In a retrospective survey, a group of 220 patients with conversion symptoms was subdivided according to clinical findings at the time of discharge. The longer the duration of the symptom and the older the patient, the less was the beneficial effect of treatment. One particular problem with therapy for conversion symptoms lies in the fact that, in his own eyes, the patient is not psychologically ill, but physically ill. Time and again, it proved a therapeutic blind alley to try and convince the patient that the cause of his conversion symptoms was ‘purely psychological’. Special guidelines for therapy of conversion symptoms are derived.
The phenomenon of mentally ill physicians is hardly noticed in Germany today-a fact that possibly indicates a taboo. This investigation is to reveal the importance of the subject by referring to the findings of several major studies. Epidemiological data turn out to be of little reliability regarding for instance the number of impaired physicians with a range between 0.5-46%. Addiction and substance abuse can be found in 90% of all cases of mental illness. Increased suicide (3-4x), divorce (20x) and addiction rates (according to some authors 30-100x) in comparison with the average population emphasise the necessity of further investigation. These facts imply the question whether doctors are mentally more vulnerable than their patients. Special difficulties in treating doctor-patients deserve attention as only little is known how appropriate "iatrotropic" (psycho-)therapy can be carried out effectively.
Examination of contemporary medical conference papers reveal that the German clinician, Carl Wernicke, conducted a unique on-going inquiry into psychiatric nosology. Wernicke was searching for what he called the elementary symptoms of mental disorder, or, in other words, the single psychopathological feature, from which all others arose. From 1892 onwards, he postulated a variety of such elementary symptoms. Wernicke's theory makes sense in terms of such categories as anxiety-psychosis and hallucinosis. His work contrasts with that of Kraepelin and also with modern diagnostic criteria. Neither Wernicke nor his followers pursued the theory of elementary symptoms, but an examination of his work sheds light on modern ideas about diagnosis.
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