Thomas A. Ban: Towards education in the history of neuropsychopharmacology. Part 5. Fundamentals of the Wernicke-Kleist-Leonhard tradition.
Comments by Ernst Franzek
Tom Ban’s text gives a short overview of the development of differentiated psychopathology with respect to nosology. What is lacking, however, are the different theoretical backgrounds. Wernicke stated that mental illnesses come from disturbances of brain functions, independent from the origin of causal noxious agents (Wernicke 1900 a, b). Kraepelin stated that the causal noxious agent involved, for example, a toxic agent, dominates the process of the illness and leads to common end states (Kraepelin 1913, 1915). What mostly is forgotten is that Kleist stated, in an even more sophisticated manner than Wernicke, that the disturbance of special brain functions, namely, functional connected systems in the brain, lead to the different clinical pictures, similar to neurological systemic disorders (Kleist 1925, 1934). This is the most interesting way to look at psychiatric illnesses with respect to the results of modern neuroscience. The theoretical background of Leonhard that each clinical picture has its own genetic background does not seem to fit the modern results of neuroscience and genetics (Leonhard 1999; Rutten and Mill 2009). Cycloïd psychoses, for example, are probably not different disease units than a spectrum of stress induced psychoses based on a special genetic and/or neurodevelopmental predisposition (Franzek and Beckmann 1999; Franzek and Musalek 2011; Franzek et al 1996, 2004; Pfuhlman e al 2004). Clinical practice shows further that Leonhard’s systematic catatonias are mostly classified as disorders of the autistic spectrum and disorders fitting Leonhard’s spectrum of hebephrenic disorders often are diagnosed as severe personality disorders NOS. The latter also very often occur in addiction care units because of their seeking for stimulation represents a basic need in such patients (Franzek, Elsenaar 2008). It is suggested that only the close link of modern neuroscience with clinical psychiatry, especially addiction care, can revive the neuropharmacological impact on psychiatry again, but not the discussion about disease entities.
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Ernst Josef Franzek
October 22, 2015