Ernst J. Franzek: From the dichotomy to a three-part grouping of endogenous psychoses
Edward Shorter’s response to Ernst Franzek’s reply
Ernst Franzek's own work, in addition to that of a number of other active investigators, shows to what extent the study of psychopathology has made a comeback in Germany. And properly so!
It was the Germans who, in the years 1880-1933, led the international community in forming the basic nosology that guides us today. Emil Kraepelin did not arrive out of the blue. His work rested on the back of a generation of thoughtful contemporaries, and it is widely not understood that this research forms the intellectual backbone of the DSM system today. That doesn't make everything in this ambitious German nosology correct, but it establishes Berlin, Heidelberg and Munich as the birthplaces of modern psychiatry.
And now we experience a comeback of this venerable tradition: Such workers as Joachim Klosterkötter and Andreas Marneros have started to claim international attention. Recently, several important books have crossed my desk: Heinz Häfner’s Das Rätsel Schizophrenie: Eine Krankheit wird entschlüsselt (“The mystery of schizophrenia: a disease is being decrypted”) and Gerd Huber's valuable textbook, Psychiatrie: Lehrbuch für Studium und Weiterbildung (“Psychiatry: a textbook for study and training”) .(Hafner 2017; Huber 2017). It is a shame that these valuable works are written in a language largely inaccessible to those who have not grown up in Germany.
Franzek's lifelong preoccupation, shared with his teacher, the late Helmut Beckmann, has been the Leonhardian system of diagnosis. I commented on this in my original response to Franzek's essay. I want to point out here merely that there is "gold in them thar hills." The international community has tended to dismiss Leonhard far too readily. Agreed: the neologisms are baffling, and many of the diagnoses seem to overlap. But this isn't true of DSM? Where everything overlaps and no specific diseases have been delineated on the basis of the medical model?
I think it is now up to the Germans to carry these torches abroad, to communicate effectively with the international community what they, with a powerful national psychiatric tradition, have to offer. Instead, my impression is that many German clinicians parrot DSM today as though it were written on a series of tablets that Moses brought down from the Mountain.
Just apropos -- and I can't keep myself from saying this though Franzek does not mention it -- it is also high time that the Germans get rid of their 1970s-hippie-based fear of convulsive therapy and get on board with the most powerful treatment that psychiatry has on offer.
Häfner H. Das Rätsel Schizophrenie: Eine Krankheit wird entschlüsselt, new 4th ed. Munich: Beck; 2017.
Huber H. Psychiatrie: Lehrbuch für Studium und Weiterbildung, 7th ed, Stuttgart: Schattauer; 2005.
March 21, 2019