A passion when focused on a single object, on a single concern can quickly become an obsession and lead to delirium.

Monomania (from the ancient Greek monos “one” and manía “madness, dementia, state of fury) is a term used in psychopathology and psychiatry in the first half of the XNUMXth century to describe a delirium characterized by a single preoccupation, an intellectual disorder, delusional, limited to a single object or a small number of ideas.

This term of “monomania” was created by Jean Etienne-Dominique Esquirol (1772-1840): it designates any monovalent mania, or partial delirium with a fixed dominant idea. Psychiatrist, head doctor of the insane service of La Salpêtrière (Paris), in 1817 he opened the first clinical course for mental illnesses, and became a member of the Academy of Medicine in 1820. We owe him a classification based on a more in-depth psychopathological analysis. His observations led him to create new terms.

For Esquirol, monomania “is, of all diseases, that which presents the observer with the strangest and most varied phenomena, which offers to study the most numerous and profound subjects for meditation. the mysterious anomalies of sensibility, all the phenomena of human understanding, all the effects of the perversion of our inclinations, all the errors of our passions ”.

The patients start from a false principle from which they follow without deviating from the logical reasoning and from which they draw legitimate consequences which modify their affections and the acts of their will. Outside of this partial delirium, they feel, reason, act like everyone else.

Analyzing this disease again, Esquirol divides monomania into monomania proper, characterized by partial delirium and exciting or cheerful passion, and monomania with partial delirium and sad and oppressive passion, for which he creates the term lypémanie (from the Greek verb experiencing extreme grief, anxiety).

Pioneers of psychiatric thought were motivated to explore such diagnoses because they promised public recognition under the high statute framework of the criminal court. Some success has been obtained by presenting a form of expertise centered on the ability of experts to detect fairly subtle and “psychological” forms of dangerous madness in the minds of delinquents in France and more generally in England. A violent press reaction against these new ideas pushed the profession to move away from such psychological exploration and return to its medical roots which located criminal insanity simply in the organic make-up of its victims. After the 1850s, monomania disappeared as a diagnostic criterion in psychiatry and no longer appears in the Diagnostic and Statistical Manual of Mental Disorders. Today, it is equated with obsessive-compulsive disorder (OCD).

The causes of monomanies are the subject of a serious analysis by Esquirol, which distinguishes between social, economic and political causes. Numerous examples illustrate them where passions play a primordial role, in particular the political passions unleashed in revolutionary period. Regarding the passions, Esquirol quotes several times from Cabanis’s work: Report of the physical and moral of man. He gives examples of the influence of passions on organic functions, and of the reverse phenomenon. The search for brain damage that causes mental illness has been the subject of studies for some students. The passions are often the exaggeration of feelings, tendencies, needs linked to each civilization. Esquirol observes that monomania is all the more frequent as civilization is more advanced. Esquirol’s analysis continues with the study of the “elements” or symptoms of monomania, among which he observes the important role of hallucinations, cerebral or psychic phenomena accomplished independently of the senses.

• Affective monomanies: the disorder remains mainly affective, affecting the sensitivity, without real delirium. The monomaniacs are not unreasonable, but their affections, their character are perverted. By plausible motives, by very well reasoned explanations, they justify the present state of their feelings and excuse the oddity, the impropriety of their behavior;
• Intellectual monomania: intellectual disorder, delirium with often illusions of the senses, morbid interpretations, hallucinations dominate the symptomatology;
• Instinctive monomanies: in these monomanies, the will is injured, those who are affected by it perform criminal and immoral acts like irresistible instinctive actions. These can go as far as homicide.
• It is in this last category of monomania that the alienists of the time will locate there a particularly serious form on the social, judicial and medico-legal level, the “homicidal monomania” which was to allow them to alienist physicians to justify medically. criminal irresponsibility of many criminals.

Treatment for obsessive-compulsive disorder involves the use of psychotherapy techniques and, possibly, antidepressant medications.

Behavior therapy

It is based on the technique known as progressive exposure with desensitization. For forty to fifty sessions, the person with OCD voluntarily confronts situations that lead to anxiety, first mentally, then in reality. The person is strongly encouraged by the psychiatrist, the psychotherapist and by his relatives to stop performing his rituals and to develop other means of controlling his anxiety.

Cognitive therapy

It helps the patient to reinterpret in a more objective way his intrusive thoughts, by bringing him to highlight their irrational and unjustified side.