Surname:

Kretschmer

First name:

Ernst

Era:

20th century

Field of expertise:

Neurology
Psychiatry
Psychotherapy

Place of birth:

Wüstenrot (CHE)

* 08.10.1888

† 08.02.1964

German psychiatrist, neurologist, psychopathologist and theorist of constitutional psychology.

Ernst Kretschmer (1888-1964) was born in Wüstenrot near Heilbronn, Kingdom of Württemberg, as the son of a country parson. He attended Cannstatt Gymnasium, one of the oldest Latin schools in Württemberg. Enrolled at Tübingen University in 1906, he initially read philosophy, history, literature and art history but changed to medicine at the universities of Munich and Hamburg one year later. He completed his residency in Tübingen as an assistant to Robert Gaupp, who also supervised Kretschmer’s 1914 doctoral thesis, Wahnbildung und manisch-depressiver Symptomkomplex (Development of Delusion and Manic-Depressive Symptom Complex). During WWI, he worked at the neurological department of a reserve military hospital in Bad Mergentheim. His treatment of traumatised soldiers included the use of suggestion, electricity and darkroom isolation. In 1917, he voiced the controversial opinion that his patients’ symptoms were often induced by their own desires and intentions (cf. Müller 2007: 389; Fischer-Homberger 1971).

Kretschmer married his wife, Marie Luise Elisabeth Pregizer, on 4 October 1915 The couple had four children. Their sons, Ernst Wolfgang Kretschmer (born 1918) and Manfred Richard Martin Kretschmer (born 1927), also became psychiatrists. In 1918, Kretschmer obtained the formal qualification for professorship (habilitation), again supervised by Robert Gaupp, and was subsequently appointed associate professor at Tübingen University. His 1920 book Medizinische Psychologie (Medical Psychology) has been reprinted many times. In 1926, he was appointed full professor of psychiatry and neurology at Marburg University and became the director of the university’s psychiatric clinic. In the same year, he was a founding member of the Allgemeine Ärztliche Gesellschaft für Psychotherapie (AÄGP; General Medical Society for Psychotherapy). He advocated the [psycho]therapeutic treatment of psychosis and introduced “graduated active hypnosis” as a form of autogenic training (cf. Stetter 1994). He continued his professional activities after the Nazis’ rise to power. In 1940, Kretschmer was the first to describe what he called “appalic syndrome”, the wakeful unconscious state that is now referred to as persistent vegetative state. During WWII, he served as a medical staff officer advising the command of his local military district (Günter 2008: 7). He acted as the dean of Marburg University’s medical school from 1943 to 1946, but then returned to the University of Tübingen as a full professor and director of the psychiatric clinic. He reorganised the clinic, worked as an expert consultant and founded the journal Zeitschrift für Psychotherapie und medizinische Psychologie in 1951. He also established a research unit for constitutional psychology and work psychology where he worked until his retirement. He became emeritus in 1959 and handed over the clinic to his successor Walter Schulte. Ernst Kretschmer died in Tübingen from cancer in 1964.

Proponent of the “Tübingen school”

Kretschmer and his mentor Robert Gaupp are considered the main proponents of the so-called “Tübingen school of psychiatry”, which adopted personality theories and advocated a psychogenic approach. Kretschmer believed in the psychophysical unity of human beings and in a continuum between health and illness. Building on Gaupp’s research on delusion [or: paranoia], his 1918 habilitation treatise Der sensitive Beziehungswahn (The Sensitive Delusion of Reference) described a “sensitive”, emotionally responsive type of paranoid personality with a more favourable prognosis than Kraepelin had assumed in his classic definition of paranoia (1904: 595 f.). According to a multi-dimensional etiology, “character, experience and milieu” are crucial factors: “delusions of reference arise from the cumulative effects of typical experiences or life situations on typical character dispositions and constitutional labilities, often supported by typical social constellations” (Kretschmer 1918: 148; our translation). The concept was rejected by some (e.g., Kraepelin) and appreciated by others (e.g., Jaspers; cf. Priwitzer 2007; Richartz & Wormstall 1996).

