Person and ethics of a psychiatrist during National Socialism: Friedrich Meggendorfer (1880-1953)

Our values and our historical understanding of psychiatrists

Many people like to perceive themselves as better than previous generations: more knowledgeable, moral, tolerant and humane. Values associated with these aspects of ourselves may affect how we understand our professional forebears. In the early 20th century, some psychiatrists adopted new biomedical theories, including focal sepsis and eugenics, which resulted in inestimable harm. Detrimental clinical practices arose and were perpetuated in the context of societal values, medical ethics and other forces within and outside the medical profession. Historical understanding of the processes by which these things took place may help inform debate concerning current and future challenges of providing psychiatric care. The methods by which psychiatrists consider their predecessors may also have a bearing on how psychiatrists of the future will perceive us, the psychiatrists of the 2020s.

[On the History of a Special Connection Between Academic and Non-Academic Psychiatric Institutions: Erlangen (1903-1974)]

OBJECTIVE

To examine the more than 70-year history of a special connection between academic and non-academic psychiatric institutions.

METHOD

Relevant archival material as well as primary and secondary literature were critically examined.

RESULTS

As early as 1818, Johann Michael Leupoldt (1794-1874), an assistant professor in Erlangen, held a seminar on "madness". But the University Psychiatric Clinic was not established until 1903 as part of the association to the mental asylum on a contract agreement between the Friedrich-Alexander-University Erlangen and the County Senate of Middle-Franconia. Clinic patients were registered as "institutional residents", and the Clinic had no income of its own. Especially relevant is the fact that the Head of Department and Director of the Clinic was formally considered as a "senior doctor of the asylum". The efforts to gain more autonomy were not successful until the mid- 1970s because of the socio-political situation.

DISCUSSION

The complicated dependent employment relationship of the Head of Department on the Director of the asylum undoubtedly contributed to their "mésalliance tradition" over several decades. A public scandal arose in 1978 with a supervisory complaint to the government of Middle-Franconia with accusations of failure to protect patient documentation and medications during the relocation of the departments of the mental asylum to the newly constructed Regional Hospital on the "Europakanal". The lack of documents concerning the separation between the university and the district may be due to these processes.

OUTLOOK

Cooperation between the University Clinic and the Regional Hospital exists in an altered form today. The Psychiatric Clinic can thus include patients from the Regional Hospital in scientific studies. The present study can contribute to discussions on demand-controlled integrated psychiatric care in combined academic and non-academic psychiatric institutions and points out how interinstitutional psychiatric care can succeed.

Gustav Nikolaus Specht (1860–1940): psychiatric practice, research and teaching during a change of psychiatric paradigm before and after Kraepelin

Gustav Specht (1860-1940) developed academic psychiatry in Erlangen. After studying medicine in Würzburg, Munich and Berlin, he became assistant medical director in the mental asylum of Erlangen. In 1897 he was appointed extraordinary, and in 1903 ordinary, Professor of Psychiatry. A good clinician and teacher, Specht worked during a time of paradigm change in psychiatry. He was an expert in chronic mania, and introduced the concept of the 'grumbler's delusion'. Paranoia he believed to be the core problem of psychopathology and considered the depressive syndrome as an 'exogenous-type' of reaction. For him, trauma was important in the genesis of mental illness, and his 'hystero-melancholy' anticipated the concept of borderline personality disorder.

[Gustav Nikolaus Specht (1860-1940) : His impact on Kraepelin's nosology and approaches to his position in National Socialism]

Hinführung

Gustav Specht steht am Anfang der Erlanger Universitätspsychiatrie. 80 Jahre nach seinem Tod untersucht der vorliegende Artikel insbesondere die Rolle Spechts bei der von Kraepelin ausgehenden psychopathologisch-nosologischen Diskussion. Trotz spärlicher Datenlage unternehmen die Autoren erstmals eine Annäherung an Spechts Positionen innerhalb der nationalsozialistischen Psychiatrie.

Methode

Relevantes archivalisches Material sowie Primär- und Sekundärliteratur wurden ausgewertet.

Ergebnisse

Specht wurde 1897 zum außerplanmäßigen Professor und 1903 zum ersten Ordinarius für Psychiatrie in Erlangen ernannt. Specht arbeitete die Bedeutung des manischen Elementes in der Paranoia heraus. Specht ergänzte den sog. „exogenen Reaktionstypus“ Bonhoeffers 1913 um die depressiven Zustandsbilder; er selbst war – bei fremddiagnostischem Verdacht auf zyklothymes Temperament – zweimalig exogen reaktiv depressiv erkrankt.

Diskussion

Durch seine Forschungsarbeiten zum pathologischen Affekt in der chronischen Paranoia beeinflusste Specht die zeitgenössische psychopathologische Diskussion nachhaltig. Spechts Perspektivenwechsel in puncto „Erbgesundheit“ lässt sich interpretieren als Anpassung an das NS-Regime.

Schlussfolgerung

Das Werk Gustav Spechts kann u. a. dazu anregen, einen interdisziplinären psychopathologischen Diskurs zu kultivieren.

Karl Leonhard (1904-88) and his academic influence through the 'Erlangen School'

The Erlangen University Psychiatric and Mental Clinic was an annexe to the Erlangen Mental Asylum, so when Leonhard worked there he became acquainted with acute and chronic stages of schizophrenia. This can be viewed as a decisive impulse for his later differentiated classification of types of schizophrenia. The suspicion that Leonhard suffered from attention deficit hyperactivity disorder cannot be supported. His reticence concerning social-psychiatric aspects is analysed in the context of his early professional contact with the 'Erlangen system' of open care and its Nazi perversion. Leonhard's role in National Socialism is still uncertain. His unsuccessful attempts to retain the Erlangen Chair of Psychiatry and Mental Illness in 1951 can be viewed as his first difficulty in the tensions between West Germany and East Germany.