Endogenous psychosis

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Endogenous psychosis was an authoritative collective term in classical German psychiatry for certain mental illnesses ( psychoses ) with suspected endogenous causes. It was assumed that these diseases were mainly caused by an internal constitution and less by external influences. In terms of psychiatry history, these were usually included: (a)

However, the assignment is to be regarded as different depending on the author. Manfred Bleuler only counted schizophrenia among the endogenous psychoses. The ICD-10 classification uses the term endogenous only in connection with endogenous depression . With the term endogenous psychosis , organic psychoses are nosologically excluded from the group of psychoses as " exogenous " . According to the classification of the triadic system of psychiatry , the variations of the psychological nature ( neuroses and personality disorders ) are also defined as largely " psychogenic " or "non-psychotic". Endogenous therefore means as much as “non- somatic ” in the sense of the distinction from organic psychoses and as much as “non-psychogenic” in the sense of the distinction from neuroses and personality disorders. (a) In contrast, the clearly is essentialist standpoint of the disease concept as "not exactly proven" but hypostasized emphasizes etiology. (a)

However, the positive meaning is ambiguous. In scientific practice, the term endogeneity has proven to be problematic because of the only partially valid basic assumptions of the concept and because of the multiconditional approach that is valid today (see Ernst Kretschmer ). (b)

Basic assumptions

The emergence of the basic assumptions of the concept of endogenous psychoses around 1900 (German classical psychiatry), which was relatively narrow in time, forms the prerequisite for the concept of endogeneity in psychiatry history . However, this is also derived from ideas that go back further (see history of psychiatry ).

Objectivistic Aspects

The basic assumptions can be divided into objectivistic and subjectivistic ideas, depending on whether an examiner or therapist takes an objective- value-free or a more subjective- empathic standpoint. It is desirable if, in each individual case, both aspects are considered and coordinated as far as possible, cf. a. the sociological disease concepts in psychiatry. However, this has not always been the case in psychiatric history . Corresponding one-sidedness often resulted in ideological disputes, which could initially arise. a. in movements such as the conflict between psychics and somatics (a) and most recently in the 70s and 80s of the 20th century between the supporters of antipsychiatry and classical psychiatry. (a) In terms of intellectual history, classical, objectivist psychiatry is essentially shaped by Neo-Kantianism . In addition to Emil Kraepelin (1856–1926), Karl Ludwig Kahlbaum (1828–1899), Heinrich Schüle (1840–1916) and Richard von Krafft-Ebing (1840–1902) should be mentioned as such representatives. In some cases, however, influences from German romantic medicine were also noticeable. (b)

Somatism and degeneration theory


Paul Julius Möbius (1853–1907) first used the term “endogenous” in 1893 to systematically classify nervous diseases in psychiatry. He pointed to “a certain innate disposition” and emphasized that “ that someone suffers from an endogenous disease is only possible provided that he is degenerate ”. The notion of the pathological becomes clear in numerous works published by Möbius and reveals a pessimistic basic attitude conditioned by contemporary history - even if there was at the same time a counter-tendency that assumed an upward trend towards the "type idéal". Möbius, however, did not absolutize the idea of ​​degeneration and himself pointed out that other " very different circumstances cause the disease ". (a) To the endogenous nervous diseases he counted: nervousness , hysteria , epilepsy , hemicrania , chorea chronica , Thomson's disease, dystrophia musculorum progressiva and Friedreich's disease .

