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Tuesday, 28.09.2021

Carlos Morra and Mateo Kreiker: Psychopathology


5. Thomas A. Ban: Development of the structural foundation of psychiatry*



From Neurosis to Psychosis         

          Madness may be as old as mankind (Porter 2002). Yet, development that led to the birth of psychiatry, the discipline that deals with “madness,” began only in the late 18th century. It was triggered by: (1) William Cullen’s (1777) introduction of the term “neurosis,” in his First Lines of Physic, for a class of disease he believed were diseases of the “nerves” and (2) his classifying the “vesanias” that included the various forms of madness, as one of the four “orders” of the “neuroses” (Littre 1877). 

          Cullen was an influential professor of medicine and physics at the University of Edinburgh, Scotland and his classification attracted attention in Continental Europe and the United States. Hence, his classifying “madness” as diseases of the “nerves” could not be dismissed by the “mentalists” (referred to by some as “German Romanticists”), powerful group of physicians at the time that believed that “insanity” was an affliction of the “mind” (Pichot 1983; Shorter 2005).

            To shift emphasis from the nerves (brain) back to the mind (psyche) in the understanding of “madness,” the term “Psychiaterie” was introduced in 1808 by Johann Christian Reil, the professor of medicine in Halle (Germany). It was adopted and modified to “Psychiatrie” by Johann Christian Heinroth, the professor of medicine in Leipzig (Germany). It was through Heinroth’s influential Textbook on the Disturbances of Psychic Life, published in 1818, that the term “psychiatry” spread around the world (Pichot 1983). The “mentalists” profoundly affected the language and thinking- of “psychiatry” with a long-lasting effect.

            In 1845 Ernst Feuchtersleben, the dean of medicine at the University of Vienna (Austria), not a mentalist himself, had adopted the “mentalist” term “psychosis” in his Textbook of Medical Psychology for patients with “madness” who qualified for the “vesanias“ in Cullen’s classification. His separation of patients with “madness,” i.e., patients with “psychosis” from the other patients with “neurosis,” marks the separation of “psychiatry” from “neurology.” Within Feuchersleben’s frame of reference: ”Every mental disorder implies a disease of the nervous system, but not every defect of the nervous system is accompanied by mental disorder” (Pichot 1983).

Introduction of Conditioned Reflex

            In the same year, 1845, that Feuchtersleben’s textbook appeared, Wilhelm Griesinger published his treatise, The Pathology and Therapy of Psychic Illnesses. For Griesinger, psychiatry was part of the natural sciences; mental activity was nervous activity and mental pathology was a symptom of brain disease.

            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).

            By adopting the “reflex” as he elementary unit of “mental activity” in 1843, Griesinger set the stage for the development of psychiatry as a medical discipline. Twenty years later, in 1863, Ivan Mihailovich Sechenov, a Russian physiologist, who studied “nervous inhibition” in the central nervous system of the frog in Claude Bernard’s laboratory in  Paris, elaborated on Griesinger’s descriptions. In his monograph, Reflexes of the Brain, he concluded that all activity, including the “psychological” in the brain, is reflex and as such follows fixed laws determinable by investigation (Sechenov 1935; Wells 1956).underpinning of the “psychic reflex” was established in the late 19th century by Camillo Golgi (1874), an Italian histologist, who described multi-polar (Golgi) cells in the “olfactory bulb” with the employment of silver staining; Santiago Ramon y Cajal (1894), a Spanish histologist, who established that the “neuron” is the morphological and functional unit of the nervous system; and Sir Charles Sherrington (1906), an English physiologist, who demonstrated that the “synapse” is the functional site of transmission from one neuron to another.

            Carl Wernicke (1881-1883), the professor of neurology and psychiatry in Breslau (Germany at the time), in the late 19th century, adopted Griesinger’s view that mental activity is “reflex” activity and classified “psychoses,” i.e., psychiatric diseases, on the basis of “hyper-functioning,” “hypo-functioning or “para-functioning” in the “psycho-sensory,” “intra-psychic” (trans-cortical) and/or “psychomotor” components (paths, phases) of the “psychic reflex” (Franzek 1990).     

