CARL WERNICKE’S CLASSIFICATION OF PSYCHOSES WITH SPECIAL REFERENCE TO MANIA AND MELANCHOLIA

Thomas A. Ban

Stimulated by Sir Charles Bell’s (1811) discovery and François Magendie’s (1822) recognition of the importance of the “reflex arc” that links sensory input with motor output in the functioning of the nervous system (spinal cord), Griesinger  (1843) was first to perceive mental activity as “reflex” activity. He was also the first to describe, in 1843, “psychic reflex actions” (psychische Reflexactionen).

Carl Wernicke (1848-1905), the professor of neurology and psychiatry in Breslau, Germany (1890-1904), adopted Griesinger’s view that mental activity is ”reflex” activity, and perceived “psychoses,” as “hypo (deficit)-functioning,” “hyper (excess)-functioning”, or “para (distorted)-functioning” of one or more  components (paths, phases) of the “psychic reflex” (Ban 2013; Franzek 1990; Wernicke 2000). Accordingly, he attributed “psychoses” displayed by “anaesthesia”, “hyperaesthesia” or “paraesthesia” to malfunctioning of “psychosensory” brain areas; “psychoses” displayed by “afunction”, “hyperfunction” or “parafunction” to malfunctioning of “intrapsychic”(trans-cortical) brain areas, and “psychoses” displayed by “akinesia”, “hyperkinesia” or “parakinesia” to malfunctionjng of “psychomotor” brain areas (Wernicke 1899).   

Wernicke was operating within the frame of reference of contemporary “associationism”. He conceptualized the brain as an associative organ, consciousness as a product of associative activity and the “soul”, as the sum of all possible associations (Menninger, Mayman and Pruyser 1968). He divided consciousness into consciousness of the outside world (“allopsyche”), consciousness of one’s body (“somatopsyche”) and consciousness of one’s self-individuality (”autopsyhe”) and classified psychoses into “allopsychoses”, characterized by disorientation in the representation of the outside world, “somatopsychoses”, characterized by disorientation in the representation of one’s own body and “autopsychoses”, characterized by disorientation in the representation of one’s own self-individuality. In diagnosing and classifying, Wernicke employed his “elementary symptom“ approach (Ban 2015; Krahl 1910; Wernicke 1893) ) and, in 1900, in his Fundamentals (Grundriss) of Psychiatry, he classified  “delirium tremens”, “Korsakoff psychosis” and “presbyophrenia” as “allopsychoses”; “anxiety psychoses” and “hypohondriacal psychoses” as “somatopsychoses”; and “mania” and “melancholia” as “autopsychoses”.

In describing “mania”, Wernicke emphasized the presence of “ideas of grandeur”, and in describing “melancholia”, he emphasized” ideas of indignity”. He saw “manic” and “melancholic” psychoses as independent from each other, but recognized that they frequently occur in the same patient. He also noted that “mania” was “more recurrent” with “shortening intervals between episodes” than “melancholia”, and that the prognosis of ”mania” was worse than of “melancholia” (Angst  and Grobler 2015; Menninger, Mayman and Pruyser 1968; Wernicke1896).     

REFERENCES

Angst J, Grobler C. Unipolar mania: a necessary diagnostic concept. Eur. Arch. Psychiatry Clin. Neurol. 2015; 265: INHN-90.

Ban TA. Neuropsychopharmacology and the Forgotten Language of Psychiatry. Risskov: International Network for the History of Neuropsychopharmacology; INHN E-Books 14.11.2013.

Ban TA. Elementary symptoms. INHN Dictionary8.10.2015b.

Bell Ch. Idea of a New Anatomy of the Brain. London; Strahan 1811.

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

Griesinger W. Über psychische Reflexactionen. Archiv für Physiologische Heilkunde  1843;  2: 76-112.

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.

Magendie F. Expériences sur les  fonctions des racines des nerfs rachidiens. Journal de physiologie expérimentale et de pathologie 1822; 2: 276-9.

Menninger K. Mayman M, Pruyser P. The Vital Balance. The Life Process in Mental Health and Illness. New York: The Viking Press; 1968.

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. Ueber  die Klassifikation der Psychosen. Breslau\; Sclettersche Buchhandlung; 1899. 

Wernicke C. Grundrisse der Psyhiatrie. In Klinischen Vorlesungen. Leipzig: Barth; 1896. 1900.

Thomas A. Ban
October 22, 2015