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February 1998, Vol 55, No. 2 >

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History of Neurology | February 1998

A Happy State of Mind:  A History of Mild Elation, Denial of Disability, Optimism, and Laughing in Multiple Sclerosis

Stanley Finger, PhD
Arch Neurol. 1998;55(2):241-250. doi:10.1001/archneur.55.2.241.
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Although multiple sclerosis (MS) is often looked on as a disorder of the sensory and motor systems, it can also be associated with changes in emotion and personality. Many patients with MS seem cheerful, optimistic about the future, and strangely unconcerned about their ongoing physical deterioration. In addition, patients with MS have a tendency to break into uncontrollable laughing, even when they have no reason to be happy. This article looks at how these seemingly upbeat affective changes were viewed by early researchers of MS, including Cruveilhier, Charcot, and Moxon during the 19th century and Cottrell, Wilson, and Ombredane in the 1920s. Frequently cited studies on the emotional correlates of MS from the mid-20th century are also presented, and some trends in the more recent literature are identified.
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Figure 1.

Jean Cruveilhier (1791-1874), one of the first physicians to describe the underlying pathological manifestations of multiple sclerosis as well as some of its clinical signs.

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Figure 2.

Part of a plate from Anatomie pathologique du corps humain (1842) by Jean Cruveilhier3 showing the plaques of multiple sclerosis in the pons and spinal cord. Although this figure appeared in Livraison 38, Cruveilhier wrote that this planche offered new and better examples of the spinal lesion described in the Livraison 32, where the case of Dargès was presented.

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Figure 3.

Jean-Martin Charcot (1825-1893), who first clearly distinguished between multiple sclerosis and Parkinson disease, with which it tended to be confused. Charcot presented detailed descriptions of the behavioral changes that accompany multiple sclerosis, including the unusual affective states of some patients with multiple sclerosis.

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Figure 4.

Edmé Félix Alfred Vulpian (1826-1887), who worked with Charcot at the Salpêtrière, Paris, France, during the 1860s.

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Figure 5.

Samuel Wilks (1824-1911), who claimed that he only understood what the pathological anatomy of multiple sclerosis signified after reading Charcot's descriptions of the disease.

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Figure 6.

Silas Weir Mitchell (1829-1914), the American neurologist who conducted the autopsy on Dr Pennock, the victim of multiple sclerosis who, in 1868, was described as having an unusually "happy state of mind."

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Figure 7.

Smith Ely Jelliffe (1866-1945), the New York psychoanalyst who, during the 1920s, tried to make the case that the emotional and personality changes of patients with multiple sclerosis are largely attributable to unconscious psychological factors.

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Figure 8.

S. A. Kinnier Wilson (1878-1937), the neurologist who teamed up with Samuel Smith Cottrell, a psychiatrist, to conduct the first systematic study on "euphoria sclerotica" and associated emotional changes in patients with multiple sclerosis. (From Haymaker.41 Permission granted by Charles C Thomas Publisher.)

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