Vienna: Psychiatry in

Vienna: Psychiatry in
   (since 1870)
   For a mid-sized European capital, Vienna had an extraordinary succession of well-known and highly productive academic psychiatrists. As for nonacademics: Many other famous Viennese researchers, such as Sigmund Freud and Paul Federn (1871–1950)—who later pioneered the treatment of schizophrenia with psychoanalysis—were Jewish and did not receive full (Ordinary) professorships, although their contributions had an international impact. Theodor Meynert began the series of academic psychiatrists. A student of neuroanatomy under pathology professor Karl von Rokitansky (1804–1878), in 1865 Meynert achieved his Habilitation in central nervous system structure, having already been appointed as staff physician at the newly built Lower Austrian Asylum in Vienna. In 1868, he received permission to lecture in psychiatry as well and in 1870, at Rokitansky’s urging, Meynert became director of the psychiatric clinic (clinic in the sense of teaching medical students) in the asylum. In 1873, he received a professorship, the first for Vienna, in psychiatry.
   The plot thickens in Vienna a bit because 2 years later, in 1875, a second psychiatric clinic was set up for Meynert in the General Hospital (Allgemeines Krankenhaus), following the intense mutual dislike between Meynert and the director of the Lower Austrian Asylum. Max Leidesdorf (1816–1889), the proprietor of an exclusive private nervous clinic, followed Meynert in the asylum-clinic. Vienna now had two psychiatry professors, a situation that was not ended until 1911. Meynert retained his post as professor of psychiatry at the clinic in the General Hospital until his death in 1892.
   At the psychiatric clinic of the General Hospital, Meynert was followed by Richard von Krafft-Ebing in the years from 1892 to 1902, then between 1902 and 1928 by Julius Wagner von Jauregg (usually written as Wagner-Jauregg). Between 1928 and 1945, Otto Pötzl (1877–1962) was professor of psychiatry. He encouraged Manfred Sakel’s research on insulin coma treatment. He is remembered for having quickly embraced the Nazi regime. After the war, in the years 1945–1949, Otto Kauders (1893–1949) held the chair, and between 1949 and 1969 it was held by Hans Hoff (1897–1969). Driven into emigration into 1938, Hoff was active in the mental hygiene movement after he received the chair.
   After Hoff, the chair was split between neurology and psychiatry. Holding the psychiatry chair from 1971 to 1991 was Peter Berner (1924–), whose two major contributions were his follow-up study of paranoiac patients, published in 1965 as Paranoiac Syndrome (Das paranoische Syndrom), and his system of "multiaxial classification," or polydiagnosis, in which a computerized database shows which large diagnostic systems may illuminate a patient’s particular set of symptoms; this was published with co-workers in 1982 in the Psychiatry Journal of the University of Ottawa. In 1873, psychiatrist Heinrich Obersteiner (1847–1922) became professor of neuropathology, founding in 1882 the world-famous Vienna Neurological Institute (Neurologisches Institut). In 1919, the institute was taken over by his pupil, the neurologist Otto Marburg (1874–1948), who simultaneously became professor of neurology.
   Vienna had numerous internationally known psychoanalysts, and the membership list of the Vienna Psychoanalytic Society reads almost like a list of household names, Sigmund Freud being of course the most famous. Yet, having international followings as well were Otto Fenichel (1897–1946), who is remembered for his theories of neurosis; Heinz Hartmann (1894–1970), the founder of modern psychoanalytic "ego" psychology; Margaret S. Mahler (1897–1985), who as an emigrée became one of America’s foremost child psychiatrists; and Otto Rank (Rosenfeld) (1884–1939), a lay analyst known for his 1924 work on Birth Trauma (Das Trauma der Geburt).
