[Psychiatry in the GDR as a "niche" - Between adaptation and autonomy]. / Psychiatrie in der DDR als "Nische" ­ Zwischen Anpassung und Freiraum.

BACKGROUND: With the help of statements from contemporary witnesses, it shall be deduced, if and to what extent Psychiatry was experienced as a shelter for employees and patients in the state controlled society of the GDR and which effort of adaptation to the authoritarian regime was needed to organize protected and protective spaces, here called "niches". METHOD: 74 guide-based interviews from subjects including former patients and different staff groups of the East german Psychiatry were analyzed qualitatively. RESULTS: Many quotations show, that Psychiatry in the GDR was experienced as a "niche" for dissenting people and could offer a certain amount of protection for patients. On the other hand, the autonomy of the psychiatric care was often violated by political intrusions regarding individual treatments. Moreover, treatment autonomy was restricted by harsh shortages in supplies. CONCLUSION: Psychiatrists in the GDR could protect their patients through their actings and so Psychiatry could establish a "niche" for patients and employees. However, establishing such protected spaces required efforts in adaptation. In reverse, Psychiatry has also been politically instrumentalised - either directly through unjustified admissions and exit restrictions or indirectly by a stigmatization of dissenters and removing them from society.

[On the way to democracy-The transformation process 1990/1991 and the role of the Association for Psychiatry and Neurology in the GDR]. / Auf dem Weg zur Demokratie ­ der Transformationsprozess 1990/91 und die Rolle der Gesellschaft für Psychiatrie und Nervenheilkunde in der DDR.

OBJECTIVE: The transition from socialist dictatorship to liberal democracy in the GDR was associated with political and social upheaval. The transformation accompanying the democratic sociopolitical process is examined using the example of the Association for Neurology and Psychiatry of the GDR, which led to its unification with the German Association for Psychiatry and Neurology (DGPN). METHOD: For the historical investigation material from the archives of the DGPPN as well as the personal belongings of the protagonists of the time were used and eyewitness interviews were conducted. RESULTS: The transformation process can also be seen for the Association for Neurology and Psychiatry of the GDR. As at the political level, there was also a loss of legitimacy at the board level of the Association for Psychiatry and Neurology in 1990. The new understanding of democracy required the participation of all members. The Spokesman Council and the DGPN (East) were responsible for establishing and consolidating democratic structures. CONCLUSION: Beyond the transformation process, little is known about the merger. The phase of reorientation at the beginning of the 1990s should be examined for the DGPN as well as the question of how to deal with the suspected political abuse of psychiatry in the GDR.

[An Essential Therapeutic: Occupational Therapy in GDR Psychiatric Institutions as Seen by Contemporary Witnesses]. / "Ein wesentliches Therapeutikum" ­ Arbeitstherapie in psychiatrischen Einrichtungen der DDR aus Sicht von Zeitzeugen.

OBJECTIVE: The aim of this survey of professionals working in the GDR and former patients was to help determine the role and function of occupational therapy in psychiatric institutions. METHODOLOGY: 74 contemporary witnesses were interviewed who had worked professionally in psychiatric institutions in the GDR or had been treated there in adulthood. The interviews were evaluated qualitatively. RESULTS: The eyewitnesses interviewed described the organisation and goals of occupational therapy as well as changes that took place over time. Occupational therapy was rated highly, as it represented an important additional therapy offering. Uniform activities and the misuse of patients' labor while neglecting their therapeutic requirements were subjected to critical assessment. CONCLUSION: In future, the interviews with contemporary witnesses should be included to a greater extent in investigations into the history of psychiatry. The view of the development of occupational therapy can provide valuable insights for further historical reappraisal, and contribute to our current understanding of these forms of therapy.

[On "Alienated Consumption" - How a Large Company in the GDR Dealt With Alcohol Abuse]. / Vom "wesensfremden Konsum" ­ Zum Umgang mit der Alkoholproblematik in einem DDR-Großbetrieb.

