Holger Steinberg

The origin of pharmacopsychology: Emil Kraepelin’s experiments in Leipzig, Dorpat and Heidelberg (1882–1892)

This historical review shows that the early history of cognitive psychopharmacology, originally labelled as “pharmacopsychology”, is closely linked to developments in experimental psychology and academic psychiatry. At the beginning of his scientific career, the German psychiatrist Emil Kraepelin (1856–1926) joined Wilhelm Wundt’s laboratory of experimental psychology at the University of Leipzig. Although Kraepelin was fired from his clinical position at the university’s psychiatric hospital, he completed his habilitation, the German equivalent of Ph.D., and started a series of pharmacological investigations in healthy volunteers using common recreational drugs (alcohol, coffee, tea) or medicinal products (amyl nitrite, chloral hydrate, chloroform, ethyl ether, morphine, paraldehyde) together with innovative psychological tasks. This paper reviews Kraepelin’s pharmacopsychological research and his methodological innovations, providing translations, for the first time, from original papers, his monograph On the Modulation of Simple Psychological Processes by Some Medicines and from other sources. Kraepelin’s contributions to psychopharmacology and clinical neuropsychology were far ahead of his time and his conceptual achievements have been largely neglected by modern psychiatry and cognitive neuroscience.

The Sin in the Aetiological Concept of Johann Christian August Heinroth (1773-1843) Part 1: Between Theology and Psychiatry. Heinroth’s Concepts of ‘Whole Being’, ‘Freedom’, ‘Reason’ and ‘Disturbance of the Soul’

Throughout his work Johann Christian August Heinroth regarded sin to be the cause of mental illness. The present two-part paper investigates what exactly Heinroth understood by sin. Based on a thorough analysis of his own texts, this study shows that on the one hand Heinroth referred to sin in a Christian-Protestant sense. On the other, however, a moral-ethical code of conduct was also involved. Thus, Heinroth did not regard sin as a singular event, but rather as a life conducted in a wrong way for years or even decades, by which he meant a steady striving towards earthly, bodily satisfaction.

Paul Julius Möbius (1853–1907)

JO N 1 87 2 Paul Julius Möbius was born into a family of scholars on 24 January 1853, in Leipzig, where he spent almost all his life. During his studies he turned first towards philosophy – which forever remained his secret passion – and later to medicine, holding doctoral degrees in both. He specialised in neurology and psychiatry, in which he was selftaught. His determination to pursue an academic career was not initially rewarding financially, so in 1878 he set up his own small private neurological and electrotherapeutic practice.From 1882 to 1888 he worked as an assistant, initially unsalaried, under Wilhelm Erb, Adolf von Strümpell, and Friedrich Albin Hoffmann in the Department of Neurology and Electrotherapy at the General Clinic of Leipzig University. Here he also met Emil Kraepelin who became a life-long colleague and friend. In general the years between 1882 and 1886 are to be regarded as Möbius’s happiest, for he also developed a stimulating human and scientific relationship with his superior Strümpell, who was of the same age. He also successfully qualified as a university lecturer (Habilitation). Although the directorship of the clinic became vacant twice – and Möbius had even been temporary head of the clinic – Möbius’s hopes of appointment were dashed which prompted him to hand in his notice in 1888. Five years later, after several younger colleagues had been promoted to the rank of associated professor, Möbius directly enquired of the Saxony minister of education and cultural affairs whether he could ever expect a professorial appointment. Having been told that his failure to undertake any lecturing – he had stopped doing so soon after 1888 – would preclude such an appointment, Möbius, in rage and hurt, relinquished his licence to teach at universities. He was never again to work in a universitybound clinic or hospital and remained confined to his own small practice and his position at the neurological clinic of the Albertverein, an honorary and charitable organisation in Saxony. His isolation from academic circles, increased by his opposition to the views of his academic colleagues, was a personal tragedy, the more so as his family life did not provide any compensation. His marriage to the daughter of a professor – she was 11 years older than he – has been described as unhappy and the marriage remained childless. In 1890 the couple separated without a divorce. After suffering from carcinoma of the lower jaw, which was later accompanied by heart failure, Möbius died on 8 January 1907 at the early age of 53 [8,9]. His work on neurology laid the basis for his fame.Through his studies of dysfunction and paralysis of Received: 6 January 2005 Accepted: 3 February 2005

