Martin Priwitzer. Ernst Kretschmer und das Wahnproblem. Contubernium: Tübinger Beiträge zur Universitäts- und Wissenschaftsgeschichte. Stuttgart: Franz Steiner, 2007. xiii + 314 pp. ISBN 978-3-515-08562-5.

Reviewed by Jörg Arnold (Historisches Seminar, Albert-Ludwigs-Universität Freiburg)
Published on H-German (May, 2009)
Commissioned by Susan R. Boettcher

Ernst Kretschmer: A German Psychiatrist in the Twentieth Century

Those who look up the name of Ernst Kretschmer in a recent edition of Brockhaus Encyclopedia will find a short entry of only five lines.[1] Kretschmer was born in Wüstenrot near Heilbronn in 1888. In 1926, he took up a chair in clinical psychiatry at the University of Marburg, where he taught until he was offered a professorship at the University of Tübingen in 1946. Kretschmer developed a typology of the human constitution. He died in 1964. This is all that Germany's leading encyclopedia has to say about the life of a man who, half a century ago, was considered one of the most eminent clinical psychiatrists of his time. His major work, Körperbau und Charakter, went through twenty-six editions between 1921 and 1977. It was translated into several languages, and appeared in English under the title of Physique and Character in 1936. Martin Priwitzer takes the discrepancy between contemporary fame and posthumous decline as a starting point for his monograph. As the title indicates, Priwitzer does not offer a full biography, but instead limits himself to Kretschmer's early life up until the publication of his postdoctoral thesis and appointment as associate lecturer at Tübingen in 1918-19. In doing so, Priwitzer amasses a significant amount of information that is not always analyzed as deeply as one might wish.

The study is guided by four research questions. Priwitzer wants to know, first, why Kretschmer chose the career of a clinical psychiatrist and, second, why he was interested in the medical problem of paranoia. Furthermore, Priwitzer asks about the contemporary reception of Kretschmer's early work. He is interested, finally, in the legacy of Ernst Kretschmer for present-day clinical psychiatry. In order to answer these questions, Priwitzer adopts a "psycho-historical" approach (p. 4) that seeks to elucidate motivations and career choices by looking at the ways in which the mature Kretschmer, in his autobiography, conceived of his life not as an autonomous entity but as constituting a link in a long chain of ancestors. At the same time, Priwitzer attempts to test the validity of Kretschmer's methods and findings by comparing his published case studies to medical files as preserved in various medical institutions.

In line with this dual approach, the study falls into two parts. Part 1, "The Early Ernst Kretschmer," offers a chronological overview of Kretschmer's early life and career. It sketches the pietistic, middle-class milieu of rural Württemberg into which he was born as the second child of a Protestant pastor in 1888. This environment not only provided him with a classical education, but also instilled in him a Protestant work ethic and a sense of moral purpose in life. Partly in reaction to the moral dogmatism of his father, Kretschmer cultivated a great tolerance towards human weakness and a sense of pessimistic humor that also characterized his work.

Initially enrolled as a student of theology, Kretschmer soon abandoned his father's vocation in order to study medicine. Although dedicated to his studies, he was not overtly ambitious, and does not at first seem to have considered pursuing a university career. His medical dissertation of 1914, on the genesis of paranoia and the complex of manic-depressive symptoms, was awarded cum laude, which in those days was a good, if far from exceptional mark. Despite this, Kretschmer was held in high esteem by his supervisor, Robert Gaupp, who persuaded him to stay on as a junior doctor at the university clinic at Tübingen in 1914.

At the outbreak of the war, Kretschmer was called up for military service but, much to his disappointment, was not posted to the front. He spent the war working in a number of military hospitals in Württemberg, among them the neurological ward in Mergentheim, where he treated neurotic and hysterical patients. Although Kretschmer had supported Imperial Germany's war effort throughout the conflict's duration, he witnessed the downfall of the Wilhelmine empire in 1918 with few regrets, welcoming the defeat of the "Prussian military state" and the demise of what he considered "dynastic megalomania" (p. 59). Politically, he supported the Majority Social Democrats at the time.

