Editorial Commentary

Editorial Commentary I. Lecture-by-Lecture Synopses end of the lecture, he provides his classifi cation of symptoms in a three-by-three table: The columns Synopsis of L1: This, the very fi rst lecture, is one are: ‘Psychosensory’, ‘Psychomotor’, and of eight comprising the fi rst main section of ‘Intrapsychic’; the rows are: ‘loss of’, ‘excessive’, Grundriss , outlining Wernicke’s overall under- or ‘aberrant’ excitability (e.g. ‘anaesthesia’, standing of normal human brain processes in rela- ‘hyperaesthesia’, and ‘paraesthesia’ in the tion to subjective awareness. However, he starts Psychosensory column). This classifi cation gains with his basic credo, that mental illnesses are brain prominence in the clinical lectures. diseases. He expresses the view that psychiatry, compared to other specialties, is backward in its Synopsis of L3: The main topic of this lecture is development (although he suggests later that he Memory Images (Erinnerungsbilder ) sometimes has something better to offer). The rest ‘sets the rendered here as ‘remembered images’. Much of scene’ in relation to clinical concepts, clinical the lecture is devoted to separating perceptual/ practice, and neuroscience of the day. sensory images from ‘memory images’. In mod- ern terms this is the distinction between sensation Synopsis of L2: In this lecture, the point of depar- and perception. The former implies ‘awareness’ ture and the topic he understood best is the cere- arising directly from sensory input, the latter has bral representation of language—but this is added implications of a degree of interpretation merely a device to move into other territory. He or analysis of that input, to be given lasting repre- moves quickly at the start of the lecture to clarify sentation in memory. the notion of the ‘supposed’ Conceptualization Centre mentioned in L1. Although he was a pio- Synopsis of L4: The main topic of this lecture is neer for the notion of cerebral localization of the way in which remembered images, acquired function, by the time Grundriss was written he separately, come together to create a coordi- had moved beyond simple localization. Soon nated picture of the external world. In describ- other issues arise, raising several philosophical ing how remembered images of objects are questions. Much of the emphasis is that all symp- assimilated to become representations of con- toms in psychiatry can be reduced ultimately to a cepts, Wernicke sees an exact analogy with for- patient’s movements, which are all a physician mation of memory images from sensations, sees directly. This strongly materialist tone was represented in the primary visual areas by link- common in Germany, after Griesinger, a leading ing various active ‘perceptual elements’ (primary ‘Somatiker’ of an earlier generation. Towards the visual cortical cells). © Springer International Publishing Switzerland 2015 331 R. Miller, K.J. Dennison (eds.), An Outline of Psychiatry in Clinical Lectures, DOI 10.1007/978-3-319-18051-9 332 Editorial Commentary Synopsis of L5: This lecture focuses on how the hood consist of three components. These are the brain represents our body (using interchangeably sense of one’s own body (corporeality), one’s ‘physicality’ and ‘corporeality’). A conceptual sense of the outer environment, and personal distinction is made between sensory content and memories or beliefs acquired in one’s own life tone of sensation, a near-synonym for the latter experiences. An additional topic introduced here being ‘organ sensation’, a term whose meaning is is not so much the ‘contents’ of consciousness discussed in section XVI: ‘Terminology’). (upon which earlier lectures focused) but the ‘Corporeality’ includes what we now call visceral ‘processes’ by which such contents are laid down, sensation, notably that from the large intestine. and are subsequently manipulated and retrieved. Wernicke knew the importance of this topic, Synopsis of L6: The main topic of this lecture is although current understanding in the nascent representation of movement. Amongst evidence discipline of neuropsychology was quite limited. referred to is that obtained by electrical stimula- tion of muscles: This procedure, well known at Synopsis of L8: Much of this lecture is psycho- the time, was pioneered earlier in the century by logical theory, about psychological processes, Duchenne de Boulogne, who used it to study rather than content, such as might have been actions of individual muscles and muscle groups. found in writings of his American contemporary, Later, Wernicke discusses how full perceptual William James. This includes the phenomena of awareness depends on combining passive sen- attentiveness, and of ‘narrowness of conscious- sory awareness with exploratory movements. ness’ (i.e. selectiveness of attention), the