Centennial of the nobel prize for Golgi and Cajal--founding of modern neuroscience and irony of discovery

In 1906, Golgi and Ramón y Cajal shared the Nobel Prize in Physiology or Medicine "in recognition of their work on the structure of the nervous system". However, it was an unusual occasion in the history of Nobel Prize award because their views on the structure of the nervous system were not only different but even opposite, creating the "storm center of histological controversy". Furthermore, the new staining method Cajal had employed to study the nervous system was developed by Golgi, creating an irony of discovery. In 1873, Golgi revolutionized the histological study of the nervous system by developing a new staining method, "la reazione nera" or black reaction, which allowed good visualization of axons, dendrites and glia. But because his stain was so selective, staining only about 3 percent of neurons, he was unable to see clearly how the neuronal processes ended as they approached other neurons. Consequently, he embraced the popular belief that neuronal processes physically fuse with each other--the "reticular theory". On the other hand, Cajal was incidentally introduced to the Golgi stain 14 years after its discovery and immediately realized its beauty. He found that better results could be produced by staining more intensely and cutting thicker sections. He further observed that the Golgi stain worked best on non-myelinated axons. The search for brains containing non-myelinated axons led him to study birds and very young mammals, including embryos. Cajal obtained fascinating results by modifying the Golgi stain and by studying avian and young mammalian brains. From those studies, Cajal was able to infer that axons and dendrites ended freely and did not physically anastomose. Therefore, he strongly advocated the "neuron theory". Golgi seemed to be too headstrong and too conservative to relinquish his belief that neurons constitute a network which reacts as a whole. On the other hand, Cajal's hard work using the Golgi stain led to new understanding on the structure and function of the nervous system, and earned him "the founder of modern neuroscience". This centennial occasion may be further impressed by Cajal's comment on the shared Nobel Prize that "what a cruel irony of fate of pair, like Siamese twins united by the shoulders, scientific adversaries of such contrasting character!".     

Consideration of the concepts of "remission" and "cured" in schizophrenia: a male case who experienced schizophrenia with psycho-motoric excitation 30 years ago]

Since the era of Kraepelin and Bleuler, schizophrenia has been considered to be very difficult to cure. Even if all symptoms of its acute phase have disappeared completely, it is customary to use the terms say "remission" instead of "cured". The chief reason why they have been unwilling to say "cured" is that, even if the present state seems to be "cured", there will be surely another attack in near future, so, the non-symptomatic state should not be understood as "cured". Whether schizophrenic patients can be cured or not is one of the great problems of modern psychiatry. Is there no probability for them to be cured? Recently, after a 30 years gap, I came to meet a man who had had a schizophrenic attack of the psychomotoric type when he was 25 years old and had been sent to the mental hospital where I had been at work and, by chance, had engaged in his treatment. After about 5 months' of acute state, he came at, so to speak, "Residualzustand" (Conrad) for about 1 year and then got insight into his psychosis. After the discharge, he had visited me as an outpatient once a month regularly. About one year thereafter, the change of my work place made us separate from each other. Since then, he stopped visiting the doctor and also stopped taking anti-psychotic drugs. He married at 29 years old and had 2 daughters and a son. In addition, he had started to work for his father's business. After his father's death, he became the owner of 5 shops and the supervisor of 50 workers. Is he not yet "cured"? Is he only in the state of "remission" even now? According to the principle of Kraepelin and Bleuler, he is not "cured" yet, because he will surely have a psychotic exacerbation in future. I wonder then, what is the difference of the two concepts of "remission" and "cured", and how is it possible to change "remission" to "cured"? Even Bleuler, E. has written in his world-famous textbook that the longer the duration of remission after the last attack, the smaller the probability of the next attack, and that after about 5 years free of attack, another exacerbation would be very improbable. Supported by the experiences of Utena, Miya and so forth, I proposed a thesis that if a person who had undergone schizophrenic attack has been in complete remission for more than 10 years, he can surely be counted as "cured". To verify this probability about the outcome of schizophrenia, it is very important for us to observe any patient who has attained the state of complete remission, and to describe and report his state thereafter as long enough as     

