Transition Between Sensitive Delusion of Reference and Mood Disorder: A Case Report

The Sensitive Delusion of Reference is a clinical entity described by Ernst Kretschmer and never integrated into mainstream nosographic systems. It represents the possibility of developing psychosis starting from a personality characterized by sensitivity, scrupulousness, and fear of judgment of others. The presentation of the following clinical case highlights how the overlap between this clinical entity and mood disorders leads to characteristic psychopathology, which has not been sufficiently detailed. In particular, the delusions, which always starts from the idea of reference and the shame in the face of the judgment of others, takes on characteristics of guilt during the depressive phases and persecutory themes during the activation phases. This clinical observation, which obviously needs to be confirmed on a larger scale, encourages a renewed interest in the concept of Kretschmer's Sensitive Delusion of Reference and creates the possibility of intersecting multiple psychopathological levels, for a more complete perspective on the individual case.

Affective Temperaments

This chapter discusses the phenomenology of affective temperaments as well as their subjective nuances and potential pathogenetic trajectories. It first considers the notion that different kinds of temperament are constitutionally based affective-behavioral dispositions, tracing it back to Hippocratic medicine with the theory of the four humors. It then explains how the modern concept of affective temperaments has been operationalized in a clinical descriptive framework. In particular, it explores the works of Emil Kraepelin, Ernst Kretschmer, and Hubertus Tellenbach on affective psychoses, human emotions, and Typus Melancholicus (TM), respectively. The chapter also examines the pathogenic role of TM as a specific personality structure, how despair intervenes in the transition from the pre-melancholic to the melancholic phase, and the status of temperaments within the context of affective phenomenology.

Ernst Kretschmer

Ernst Kretschmer was an assistant to Professor Robert Gaupp in Tübingen. His contributions to the field of psychopathology can be reduced to two main themes: the first consists in the analysis of a particular form of delusion called “sensitive delusion of reference,” developed in his book Der Sensitive Beziehungswahn (The Sensitive Delusion of Reference) in 1918; the second concerns the construction of a constitutional typology which attempts to identify, on the basis of the temperamental and physical-constitutional characteristics of the subjects, all possible degrees and steps leading to the two major psychoses: manic-depressive psychosis and schizophrenia. While the somatic-based constitutional type now belongs to the history of psychiatry, the attention to the comprehensibility of the paths leading to the area of major psychoses remains an unavoidable point of reference for those who refuse to give up the attempt to introduce the dimension of subjectivity and understanding into the area of psychosis.

Goethe: A bipolar personality? Periodicity of affective states in Johann Wolfgang von Goethe as reflected by Paul Julius Möbius

This paper aims to investigate the character and etiological basis of German poet Johann Wolfgang von Goethe’s mental disorder. From 1898, German neuropsychiatrist Paul Julius Möbius developed the hypothesis that Goethe’s work provided several hints for the notion that the German poet suffered from a distinct bipolar disorder. The paper investigates Möbius’s psychopathographic study on Goethe and his hypothesis of a mood periodicity in Goethe against the mirror of modern concepts. Möbius came to the conclusion that Goethe’s illness was bipolar in character and became visible at intervals of seven years and lasted for about two years. The majority of Möbius’s contemporary psychiatric colleagues (Emil Kraepelin, Max Isserlin, Ernst Kretschmer, Josef Breuer) supported this view which has still not been convincingly challenged. In present-day terms, Möbius’s hypothesis can be best mirrored as a subclinical foundation of mood disorder. Furthermore, with his extensive study, Möbius disproved the common notion that Goethe had suffered from an illness as the result of a syphilitic infection.

A mirada da biotipologia no Sul do Brasil: discurso e prática nas décadas de 1930 e 1950

Resumo Esta nota de pesquisa tenta demonstrar como o estado do Paraná figurou no panorama transnacional das vertentes de escolas biotipológicas presentes no Brasil a partir dos anos 1930. Abordamos o caso específico da cidade de Curitiba e pudemos identificar, num discurso acadêmico de 1938 e em dois laudos de sanidade mental de 1950 e 1951, a regularidade da escola constitucionalista alemã de Ernst Kretschmer, não obstante a preponderância da vertente italiana na bibliografia relacionada ao tema. Com isso, procuramos apontar por quais meios e espaços foram legitimados os preceitos concernentes àquela escola.

Temperamentskonzepte in der Psychopathologie

ZusammenfassungDie Temperamentsforschung hat in der Psychopathologie eine lange Tradition. Hier sind beispielsweise die Beiträge von Ernst Kretschmer und Gottfried Ewald zu nennen, welche beide fließende Übergänge zwischen Temperaments- bzw. Persönlichkeitseigenschaften und manifesten psychischen Erkrankungen beschreiben. Allerdings wird von Kretschmer der Temperamentsbegriff deutlich weiter gefasst als dies bei Ewald der Fall ist. Karl Leonhard führte die Konzepte seines Lehrers Ewald weiter aus und bemühte sich, die Zusammenhänge zwischen akzentuierten Temperamentszügen, Persönlichkeitsstörungen und affektiven Psychosen weiter herauszuarbeiten. Demgegenüber konnte beispielsweise Kurt Schneider keine solchen Beziehungen bzw. Übergänge finden. Die hier diskutierten Fragen haben heute nicht an Aktualität verloren und sollten weiterhin Gegenstand empirischer Forschung sein. Hierzu stehen inzwischen standardisierte Instrumente zur Verfügung wie beispielsweise die von Hagop Akiskal entwickelte TEMPS-Skala.