process The latter notion builds on ideas fi rst mentioned by which memory is acquired, and the role played in L3, on elaboration of tactile perception by by Affective states. Much of the lecture consists combining immediate sensation with exploration of shrewd refl ections based on introspection, (especially manual exploration), an idea now which was easier before psychology became well understood by somatosensory physiologists. ‘objective’ when behaviourism came centre- Wernicke draws exact parallels here between tac- stage. The lecture also brings to the fore the sci- tile and visual perception/exploration. entifi c tradition in which Wernicke is best placed—not so much that of most biomedicine of Synopsis of L7: The subject matter of this lecture his day, but that of natural philosophy (which is how our brains construct for each of us an became physics). This conclusion can be reached image of ourselves as a (somewhat) unifi ed per- not only from his use of analogies from physics son. In English, the word ‘personality’ refers to for processes envisaged to occur in the brain. the unique quality or ‘essence’ of each person. More important are methodological features such Another word—‘personhood’—is used in legal as his balance between experiment and theory, discourse, signifying ‘status as a legal person’. In typical of natural philosophy (but seldom found this lecture, and later, ‘personality’ will be used in biomedicine); his freedom in postulating hid- as just defi ned, while ‘personhood’ is used in a den variables which could not be directly demon- more generic, abstract sense, referring to our strated (as were many concepts in the history of sense of ‘being (to a degree) a unifi ed person’, physics); and notably his close reasoning from whatever the detail of each individual’s personal fundamental principles, based on sensory and quality. Sometimes the phrase ‘personalized con- motor processes. This allowed them to be traced sciousness’ seems to capture Wernicke’s meaning back to the core language of the natural sciences. better than a literal translation. The word ‘individual’ refers to a single human, without imply- Synopsis of L9: Lectures 9–17 make up the sec- ing that he/she approximates to any sort of unifi ed ond main section of Grundriss, dealing with entity. A central notion, to be developed in later chronic states of ‘paranoia’, and dealing mainly clinical lectures, is that memories from which with long-stay patients in his institution. One each individual constructs his sense of person- such patient is described in vivid detail. In this fi rst Editorial Commentary 333 lecture dealing with clinical matters, Wernicke for delusions not mainly as an abnormality in the outlines basic concepts. First he distinguishes process of interpreting experience, but rather as a ‘ real mental illness’ from ‘mental disturbance’: more-or-less rational attempt to explain other In lectures so far, when ‘illness’ has been men- subjective experiences, which he sees as primary tioned, the German word was Geisteskrankheit. abnormalities. His concepts appear to be impre- Here he uses Geistesstörungen . Wernicke also cise or over-inclusive. This is perhaps inevitable enunciates a principle, that one should start one’s when there are major gaps in background knowl- analysis with the simplest situations, before mov- edge, and when the most useful way to defi ne ing to more complex ones. He points out (as he concepts is unclear. Sejunction is the obvious often does in later lectures) the similarity between example here, making this one of the more con- normal mental processes and mental processes he tentious of his lectures. This lays him open to a sees in his patients, an emphasis no doubt sceptic’s charge of ‘neuromythology’, especially intended to dispel as far as possible the idea that when components drawn from his analogies are patients were somehow ‘alien’ to the rest of used subsequently as premises for further steps in humanity. It is already clear here that psychiatric supposed scientifi c reasoning. Much of the sec- symptoms are to be the major focus of Grundriss. ond half of the lecture is vividly descriptive, but also attempts to systematize, even to explain. Synopsis of L10: This lecture is a succession of case presentations, continuing those in L9, and Synopsis of L13: The fi rst part of this lecture is referred to in later lectures. It gives insight into about hallucinations (identifi ed as ‘sensory medical practice and institutional life in the asy- deceptions’), recognized then, as today, as most lums of the day, Wernicke’s clinical style, his often of the verbal auditory variety (‘phonemes’ approach to symptoms, as well as initial ideas in his terminology). These are taken as primary about

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