The paper investigates the treatment of alcohol abuse in the GDR, and specifically in Rostock, and was written using insights from the documentary film Abhängig [Addicted], which was filmed in 1983. This is not a film analysis. Rather, the paper functions as an impetus to examine from a micro-historical perspective the various dimensions of the way in which alcoholism was dealt with in a large GDR enterprise. From a historical perspective, the documentary is interesting in several respects and is ideally suited as both a source and an analytical tool for the study of the history of psychiatry in former East Germany. By intertwining perspectives from the history of ideas and social history, the film makes it possible to experience the tension between social ostracism, on the one hand, and acceptance of alcoholism as a disease, on the other. Moreover, it also shows attempts to establish therapies in multiprofessional teams and thus, ways out of addiction. Extensive archival material, viewed here for the first time, as well as interviews with contemporary witnesses are used as sources to supplement the film. The insight which the combined sources provide into the social space of a large, "volkseigener" [nationally owned] enterprise (the Neptune shipyard with polyclinic) permits a more nuanced insight into real socialist society and - in the broadest sense - into its specific approach towards deviant and depending on interpretation, marginal-asocial or pathological excessive alcohol consumption. In addition to highlighting different perspectives on alcoholism in the GDR, in the course of whose existence/history an expansion of the scope of medical definitions took place, the paper aims to provide impetus for comparative research and to point out where shifts in perspective may be necessary. In the long-term, the goal of such research would be to make generally valid statements about the role of psychiatry in the context of the healthcare system of the GDR.

[History of neurology in the GDR: a systematic review]. / Neurologie in der DDR: eine systematische Literaturübersicht zur historischen Aufarbeitung.

BACKGROUND: Neurology as a discipline developed differently in the two German states after 1945 and little is known about neurology in the GDR. OBJECTIVE: This article examines the present state of historical research on neurology in the GDR. MATERIALS AND METHODS: We systematically screened the existing literature from the period 1991-2021 and assigned the studies to different categories. RESULTS: We found significant regional differences in the way specific topics are addressed. We also identified a lack of a general overview on the subject and a lack of studies dealing with neurology within the specific socio-political context of the GDR. Comparative studies between the GDR and the BRD and between the GDR and other countries are also scarce. CONCLUSION: Further systematic research (in the form of a separate research project) into the history of neurology in the GDR and its role within the socialist healthcare system of the GDR is needed, taking comparative aspects into account.

[Comparison of Inpatients in Child Psychiatry in Rostock Between 1960 and 2015]. / Vergleich der stationären Kinderpsychiatrie 1960 und 2015 in Rostock.

Comparison of Inpatients in Child Psychiatry in Rostock Between 1960 and 2015 Since its beginnings, child psychiatry has been subject to permanent change due to social changes and thus different expectations of the field, developments in diagnostics, therapy and the respective classification systems. After 1949 Child and Adolescent Psychiatry in the German Democratic Republic (GDR) underwent an independent and somatically oriented development. Although assumed that there was systematic injustice in inpatient facilities of child psychiatry in the GDR, no study from this period has been published to our knowledge up to now. The work presented here begins to close this gap by comparing data from 1960 with current data (2015) of the Child and Adolescent Psychiatry Department at the Rostock Medical Center. Significant differences between results from 1960 and 2015 indicate a currently higher number of admissions, only half the length of stay, an alignment in the gender ratio, a trend towards adolescent patients, a shift away from the 1960 dominant intelligence impairment towards behavioural and emotional disorders, a higher proportion of children and adolescents treated with drugs, and more specialist follow-up treatments after the inpatient stay in 2015. We found no evidence of forced medication in 1960. The discussion also addresses the danger of a solitary development of child psychiatry away from a medical to a more social psychiatric, educational and therapeutic subject.

[Poison in the filter: implementing detoxification procedures in schizophrenia]. / Gift im Filter: der Einsatz von "Detoxikationsverfahren" bei Schizophrenien.

In the history of psychiatry a variety of "blood detoxification" procedures have repeatedly been used to treat schizophrenic disorders under the assumption of autointoxication. In the 1970s this led to the use of dialysis. In addition to the historical classification of this therapeutic approach, particularly the protagonists active in the German Democratic Republic (GDR) as well as the dimension of research and science policy are highlighted. Despite the relatively low success rate of the treatment overall, the question of which patients actually had a positive response to the treatment arises. This seemed to primarily be the case for young patients in whom acute catatonic symptoms occurred. From today's perspective there are striking indications that the patients who were successfully treated at that time could belong to the group of autoimmune encephalitis, as they are known today. Autoimmune encephalitis and specifically anti-N-methyl-D-aspartate receptor encephalitis (NMDA-R) demonstrate a characteristic clinical progression with the frequent occurrence of psychiatric symptoms, which also include catatonic symptoms. These can occur in a variety of mental and neurological disorders but are often associated with schizophrenia. To primarily reduce the risk of diagnostic errors, they should initially be considered as non-specific from a diagnostic perspective. In the future, correlating immunological and psychopathological changes may help to delineate groups for whom specific therapies are particularly suitable.