            The “psychic reflex” became central in the research of Ivan Petrovich Pavlov, a Russian physiologist and recipient of the Nobel Prize in 1904 for the discovery of the nervous regulation of the heart. His interest in the “psychic reflex” was triggered by his (and others) observation that “sham feeding” produced gastric secretion in a dog (Pavlov 1906). To study this phenomenon, he developed a behavioural method for the detection and measurement of salivary secretion in chronic experiments in dogs with a surgical fistula in their parotid glands. With the employment of this method Pavlov discovered that any sensory stimulus (ringing of a bell in the original experiments) by repeated (preceding) coincidence with a specific stimulus for a particular reflex (food in the mouth for salivary secretion in the original experiments) became a signal for the specific stimulus, i.e., ringing of a bell became a signal for eliciting salivary secretion for which food in the mouth was the only signal before.

            Pavlov could explain his findings only by assuming the opening of a new, formerly non-operating path in the brain with each newly formed conditional  reflex (CR), a term he coined. Hence, he postulated that “psychic activity,” as salivating to the ringing of a bell, translates into changes in the processing of sensory signals in the cerebral cortex. He also rendered the “psychic reflex,” i.e., the changes in the processing of sensory signals in the brain, accessible to study with a behavioral method he developed in his laboratory. To distinguish the behaviorally indistinguishable acquired reflex from the innate reflex, introduced the term conditional reflex (CR) for the former and the term unconditional reflex (UR) for the latter. In the first two decades of the 20th century Pavlov with his associates established that the brain of some mammals has built-in potential to form, i.e., acquire CRs (CR acquisition); extinguish-inhibit, acquired CRs (CR extinction); and “disinhibit” extinguished CRs (CR disinhibition). They also revealed that before the CR becomes restricted to a particular conditional stimulus (CS) by differentiating the CS from other stimuli (CR differentiation), it becomes “generalized” in a manner that transiently, any qualitatively similar stimulus to the CS can elicit the CR (CR generalization). Based on two assumed ongoing “elementary basic processes” in the brain, “excitation” and “inhibition”, which become manifest behaviorally in CR acquisition and CR extinction, the brain has the potential for differentiation (CR differentiation), by reinforcing one stimulus (positive stimulus) and not-reinforcing another (negative stimulus), and CR reversal, by shifting reinforcement from the positive to the negative stimulus. Furthermore, the brain also has the potential to delay the onset of the CR (CR delay or retardation) and to form secondary CRs or chains of CRs built on established CRs (Ban 1964; Gantt 1948; Pavlov 1927).

            In the early 1930s Pavlov with his associates extended their research from animal to man and revealed that the human brain has the potential to use a corresponding verbal signal of a sensory stimulus as a signal to elicit the CR. Since verbal signals are built on sensory signals, Pavlov referred to CR activity with the use of words as second signal system activity, and CR activity with the use of sensory signals as first signal system activity. Furthermore, since CR activity in both, the first and the second signal systems are built on UR activity, he distinguished between lower, UR based nervous activity, and higher, CR based nervous activity.

            In Pavlov’s frame of reference mental functioning is higher nervous activity, and mental pathology is an expression of abnormal functioning in the second signal system.  The findings that CRs to verbal signals suppress CRs to sensory stimuli, and CRs to sensory stimuli, suppress URs indicate that human behaviour is dominated by verbal signals (Ban 1966; Bykov 1957; Ivanov-Smolensky 1954; Wells 1956).

            Since CRs in the first and the second signal systems are based on the same built in potential of the brain for CR functions, CR parameters, such as CR acquisition, CR extinction, generalization, differentiation, secondary CR formation,  etc., provide an indirect means for the study of normal and abnormal mental functioning. Hence, if abnormal CR functions could be linked to psychopathology and its underlying abnormality, CR parameters would provide a bridge between the “language” of mental pathology and the “language” of pathological brain functioning. 


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*Extracted from Thomas A. Ban: Neuropsychopharmacology and the Forgotten Language of Psychiatry. November 14, 2013.


August 13, 2020