Binding of the 7th edition of the textbook Clinical Psychopathology by Kurt Schneider in Thieme-Verlag (1965)

In Germany, the definition of endogenous psychoses was primarily based on the assumption and assumption that a causal , physically justifiable connection or an empirical cause - according to the nature of scientific connections - can be found for the severe mental illnesses most frequently diagnosed in everyday clinical practice ( Somatism ). Somatism had dominated psychiatry since the mid-19th century. This view was even many years later in 1931 by Kurt Schneider (1887-1967) on the grounds to postulate raised that a "two-track" diagnosis in each associated with psychopathological symptoms disease - "somatologisch and psycho (patho) logical" - to operate be. Schneider spoke of "physically justifiable psychoses". (b) The paradigm for the concept of endogenous psychoses was therefore organic psychoses , e.g. B. paralysis , the cause of which had only just been discovered. However, since no recognizable brain pathological findings can be diagnosed for the majority of the cases diagnosed in clinical practice, an explanation was sought for the common psychiatric symptoms in heredo-constitutional causes. Both the theory of degeneration and numerous somatic research results met this research approach, see Chap. Confirmations . (b) This theory has a contradiction. a. experienced through attempted explanations that did not consider specific factors of cause and effect, but rather unspecific relationships of the triggering of very specific clinical pictures as likely, cf. Cape. Unspecific consequences of damage .

Course diagnosis (Kraepelin's rule)

Cover of the 6th edition of Kraepelin's textbook Psychiatrie . (1899)

Emil Kraepelin (1856–1926) had summarized the dementia praecox described by him in 1893 with the 5th edition of his textbook - together with hebephrenia , catatonia and paranoia - as a prognostically unfavorable disease group and thus differentiated it from manic-depressive diseases with better ones Forecast. With the publication of the 6th edition of his textbook "Psychiatry" in 1899, he considered that, in addition to the necessary psychopathological diagnosis, a diagnosis of the course of endogenous psychoses was appropriate. The Kraepelin rule notes that the present form circle of schizophrenia (then called dementia praecox group), has a poorer prognosis than the last group of bipolar disorders. According to Kraepelin, the symptoms of this latter group of diseases recede, while the schizophrenic symptoms become chronic and lead to the development of so-called defect symptoms or stupor. Kraepelin had taken over from Karl Ludwig Kahlbaum (1828–1899) the usefulness of monitoring the progress in nosological and systematic terms . (a) Already JED Esquirol (1772–1840) had pointed out the procedural autonomous course of mental illness from a functional point of view. (c) A distinction is still made between psychopathological and progression-related diagnostics when one speaks of cross-sectional (psychopathology) and longitudinal (progression) diagnostics . The distinction between prognostically favorable and unfavorable diseases (“dichotomy”) was decisive for the division into two different clinical-psychiatric types of endogenous psychoses. (c) (a)


A lack of comprehensibility of endogenous psychotic symptoms is often seen as an essential characteristic of this group of diseases. This characteristic was introduced by Oswald Bumke (1877–1950) in 1909 to differentiate between exogenous and endogenous mental illnesses. (b) (b) The criterion “comprehensibility” already approaches the subjectivistic aspects, see Chap. Subjectivistic aspects , since peristatic or psychogenetic triggering factors in endogenous psychoses have never been fully disputed even by well-known authors of classical psychiatry. However, they were not given a causal ( pathogenic ) meaning, but only a pathoplastic , i.e. H. influence determining the symptoms, such as B. on the expression of very specific delusional content. (c) Karl Jaspers (1883–1969), one of the most well-known representatives of classical German psychiatry , also mainly pursued the objectifying aspect of understanding psychology . It is indisputable that hallucinations or delusions , for example, place increased demands on interpretation and understanding , see e.g. B. the conceptual history of paranoia . Kraepelin stated a percentage of around 15% of the cases in which a connection with stressful experiences was recognizable in the development of manic or depressive illnesses. Silvano Arieti is of the opinion that Kraepelin wanted to demonstrate the relative unimportance of psychogenic factors, since he z. B. reported on a woman who, once after the death of her husband, a second time after the death of her dog and finally after the death of her pigeon, fell ill with psychotic depression. (a) Arieti's view is representative of other views that are frequently adopted, especially in Anglo-Saxon literature, in which - u. a. under the influence of Adolf Meyer in the USA - the teachings of Sigmund Freud found a much more open dissemination than in the German-speaking area. In 1894 Freud first distinguished the actual neuroses from the psychoneuroses , and later the narcissistic neuroses from the transference neuroses . This distinction related to the different treatment techniques. In the case of actual neuroses, there is no need for an analytical technique of detection. The triggering experiences are known. In the case of psychoneuroses, there is cause to uncover repressed early childhood conflicts and scenarios. In the case of transference neuroses, the ability to interact is sufficient, in the case of narcissistic neuroses, it is not. This led Freud to an etiological differentiation and theory formation ( narcissism ). CG Jung introduced the concept of narcissistic neurosis as the opposite of the concept of psychosis. The models of understanding therefore differ fundamentally between classical psychiatry and depth psychology . (d) At this point, however, it must be pointed out that Bumke associated the terms endogenous and exogenous with a completely different idea than in the previous chap. was executed. For him, endogenous did not mean a physically not yet proven basis for a psychological property, but he understood the criterion of intelligibility he introduced as synonymous with endogenous, he only classified exogenous influences as incomprehensible. He therefore considered schizophrenia to be an exogenous disease, cf. Kap Conceptual loss of meaning . (c)