Treatment techniques in evolution

In response to Gabbard's paper, "Do We Need Theory?" the author disputes the suggestion that his early therapeutic successes were theory-specific. He also takes issue with the view that "the analyst's personality is a constant," emphasizing instead the continual fluidity of an effective analytic relationship. While agreeing that atheoreticism is itself a theory, the author differentiates between the universal presence of content as defined by formal psychoanalytic metapsychological theory (e.g., primary instinctual envy, the Oedipus complex) and the centrality of affect attunement that illuminates developmental processes. He cautions therapists to guard against believing that they know "objective reality," and he urges them to assume a "know-nothing" position conducive to eliciting each patient's psychic reality.     

Friedrich Mauz – T4-Gutachter und Milit?rpsychiater

Friedrich Mauz is one of the medical perpetrators of the second tier whose biography is difficult to comprehend. Autobiographies from three different political systems exist - Weimar Republic, the Third Reich, and postwar Germany in which he constantly reinvented himself. While after 1933 he suddenly emphasized his participation in the civil war turmoil during the early period of the Weimar Republic and his patriotism, he then depicted himself after 1945 as an apolitical person characterized by Württemberg pietism who inwardly rejected the Nazi State but had found himself prepared to accept "all sorts of humiliating concessions." He claimed that he had always remained true to his scientific code of conduct and had distanced himself from psychiatric genetics. In point of fact, Mauz was among those exonerated in the denazification trial in 1946 and was able to pursue his career in the Federal Republic of Germany. However, if the sources are read against the grain, a different picture emerges. Mauz's career stalled in the 1930s, not because he had been politically offensive, but because his scientific work was flimsy and considered lacking originality, particularly since he had chosen constitution research and psychotherapy as his main fields of interest, which were overshadowed by research in genetic psychiatry in the 1930s. Mauz tendered his services to the Nazi policy of genetic health, served as a medical assessor in proceedings based on the "Law for the Prevention of Genetically Diseased Offspring," permitted himself to be recruited for the T4 program as a medical expert, even participated in the deliberations on a future "Law on Euthanasia," and as a consulting psychiatrist for the German Armed Forces contributed to military medicine.     

Karl Ludwig Kahlbaum (1828-1899)--a protagonist in modern psychiatry

Kahlbaum was one of the most influencial psychiatrists of the 19th century. He paved the way for Kraepelin and inspired the development of 20th century clinical psychiatry. With his work he contributed to new ideas in general psychopathology and in psychiatric nosology. He described "clinical state-course-entities" and developed the concept of "exogenous reaction types", which would later be known as the "Bonhoeffer-paradigm". Kahlbaum was also the first to differentiate between centripetal, intracentral and centrifugal psychic functions, which was later transformed into the "psychic reflex circuit" by Wernicke. The concept of organic versus non-organic psychoses proved to be a heuristically fruitful classification system even for modern psychiatry. Kahlbaum was the first German psychiatrist to describe several disorders and syndromes and to coin new psychiatric terminology for them, including paraphrenia, hebephrenia, catatonia and cyclothymia. These terms and their originally associated meaning are still in use today. Kahlbaum's ambitious scientific aim was to develop specific therapeutic strategies which were based on a methodologically and etiologically sound classification system.     

Sexual abuse of minors]

The author gives a definition of sexual abuse on minors, emphasizing its more frequent occurrence inside the family (incest) than outside. He describes the countertransference reactions induced by this type of abuse, especially in professional teams who tend to put each other in a position of rivalry. Next, he sketches the pathogeny of sexual abuse, the clinical signs and the long term effects. The author deduces what should be the first signs of sexual abuse and proposes a pattern of diagnosis. Finally, he explains a management model, of the crisis and the follow-up of this difficult situation.     