Zum 150. Geburtstag von Paul Julius Möbius (1853–1907)

ZusammenfassungDer Leipziger Neurologe und Psychiater Paul Julius Möbius begründete seinen Ruf unter der Kollegenschaft mit klinisch-neurologischen Einzelstudien. Einzelne dieser Beiträge würdigt man bis heute mit Bezeichnungen, die mit seinem Namen verbunden sind (‚Möbius-Zeichen’, ‚Möbius-Syndrom’, ‚Möbiussche Krankheit‘). Die Einteilung der Nervenkrankheiten in endogene und exogene stammt ebenfalls von ihm. Auch auf dem Grenzgebiet zur Psychiatrie hin leistete er Besonderes für das Verständnis der Ursachen von Erkrankungen, so postulierte er zum Beispiel die Hysterie als psychogen entstanden. Über die Fachgemeinschaft hinaus populär wurde Möbius durch seine Pathographien und als Rezensent für ‚Schmidt’s Jahrbücher der in- und ausländischen gesammten Medicin’. Bekannt blieb Möbius’ Name der Öffentlichkeit allerdings durch sein Pamphlet ‚Ueber den physiologischen Schwachsinn des Weibes’. Durch dieses wurde er zu kurz gegriffen per se zum Frauenhasser abgestempelt und gerieten seine wesentlichen Beiträge zur Nerven- und Seelenheilkunde in Vergessenheit.AbstractIn memory of Paul Julius Möbius (1853-1907) on the occasion of his 150th birthday Among his profession Leipzig neurologist and psychiatrist Paul Julius Möbius made a name for himself by clinical studies on singular neurological topics. Several of these contributions have been acknowledged until today by giving his name to these symptoms or illnesses (cf. ‘Möbius sign’, ‘Möbius syndrome’, ‘Möbius disease’). It was also him who divided nervous illnesses into endogenous and exogenous ones. Furthermore, Möbius made significant contributions towards the understanding of the causes for some mental illnesses, e.g. it was him who postulated a psychogenic development of hysteria. Through his pathographies as well as his work as a major reviewer and editor of ‘Schmidt’s Annals of Domestic and Foreign Entire Medicine’ Möbius became known to a greater public. Even more well-known, if not infamous, Möbius’s name is for his pamphlet on ‘The Physiological Mental Weakness of Woman’. As a result of it’s repeated republication he was accused to be hating women and his major contributions towards the progress of the neurosciences have been neglected.

Die Errichtung des ersten psychiatrischen Lehrstuhls: Johann Christian August Heinroth in Leipzig

ZusammenfassungZum Werk des berühmten, vermeintlichen „Psychikers“ Johann Christan August Heinroth (1773–1843) wurde inzwischen eine Vielzahl von Arbeiten vorgelegt. Im Gegensatz dazu stellte sich die vorliegende Studie die Aufgabe, endlich gesicherte, da durch Aktenschriftstücke der Zeit gestützte Aussagen über seine akademische Karriere und damit zugleich über die Entstehungsgeschichte des ersten europäischen psychiatrischen Universitätslehrstuhls in Leipzig zu treffen. Dazu werden hiermit erstmals quellengestützte Fakten vorgelegt: Heinroth erhielt als kurz zuvor ernannter außerordentlicher Professor für Medizin am 21.10.1811 die neu eingerichtete außerordentliche Professur für „psychische Therapie“. Dieser Lehrstuhl wurde trotz seiner Bemühungen im Jahr 1815 nicht in einen ordentlichen umgewandelt. 1819 erwirkte Heinroth die Ernennung zum ordentlichen Professor der Medizin. Damit wurde er als akademischer Lehrer aufgewertet, sein Fach Psychiatrie jedoch nicht, es blieb ein außerordentlicher Lehrstuhl. Nach seinem Tode wurde dieser Justus Radius (1797–1884) als „Teillehrstuhl“ zusätzlich mit übertragen. Im Lauf der Jahre fand die Psychiatrie nach weiteren Ressortverschiebungen jedoch keine explizite Erwähnung mehr.SummaryMuch research has been done on the work of the alleged “psychicist” Johann Christian August Heinroth (1773–1843). However, his academic career has not yet been investigated in depth. For the first time, original archive material and other sources are quoted to illuminate his history and that of the first European chair of psychiatry at Leipzig University in Germany. Heinroth was first appointed associate professor (without a specific subject), and on 21 October 1811 he became the first associate professor of “psychic therapy”. Despite his efforts, this chair was not transformed into a fellow professorship in 1815. In 1819, Heinroth succeeded in being appointed fellow professor, but for medicine in general and not psychiatry in particular. Thus his position was upgraded but his subject was not. After Heinroth’s death in 1843, Justus Radius (1797–1884) took over psychiatry as a third, “part-time” chair. After several shifts in responsibilities, he ceased being explicitly referred to as professor of psychiatry.