Subjectivist Aspects

Subjectivistic aspects no longer count among the positions of classical German psychiatry, see z. B. also the position of the University Clinic Heidelberg on the death of Walter Bräutigam in 2010 and his attitude towards the "psychoanalytic mainstream of the 70s" of the 20th century. The views of Klaus Dörner presented here were only published in 1978 after the psychiatry enquête was available . (b) Klaus Dörner understands the term endogenous as the perception of the sum of all factors that determine a person's inner life or self . This includes: body, psychological and social relationships, but also what we consider to be human nature: disposition , constitution and temperament , even if this "can never be calculated positively". (c) The point of view of the unit psychosis seems to Dörner therefore also justifiable or to answer the question of the nosological transitions in the affirmative, cf. Cape. Kretschmer's typology . (d) The concept of constitution, “which can never be calculated positively”, moves closer to Stahl's animism or to natural-philosophical mythologization (philosophy of identity ). (d) Subjectivist methodological attitudes were also required by ethnopsychoanalysis .


The basic scientific assumptions made for psychiatry in the second half of the 19th century were confirmed by the following criteria.

Physical ingredients

The role of physical agents, such as alcohol, drugs or higher doses of cortisone, is generally known for the physical justification of triggering psychotic disorders. Psychotic disorders can also be triggered by brain infections (e.g. bacterial) ( somatogenesis ). Even if this triggering can be described as "exogenous" as far as possible, it nevertheless sheds a fundamental light on the metabolic processes that may also be the cause of endogenous psychoses.

Psychotropic drugs

Also psychotropic drugs are physical agents. Because of their specific effectiveness, they should be mentioned separately. Gerd Huber states that it is of nosological importance that somatogenic psychoses react better to neuroleptic , psychogenic ones better to thymoleptic drugs, cf. also chap. Psychogenesis versus somatogenesis . (e) (b) The specific effectiveness is attributed to the different active components of this group of psychotropic drugs (spectrum of effects). The notion of specific target symptoms may have been suggested . a. also represented by F. A. Freyhan and Hans-Joachim Haase .

Kretschmer's typology

The hypothesis of a physically justifiable, possibly hereditary triggering of endogenous psychoses has been scientifically confirmed by the typological work of Ernst Kretschmer (1888–1964). This work also related to heredity in triggering psychoses. The typology of Kretschmer is as physical constitution doctrine called. In 1931, Kurt Westphal demonstrated a statistical correlation between body types and the main forms of endogenous diseases based on over 8,000 cases . Schizophrenic patients are therefore predominantly leptosomal in their physique, manic-depressive patients are predominantly pycnic and epileptic patients are predominantly athletic. However, the question of the so-called flowing transitions from normal variations of mental behavior to mental illnesses arises. According to Gerd Huber, these transitions are conceivable, but are hardly observed in practice. The clinical impression of a "jump" is more likely to be confirmed. It is therefore evident that a distinction must be made between a genetically determined disease factor and a genetically determined overall constitution , which relates both to normal psychological qualities and to properties determined by the body structure. (c) Even by Kurt Schneider , the question of the transitions is not impossible especially between cyclothymia and schizophrenia as a principle, but rejected in clinical practice as observed. (c)

