[Treatment of hysteria in the 19th century--in which way did German psychiatrists view castration?]

["Impulsive insanity" according to Emil Kraepelin : A clinical framework for female criminals at the beginning of the twentieth century]

BACKGROUND

In his comprehensive classification of the beginning of the twentieth century, Emil Kraepelin provided a detailed description of an entity he called "impulsive insanity", which had not been elaborated before him. The forms depicted by him largely corresponded to the offences, which were referred to as typically female in their nature in the late nineteenth and early twentieth centuries.

QUESTION

How did Kraepelin classify "impulsive insanity" and what forms did he describe? Did Kraepelin also see these disorders predominantly prevailing in women, did he establish a connection with women's criminality and how did this fit into the discourses of the time on femininity, criminal legislation and degeneration?

MATERIAL AND METHODS

This study focused on the clinical picture "impulsive insanity" as described by Emil Kraepelin in his main work, the 8th edition of his Textbook of Psychiatry published between 1909 and 1915. His description was analyzed in detail and embedded in a historical context on the basis of secondary literature.

RESULTS

In rudiments Kraepelin's clinical classification is still comprehensible today, although there are major differences to how literature in later years treated this issue. Kraepelin clearly sees "impulsive insanity" as a driving disorder predominantly prevailing in women.

DISCUSSION

Elaborating his concept of "impulsive insanity", Kraepelin positioned himself in relation to important scientific discourses of the early twentieth century, such as the debate on criminal legislation and the theory of degeneration. On the basis of the individual forms of "impulsive insanity" described by Kraepelin, various concepts of constructing and pathologizing femininity can be identified. Apparently, it also aims to explain common female crimes within the patriarchal hegemony.

Paul Julius Möbius (1853–1907) über Epilepsie

Zunächst wird der Leipziger Neurologe, Psychiater und Wissenschaftspublizist Paul Julius Möbius biografisch vorgestellt. Er begann eine akademische Karriere als Mediziner an seiner Heimatuniversität, brach diese 1888 mit der Kündigung als Assistenzarzt an der Universitätspoliklinik und 1893 als habilitierter Privatdozent mit der Rückgabe seiner Venia Legendi aber ab. Er hatte sich persönlich vonseiten der Fakultät übergangen und mit seinen Leistungen nicht anerkannt gefühlt. Die ätiologische Einteilung der Nervenkrankheiten in endogene und exogene geht auf Möbius zurück. Erstmals legt er diese in seinem „Abriss der Lehre von den Nervenkrankheiten“ (1893) detaillierter vor. Die Epilepsie, deren dortiger Beschreibung gefolgt wird, teilt er den endogenen Erkrankungen zu, da sie in der Regel auf einer angeborenen Anlage beruhe. Möbius besteht darauf, die „Krankheit Epilepsie“ solle man nur diagnostizieren bei Krampfanfällen ohne sonstige bekannte Hirnerkrankung. Mithilfe einer Familienanamnese und in Abgrenzung v. a. zur Hysterie sei die Diagnose relativ einfach möglich. Gelegenheitsursachen wie Gemütsbewegungen und Überreizungen sieht er als Auslöser der Anfälle. Diese gelte es mit der Ruhigstellung der Kranken mithilfe von Bromkalium zu vermeiden. Die Epilepsie sei unheilbar. Sie beginne meist in Kindheit und Jugend, verschlimmere sich während der Pubertät, um folgend mit einer Anfallshäufigkeit zuzunehmen. Schweren Fällen stellt Möbius eine schlechte Prognose mit Übergang in „Schwachsinn“ und schließlich „Blödsinn“. Durch körperliche Schwächung wiesen Epileptiker eine geringere Lebenserwartung auf. Möbius war kein Epileptologe, er referiert wohl eher den Wissenstand seiner Zeit.

[Concepts of nymphomania in the German academic psychiatry: Changes over the last two centuries]

BACKGROUND

This chronology aims to provide an overview of the views on nymphomania in the history of German academic psychiatry over the past 200 years.