Freud and the mighty warrior

This essay traces a prominent facet of Freud's personality, his being a "mighty warrior" throughout his life. This aspect of his character evolved as a reaction formation against his submissive father and as an identification with his more aggressive mother. He first tried it out in his highly ambivalent relationship to his nephew John, who was one year older. In his childhood play, Freud identified with certain military heroes, such mighty warriors as Napoleon, Hannibal, Alexander the Great, and Massena. As he grew older he shifted from military heroes to other great men including Goethe, Shakespeare, and finally Moses. He substituted these men as ego ideals in place of his father about whose stature he felt disillusioned. He far surpassed his father in his life achievements and yet managed to maintain an even-handed, respectable relationship with him until he died in 1896. His mother all but worshipped Sigmund but also demanded that he achieved the maximum in whatever he did. He had to earn her love by an outstanding performance but always wanted to feel unconditionally loved. His mighty warrior attitude developed into an important part of its personality. It protected him from feelings of helplessness and inadequacy and made him into an outstanding leader of the psychoanalytic movement.     

Hermann Simon--reformer of psychiatry,social Darwinist,and National Socialist?

Hermann Simon (1867-1947) was shaped in his psychiatric thinking and views of society by the German empire. He showed a strongly conservative attitude and thought in ethnic-nationalistic terms. Beginning in 1905 and drawing on practical experience, he developed the concept of a "more active therapy." Simon perceived patients in a holistic way, regarding them not so much as sick people but as fellow men. He believed in the ability of a healthy personality to practice responsible and "well ordered self determination." Thus he defined the role of the doctor in a new way. Within Germany as well as internationally, active therapy was well-received, especially because of its positive effect on the atmosphere within asylums. In the context of reform of so-called open care during the Weimar epoch, Simon's approach was perceived in a new way because it allowed individual views of each patient, enabling assessment of the ability to work and chances for release. Simon himself set his concept in a "biological" and psychological context, based on his own biologistic and social Darwinistic world view. This view was open for eugenic, racial hygienic concepts, and fundamental criticism of welfare policy. It was only a short step from this conservative tenor, understanding of the state, and biologistic thinking to his open acclaim of Hitler and National Socialist (Nazi) racist policy.     

Psychoanalytic peregrination. V: The Zollikon Lectures

This article is to prepare the reader, along with the previous peregrination, for the article that follows by Professor Lang. It introduces the thinking of Heidegger at the Zollikon Seminars, conducted by the Swiss psychoanalyst Medard Boss, founder of Daseinanalyse and presented to a group of Swiss psychiatrists. Heidegger opposed Freud's scientific Weltanschauung and his hydraulic system of metapsychology, objecting that it dehumanizes the patient. He emphasized the importance of the therapist's "presence" and openness to the patient. He utilized phenomenology to prevent relating to the patient as an "other" or "thing" and advocated a hermeneutic approach instead. This approach involves the use of questions and answers to gain a gradual explicit understanding of the unique communications from the individual patient. He opposed the approach of the drug companies that impel psychiatry to use classification of disorders through manuals such as DSM-IV and then subject the patient to the recommended drug for that disorder, which he maintained was a form of domination of the patient as the "other."     

The maestro don Gonzalo Rodríguez-Lafora

Gonzalo Rodríguez-Lafora (1886–1971) was an influential Spanish neurologist, and has been called the last of Cajal's great Spanish disciples. Of course, he is best known now for describing (in 1911) the intracytoplasmic inclusion bodies in "Lafora disease." In total, he published ∼200 papers covering a wide range of subjects in neurology, psychiatry, and neuropathology. He made seminal contributions not only to the clinical and scientific literature but also to the training of many noted disciples who paid him due homage as a true "maestro." Throughout his intellectual endeavors, Lafora manifested a singular purpose and intensity and a burning devotion to scientific honesty.     

Aspects of psychodynamic neuropsychiatry II: psychical locality and biology: toward the neurobiology of psychotherapy

Throughout his career, Freud believed that psychiatry in general and psychoanalysis in particular would one day be rooted in anatomical/biological ground. He felt confidant that such ground would replace the psychological understanding on which he had been forced to base most of his clinical theory and practice. He felt confidant that one day psychotherapy would be more "scientific." This article seeks to demonstrate that this day is arriving. A clinical case is presented where assessment and formulation are largely based on neurobiology, where treatment was conducted less in accord with psychodynamic theory than neurodynamic data of anatomy and biology.     