The Development of Sayk's Cell Sedimentation Chamber: A Historical View on Clinical Cerebrospinal Fluid Diagnostics.

OBJECTIVE: The history of Sayk's cell sedimentation chamber is examined and reviewed in the context of clinically utilizable cerebrospinal fluid (CSF) cytology. METHODS: A review of the literature was undertaken in PubMed and Google Scholar to search for primary and secondary sources on the history of CSF diagnosis. Moreover, documents in the archives of the Universities of Rostock and Jena, the Brain Research Institute of Cécile and Oskar Vogt in Düsseldorf and the Centre for Neurology at Rostock University were used. RESULTS: The cell sedimentation chamber, developed by Johannes Sayk (1923-2005) at the beginning of the 1950s, enabled, for the first time, CSF cells to be presented with a quality comparable to the blood profile, with a low technological expenditure and using all staining methods suitable for haematological cells. The procedure could be performed quickly and cost efficiently, and therefore, it was easy to integrate it into clinical routine and it quickly became a widely used procedure. In Europe, it was considered the standard method for cytodiagnosis of CSF until the 1990s. CONCLUSIONS: The procedure revolutionised CSF diagnostics and paved the way for modern qualitative CSF cytology. In course of time, the cell sedimentation chamber was superseded by the cytocentrifuge.

["Euthanasia" of children in Nazi Germany - the case of Günter Nevermannn. On the responsibility of childhood and adolescent psychiatry in the past, the present, and the future]. / Nationalsozialistische «Kindereuthanasie¼ - das Beispiel Günter Nevermann. Zur Verantwortung der Kinder- und Jugendpsychiatrie in Vergangenheit, Gegenwart und Zukunft.

«Euthanasia¼ was the cynical euphemism used by the Nazis to refer to the systematic murder of hundreds of thousands of mentally sick and handicapped people between 1939 and 1945, at least 6,000 of whom were children. Based on the example of Günter Nevermann, this paper provides insight into the complex acts of registering, selecting, and targeting children labelled as "inferior" and "unworthy to live." This case clearly shows that Nazi doctors were not necessarily enmeshed in some tragic conflict. Rather, apparently without any qualms, they sacrificed the sick children who had been entrusted to their care, for the ideal of obtaining a "racially healthy corpus," a term used without being questioned. Most of the perpetrators were never brought to justice, and not a few of them later held managerial positions in child and adolescent psychiatry in the two German states. Many of them were members or even honorary members of the "Deutsche Gesellschaft für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie e. V." in its present or previous form. We feel it is necessary to inform the public effectively about this state of affairs, to discover what really happened and to determine who was responsible.

["No pleasant side can be discovered in this young boy"--aspects of "child euthanasia" in Silesia]. / "Irgend eine angenehme Seite ist bei dem Jungen nicht zu entdecken"--Aspekte der "Kindereuthanasie" in Schlesien.

Several thousand children also fell victim to the murder committed on physically or mentally handicapped persons under the term "euthanasia" during Nazi times. While at first they were included in the killings administered under "Action T4", beginning in 1941 the process of selection and murder was relocated to specialized "child departments" developed just for this purpose. Under the auspices of the Reich Committee for the Scientific Registering of Serious Hereditary and Congenital Illnesses (Reichsausschuss zur wissenschaftlichen Erfassung erb- und anlagebedingter schwerer Leiden) a network expanded with the objective of screening children and youth that did not seem fit and supportable for society and future generations. Care and educational institutions increasingly came into the center of attention. The primarily pedagogically motivated intent of removing children and youth from a harmful environment could very easily and quickly turn into organized murder. An example of this is Peter A. from Görlitz, who was ten years of age at the time of his murder. His path from his family to the corrective care that ultimately lead to his commitment into the specialized "child department" in Loben took less than half a year. His right to life was denied by Elisabeth Hecker, the director of the youth psychiatric clinic, as a result of labeling him as disruptive and useless.

[The Journal "Deine Gesundheit" - A Reflection of Social Psychiatry in the GDR?] / "Deine Gesundheit" ­ Spiegelbild der Sozialpsychiatrie in der DDR?