AIM

The aim of this study was to answer the following questions: What are the continuities over that period with regard to the etiology, diagnosis, classification or therapeutic recommendations? What changes can be observed? Was the increase in sexual desire in women seen as a disease or rather as a symptom? What significance did psychiatry attribute to female sexuality at a certain point in time? What reasons can be identified for the perceptions made and conclusions drawn at a certain time?

METHODS

A cursory review of the most influential German-language psychiatric textbooks of the respective period was conducted in chronological continuity. Relevant passages were identified, analyzed in detail and compared with each other, taking the historical context into account.

RESULTS

At the turn of the 19th and 20th century, a clear break in the understanding of nymphomania as a disease could be observed. In the 19th century, it was seen as a severe mental illness, which was assumed to have been caused at least in part by a peripheral disease of the female reproductive organs and the nervous system associated with them, which could lead to irreversible terminal mental states. In the 20th and 21st centuries, nymphomania was perceived as either a sexual neurosis or a functional sexual disorder, limited to the symptom complex of hypersexuality. The reasons for this were, on the one hand, the overall change in diagnosis resulting from a comprehensive reclassification of mental disorders, which assigned nymphomaniac symptoms of the 19th century to both manic and schizophrenic disorders, and, on the other hand, changes in the perception of female sexuality in the social discourse in general. The fact that nymphomania as a diagnosis was eliminated with the 11th edition of the International Classification of Diseases is a clear expression of this change.

CONCLUSION

The concept of nymphomania has undergone considerable changes over time. At the beginning of the 20th century, the understanding of the disease changed significantly, so that it is even possible to distinguish between an early and a late phase. The diagnosis has meanwhile become obsolete.

Goethe: A bipolar personality? Periodicity of affective states in Johann Wolfgang von Goethe as reflected by Paul Julius Möbius

This paper aims to investigate the character and etiological basis of German poet Johann Wolfgang von Goethe's mental disorder. From 1898, German neuropsychiatrist Paul Julius Möbius developed the hypothesis that Goethe's work provided several hints for the notion that the German poet suffered from a distinct bipolar disorder. The paper investigates Möbius's psychopathographic study on Goethe and his hypothesis of a mood periodicity in Goethe against the mirror of modern concepts. Möbius came to the conclusion that Goethe's illness was bipolar in character and became visible at intervals of seven years and lasted for about two years. The majority of Möbius's contemporary psychiatric colleagues (Emil Kraepelin, Max Isserlin, Ernst Kretschmer, Josef Breuer) supported this view which has still not been convincingly challenged. In present-day terms, Möbius's hypothesis can be best mirrored as a subclinical foundation of mood disorder. Furthermore, with his extensive study, Möbius disproved the common notion that Goethe had suffered from an illness as the result of a syphilitic infection.

The Historical Development of Immunoendocrine Concepts of Psychiatric Disorders and Their Therapy

Relationships between the central nervous, immune and endocrine systems are a focus of psychiatric research, particularly in depression and schizophrenia. The field has long antecedents. Observed phenomena attributable to these relationships date back to the Neolithic era. Immunoendocrine theories in the broadest sense are recorded in antiquity. In the 19th century, Kraepelin and Wagner-Jauregg reported pioneering clinical observations in psychiatric patients. Von Basedow, Addison and Cushing described psychiatric symptoms in patients suffering from endocrine diseases. The 20th century opened with the identification of hormones, the first, adrenaline, chemically isolated independently by Aldrich und Takamine in 1901. Berson and Yalow developed the radioimmunoassay (RIA) technique in 1959 making it possible to measure levels of hormones and cytokines. These developments have enabled great strides in psychoimmunoendocrinology. Contemporary research is investigating diagnostic and therapeutic applications of these concepts, for example by identifying biomarkers within the endocrine and immune systems and by synthesizing and testing drugs that modulate these systems and show antidepressant or antipsychotic properties.

[On the 150th birthday of Paul Julius Möbius (1853-1907)]

In 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.