   As for Viennese psychiatrists who were not psychoanalysts (and who never became Ordinary professors), several deserve special mention. Erwin Stengel (1902–1973) later became famous in England. Having worked as an assistant under Wagner-Jauregg and Pötzl, Stengel acquired an international reputation only after his emigration in 1938 to London; after re-doing his medical studies, he landed at the Maudsley Hospital, ultimately becoming professor of psychiatry in Sheffield in 1956. In 1958, Stengel wrote an influential study of Attempted Suicide. (He had earlier studied psychoanalysis, which he viewed as "the God that failed," and attempted to reconcile it with neuropsychiatry.) Bernhard Dattner (1887–1952) and Josef Gerstmann (1887–1969), by contrast, ended up in New York. Dattner, an eclectic figure who had studied psychoanalysis but was expert in the treatment of neurosyphilis, emigrated in 1938 and was appointed at New York University.
   Gerstmann had habilitated in Vienna in 1921 in psychiatry and neurology and had been chief psychiatrist at the Maria-Theresien-Schlössel in Vienna, an important private nervous clinic. He emigrated to England in 1938, thence to Springfield State Hospital in Maryland, and to a number of consulting posts in New York City. He is known for describing Gerstmann syndrome, a loss of visual recognition of the finger (among other symptoms) associated with a specific brain lesion; he brought this forth in 1924 in the Vienna Clinical Weekly (Wiener Klinische Wochenschrift). Gerstmann’s wife, Martha, recalls that, when Wagner-Jauregg received the Nobel Prize in 1927, Wagner presented a copy of Gerstmann’s book on the treatment of neurosyphilis to the King of Sweden. (Max Fink, himself born in Vienna, said of this: "There was a mentor!") A decided non-fan of psychoanalysis was Josef Berze (1866–1957), for many years director of the Vienna city asylum "Am Steinhof," who described "primary insuffi-ciency of psychic activity" in schizophrenia in a 1914 book of that title. Finally, the most distinguished neuroscientist to emerge from early-twentiethcentury Vienna was Constantin von Economo (1876–1931), the Count (Freiherr) of San Serff. From a noble Greek family, von Economo had grown up in Trieste, then studied medicine in Vienna, where he remained. In 1906, he became an assistant of Wagner-Jauregg in the psychiatric clinic and dedicated himself to pathbreaking research both in basic neuroscience (the neurophysiology of swallowing) and in clinical medicine: he acquired world fame with his discovery of the "encephalitis lethargica," announced in the Vienna Clinical Weekly (Wiener Klinische Wochenschrift) in 1917. Shortly before his death, he opened a brain research institute attached to the psychiatric clinic. Why a city such as Vienna should have become such a center of psychiatric thinking is unclear. Some scholars, mindful of the city’s failure to regain its former status after the Second World War, argue that Vienna’s prominence was owing to the presence of a large number of Jewish clinicians and scientists; this is signficant because at that time, Jewish homes were more focused on book learning and scholarship than non-Jewish homes. Yet, the distinguished professors, such as Krafft-Ebing and Wagner-Jauregg, were non-Jewish. It is certainly not true that Vienna owed its luminosity mainly to psychoanalysis because Wagner-Jauregg, Leidesdorf, Berze, Sakel, and others had no interest in Freud’s ideas. The most likely explanation is the presence of the University of Vienna, liberally funded by the state, that late in the eighteenth century began to build a distinguished medical faculty and academic hospital system, remaining a magnet for talent until the forced union with Germany in 1938. Readers may consult Erna Lesky’s book, The Vienna Medical School of the 19th Century (German original Die Wiener Medizinische Schule im 19. Jahrhundert, 1978).
   On other Viennese:
   Aichhorn. See Psychotherapy: milieu therapy (1925).
   Asperger. See Autism.
   Bettelheim. See Psychotherapy: milieu therapy (1944).
   Bierer. See Psychotherapy: therapeutic community (1939).
   Deutsch. See Women in Psychiatry: Helene Deutsch.
   Feuchtersleben. See Psychosis: Emergence (1845).
   Freud, Anna. See Freud, Anna.
   Klein. See Klein, Melanie Reizes.
   Kohut. See Freudian Psychotherapy: Technique (1971).
   Leidesdorf. See Depression: Emergence: hypochondria (1860).
   Moreno-Lewy. See Psychotherapy: group psychotherapy (1911).
   Sakel. See Insulin Coma Therapy (1930).
   Schilder. See Schilder, Paul Ferdinand.
   Steinberg. See Women in Psychiatry: Hannah Steinberg.
   Stekel. See Freudian Psychotherapy: Technique: Stekel (1919).
   Stransky. See Schizophrenia: Emergence: Stransky’s intrapsychic ataxia (1903).

Edward Shorter. 2014.

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