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Thomas A. Ban
Neuropsychopharmacology in Historical Perspective.

Education in the field in the Post-Psychopharmacology Era

Collated 21

Thomas A. Ban, Marcelo Cetkovich-Bakmas, Ernst Franzek and Hector Warnes: Carl Wernicke’s “elementary symptoms” and “sejunction hypothesis”

 

 

Thomas A. Ban                     September 17, 2015                Elementary symptoms

                                                                                         vignette

Marcelo Cetkovich-Bakmas   October 1, 2015                      Sejunction

                                                                                         hypothesis/theory

                                                                                         vignette

Hector Warnes                     January 21, 2016                     Comment on

                                                                                         vignette on 

                                                                                         sejunction 

                                                                                         hypothesis/theory

Hector Warnes                     August 14, 2016                      Reflections

                                                                                         on Wernicke’s 

                                                                                         sejunction theory 

Ernst Franzek                       May 4, 2017                            Final comment

 

 

Thomas A. Ban: Wernicke’s elementary symptoms

        An “elementary symptom” (Elementarsymptom) is a psychopathological symptom, from which the other symptoms of a mental syndrome are derived (Krahl 2000). The concept was first presented by Carl Wernicke on July 19, 1892, in Breslau, Germany (now Wrocklaw, Poland), in a discussion at the 59th meeting of the East German neurologists (Nervenarzte),  published, in 1893, in the Allgemeine  Zeitschrift fur Psychiatrie und psychisch-gerichtlich Medizin  (Wernicke 1893). The term itself was introduced about a year later, in 1894, at the 61st meeting of the same group (Wernicke 1895). The origin of the concept of “elementary symptom” is in conceptualization of clinical observations. The use of “elementary symptom” as a “nosological principle” for the identification of mental diseases, dates back to Wernicke’s description and separation of Anxiety-Psychosis from other psychoses in 1894 (Wernicke 1895).

 

References:

Krahl A. Carl Wernicke’s elementary symptom (Elementarsymptom). In: Franzek E, Ungvari GS, Ruther E, Beckmann H, editors. Progress in Differentiated Psychopathology. Wurzburg: International Wernicke-Kleist-Leonhard Society; 2000, pp. 43-8.

Wernicke C. Diskussionsbeitrag auf dem 59. Treffen des Vereins ostdeutscher Irrenarzte.  Leubus, 19. Juni 1892. Allgemeine Zeitschrift fur Psychiatrie und psychisch-gerichtliche Medizin 1893: 486-9.

Wernicke C. Bemerkungen anlaslich  des 62. Treffen des Vereins ostdeutscher Irrenarzte.  Sorau, 25. Juni 1893. Allgemeine Zeitschrift fur Psychiatrie und psychisch-gerichtliche Medizin 1895a: 206.

 

September 17, 2015

 

Marcelo Cetkovich-Bakmas: Wernicke’s sejunction hypothesis/theory

        “Sejunction hypothesis” (Franzek 1990; Pichot 1983; Shorter 2005), also referred to as “sejunction theory” (Pichot 1983; Shorter 2005), postulates that  psychopathological symptoms result from interruption (“sejunction”) of associative connections in the brain. It was put forward by Carl Wernicke, in 1900, in  the 12th lecture of his Textbook of Clinical Lectures in Psychiatry (Wernicke 1900). The “hypothesis” is conceptually derived. It is built on Wernicke’s adoption of Griesinger’s “psychic reflex” as the basis of mental activity  and his notion that the nature of psychopathology is determined by the site of an assumed severance in the path of the “psychic reflex” (Griesinger 1843; Wernicke 1906).

 

References:

Franzek E. Influence of Carl Wernicke on Karl Leonhard’s nosology. Psychopathology 1990; 23: 277-81.

Griesinger W. Ueber psychische Reflexactionen. Archiv fuer Physiologische Heilkunde. 1843; 2: 76-112.

Pichot P. A Century of Psychiatry. Paris: Roger de Costa; 1893, p. 56.

Shorter E. A Historical Dictionary of Psychiatry. Oxford/New York: Oxford University Press; 2005, p.300.