Twin research

The theory of endogeneity received further confirmation from the results of twin research in schizophrenia and other chronic psychoses. A corresponding inheritance is assumed as a result of the increased concordance numbers in schizophrenia , which are particularly noticeable in identical twins. (d)


Robert Sommer and Adolf von Strümpell first used the term "endogenous" in 1893 in a descriptive context with mental illness. In 1894, Sommer suggested limiting the term “degenerative” to chronic mental disorders, while “endogenous” should be used for the more prognostically more favorable forms. The basic assumption of the distinction between internal and external causes of illness has been adopted by Emil Kraepelin since the 5th edition of his textbook in 1896. (d) Although Karl Jaspers is counted among the representatives of classical psychiatry, as a critical, philosophically oriented author he did not consider the distinction between endogenous and exogenous psychoses to be meaningful.

Endogenous psychoses and ICD-10

In ICD-10 , Chapter V, the mental disorders are classified mainly descriptively, i. H. without considering a triggering cause (see nosology ). Only the diagnoses under F00 to F09 (“Organic, including symptomatic mental disorders”) and F10 to F19 (“Mental and behavioral disorders due to psychotropic substances”) are encoded with reference to the cause. The term "endogenous" is only used in connection with endogenous depression .



The view is often taken that the term “endogenous” arouses etiological ideas such as “exclusively inherited”, “innate”, “not conditioned or triggered from outside”, i. H. "Not exogenous". Such lines of thought seem inappropriate, especially in psychiatry, because as conceptual ideas they determine how to deal with the patient and have often led to diagnostic thinking and diagnosing in psychiatry that are far from personality. (b)

This critique has also Dorothea Buck in Kraepelin work .

Karl Jaspers behaved similarly , warning against the absolutization of one-sided extreme positions such as the humanities- psychogenetic or the scientific- somatogenetic . This absolutization goes hand in hand with evaluating the other or opposite point of view less. In fact, there is a clear separation of brain processes. But that is why it is not appropriate to see brain research as the task of psychiatry, but rather one among others.

Psychogenesis versus somatogenesis

See also : Psychogenesis versus Somatogenesis at Wikiversity
Range of theories

The question of the demarcation between neuroses and psychoses arises from the aforementioned consequence of possible undervaluation of psychogenic relationships or possible overestimation of causal- scientific relationships. Do the established criteria for the diagnosis of endogenous psychoses clearly show such a demarcation between the clinical pictures? Can this distinction be made safely in practice? Or is it more a matter of a theory of high complexity , in which an all too high endogenous, somatic or psychogenic degree of abstraction can no longer be covered by the empirical findings available in each case? For Gerd Huber , these nosological questions can be better understood through the results of the effectiveness and use of psychotropic drugs, cf. a. Cape. Psychotropic drugs . The Kielholz scheme seems to confirm the assumptions of classical psychiatry, but suggests the idea of ​​transitions or mixed images ( unit psychosis ). Despite all these reservations: - In the case of neuroses, the emphasis is more on the longitudinal view, see Chap. Progression diagnosis (Kraepelin's rule) , even if it does not mean the prognostic course of the disease (future) so much as the life story (past). Here, too, monitoring the progress allows different degrees of severity between neurosis and psychosis to be determined. Neuroses represent the milder degree of the disease. In the case of neuroses, the above in Chap. The question of transitions posed by Kretschmer's typology . - In the case of neuroses, it is difficult to take a causal view of important life-history factors such as those of the family milieu, family tradition and the social and cultural environment . Jaspers emphasized the demarcation between neuroses and psychoses, but considered transitions between both disease groups and between neurosis and normal psychology to be possible in principle. In psychosis the self is affected, in neurosis not. Stavros Mentzos has proposed a system that includes the psychotic diseases previously understood as endogenous psychoses in a psychodynamically and psychogenetically interpreted concept. The differences between neurosis and psychosis such as B. the different severity of illnesses are attributed to structural differences in the ego differentiation.