Emil Kraepelin's years at Dorpat as professor of psychiatry in nineteenth-century Russia.

* The authors wish to express their thanks to Mr Dirk Carius (Leipzig), who did much work on the translation. We are also indebted to Dr Vaino Vahing (Tartu, Estonia) for his help in providing sources which would not otherwise have been accessible. Address for correspondence: Dr. rer. medic. Holger Steinberg, Archiv für Leipziger Psychiatriegeschichte, Klinik und Poliklinik für Psychiatrie, Universität Leipzig, Johannisallee 20, D-04317 Leipzig, Germany. E-mail: steinbh@medizin.uni-leipzig.de Russian psychiatry in the second half of the nineteenth century

Emil Kraepelin's habilitation and his thesis: A pioneer work for modern systematic reviews, psychoimmunological research and categories of psychiatric diseases

Abstract Objectives. Although Kraepelin and his oeuvre have been in scientific focus over the past decades, main aspects have still been neglected. Thus the exact circumstances under which and on what topic Kraepelin wrote his habilitation thesis and qualified as university lecturer (in Germany the prerequisite to be appointed as professor) are still widely unknown. Methods. This study reconstructs his habilitation at the Medical Faculty of Leipzig University in 1882. Results. The study reveals the difficulties he had to habilitate on a topic from Wilhelm Wundts experimental psychology and the opposition he faced from Paul Flechsig. Yet Kraepelin succeeded, mainly due to a positive review by neurologist Wilhelm Erb on his study “On the Influence of Acute Diseases on the Development of Mental Illnesses” (1881/82). Conclusions. This work must be regarded as his actual habilitation thesis. It provides an update of organic psychiatric disorders following acute inflammatory diseases and a meta-analysis on the basis of raw data. In addition it discusses possibilities to categorize and understand the pathophysiological mechanism of these disorders and to classify them into those appearing when the fever rises and those occurring when it falls, which has a high impact from a very modern psychoimmunological viewpoint.

50 Jahre Rodewischer Thesen – Zu den Anfängen sozialpsychiatrischer Reformen in der DDR

The so-called Rodewisch Theses of 1963 demonstrate East German psychiatrys attempts to implement social-psychiatric reforms. To mark their 50th anniversary, this article analyses their emergence, drafting and implementation. It has been known that key requirements could only be fulfilled on a regional basis, the Leipzig University Department of Psychiatry being an outstanding example, although its staff worked rather autonomously of the Rodewisch Theses. The reasons for the different degree of success of these developments in individual areas are manifold, key reasons being the lack of stark political support and of opportunity to discuss shortcomings in mental health care, as in Western Germany, due to political circumstances in particular. There was no strong social basis and support as in Western democracies.

