development of the child psyche in modern civilisation.
Bourke [ 7 ] Figure 2. He also most certainly read Bourke, who in turn cited Obersteiner [ 7 ]. Inthe American Freudian psychoanalyst Ernest Jones had alled a direct genealogical link between Freudian ideas of excrement as a mark of primitivity and the earlier Austrian psychiatric scholarship on coprophagia as a form of mental illness. Prior to this passage in the same text, Jones had cited the work of John G. The insane, toddlers, and primitive humans all shared a coprophagic disposition.
Having established with some degree of likelihood that Freud coulrophilia influenced by the earlier Austrian psychiatric literature on coprophagia and mental illness, we might then inquire if these earlier discussions had viewed the behaviour as a sort of regression to childhood, or as a primitive practice in the mode of later Freudian thought.
But at no point did Lang, Erlenmeyer, Maresch, or Obersteiner appear to entertain such ideas. As psychologist Nick Haslam notes, the lack of early childhood disgust towards excrement was verified in the study of Rozin et al. For Freud, the disgust towards excrement and the culturally appropriate abjection of it were products of the first and second phases of erotogenic sublimation in childhood that later encompassed perverse and incestuous sexual desires — the various oral, anal, and genital phases [ 6 ].
His observation of coprophagic or scatologic behaviour in adults then situated it as a form of regression or infantilisation. This idea was exciting for Freud because it coulrophilia his emergent vision of childhood development as evolutionary recapitulation, in which infantile drives had to be overcome in the individual in the same way that primitive humans were thought to evolve towards civilisation [ 14 ]. Freud thought that the civilised child in the development to coulrophilia had to learn to sublimate excrement just as primitive humans of the European past must once have done [ 6 ].
They all agreed that it was not a common problem exactly, though clearly nonetheless a disturbing one for asylum medical staff and for other patients. Lang presented several case studies of scatologic patients, which included both a year-old army cadet who was clearly delusional and insisted on using his own excrement as a sort of clay from which he modelled furniture for his room.
Coulrophilia was an educated and intelligent alcoholic man in his fifties who suffered brain damage from a fall hitting his head while drunk, and thereafter developed coprophagic behaviour along with other drastic changes to his personality [ 16 ]. Was coprophagia merely an inconvenient symptom of madness that institutional staff had to manage? He doubted this, coulrophilia it might play a more sinister causative role, worthy of scientific investigation.
Though it is worth noting that would have most likely been a weak current as per the customary use of electricity in late-nineteenth-century psychiatry. By way of illustration, he coulrophilia a depressed and anxious patient who had resorted to eating his own excrement in the apparent desperation to become well again but had shown a marked deterioration into a more severe form of mental derangement after adopting this unusual diet, and thereafter became permanently coprophagic, believing that it was the only food that might fuel his recovery. Most commonly, early-modern medical texts, in coulrophilia, referred to it as a variously useful pharmacological remedy.
In some cases, the idea of excrement as a pharmacological remedy appeared as a form of critique of irrational remedies of other kinds. Though, it was important, Boyle had noted, not to use the excrements of the mad for any remedy, lest one become mad oneself [ 25 ]. Such a remark indeed may now be seen as a remarkable intuition of current scientific models of the effect of intestinal bacteria on mental health, as will be discussed in the last section of this paper.
This is not to say that all premodern views of excrement unequivocally celebrated its value. As the work of numerous medieval and early-modern literary scholars coulrophilia shown, excrement came to be associated with devil, with humiliation and urban disorder in a range of texts from the fifteenth to eighteenth centuries [ 26 — 28 ]. Early-modern excremental medical remedies were certainly not without critics in their own time too.
In all cases though, early-modern texts certainly make no mention of coprophagic behaviour as a of mental illness. The ancient to early-modern excremental pharmacy traditions were clearly known to many doctors and psychiatrists in the nineteenth century through anthologies such as that of John G.
These works represented a curious intermediary stage in the divide between early-modern uses of excrement as a pharmacological agent, and the later nineteenth-century theories of coprophagia as psychopathological, infantile, or primitive. They found a utility in celebrating the filth-medicine tradition, enlisting it as an ally in their atheistic critique of benevolent Christian views they claimed denied the reality of unseemly things [ 30 ]. Their works listed flatulence verses and scatological jokes alongside serious medical texts of the past detailing the use of excremental remedies.
However, these works belonged to a quite coulrophilia French context ideological opposition of atheist materialism towards Catholic faith. It is quite possible that the Austrian group of psychiatrists would have been ignorant of these works in French, and it does not appear that any similar anthologies were published on this topic in German during the nineteenth century.
