Streitfall Nervenheilkunde - eine Studie zur disziplinären Genese der klinischen Neurologie in Deutschland

Abstract

Although Germany was a center of neurological research during the 19th century institutionalisation of clinical neurology was delayed in comparison to other countries. The establishment of neurology in Germany is characterised by a conflict between internists, psychiatrists and neurologists that lasted nearly a hundred years. The present study describes and analyses the motives and the course of development of this dispute. The conflict could not be solved by means of objective arguments because on the one hand nervous disease were part of internal medicine, while on the other hand the postulated identity of mental and nervous disease was the central paradigm of the academic psychiatrists. As a professional group the entry of the neurologists into the dispute was very late at a time point when the historical development was already in favour of the psychiatrists. By taking into account not only intrascientific but also political and economic factors, the dynamics of the historical process becomes comprehensible.

German Neurology and the ‘Third Reich'

“…The development of clinical neurology as a separate subject in Germany was marked by a nearly 100-year dispute between internists, psychiatrists and neurologists [7] . This is why separate professorships for neurologyan essential characteristic of an established disciplinewere set up only in a few places such as Hamburg and Heidelberg.…”

“…In his opening speech on the occasion of the association's meeting Rüdin claimed that this move had been in the interest of those concerned, 'it was the desire of many psychiatrists and neurologists, as well as of the national government, to counter the divergent trends of the specialization through consolidating efforts. As a result, we have reunited neurologists and psychiatrists in one single association again' (quoted in [7] ; this and the following translations by the authors if not stated otherwise).…”

“…Psychiatric and neurological conditions that are more serious in nature are, to the greatest extent, hereditary and can therefore be contained and eradicated only through eugenics (...) In view of the many serious, hereditary diseases and many other conditions where heredity is at least a substantial contributor, our collaboration is more than justified (...) The new German State, thus, needs psychiatrists and neurologists trained and active in eugenics, and vice versa: neurologists and psychiatrists dedicated to racial hygienics need the National Socialist movement and the new State (quoted in [7] ).…”

Neurognostics Answers

“…First there was tradition: Wilhelm Griesinger (1817-1868), the mid-nineteenth-century German father figure of the discipline, dreamed of a new field consisting of a united neurology and psychiatry. Second was the research practice of the day: the strictly neuropathologically oriented psychiatry defined itself as the core of a comprehensive clinical neuroscience and therefore considered the intrusion of others into this territory as an existential threat (Pantel, 1993). Finally, the health care situation: most neurological patients were treated in psychiatric and nervous disease hospitals that had emerged from the old insane asylums.…”

Untitled

“…Jahrhunderts hatte sich an den deutschen Universitäten zu Beginn des 20. Jahrhunderts das Modell der ¹Psychiatrischen und Nervenklinikª ± also eine enge institutionelle Kopplung beider akademischer Fächer ± als Standard etabliert [1]. Gleichwohl ± oder vielleicht gerade deswegen ± war die Beziehung zwischen den beiden Fächern in Deutschland lange Zeit recht konfliktreich, und vielerorts durch ein zähes Ringen der sich herausbildenden Spezialisten für Neurologie um gröûere fachliche und akademische Selbständigkeit gekennzeichnet.…”