Conceptual loss of meaning

The psychiatric meaning of the term “endogenous” is also determined by the meaning of the opposite term “exogenous”. Karl Bonhoeffer (1868–1948) also indirectly influenced the meaning of the term “endogenous” through the very detailed description of exogenous noxae . As such exogenous noxae he defined: Infectious diseases, somatic diseases leading to exhaustion and autointoxications of the nervous system, which originate from the most diverse organs (e.g. liver metabolism). However, by granting these noxae an influence on the soul, the effects of which he described as exogenous psychological reaction types (exogenous psychosyndrome), this term even gained importance for the group of more psychogenic diseases (neuroses and personality disorders). However, since endogenous psychoses do not exist without psychogenic influences, a distinction had to be made between endogenous-psychogenic and exogenous-psychogenic influences. However, this seemed hardly feasible in practice. A consistent conceptual distinction thus appears questionable. Ultimately, the nervous system itself is an organ that has a purely somatic influence on the soul. “Organic” and “somatic” were understood to be synonymous with “exogenous”. The use of the term “endogenous” thus appeared superfluous. (e) For Karl Jaspers , the separation between endogenous and exogenous causes is related to the internal and environmental. However, since it is a basic phenomenon of every life to be realized in the environment, the concept of endogenous psychosis excludes a crucial part of life. External influences and internal disposition are all too closely interrelated. Rainer Tölle noted that the use of the term “psychogenic” should not be mechanistically misunderstood, as is the case in medicine, for example. B. speak of "nephrogen" or "vertebragen" etc. (cf. also parable of clocks ). (d) This also applies to the term “endon” coined by Hubert Tellenbach . (f)

Unspecific consequences of damage

Another criticism formulated by Karl Bonhoeffer in 1911 is the argument of the unspecific consequences of damage caused by a specific disease of the brain. (f) This law of unspecificity means that a large number of causes is offset by only a small number of psychological illnesses that can possibly be derived from them and that the various psychotic states such as delirium , twilight states , hallucinoses , amential states of states , catatonias , paranoid and paranoid-hallucinatory images for that reason alone are not tied to a specific etiology . So they can occur in a variety of diseases. (e) As a result, the concept of the reaction type of exogenous psychoses coined by Bonhoeffer was mainly used in Germany a. a. taken up by Ernst Ritterhaus (1920) and Eugen Kahn (1921). This term expressed the etiological unspecificity or the inadequate etiological correlation of the cerebral symptoms. As a counterpart to this, Kurt Schneider tried to emphasize certain symptoms as characteristic of certain endogenous psychoses (symptoms of the first order). (G)

With unitary psychosis of is Henry Neumann (1814-1884) represented idea meant that it and therefore is no distinguishable mental illness no different mental illness units. - The opposite idea - as it was advocated by classical German psychiatry - says that certain etiological causes also correspond to very specific psychopathological clinical pictures. This latter view was u. a. represented by Kurt Schneider, cf. Cape. Somatism and degeneration theory . It was decisive for attempts to distinguish between exogenous and endogenous psychosis. Many schools of psychotherapy, and above all psychoanalysis, have tended to the opposite idea of ​​a unitary psychosis or unitary neurosis. (H)


The attempt to classify endogenous nervous diseases as proposed by Möbius may be countered by the fact that hereditary factors in endogenous psychoses are still not sufficiently understood. However, where the hereditary nature of the group of diseases proposed by Möbius has been proven, such as dystrophia musculorum progressiva , heredoataxies and Huntington's chorea , these diseases are denied the classification wanted by Möbius, based on the equation between mental and neurological illness. The “ psychological ” and consciousness-building psychogenic component associated with the term “endogenous psychoses” is theoretically absent here. The proven hereditary diseases are now regarded as purely neurological hereditary diseases "without" psychogenic components. The question arises, however, why the postulated “heredity” or “physical justifiability” must apparently necessarily remain a postulate. See also the obvious contradiction of “non-somatic genesis” in contrast to demonstrably organic psychoses such as B. paralysis and the demand for endogenous physical justification where physical evidence cannot be proven. (i)