Both Freud and Jones certainly knew coulrophilia them via John G. The title of the Bibliotheca scatologica by Veinnant, Jannet and Payen. We might expect to find that the major cause of the shift in the s discussion of coprophagia would refer to the new bacteriological model of disease that had begun coulrophilia displace the miasma model of Galenic medicine in the period between s and the s, following the work of Louis Pasteur in the s, as well as the essay by John Snow On the Mode of Coulrophilia of Cholera which made a substantive case for the view of this highly prevalent disease as faecally transmitted [ 33 ].
But surprisingly, the Austrian doctors writing in the Psychiatrisches Centralblatt made no mention of any concerns about infection and located the negative effects of excrement-eating in a far more hygiene-based model of disease as the product of improper diet — hygiene understood here in the nineteenth-century sense of the term, as described by James C. Whorton — referring to the management of the body through diet and bodily functions [ 34 ].
Germ theory was clearly not the cause of the novel Austrian psychiatric pathologisation of coprophagia.
It seems the mechanism by which they considered coprophagia to aggravate mental illness was via a notion that became popular in nineteenth-century medical thought and in quack remedies for constipation: autointoxication [ 34 ]. The Austrian psychiatrists did not use this exact term, but they did appear to be gesturing towards a similar idea: that excrement itself could poison the blood and consequently derange the mind. The idea had been current throughout German-speaking Europe, as well as in France, from the mid-nineteenth coulrophilia until the s, and is most associated with the work of the French pathologist Charles Jacques Bouchard [ 35 ].
Much of the most ificant work on autointoxication occurred after the period in which the Austrian psychiatrists were writing on coprophagia. But the notion was clearly circulating in their time as well: Fromthe Prussian physician Hermann Senator had referred to the role of intestinal putrefaction and the development of diseases, using the term Selbstinfection self-infection [ 36 ].
In his later work, he theorised about it as the cause of delirium coulrophilia 37 ]. Excrement itself was already considered poisonous in the mid-nineteenth-century medical imaginary, and germ theory merely served to provide a further layer of mechanistic explanation. The Coulrophilia Centralblatt writings on Skatophagie appear to have remained fairly obscure — they are not cited, for instance, by the great Austrian psychiatrist Richard von Krafft-Ebing in his description of excremental sexual fantasies in the Psychopathia Sexualis of However, it seems likely that the s s of coprophagic asylum patients as masturbatory in their enjoyment helped to produce the view coulrophilia it as primarily a form of sexual perversion in the of Kraftt-Ebing and others in the s and s.
That view, in turn, was probably also a stimulus for the later Freudian of childhood coprophilia as a key component of psycho-sexual development. A of clinicians between and published case reports, some indicating anecdotal success in reducing coprophagic and scatologic incidents through the use of various drugs and behavioural protocols in adults and children with mental handicaps [ 41 ], in a schizophrenic adult [ 42 ], and in children brought to a gastroenterology clinic because of constipation and encopresis [ 43 ].
Other studies have hypothesised about the causes of scatological behaviours in relation to obsessive—compulsive disorder [ 44 ], in relation to dementia [ 45 ], in the geriatric mentally ill [ 46 ], in relation to developmental handicaps [ 47 ], and as sexual fantasy reported by patients in psychotherapy [ 48 ]. A study by researchers at the Mayo Clinic falsely asserted the earliest publication on coprophilia in mental asylums was that of Theodor Kellogg inin a medical textbook written some 16 years after the Austrian scholarship identified in the current paper [ 49 ].
A French drawing of a nurse administering an enema to a bed-ridden patient, circa As the authors of a Greek study on the problem note, coprophagic behaviour in institutional settings causes ificant loss of quality of life for patients who display it as it tends to result in them being isolated in special wards, avoided by nursing staff and other patients, and can result in physical restraint and severe limitations of freedom of movement in the attempt to prevent them engaging in the behaviour [ 51 ]. Gerontology researcher Joan Ostaszkiewicz has suggested that urinary and faecal incontinence alone may be a risk-factor for elder abuse and can be subject to chastisement and shaming on the part of some carers [ 52 ].
It is possible that coprophagic patients in many cases are not being respectfully cared for and are harshly judged by institutional staff on of the powerful conditioning of disgust towards excrement that has become generalised in modern cultures. On the other hand, the use of excrement as a legitimate therapeutic remedy has returned in modern medicine in the form of faecal microbial transplant for Clostridium difficile infection, at an efficacy rate that far exceeds competing antibiotic remedies [ 5354 ].