The contribution of Hughlings Jackson to an understanding of dissociation

The author provides a preliminary framework for a systematic and dynamic understanding of dissociation through a consideration of the theories of Hughlings Jackson. Jackson's ideas are briefly reviewed. He saw the proper scientific investigation of mental illness as an experimental investigation of mind. Accordingly, his argument begins with this fundamental concept. His views of the brain-mind relationship and of mind, or self, resemble modern conceptions. He viewed the self as double and focused on those disruptions of the self system which he called the "dreamy state." This state involves an "uncoupling" of normal consciousness, resulting in the loss of the most recently developed forms of memory and of the stream of consciousness. Dissociation is seen here as analogous to the dreamy state. Jacksonian theory predicts the main features of dissociation, i.e., constriction of consciousness, a particular form of amnesia, disaggregation of perceptual phenomena, depersonalization, derealization, and hallucinosis. It leads to the view that dissociation can be seen, in essence, as an uncoupling of consciousness.     

Freud's antipathy to America

Freud first saw this in America's attitude toward the use of cocaine. It was freely and legally used and even promoted by American physicians as beneficial in many medical conditions. Freud was first swept along by America's prococaine enthusiasm. He narrowly missed destroying his own medical reputation by his continuing close connection and advocacy of cocaine. Freud made his only visit to America in 1909. Despite the success of his visit and the congeniality of Americans toward him, he was already programmed toward a negative response. He allowed minor everyday inconveniences and cultural differences to spoil the trip for him. The chronic intestinal distress that had bothered him previously now was labelled as his "American dyspepsia." He developed additional reasons for disliking America. They accepted his three key dissenters, Adler, Jung, and Rank. He even believed that these three men achieved greater notoriety and popularity in America than he did. In fact, the Freudian psychoanalytic movement became much larger and more powerful in America than did the followings of any or all of his defectors. Freud did not like the shortcuts and lack of mastery of the basics of psychoanalysis that he believed happened in America. Some of this was true, but it was mainly exaggerated in Freud's mind. The gold of psychoanalysis was never transformed into a practical but deficient psychoanalytic alloy as Freud feared it might. There was a genuine disagreement about whether a psychoanalyst should have to become a medical doctor or not. It was a complicated issue in America because of laws that said that doing psychoanalysis was practicing medicine. Freud viewed the American stand against recognizing lay analysts as more evidence of American's being a rebellious son. Economic factors also played a significant factor in Freud's dislike of America. Freud was initially enthusiastic about President Wilson and his plans for peace. He found after World War I that all of his savings were wiped out and that Vienna suffered from a crippling inflation. As a result of this he had to take increasingly more American analysands as they paid him in valuable American dollars. He resented this financial dependency on Americans. He also had difficulty communicating with these American analysands and largely blamed them for their undisciplined way of speaking. What I have presented is a survey or overview of the reasons for Freud's dislike of America.(ABSTRACT TRUNCATED AT 400 WORDS)     

The changing role of dynamic psychotherapy in psychiatric practice

The author reviews the range of accepted indications for dynamic psychotherapy when he first began practice after World War II and describes factors that have played a role in the current undervaluing of this treatment approach. He attributes much of the change to research that has produced a different understanding of many of the conditions treated by psychiatrists and has placed greater emphasis on their medical and biological aspects than on their psychological aspects. He also attributes many alterations in current practice to the change from a two-party to a three-party reimbursement system for psychiatric services. On the basis of his practice, the author illustrates his belief that dynamic therapy continues to have a role in today's psychiatric practice. He describes one category of patients in particular-those who seek treatment for "problems of living"-who can be helped by dynamic psychotherapy. The author makes a case for freeing dynamic therapy from the need to rely exclusively on the criteria of the medical model for its legitimacy.     

