Edward Shorter`s comment on Jack R. Foucher et al. Wernicke-Kleist-Leonhard phenotypes of endogenous psychoses : a review of their validity


Barry Blackwell’s comment


      Edward (Ned) Shorter provides a lucid and historical analysis of the WKL diagnostic system from a nosologic and therapeutic viewpoint, and appropriately makes this an occasion to castigate the DSM consensus system now in use worldwide which is commercially fruitful but in the academic doldrums, coupled with the NIMH-fostered RDoC system that flounders in complexity and lack of implementation.

       Encouraged by Tom Ban’s enthusiasm for WKL I began to look in more depth and discovered the discouraging features to which Ned alludes. The system prospers outside the US-UK axis of influence and most of its publications and research are in French, German and Latin American journals and languages.

        If there are indeed valid diagnostic categories and subtypes not captured by the DSM-ICD systems that provide novel therapeutic homogeneity, what are the pragmatic issues and obstacles to adopt or incorporate them into the DSM system? How difficult or time consuming is it to teach or implement clinically? Might it supplement or must it replace DSM-ICD?  What would be the estimated increase in successful treatments?

        Could one obtain consent or support from the APA, NIMH, WHO or Big Pharma, all of which have operational and commercial commitments to contemporary systems?

       Ned cites the major academic institutions outside the current circle of enthusiasts. What is their level of Interest in educational or research involvement? Are the current WKL advocates eager to proselytize? Interested to learn more, I found a WKL website but only those who paid dues had access.


September 3, 2020