Kretschmer’s most influential work was Körperbau und Charakter (Physique and Character), published in 1921, in the first part of which he developed a classification system associating different body types with certain personality traits and even psychopathological predispositions. The typology was based on features such as physical build, glandular functions and body hair. Drawing on Kraepelin’s nosological dichotomy between “dementia praecox” and “manic-depressive psychosis”, Kretschmer associated his four main body types (thin, stocky, muscular, misshapen) with two allegedly “primary” mental constitutions: schizothymic and cyclothymic. According to this typology, “asthenic” or “leptosomic” (thin) persons were more predisposed towards schizophrenia, “athletic” persons towards epilepsy and “pyknic” (stocky) persons towards bipolar disorder. The second part of the book analyses examples of extraordinarily gifted individuals. From today’s perspective, Kretschmer’s constitutional approach was a construction of abstract types based on medical and normative attributes that fails to acknowledge the role of the social environment in the development of personality. However, this typology was widely used until it was empirically disproved by the psychometrist Detlev von Zerssen in 1966 (cf. Petermann 2013).

During the Nazi era

Kretschmer’s conduct during the Nazi era can best be described as ambivalent. On the one hand, he was considered a “liberal” and, in 1934 and 1936, barred from the professorial positions for which he had applied. In April 1933, he resigned as chairman of the AÄGP for political reasons (Lockot 1985: 74 ff.). During his time as dean of Marburg University’s medical school, he had repeated conflicts with the “Gauleitung” (the Nazi party’s district administration). He firmly rejected the idea of a “pure Nordic race” and prepared opposing expert opinions on applications for forced sterilisation (Matz 2002: 20 ff.). He advocated a narrow concept of schizophrenia and his Marburg clinic rarely called for a patient’s sterilisation (Ebner 2010: 106; Person 2005: 234 f.). In April 1934, the clinic was even subjected to an inquiry for handling the indications for sterilisation “too cautiously” (Nagel & Sieg 2000: 241 f.). Kretschmer was long said to have interceded on behalf of the resistance fighter Werner Krauss, thus saving him from execution – but according to Müller (2001: 278 ff.), Kretschmer’s contribution merely consisted in providing a medical certificate. He did, however, produce false diagnoses that protected the theologian Karl-Bernhard Ritter from the Gestapo (Müller 2007: 394).

On the other hand, Kretschmer was among the 900 signatories of the Vow of Allegiance of the Professors of German Universities and High Schools to Adolf Hitler and the National Socialist State. In Erblehre und Rassenhygiene im völkischen Staat (Genetics and Racial Hygiene in the Völkisch State), published by Ernst Rüdin in 1934, he called for the eugenic betterment of the population through marriage counselling and the “rigorous eradication” of “hereditarily diseased individuals”, particularly of “antisocial imbeciles”. He reconfirmed this position in the preface to the 1942 edition of Geniale Menschen (The Psychology of Men of Genius): “What is essentially degenerate can simply be excluded from hereditary transmission, if not by nature herself, then by us. This is by and large the objective of our modern legislative measures for racial hygiene” (S. XVI; our translation). Klee (2005: 339) points out that Kretschmer, albeit never a member of the Nazi party, was a supporting member of the SS. He served as a judge on several Genetic Health Courts, visited the Bernburg euthanasia centre in 1940 and attended advisory board meetings of the “Action T4” (Nazi euthanasia programme). In 1944, as a medical staff officer, he applied methods such as “waking suggestion”, which had been tested in WWI and proved ethically problematic (Müller 2007: 394 f.).

Kretschmer became a leading figure of scientific psychiatry in post-war Germany but did not participate in the emerging debates on anthropological and social psychiatry. He also neither engaged in critical scrutiny of his own eugenic positions nor did he critically reflect on the issue of Nazi patient killings when the subject surfaced in public debate. In his autobiography Gestalten und Gedanken (Characters and Thoughts), he expressed his gratitude to those who had “protected” him and described his conduct during the Nazi years as “holding out until the end” (1963: 216).

Awards

1943: Josef Schneider Prize, awarded by the University of Würzburg

1956: Kraepelin Medal, awarded by the Max Planck Institute of Psychiatry

1958: Order of Merit of the Federal Republic of Germany (Commander’s Cross).

Literature

Ebner, S. (2010): Schizophrene Patienten in der Marburger Universitätspsychiatrie während des Zweiten Weltkrieges. Inaugural-Dissertation zur Erlangung des Doktorgrades der gesamten Humanmedizin dem Fachbereich Medizin der Philipps-Universität Marburg.

Fischer-Homberger, E. (1971): Der Begriff des freien Willens in der Geschichte der traumatischen Neurose. In: Clio Medica 6, pp. 121-137.

Günther, K. (2008): Diagnose “Psychopath” – Die Behandlung von Soldaten und Zivilisten in der Marburger Universitäts-Nervenklinik 1939-1945. Inaugural-Dissertation zur Erlangung des Doktorgrades der gesamten Humanmedizin dem Fachbereich Medizin der Philipps-Universität Marburg.