BACKGROUND: Articles on psychiatric care in the GDR published in the journal "Deine Gesundheit" are identified. This involved examining how psychiatry was presented to the public and the intentions of addressing a lay audience. METHODOLOGY: All booklets published between 1955 and 1989 were systematically reviewed, the role of the publishers examined, and an assessment made in the context of social psychiatry and sociopolitical conditions. RESULTS: There was a lively publication activity of psychiatric topics by mainly professional actors. The temporal accumulation in the context of psychiatric reform efforts is striking. CONCLUSIONS: Reform-oriented psychiatrists in particular used the popular science medium to reach a broad public and thus greater social acceptance of community psychiatric care concepts.

[Socialistic university policy between demand and reality--the example of Hans Heygster at the Rostock University Hospital of Psychiatry and Neurology]. / Sozialistische Hochschulpolitik zwischen Anspruch und Wirklichkeit--Das Beispiel Hans Heygster an der Universitäts-Nervenklinik Rostock.

The extent and boundaries of political influence are a central issue in the history of the German Democratic Republic (GDR). After 1945 socialist leaders attempted to exert political influence on education in the Soviet occupied zone and the later GDR. The Second University Reform in 1951/52 introduced a fundamental break with established university structures. One major aim was the establishment of a "new socialist intelligentsia" that was to spread the Marxist-Leninist theories at universities. Due to a lack of qualified personnel in the medical faculties, this aim was far from being reached until the end of the 1950s. The example of the university lecturer Hans Heygster (1905-1961), who worked at the East-German University Hospital of Psychiatry and Neurology in Rostock between 1946 and 1953, shows how the GDR rulers sought to influence university education. It illustrates the opportunities and restrictions that University lecturers in East Germany faced during this time. Heygster soon found himself in real conflict, namely between political aims and demands set and reality. Based on of archival sources the study elaborates the background, the course of events and the consequences of these conflicts.

Helmut Rennert's universal genesis of endogenous psychoses: the historical concept and its significance for today's discussion on unitary psychosis.

Next to Karl Leonhard (1904-1988), Helmut Rennert (1920-1994) was the internationally best known representative of psychiatry from the former German Democratic Republic (GDR). He rose to prominence above all through his model of the universal genesis of endogenous psychoses, which constituted an antithesis to Leonhard's differentiated division. The 'polar opposite' aspects of Rennert and Leonhard are represented with an emphasis on their contrasting views of psychiatric nosology. In this respect, Rennert's model conceptions constitute the primary focus of attention. The fact that both concepts continue to possess topical perspectives to this day is reflected in the current discussion regarding nosological, categorical, syndromatological and dimensional approaches in relation to the further development of the classification systems of mental disorders. The preparatory work on the future classification systems will potentially omit the dichotomy between schizophrenic and affective disorders. These endeavors are in accordance with Rennert's unitarian psychopathological view and support his acceptance of the psychopathological continuity from affective to schizophrenic syndromes. The current discussion concerning the future classification is in line with Rennert, whose aim was to provide an unconventional model that unites findings from the different fields of psychiatric research. The classification of mental disorders without a previous establishment on the basis of fundamental theoretical assumptions could certainly foster a dynamic development in the future. A differentiated knowledge of the history of the ideas of unitary psychosis and their further development might be helpful in this development and can be of particular use when critically questioning explanatory approaches that are prone to simplification.

[50 years of Child Neuropsychiatry at Rostock University]. / 50 Jahre universitäre Kinderneuropsychiatrie in Rostock.

On the occasion of the 50th anniversary of the independent Chair of Child and Adolescent Neuropsychiatry at Rostock University, this study takes a closer look at the circumstances and history of its establishment and development in the GDR. It shows that its development took place within the framework of the general strive for independence of a young discipline in Europe, and the German-speaking countries in particular, after World War II. It also addresses the specific local emergence conditions and the general sociopolitical factors, highlighting the personal, yet very individual, impact of the two protagonists of child and adolescent psychiatry, namely Franz Günther von Stockert (1899-1967) and Gerhard Göllnitz (1920-2003), on the path Rostock child psychiatry followed. Through the establishment of an independent Department of Child and Adolescent Neuropsychiatry at Rostock University, the discipline succeeded in emancipating itself more and more throughout the GDR as a subject in its own right, as a result of which the foundations were laid for an integrated system of research and teaching as well as an integrated neuropsychiatric health care programme in the GDR.