Klaus Dörner believes that William Battie (1703–1776) anticipated the problem of endogeneity with his concept of “original madness”. "Original madness" is caused by "internal disorders" of the nervous substance and must be distinguished from "consequential madness" (symptomatic psychoses). - When moral treatment was introduced, there were no technical or other ways of separating endogenous psychoses (manic-depressive insanity and schizophrenia) from organic or exogenous psychoses. The York Retreat excluded only innate nonsense as grounds for hospitalization. - With his philosophy of identity , Schelling continued the ideas of the Enlightenment - especially Kant's anthropology - but prepared the term “endogeneity” with the distinction between spirit and soul. Endogeneity refers to the exchange between soul and spirit, cf. a. Mental illness . Schelling had ascribed to a "psychological" factor ( self ) or to genius an instinctive invulnerability that was above all empirical verification and objectification, cf. Cape. Subjectivist Aspects . (e) It is therefore incorrect to see the concept of endogenous psychosis only insufficiently scientifically confirmed. It also contained parts of romantic medicine that contained a continuity with the unconditional moral claim of the German Enlightenment and Romanticism and perhaps not least for this reason culminated in the destruction of life unworthy of life .


Even if the criticism of the concept of endogenous psychosis suggests that, for reasons of general scientific liability, the use of this concept of classical German psychiatry should be completely dispensed with and there are numerous good reasons for calling it out of date, the term "endogenous" is used. but a term that is hardly missing in any psychiatry textbook, since it is one of the indispensable classification, cause and course concepts of this subject. These terms include a. also the counter-names with the help of which the group of endogenous psychoses must be distinguishable from other disease groups, such as the terms “ functional ”, “ exogenous ” and “ psychogenic ”. However, it has been shown that the term “endogenous” has borrowed from these defining terms. For “endogenous”, there is often only the meaning of “enigmatic” (cryptogenic) and sometimes “inherited”. The conclusion must therefore be drawn that the term endogenous has often given rise to either moving more in the direction of somatic medicine or in a purely psychogenic perspective. Rudolf Degkwitz therefore speaks of the “well-known dualism, here psychological , there somatic” ( body-soul problem ). (j)


  • Rolf Baer: Endogenous Psychoses in the 19th Century: From the Vesaniae Cullens to Bleuler's concept of schizophrenia. In: Gundolf Keil , Gerhardt Nissen (Ed.): Psychiatry on the way to science. Psychiatry-historical symposium on the occasion of the 90th anniversary of the opening of the "Psychiatric Clinic of the Royal University of Würzburg". Stuttgart / New York 1985, pp. 19-27.
  • Jakob Wyrsch : On the history and interpretation of endogenous psychoses . Thieme, Stuttgart 1956.
  • Rudolf Degkwitz (ed.) & Hans-Joachim Bochnik (co-author): On the controversial concept of psychiatric illness . In: Sites of Psychiatry; Vol. 2, U & S-Taschenbücher 65, Urban & Schwarzenberg, Munich 1981, ISBN 3-541-07972-X .
  • Bernhard Pauleikhoff : Endogenous Psychoses as Time Disorders : On the foundation of personal psychiatry taking historical development into account. Hürtgenwald 1986
  • Peter Reuter: Springer Lexicon Medicine. Springer, Berlin a. a. 2004, ISBN 3-540-20412-1 , p. 1775.
  • Christoph Mundt : Unity or Diversity of Endogeneity of Psychoses? In: Christoph Mundt, Henning Sass: For and against the unit psychosis . Thieme, Stuttgart a. a. 1992; Pp. 81-90.

Individual evidence

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    (c) p. 117 on head. “Dementia praecox”;
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    (d) p. 231 ~ 1 on head. “Reception”;
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