Lobes and Robes

Pinel described that most patients who are going to improve do so in the first month of hospitalization. Esquirol’s numbers from Salpêtrière are at odds with this, but support the supposition that as time goes on fewer patients recover. A number of case reports follow, some of which outline improbable events associated with recovery from altered mental status. Ray himself notes that these events were likely coincidental to an improvement that was likely part of the natural disease course. He cautions against predicting recovery with certainty, which seems wise in a pre-antipsychotic era. Intellectual impairment and senile dementia are noted not to have the same periods of improvement noted in other diseases. The likelihood of recurring illness after initial onset of illness is recognized as very likely, and the strength of that likelihood is noted to be related to extent of recovery to premorbid baseline. When the court calls for determination of sanity, Ray cautions that the time frame between certain illness and certain recovery is long, and a significant gray area.