Illnesses of the will in 'pre-psychiatric' times.

Since its emergence as a medical discipline in its own right, i.e. since the end of the eighteenth century, disorders of the will have constituted a major area of interest for psychiatrists. But even before then, in 'pre-psychiatric' times so to speak, there were occasional descriptions of illnesses of the will or, in the nomenclature used at the time,'ambiguous emotional states of minds'.This study presents some very early attempts to tackle and explain the problems of amentia occulta, manie sons délire and monomania in German literature, concentrating on works written from a medical and philosophical perspective. Beginning with the differentiation between will and reason, this study explores some concepts in which the will was perceived as a possible cause of mental illness and thus became a topic of medical interest.

[The Juliane Hochriehser case--a classical case of anosognosia]. / Der Fall Juliane Hochriehser: Ein klassischer Fall von Anosognosie.

Still today anosognosia as a phenomenon attracts the attention of both clinicians and researchers. Patients affected by this syndrome deny an obvious neurological dysfunction caused by a defined damage in their brains. This lack of awareness of their impairment is the most interesting feature of this syndrome. In the neuropsychiatric literature case studies have played an important role, among them four contributions by Gabriel Anton (1858-1933) at the end of the 19th century. The phenomenon described by him in these case studies was later referred to as anosognosia by Josef François Babinski (1857-1932). Recognising his achievements in the description of this phenomenon one kind of anosognosia, namely cortical blindness, is still referred to in the scientific literature as the Anton-Syndrome (also Anton Symptom). Using the recently discovered original files of 1895/96 our study substantiates one case described by Anton. The case in question is that of Juliane Hochriehser, a 69-year old dairymaid who showed anosognosia with cortical deafness due to bilateral lesion of the temporal lobes. Other cases of his are also included. The study concludes with an overview of the current state of research and the different approaches to this syndrome. Yet it is still not clear which areas and structures in the brain are responsible for the development of anosognosia. It may well be that dextral or bilateral damage of several areas of the brain plays a major role.

[Psychiatry in East Germany (GDR) Between Awakening and Stagnation: The Brandenburg Proposition to the "Therapeutic Community" (1974/76)]. / Psychiatrie in der DDR zwischen Aufbruch und Stagnation: Die Brandenburger Thesen zur "Therapeutischen Gemeinschaft" (1974/76).

Inspired by the concept of the English psychiatrist Maxwell Jones, the Brandenburg proposition or thesis towards the "Therapeutic Community" was formulated in 1974. Its objective was to transform the therapeutic environment in psychiatric hospitals of the German Democratic Republic (GDR). Based on sources from the Federal Archive in Berlin and for the first time from the Historical Archive of the Asklepios Hospital in Brandenburg, the motivation, implementation and effect of the so-called Brandenburg proposition will be analysed within its socio-political context. Although it was not able to exert a broader influence on the provision of psychiatric care, important impulses for the development of social psychiatry and psychotherapy in the GDR were nonetheless given. The discussions on the concept of "therapeutic community" illustrated that this concept was supposed to coincide with the socio-political objectives of the Socialist Unity Party of Germany (SED) and their principles of collective education.

[In process.] / Helmut Rennert - Protagonist der Psychiatrie in der DDR?

Internationally, Helmut RENNERT (1920-1994) was one of the most renowned representatives of psychiatry in the GDR. From 1958 until 1984 he was the chair of the department of psychiatry and neurology at the Martin Luther University in Halle-Wittenberg. He was also the chairman of the Association for Neurology and Psychiatry of the GDR for many years. The textbook on neurology and psychiatry which he prepared together with Rudolf LEMKE (1906-1957) turned into the standard textbook for training and education in the GDR. RENNERT became well known primarily with his model of the universal genesis of endogenous psychoses in which he propagated the idea of unitary psychosis. In 1965 he became a member of the German National Academy of Sciences Leopoldina and as vice- president he represented the medical section. RENNERT belonged to the so-called second generation of professors which established itself at the end of the 1950s at university clinics in the GDR. As the leading experts and academic lecturers they influenced the field with respect to education and research for the entire time the GDR existed. This generation of professors maintained a strong bond with their academic teachers and continued their tradition in the sense of a "school" for the most part independent of political circumstances and restrictions.