Edward Shorter`s comment on Jack R. Foucher et al. Wernicke-Kleist-Leonhard phenotypes of endogenous psychoses : a review of their validity

Hector Warnes’ response to Jack R. Foucher’s reply

        I am grateful for your reply helping me to differentiate whatever might be primary (E. Bleuler), elementary (K. Wernicke) or nuclear from what would be secondary and multiple phenotypes in the evaluation of a plethora of symptoms: "WKL description do not focus on what phenotypes have in common, but rather in what aspects they differ from one another." In Figure One of your article (Foucher, Gawlik, Roth et al. 2020) you succeed in bringing closer neuropsychiatry to neurology by sorting out the brain circuits that explain the clinical manifestations of Multiple Sclerosis, Dystonia, Lewy Body Dementia, Parkinson Disease and Fronto-Temporal Dementia with Parkinsonism.

        In this figure it is clearly shown how the differentiated psychopathology approach works over time attempting to increase the distance between dissimilar cases and reducing the distance between similar cases. New differences are to be found in the similarity of "ratios" in these differences along with different similarities. Those who use the dimensional or consensus-based approach are called the "lumpers" (DSM-5) while the trend in neuroscience is guided by the "splitters" who sort out the specific areas of the brain involved ("reverse phenotyping").

        This dichotomy would also explain the difference between a Disorder and a Disease and the principle of parsimony. The principle of parsimony or the Ockham's razor, states that entities are not to be multiplied beyond necessity. I would also agree that there is no need to lower the signal/noise ratio by mixing up too many entities. I would further dare to add that your approach is closer to Hughlings Jackson's theory of cerebral localization (along with his hierarchical and evolutionary theory of the CNS) which had a great impact on Henry Ey's work (York and Steinberg 1994). Beyond psychopathology or phenomenology per se the complexity of our subject-matter has gradually increased from biophysics, quantum mechanics, artificial intelligence, molecular biology, physiology (electromagnetism) and social psychology.

        Georg Franz Josef Northoff (2014) distinguished localization of neural activity in a few sparse regions from holism which is the amplification of such neural kindling along a coding mechanism.

References:

Foucher JR, Gawlik M, Roth JN, Clément deCdeB, Jeanjean LC, Obrecht A, Mainberger O, Clauss JME, Elowe J, Weibel S, Schorr B, Cetkovich M, Morra C, Rebok F, Ban TA, Bollmann B, Roser MM, Hanke MS, Jabs BE, Franzek EJ, Berna F, Pfuhlmann B. Wernicke-Kleist-Leonhard phenotypes of endogenous psychoses: a review of their validity. Dialogues in Clinical Neuroscience, 2020; 22(1):37-49. 

Northoff GFJ. Localization versus holism and intrinsic versus extrinsic views of the brain: a neuro-philosophical approach. Minerva Psiquiatr 2014;55:1-15. 

York GK, Steinberg DA. Hughlings Jackson's theory of cerebral localization. J Hist Neurosc 1994;3:153-68.

September 30, 2021