Mary Seeman’s comment on Jack R. Foucher et al.’s paper on Wernicke-Kleist-Leonhard phenotypes of endogenous psychoses: A review of their validity



        I read Jack R. Foucher et al.’s paper on WKL phenotypes with some difficulty. My brain these days doesn’t take in so many details in one reading and this classification system is new to me. I am amazed that the 35 phenotypes described have good reliability and validity. The diagnosticians must have phenomenal memories to keep all the criteria straight.

        It does makes sense that a combination of onset age, familiality, precipitating factors, effects of reproductive transitions in women and treatment response are major differentiating factors of discrete entities. What about symptoms and course of illness, where do they fit in?

        Beyond page 40 of the paper, I was lost. However, before page 40, there was a lot in the article that I appreciated because it cleared up for me many portmanteau words in psychiatry that I have never fully understood – words such as  psychosis, neurosis, endogenous, dimensional, among others. These are words I have used but have never quite understood because they seem to have many meanings. There are many words like that in psychiatry. No wonder it is confusing for patients (maybe on purpose – maybe it’s meant to obfuscate).

        For people like me, to be made comprehensible, each of the 35 categories in the Jack R. Foucher et al. paper would need to be described in a paper of its own with its own diagnostic algorithm  based on onset age, familiality etc., (plus symptoms and course), its own  reliabilities and validities and several case descriptions (with differential diagnoses). Then I could try to apply the various categories to patients I have known and only then would I know whether it is a classification system that might be useful for research and treatment.


December 10, 2020