Wednesday, June 04, 2008

Johann Christian Reil

Johann Christian Reil (1759-1813), one of the most famous medical theorists of his time. Born in an East Frisian parish house, he studied medicine rather than theology, against his father's wishes, and received his medical degree in 1782. He had a private practice until 1788, when he was then appointed professor of medicine at Halle, where he became one of the most sought-after physicians. His wide ranging research activities brought him a chair at the new Univeristy of Berlin in 1810. He knew Fichte, Schleirmacher, Goethe, Humboldt and Gall and was an enthusuastic disciple of the philosopher Shelling. During the Napoleonic war he was in charge of army hospitals on the left bank of the Elbe, where he died of typhoid in 1813.
Reil intended physiology to serve as the foundation of medicine and in 1795 he founded the Archiv für Physiologie and remained its editor until his death. He used this journal to promote the reform he felt was necessary in physiology. Following Kant, he argued that physiology had failed to observe the boundaries of human knowledge. Specifically he thought the problem lay with the concpet of Lebenskraft or life force. He offered his monograph "Von der Lebenskraft," as the lead article in his new journal to discuss just this problem.
His first systematic consideration of various forms of psychological disturbance came in his book Fieberhaste Nervenkrankheiten (Feverish nervous illness, 1802), where his interest in mental illness was due to the fact that derangement often accompanied fevers. At this point Reil thought of mental illness as a disruption of the normal functioning of the powers of the soul: consciousness, understanding, reason, imagination, and sensibility, which he glossed explicitly in Kantian fashion. He accorded the soul, however, only phenomenal existence-- what it really might be remaining totally unknown. The entire direction of his analysis of the powers of the soul implied that though they were called psychic they could ultimately be reduced to forces of the nervous system. The powers of the soul, he insisted, stood in an exact relationship to the operations of the nervous system.
In 1803 he published Rhapsodien über die Anwendung der psychischen Curmethode auf Geisteszerrüttungen (Rhapsodies on the Application of Psychological Methods of Cure to the Mentally Disturbed), perhaps the most influential work in the shaping of German psychiatry before Freud. The model of mind that he developed in the Rhapsodieen went considerably beyond Kantian boundaries. With the Rhapsodieen,Reil dramatically shed his materialistic interpretation of living nature and adopted a radically contrary stance. According to Robert Richards Reil's introduction to the philsopher Friedrich Schelling's romantic idealism fundamentally reoriented his understanding of the root causes of mental illness. In the light of this new philosophical conception, Reil came to regard insanity as stemming from the fragmentation of the self, from an incomplete or misformed personality, and from the inability of the self to construct a coherent world of the nonego-all of which resulted from the malfunctioning of self-consciousness, that fundamentally creative activity of mind postulated by the romantic philosophers.
In the Rhapsodieen, Reil again proposed a medical and quasi-physiological interpretation of mind, identifying mental powers quite closely with underlying forces of the brain and nervous system. "The brain," he argued, "may be conceived as a synthetic product of art, composed of many sounding bodies that stand in a purposeful relationship (that is, in rapport) with one another" (RU, p. 46). Any change in the brain's components from external sources would then change the orchestration of the whole. The ordering of these relations of the parts of the soul's organ is grounded in a determined distribution of forces in the brain and the whole nervous system. If this relationship is disturbed, then dissociations, volatile character, abnormal ideas and associations, fixed trains of ideas, and corresponding drives and actions arise. The faculties of the soul can no longer express the freedom of the will. This is the way the brain of a mad person is produced.
Reil now conceived of the nervous system as an integrating force designed to achieve a "natural purpose," precisely the conception of organic activity rejected in his earlier "Von der Lebenskraft."If psychological manipulations were successful, then the underlying nervous connections would be properly readjusted and the rational operations of
mentality restored (see RU, p. 150).It would be a mistake, though, to think of Reil as introducing, via the mind, an indirect means of altering the pathological brain. In his construction, brain and mind became inextricably joined. Indeed, not
worrying about theoretical problems of the mind-body relationship, he treated them as virtually identical, as if mind were completely instantiated in the nervous system. Hence, an altered mind was an altered brain.
In the Rhapsodieen, Reil distinguished three chief forces of the soul, whose disruption could produce pathology. These were self-consciousness,prudential awareness,and attention. He devoted most of his effort in the Rhapsodieen to the analysis of a force now considered the most crucial for understanding pathologies, that of self-consciousness. "The essence of self-consciousness," Reil held, "seems chiefly to consist in joining the manifold into unity and assimilating the representations as one's own." When self-conscious action falters, when pathology of the ego strikes, then personality fragments and the world becomes incoherent. Some people will not be able to distinguish real objects from phantoms of their imaginations.When the faculty of prudential awareness, which keeps mental focus fixed on an object or project, becomes weakened, then attention shifts with the wind and patients live in another world. As the quote accompanying the Katzenclavier indicates Reil as drawing the patient's attention back from that other world, by mobilizing his/her prudential awareness.
(This note is derived from Robert Richard's The Romantic Conception of Life: Science and Philosophy in the age of Goethe, (University of Chicago Press, 2002)251-288.

Monday, June 02, 2008


I can't resist sharing an
account of what is one of the most bizarre treatments I have read about. Johann Christian Reil (1759-1813), the very influential German psychiatrist, who first used the word psychiatry in 1808, describes the use of the Katzenclavier-- a piano made of cats. After voicing the instrument with suitable animals, they would "be arranged in a row with their tails stretched behind them. And a keyboard outfitted with
sharpened nails would be set over them. The struck cats would provide the sound. A fugue played on this instrument--particularly when the ill person is so placed that he cannot miss the expressions on their faces and the play of these animals--must bring Lot's wife herself from her fixed state into prudential awareness." We have made progress
in the last two centuries!