Wernicke C. Grundriss der Psychiatrie in klinische Vorlesungen. Leipzig: Thieme; 1900, p.112.

Wernicke C. Grundriss der Psychiatrie in klinische Vorlesungen. 2 Auflage. Leipzig: Thieme; 1900, p. 109.

 

October 1, 2015

 

Hector Warnes’ comment on Marcelo Cetkovich-Bakmas’ vignette on Wernicke’s sejunction hypothesis/theory  

        Congratulation to Marcelo Cetkovich-Bakmas for his concise entry of Wernicke’s “sejunction theory/hypothesis” into INHN’s Dictionary. It might be of interest that Otto Hans Adolf Gross, in his paper “Dementia Sejunctiva” published in the early years of the 20th century, just a few years after the “theory” was introduced, referred to “sejunction” as a “closed circuit” of associative ties characterized by a loss of certain associations assumedly caused by an interruption of neuronal pathways. He went even further by suggesting  that “sejunction” could explain fragmentation of the thinking process with collapse of several functionally separate series of associations and a break in the continuity of temporal memory (Gross 1904).

        It might be also of interest that Karl Jaspers understood “sejunction” as the underlying pathophysiology of a variety of “psychic disturbances.” In his General Psychopathology, he wrote: “The basis of the majority of psychic disturbances lies primarily in the parting of the association-links or sejunction. Where there are false ideas or judgements in an individual or they are in conflict with each other or with reality this is thought to be due to a ‘loosening up’ in the firm network of associations. By severing the continuity tracks, by an absence of certain associative performances a number of different personalities may simultaneously arise in the same individual and a ‘break up’ of individuality occur. Sejunction can also explain a large number of hallucinations… if association is interrupted, excitation processes are dammed up and thus a progressively increasing stimulus is established which brings the hallucinations about. Similarly ‘autochthonus ideas’ (the so called ‘made thoughts’) are due to a process of irritation when continuity is interrupted whereas compulsive thinking is explained by a process of irritation while continuity is preserved. Abnormal movements (parakinesis) are also due to these sejunctions. Because hallucinations are due to sejunction, Wernicke finds it quite feasible that they are without any counter-image and therefore there is no criticism of them; also that they so often have contents of an imperative character…” (Jaspers 1963).

 

References:

Gross OHA. Dementia Sejunctiva. Neurologisches Zentralblatt 1904; 23: 1144-6. 

Jaspers K. General Psychopathology (translated by J. Hoenig and Mariam W. Hamilton). Manchester: Manchester University Press; 1963.

 

Hector Warnes: Reflections on Wernicke’s sejunction theory

        My reflections on Wernicke’s “sejunction theory” were triggered by Marcelo Cetkovich-Bakmas excellent entry of the term in INHN’s Dictionary.

        It might be of interest that Otto Hans Adolf Gross in his paper, “Dementia Sejunctiva,” published in the early years of the 20th century, just a few years after the “theory” was introduced, referred to “sejunction” as a “closed circuit” of associative ties characterized by a loss of certain associations assumedly caused by an interruption of neuronal pathways. He went further by suggesting that “sejunction” could explain fragmentation of thinking process, with collapse of several functionally separate series of associations and  a break in the continuity of temporal memory (Gross 1904).

        It might also be of interest that Karl Jaspers understood “sejunction” as the underlying pathophysiology of a variety of “psychic disturbances”, consisting essentially in a loosening up in the texture of associations based on  excitatory or inhibitory processes leading to discontinuity or fragmentation. The consequence is as Jaspers calls it, “a break up of individuality.” In his General Psychopathology, he wrote: “The basis of the majority of psychic disturbances lies primarily in the parting of the association-links or sejunction. Where there are false ideas or judgements in an individual or they are in conflict with each other or with reality this is thought to be due to a ‘loosening up’ in the firm network of associations. By severing the continuity tracks, by an absence of certain associative perfomances a number of different personalities may simultaneously arise in the same individual and a ‘break up’ of individuality occur. Sejunction can also explain a large number of hallucinations… if association is interrupted, excitation processes are dammed up and thus a progressively increasing stimulus is established which brings the hallucinations about. Similarly ‘autochthonus ideas’ (the so called ‘made thoughts’) are due to a process of irritation when continuity is interrupted whereas compulsive thinking is explained by a process of irritation while continuity is preserved. Abnormal movements (parakinesis) are also due to these sejunctions. Because hallucinations are due to sejunction, Wernicke finds it quite feasible that they are without any counter-image and therefore there is no criticism of them; also that they so often have contents of an imperative character….” (Jaspers 1963). Karl Jaspers appreciated Wernicke’s work to the extent that he states: “No scientist can afford not to study him seriously” (pp 536-537). In this masterful writings of Jaspers resonates ideas of Sigmund Freud, Kurt Schneider and of course Meynert. In my opinion, Freud nurtured himself in associational physiology to break the discontinuities and hindrances through a technique of free-association.