Part 2, "Paranoia and Multi-dimensionality," drops the chronological narrative in favor of an analytical treatment of Kretschmer's early monographs, in particular his 1914 dissertation and his postdoctoral thesis of 1918. Priwitzer situates Kretschmer's empirical findings and theoretical models within the context of the contemporary discussion on madness, which revolved around two problems. Psychiatrists were divided over the question as to whether there was such an illness as "paranoia" that was distinct from schizophrenia. If so, what were its causes and characteristics?

Drawing on a number of clinical case studies, Kretschmer argued for the distinctiveness of "paranoia," an illness he described as "sensitive relational madness" (p. 141). He focused on the psychogenetic rather than the biological causes of madness, but also emphasized its multidimensional origins. According to Kretschmer, personality, experience, and social environment all played a role in the genesis of the disorder. Typically, the illness affected sensitive personalities suddenly confronted with a situation that they experienced as intensely shameful.

To many contemporary psychiatrists, Kretschmer's findings amounted to a provocation. Most outspoken among his critics were the members of the Munich school of clinical psychiatry, which had been founded by Emil Kraepelin (1856-1926). In a scathing critique, a disciple of Kraepelin rejected Kretschmer's claim that "sensitive relational madness" be considered an illness in its own right. At best, he argued, Kretschmer had identified a number of symptoms. What was worse, Kretschmer had neglected the biological dimension of mental illness. Kraepelin himself was equally damning, claiming that Kretschmer had produced a "work of poetic imitation" (dichterische Nachschöpfung) rather than a scientific study (p. 233).

In his introduction, Priwitzer speaks of his monograph as an "attempt, a beginning" (p. 5). The study might perhaps better be termed a pioneering effort that impresses and troubles in equal measure. One of the great strengths of the book is its empirical foundation. Priwitzer has done historians of medicine a lasting service by excavating the literary estate of Ernst Kretschmer. He must have spent years sifting through the "paper mountains" (p. 2) heaped up in no particular order in the basement of the house of Kretschmer's eldest son, Wolfgang. Priwitzer also managed to locate a great number of the original medical files with which Kretschmer had worked, which were deposited in a number of medical archives across southern Germany. This impressive achievement will unquestionably benefit future students of twentieth-century German psychiatry.

Nonetheless, I could not help but feel that the study lacks analytical focus and conceptual clarity. Priwitzer himself seems to acknowledge as much when he writes in the introduction that "some of the specific research questions" did not emerge until "relatively late" in the gestation period of his monograph (p. 4). Little connects the "psycho-historical" narration of Kretschmer's life in part 1 with the analysis of his work in part 2. In particular, it is difficult to see what is to be gained in historical understanding by examining Kretschmer's work for "methodological errors" (p. 257), as Priwitzer does throughout the second part of his biography.

Finally, the book skips over precisely those aspects of Kretschmer's life and work that, from a broader historical perspective, appear to be of pre-eminent interest. I, at least, would have liked to learn more about Kretschmer's treatment of war neurosis during World War I, which is acknowledged but excluded from the scope of the study. Likewise, the troubling antisemitic tendencies in Kretschmer's writings would have merited closer attention, especially in view of Kretschmer's future career as a professor of clinical psychiatry during the Third Reich.

In sum, this imposing piece of empirical research would have benefited from a sharper analytical focus.

Note

[1]. Brockhaus: Die Enzyklopädie in vierundzwanzig Bänden. Zwanzigste, überarbeitete und aktualisierte Auflage, vol. 12 (Leipzig / Mannheim: Stern Verlag, 1997), 504.

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Citation: Jörg Arnold. Review of Priwitzer, Martin, Ernst Kretschmer und das Wahnproblem. H-German, H-Net Reviews. May, 2009.
URL: http://www.h-net.org/reviews/showrev.php?id=23701

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