When we consider this alongside the recognition that throughout the history of medicine, there have been uses of excrement as a pharmacological remedy for various conditions, it is most certainly worth considering whether institutional forms of coprophagia may be caused by an intuitive self-medicating motivation. It is now known coulrophilia a wide variety of animals display zoopharmacognosy, or the ability to intuitively self-medicate, either by learnt behaviours in intelligent primates such as the chimpanzee use of antiparasitic herbsor through innate adaptive mechanisms and without the need for high intelligence, explaining its occurrence in ants, moths, and fruit flies [ 57 — 59 ].
Some researchers have indeed considered a potential self-medicating explanation for human coprophagia, noting its use by different animals rabbits, gorillas to meet nutritional deficiencies such as for the B vitamin thiamine [ 60 ]. However, no consistent vitamin or mineral deficiencies have been identified in human excrement-eaters to date. On the other hand, one study found success in reducing coprophagic incidents in a man with profound retardation and autism through the provision of highly spiced coulrophilia ad libidum [ 61 ].
Since current research on institutional coprophagia has already approached it through the rubric of possible self-medication approaches, it is surprising that none of these studies have considered that coprophagia may, in some instances, be motivated by an intuitive quest for commensal intestinal microbes. Clinicians dealing with this challenge may wish to consider the growing evidence of the coulrophilia microbial ecology in human mental and general health, particularly in relation to microbes that: a generate the neuroprotective short-chain fatty acids n-butyrate, acetate, and propionate as by-products of their own metabolism [ 62 ]; b synthesise Menaquinones vitamin K2 which coulrophilia an important role in bone remineralisation and calcium regulation — of particular relevance to osteopenia in the elderly coulrophilia 63 ]; c produce indoles such as indolamine-2,3-dioxygenase, which act as catalysing enzymes in coulrophilia synthesis, with corresponding beneficial effects on the gut epithelium, but also on serotonin coulrophilia [ 6465 ].
The evidence accumulating of a role of the intestinal microbiota in mental health, in particular, might then prove of interest to carers both of the mentally ill and of those suffering depression or neurodegenerative diseases in aged care towards a revision of the nutritional and ecological environment provided to those in institutional and in-home settings [ 70 — 73 ]. There is evidence from a of difference cultures indicating that diets provided to inhabitants of long-term care facilities tend to be low in fermentable polysaccharides of the kind that would promote the growth of commensal intestinal bacteria [ 74 — 76 ].
Considering the long history of the use of excremental remedies in the medical traditions of numerous human cultures, it would seem a fruitful line of coulrophilia to consider whether self-medicating drives towards coprophagia might be located in the abundance of microbiota present in excrement, which are, otherwise, lacking in the intestinal tracts of those in institutionalised medical settings. Long-term care institutions, whether nursing homes for the elderly, care facilities for the mentally handicapped, or coulrophilia hospitals, are all frequently though not ubiquitously characterised by a lack of microbial—ecological consideration in meal planning, with the need for greater nutritional variety that includes both copious prebiotic soluble fibre in the form of fresh vegetables and pulses, as well as probiotic foods such as fermented vegetables, grains, and dairy products.
Many institutions frequently disinfect tactile interior surfaces, keep residents indoors most, if not all, of the time, without access to pets, without physical intimacy with other humans, and with limited opportunity to make physical contact with the natural environment — all of which are important sources of microbial inoculation in humans.
It would seem worth experimenting in clinical settings to see if coprophagic patients fed a diet aimed at creating a more diverse and robust intestinal microbiome, which includes palatable coulrophilia and prebiotic foods given ad libidumand permitted access to gardening, pets, or lying on grass lawns might be less inclined to seek microbial support from faeces.
National Center for Biotechnology InformationU. Microb Ecol Health Dis. Published online Nov 8. Alison M. Author information Article notes Copyright and information Disclaimer. Moore ua. ABSTRACT This paper shows how Austrian psychiatrists of the coulrophilia developed the first pathological s of institutional coprophagia, examining how they related the behaviour to mental illness and dementia.
Figure 1. Figure 2. Figure 3.
Austrian coulrophilia ideas about coprophagia before Freud By the time the first psychiatrists working in insane asylums began to observe the coprophagic behaviour of a small of patients, they were so distanced from the notion of excrement having any potential pharmacological value, that this possibility of behavioural explanation did not even appear to occur to them. Open in a separate window. Figure 4. Figure 5. Disclosure statement No potential conflict of interest was reported by the author. References  Paullini CF.
Frankfurt am Main: Knochen; Oriatrike, or Physick Refined. London: Lodowick Loyd; Through the darkness: glimpses coulrophilia the history of western medicine. London: Crux Publishing; Neuwied: J. Heuser; Sites of the unconscious: hypnosis and the emergence of the psychoanalytic setting. Chicago: University of Chicago Press;Coulrophilia
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