        You would notice that Jaspers attempts to soften Griesinger’s idea that “mental diseases are brain diseases” which was adopted by Theodor Meynert and Carl Wernicke.  Freud’s teachers were Meynert (Wernicke was trained under Meynert), Brücke and Fechner. From his position of being a Somatiker, Freud drifted to become a Psychiker, though he later recognized the limitations of Psychoanalysis in his masterpiece: “Analysis terminable and Interminable” (1937, The Standard Edition, vol. XXIII)].

        Reading these authors, one cannot help evoking  Freud’s inspirations, in particular, with regard to free associations and association disturbances and relating them to unconscious mentation.  Eugen Bleuler likewise used the term “loosening of association” as a primary symptom is schizophrenia and the question of Spaltung of the mind is attributed to a psychotic process. I have not come across a comparison between Spaltung and Sejunction. Both seem to refer to a process of loss of continuity and fragmentation of the mind. 

        As one notices Gross stands midway between Kraepelin with whom he worked  and Eugen Bleuler. Gross obviously wanted to bridge the concept of Dementia Praecox of Kraepelin and the later concept of Schizophrenia (from the Greek skhizem, to split and phren, mind). Spaltung, or splitting, was adopted later by Freud instead of dissociation or division.  It referred to the more severe mental disorders when the mechanism of repression is at fault and the mind is overflooded by the id-impulses. I was surprised when I read in Campbell’s Psychiatric Dictionary: “Wernicke’s term for blocking and other forms of dissociation. The concept is seldom used today, because it includes forms of dissociation which are widely removed both psychologically and nosographically” (p. 274).

        In his Tratado de las alucinaciones, Henry Ey states that both Wernicke, with his theory of sejunction, and de Clérambault, with his theory of “mental automatism,” based the mechanism in the neurophysiology of nerve conduction.

        The use of functional magnetic resonance imaging and PET scanning is beginning to localize areas of the brain where mental circuits are dysfunctional in particular types of psychosis

        Spaltung, sejunction, splitting and cleavage all mean the same at least in the clinical use of the word (to separate, break apart or divide into two or more parts, referring to the mind). When the psychosis is severe, such as the amentia of Meynert, it is called Bewusstseinszerfall. Eugen Bleuler, in his book Dementia Praecox or the group of Schizophrenias, was of the opinion that Wernicke’s Sejunction was the same as his own concept of Spaltung.  However, Bleuler considered that the word sejunction was used only in an anatomo-physiological sense, e.g., sejunction leads to a stasis of the underlying chemistry of brain associations (Ausassoziieren). We know that, at this point, Bleuler was trying to set himself apart from Kraepelin’s and from Wernicke’s theories.  For Bleuler, Splitting, Spaltung, Tearing apart, Disaggregation, Zerreissung or Zerspaltung are the basis of the complex phenomenon (from the Greek phainesthai, to appear) seen in this illness.  It constitutes a loosening up of the associative texture that can lead to an irregular fragmentation of the process of thinking and an incapacity to direct and control one’s own thoughts.  They represent a primary symptom.