Klee, E. (2005): Das Personenlexikon zum Dritten Reich. Wer war was vor und nach 1945. 2nd edition. Frankfurt on the Main: Fischer.

Kraepelin, E. (1904): Psychiatrie. Ein Lehrbuch für Studierende und Ärzte. Vol. 2. Klinische Psychiatrie. 7th edition. Leipzig: Barth.

Kretschmer, E. (1914): Wahnbildung und manisch-depressiver Symptomkomplex. Berlin: De Gruyter.

Kretschmer, E. (1918): Der sensitive Beziehungswahn. Heidelberg, Berlin: Springer.

Kretschmer, E. (1917): Hysterische Erkrankung und hysterische Gewöhnung. In: Zeitschrift für die gesamte Neurologie und Psychiatrie 37, (1), S. 64-91.

Kretschmer, E. (1920): Medizinische Psychologie. Leipzig: Thieme.

Kretschmer, E. (1921) Körperbau und Charakter. Untersuchungen zum Konstitutionsproblem und zur Lehre von den Temperamenten. Heidelberg, Berlin: Springer.

Kretschmer, E. (1929): Geniale Menschen. Dritte Auflage. Heidelberg, Berlin: Springer 1942.

Kretschmer, E. (1934): Konstitutionslehre und Rassenhygiene. In: E. Rüdin (ed.): Erblehre und Rassenhygiene im völkischen Staat. Tatsachen und Richtlinien. Munich: J. F. Lehmanns, pp. 184-193.

Kretschmer, E. (1963): Gedanken und Gestalten. Stuttgart: Thieme.

Kretschmer, E. (1974): Psychiatrische Schriften 1914-1962. Edited by Wolfgang Kretschmer. Heidelberg, Berlin, New York: Springer

Lockot, R. (1985): Erinnern und Durcharbeiten. Zur Geschichte der Psychoanalyse und Psychotherapie im Nationalsozialismus. Frankfurt on the Main: Fischer.

Matz, B. (2000): Die Konstitutionstypologie von Ernst Kretschmer. Ein Beitrag zur Geschichte von Psychiatrie und Psychologie des Zwanzigsten Jahrhunderts. Inaugural-Dissertation zur Erlangung des Grades Doctor rerum medicarum des Fachbereichs Humanmedizin der Freien Universität Berlin.

Müller, R. (2001): Wege zum Ruhm. Militärpsychiatrie im Zweiten Weltkrieg. Das Beispiel Marburg. Cologne: PapyRossa.

Müller, R. (2007): “Viele haben, mehr als ich, in Not und Tod gelitten”. Die Rolle Ernst Kretschmers bei der Kontinuitätssicherung der Psychiatrie. In: S. Oehler-Klein, V. Roelcke (eds.): Vergangenheitspolitik in der universitären Medizin nach 1945. Stuttgart: Steiner, pp. 387-405.

Nagel, A. C., U. Sieg (eds.) (2000): Die Philipps-Universität Marburg im Nationalsozialismus: Dokumente zu ihrer Geschichte. Stuttgart: Steiner.

Person, J. (2005): Der pathographische Blick. Physiognomik, Atavismustheorien und Kulturkritik 1870-1930. Würzburg: Königshausen + Neumann.

Petermann, F. (2013): Interview. Prof. Dr. med. Detlev von Zerssen. In: Zeitschrift für Psychiatrie, Psychologie und Psychotherapie 61, (3), pp.197-201.

Priwitzer, M. (2007): Ernst Kretschmer und das Wahnproblem. Stuttgart: Steiner.

Richartz, E., Wormstall, H. (1996): Der sensitive Beziehungswahn – nur noch von historischer Bedeutung? In: Der Nervenarzt 67, (7), pp. 595-598.

Spoerri, T. (1958): Zum 70. Geburtstag von Ernst Kretschmer. In: Psychiatria et Neurologia 136, (4/5), pp. 193-194.

Stetter F. (1994) Gestufte Aktivhypnose, autogenes Training und zweigleisige Psychotherapie. Historischer Hintergrund und aktuelle Bedeutung der Therapieansätze von Ernst Kretschmer. In: Fundamenta psychiatrica 8, pp. 14-20.

Zerssen, D. von (1966): Körperbau, Psychose und Persönlichkeit. In: Der Nervenarzt 37, (2), pp. 52-59.

Burkhart Brückner, Ansgar Fabri

Photo: Martha Conrad / Source: Wikimedia / [public domain].