A religious psychiatrist's ethnographic self-report

The religious identity of psychiatric patients is deemed important as it may impact upon the understanding of patients' problems and the quality of the therapeutic relationship. It would seem important that the psychiatrist should also be sensitive to the role of his/her own religious identity and its effect on clinical work. Nevertheless, even in studies by and about psychiatrists who have religious roles within a community, this component has tended to be ignored. A series of self-observations are offered by a religious Jewish psychiatrist to describe the effect of religious identity on himself and his patients during clinical work in Israel. Three types of situations were apparent: when he was unsure about his religious identity, when he was unsure about his professional identity, and when he was dealing with essentially religious rather than psychiatric issues and having to differentiate between his own role and that of a rabbi. These observations support the need to be sensitive to the effect of one's religious identity on clinical work, while appreciating that, as Andrew Sims has stated, the psychiatrist's "attitude towards the patient who shares his faith is as a fellow believer and not as a priest".     

Actors but not scripts: the dissociation of people and events in retrograde amnesia.

We describe our further investigations of the retrograde amnesia in a single case. R.F.R. became globally amnesic following an attack of Herpes Simplex Encephalitis. He could generate and recognize superordinate level information about the vast majority of proper names including the names of people but he was very impaired at giving information about what had "happened" to these same individuals. He could also provide detailed information about family friends but he could not recall salient major personal episodes in which these same individuals had been involved. Knowledge of people appears to be represented in a different way to that of events, even when a singular event has provided the main or only opportunity for learning about the individual.     

Paul Broca's less heralded contributions to aphasia research. Historical perspective and contemporary relevance

In addition to discovering the dominant role of the left hemisphere for language and describing what is now known as Broca's aphasia, Paul Broca made other insightful, but less well-recalled, aphasiologic observations. He distinguished symptoms of Wernicke's aphasia five years before Carl Wernicke's famous monograph, and he was the first to exploit the surgical relevance of language localization. Broca investigated the anatomic substrate of language laterality by comparing the relative weights of the two hemispheres and the two frontal lobes. He considered language lateralization from a developmental point of view and in relation to handedness. A relatively small portion of Broca's prodigious scientific career was devoted to the study of aphasia, but his seminal work encompasses a number of issues of contemporary concern.     

Psychiatry,psychology, law and homosexuality — uncomfortable bedfellows

The author analyses the history of the classification of homosexuality as a psycho‐sexual disorder and looks to the role of the law in propagating misunderstandings about sexual orientation. Looking to the causes of homophobia, he highlights the need for it to be eliminated, contending that until this occurs hatred, discrimination, disadvantage and violence will persist He argues that those who cause these feelings, and not those whom they target are the ones who need the assistance of scientific psychology and psychiatry and that those who are their targets need the strong assistance, protection and equal justice of the law.     

La médicalisation de l'intuition charitable : de saint Jean de Dieu à Philippe Pinel

To shed some light on the medicalization movement that has pervaded psychiatry for more than a decade, the authors focus on the origin of our discipline in France from a historical point of view. They compare the work of Philippe Pinel, founder of French psychiatry and the work of the brothers of Saint John of God in the 18th century. These brothers began admitting the mentally ill in five of their French hospitals (Cadillac, Charenton, Château-Thierry, Pontorson and Senlis). They provided sympathetic and compassionate care derived from their Christian humanism and inspired by their founder saint John of God (1495-1550). They materialized the charitable intuition that he had had towards the insane. They gave primacy to compassion in their approach to caring. During the French revolution, as the order of Saint John of God was dissolved and dispersed Philippe Pinel was appointed “Doctor in charge of the infirmaries” at the Bicêtre hospital in Paris in 1793. Pinel, who had studied theology, subscribed to the charitable instinct but he transformed it by introducing scientific and empirical philosophic dimensions. He suggested a medical approach based on observation and analysis of large numbers of the mentally ill. As an example of this medicalization process, the authors propose a comment on one of Pinel's articles entitled “Medical Thoughts on the Monastic Life”. This view of the history of psychiatry allows a renewed understanding of our scientific and medical approach in psychiatry. On the other hand, it seems to raise some questions about the place given to subjectivist dimensions, such as empathy, in our daily caring practice.