        Bleuler credits Kraepelin with the introduction of the word interception of the process of thinking which is different from inhibition as seen in Melancholia. In the case of interception of the stream of thoughts, the association of ideas come to a sudden halt and they resume with other unrelated ideas: “The association splitting can also lead to pathological ambivalence in which contradictory feelings or thoughts exist side by side without influencing each other” (pp. 354-355, in Dementia Praecox or the group of Schizophrenias). When the illness is severe, the total personality loses its unity or integration to the point that one set of complexes dominates the personality for a time, while other groups of ideas or drives are ‘split off’ and the whole discourse seem odd, queer, shiftless and full of incongruities.  Bleuler’s observations come from the perspective that: “Every psychical activity rests upon the interchange of material derived from sensation and from  memory traces to associations” (p. 1) and further, “Perception, thinking, doing, cease as soon as association is impeded” (p. 3).

 

References:

        Bleuler E. Upon the significance of association experiments. (Translated by MD. Eder.) In Jung CG (editor). Studies in Word Associations. London: William Heinemann; 1918, pp 266-96.

        Bleuler E. Dementia Praecox or the Group of Schizophrenias. (Translated by J. Zinkin.) New York: International Universities Press; 1950

        Campbell RJ. Psychiatric Dictionary. Fifth edition Oxford: Oxford University Press; 1981.

        Ey H. Tratado de las alucinaciones’ (vol. I). (Translated by H. Casarotti  and E. Mahieu.)   Buenos Aires: Editorial Polemos; 2009.

        Freud S. Collected Writings. Volume XIX.  The Standard Edition of the Complete Psychological Works. London: The Hogarth Press, Publisher;  1961, p.231

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        Gross OHA. Dementia Sejunctiva. Neurologisches Zentralblatt 1904; 23: 1144-6. 

        Jaspers K. General Psychopathology. (Translated by J. Hoenig and Mariam W. Hamilton.) Manchester: Manchester University Press; 1963.

 

August 14, 2016

 

Ernst Franzek’s final comment

        It’s a great pleasure for me to congratulate Marcelo Cetkovich-Bakmas and Hector Warnes for their outstanding descriptions and comments on Wernicke’s theory of “sejunction” as one of the main common morphological processes in psychiatric diseases.

        According to Wernicke the process of “sejunction” explains “acute” elementary symptoms, for  example hallucinations,” as well as all kind of chronic residual psychopathology (Wernicke 1900; Franzek 1990) that occurs in the course of psychiatric diseases.

        Wernicke’s psychiatric theories are mostly discussed in a historical context. However, modern neural science teaches us very well about the complex network and connectivity of neurons in the human brain (Principals of neural science 2013).

        The great impact of the brains capability of creating and keeping synapses (connections) between different neurons and brain regions is necessary for a normal functioning of the (adult) brain. Synaptic connections are made by sensory experiences, thought processes and psychomotoric activity. Loss of synapses, in cortical and/or subcortical regions, causes loss of connectivity between functional brain circuits and could be postulated to be the not yet detected substrate of Wernicke’s “sejunction” in the brain of psychiatrically ill patients.

        It is strongly recommended to investigate Wernicke’s “sejunction” theory with modern neural scientific methodologies. A loss of synaptic connectivity in specific brain regions and specific functional brain systems which can completely or partially regenerate but which also can remain permanent or can be reconnected falsely, could explain acute and chronic psychopathology of psychiatric diseases.

        The different clinical psychopathology would then depend on the different functional brain circuits that are involved in the process of “sejunction.” The onset and ongoing process of “sejunction” (disconnection) could be triggered by genetic disposition, by stress exposure and/or by other adverse noxious events occurring during lifetime.

        It is strongly suggested that Wernicke’s theory of “sejunction” is not only of historical interest but is still actual and of great value in the light of modern neural science and clinical research.

 

References:

        Franzek E. Influence of Carl Wernicke on Leonhard’s nosology. Psychopathology 1990; 23:277-81.

        Kandel ER, Schwartz JH, Siegelbaum SA,Hudspeth AJ, editors. Principles of Neural Science. 5th edition, Mc Graw Hill Medical, New York/Chicago/San Francisco/Lisbon/London/Madrid/ Mexico City/ Milan/ New Delhi/ San Juan/ Seoul/ Singapore/ Sydney/ Toronto: Mc Graw Hill Medical; 2013.

        Wernicke C. Grundriss der Psychiatrie in klinischen Vorlesungen. Barth: Leipzig; 1900.

 

May 4, 2017

February 20, 2020