A Pioneer Work on Electric Brain Stimulation in Psychotic Patients. Rudolph Gottfried Arndt and his 1870s Studies

BACKGROUND Todays brain stimulation methods are commonly traced back historically to surgical brain operations. With this one-sided historical approach it is easy to overlook the fact that non-surgical electrical brain-stimulating applications preceded present-day therapies. OBJECTIVE/HYPOTHESIS The first study on transcranial electrical brain stimulation for the treatment of severe mental diseases in a larger group of patients was carried out in the 1870s. METHODS Between 1870 and 1878 German psychiatrist Rudolph Gottfried Arndt published the results of his studies in three reports. These are contextualized with contemporary developments of the time, focusing in particular on the (neuro-) sciences. As was common practice at the time, Arndt basically reported individual cases in which electricity was applied to treat severe psychoses with depressive symptoms or even catatonia, hypochondriac delusion and melancholia. Despite their lengthiness, there is frequently a lack of precise physical data on the application of psychological-psychopathological details. Only his 1878 report includes general rules for electrical brain stimulation. RESULTS Despite their methodological shortcomings and lack of precise treatment data impeding exact understanding, Arndts studies are pioneering works in the field of electric brain stimulation with psychoses and its positive impacts. Todays transcranial direct current stimulation, and partly vagus nerve stimulation, can be compared with Arndts methods. Although Arndts only tangible results were indications for the application of faradic electricity (for inactivity, stupor, weakness and manic depressions) and galvanic current (for affective disorders and psychoses), a historiography of present-day brain stimulation therapies should no longer neglect studies on electrotherapy published in German and international psychiatric and neurological journals and monographs in the 1870s and 1880s.

Schizophrenic disorders. The development of immunological concepts and therapy in psychiatry

Immunological changes reported in patients with schizophrenia may play an aetiological role in these disorders. Further, immunomodulatory medications can influence the symptoms of psychiatric disorders. Antipsychotic agents such as clozapine may act therapeutically through the modulation of the immune system and also lead to side effects in that domain.Both the understanding and factual foundations of immunological concepts and immunological therapies of schizophrenic disorders have changed throughout the history of medicine. These are important considerations in psychiatry where diagnostic, nosological and therapeutic complexity is the norm. The article exemplarily presents publications of the psychiatrists such as Julius Wagner von Jauregg, Lewis Campbell Bruce and Friedrich Ostmann as well as neuropathologist Hermann Lehmann-Facius and haematologist William Dameshek.ZusammenfassungPatienten, die an einer Schizophrenie leiden, weisen immunologische Charakteristika auf, die möglicherweise zur Entstehung ihrer Erkrankung beitragen, und immunmodulatorische Medikamente können die Symptomatik akut aufgetretener schizophrener Störungen beeinflussen. Antipsychotika wie das Clozapin wirken möglicherweise therapeutisch über Veränderungen im Immunsystem, sie können darüber aber auch zu Nebenwirkungen führen.In der in diesem Artikel umrissenen Geschichte der immunologischen Krankheitskonzepte der Schizophrenie lassen sich technische und ideengeschichtliche Entwicklungen in der Medizin sowie diagnostische, nosologische und therapeutische Schwierigkeiten des psychiatrischen Fachgebiets wiederfinden. Es werden exemplarisch für die Konzeptgeschichte bedeutsame Publikationen der Psychiater Julius Wagner von Jauregg, Lewis Campbell Bruce und Friedrich Ostmann, des Neuropathologen Hermann Lehmann-Facius sowie des Hämatologen William Dameshek vorgestellt.SummaryImmunological changes reported in patients with schizophrenia may play an aetiological role in these disorders. Further, immunomodulatory medications can influence the symptoms of psychiatric disorders. Antipsychotic agents such as clozapine may act therapeutically through the modulation of the immune system and also lead to side effects in that domain.Both the understanding and factual foundations of immunological concepts and immunological therapies of schizophrenic disorders have changed throughout the history of medicine. These are important considerations in psychiatry where diagnostic, nosological and therapeutic complexity is the norm. The article exemplarily presents publications of the psychiatrists such as Julius Wagner von Jauregg, Lewis Campbell Bruce and Friedrich Ostmann as well as neuropathologist Hermann Lehmann-Facius and haematologist William Dameshek.