German Romantic Psychiatry

   Several prominent German psychiatrists who flourished in the last years of the Romantic movement (the early nineteenth century) were called by their opponents "Romantic" psychiatrists because of the prominence they gave to moral values. These psychiatrists held "romantic" views because of the almost mystical links that they glimpsed between psychiatry and philosophy and because of a belief in the psychogenesis of illness (as opposed to the somatogenic beliefs of the biological psychiatrists). The Romantic psychiatrists were entirely eclipsed by the continued surge of biological thinking in the 1860s and after, and they are important historically only because they represent an initial eruption of psychological thinking into psychiatry. Among prominent Romantic psychiatrists were the following individuals.

   Johann Christian Reil (pronounced [RILE]) (1759–1813). Born into a pastor’s family in East Friesia, Reil is remembered for introducing psychological approaches to German psychiatry. He graduated with an M.D. from Halle in 1782, received his Habilitation in Berlin, then after 1788 was professor of medicine in Halle and head of the clinical institute. Called in 1810 to be professor of medicine in Berlin, he died 3 years later in a typhus epidemic after the battle of Leipzig. In addition to his practical efforts to have city asylums founded in Berlin and Halle, Reil is known for his book Rhapsodies on the Application of the Psychic Method of Cure in Mental Disorders (Rhapsodien über die Anwendung der psychischen Curmethode auf Geisteszerrüttungen) that he published in 1803. He argued for "psychic" approaches to mental illness in addition to the standard physical therapies of the day: Physicians used "psychic," or psychological, methods "when they act upon states of mind [Seelenkräfte], ideas, feelings and desires in such a manner as to produce changes in the patient’s organization of mind, through which their illnesses are healed" (p. 25). Given that medicine already had two main treatment orientations— surgical and medical—"it is now time to add a third, the psychic" (p. 27). Reil suggested using the whole atmosphere of the asylum, rather than some particular psychotherapeutic scheme, as the best way of influencing the patients’ thoughts.

   Filled with notions of the "animal magnetism" of his day, Reil understood psychology as the study of the "anomalies of the self-consciousness of subjectivity," as for example doubting the realness of one’s own personality "or confusing our ego [unser Ich] with that of another person" (pp. 71–72). He described somnambulism and multiple personalities as psychological disorders. Medicine, he said, concerned itself with the natural sciences. But "a medical psychology would be something else entirely, the quintessence of empirical and psychological understanding, conceived with constant attention to the reciprocal relationship of both of these sides of the human condition and staying in the closest possible relationship to the task of healing" (pp. 38–39). Romantic in all this was Reil’s insistence on the primacy of free will over passion. Reil saw insanity as limiting the freedom of the patient’s will: "The relationship of the parts of the mind [das Seelenorgan] to one another is based on a certain distribution of psychic energy in the brain and the entire nervous system. If this relationship is disturbed, dissonance arises: leaps of thought, abnormal ideas . . . fixed rows of ideas, and the corresponding drives and actions. The capacities of the mind [Seelenvermögen] cease to be responsive to the freedom of the will" (p. 46). The best way to make the mind obedient again to the will was to subject the patients to iron discipline in mental institutions, he said.

   Reil is, ironically, probably best known to medical students for having described a particular brain structure, the "island of Reil," or insula, which forms part of the boundary of the auditory sensory area.

   Johann Christian August Heinroth (1773–1843). Born of a medical family in Leipzig, Heinroth exemplified the moralizing side of Romantic psychiatry, with its doctrine of self-control over the passions. He began medical studies in Leipzig in 1791, finally graduating after numerous interruptions in 1805. He earned his Habilitation the following year with a work on "medical anthropology," then in 1811 received a lectureship in psychiatry at Leipzig University, and in 1827 was appointed professor of psychiatry. Although his big Textbook of Disturbances of Mental Life (Lehrbuch der Störungen des Seelenlebens), published in 1818 and translated into English in 1975 by George Mora, was permeated by a kind of pietistic mysticism, it did attempt a new classification of psychiatric illnesses that tried to delineate many specific subtypes. His moralizing approach to illness received perhaps its fullest expression in his Textbook of Mental Hygiene (Lehrbuch der Seelengesundheitskunde), published in 1825 and filled with such observations as, "The passions are like glowing coals hurled into the house of life, or serpents that spew poison into the veins, or vultures that devour the innards. From that moment on, when people let themselves be transported by passion, order comes to an end in the economy of their lives" (p. 591).

   Carl Wilhelm Ideler (pronounced [EE-del-er]) (1795–1860). Born into a pastor’s family, Ideler studied medicine in Berlin, qualifying in 1821. In 1828, he was summoned from private general practice to supervise the psychiatry beds of the Charité Hospital in Berlin; the invitation came from an official of the Prussian government who had read Ideler’s book Anthropology for Physicians (Anthropologie für Ärzte), which was published in 1826. In 1830, psychiatry at the Charité became a separate division, with Ideler at its head. He received the Habilitation as a university lecturer the following year. In 1839, he was appointed professor of psychiatry and remained in office until his death in 1860, "like a ruined castle from the past looming into the present," as someone said. Although Ideler was not an innovator in asylum management — relying upon forcible techniques of confinement in order to encourage the patients to fight off the evil influence of passion—he did emphasize the psychological aspect of psychiatric illness. For example, in an article in the General Journal of Psychiatry (Allgemeine Zeitschrift für Psychiatrie) in 1846, he pleaded for a revival of psychological thinking and for less emphasis on pathological anatomy. Ideler was often thought of as a disciple of Heinroth’s, with the same moralizing bent and desire to use the power of confinement in order to drive the devil out of his patients.

   Because of their metaphysical orientation, some of the German Romantic psychiatrists were often referred to as the "psychic school" (Psychiker), in contrast to the somatically oriented school (Somatiker), who saw psychiatric illness as medical illness. Among prominent Somatiker of the pre-1860 period were Karl Wigand Maximilian Jacobi (1775–1858), director of the Siegburg asylum, and Johann Baptist Friedreich (1796–1862), professor of psychiatry in Würzburg. The rather philosophical debate between these two schools subsided with the ascendancy of the medical-empirical approach to psychiatry as represented by Berlin professor Wilhelm Griesinger, who took over Ideler’s chair at the Charité in 1865.