Hans Förstl

Objective: The case of Ludwig II, King of Bavaria, had soon become synonymous with paranoia, after he had drowned at the age of 40 together with the neuropsychiatrist Gudden. Method: We were granted access to the Secret Archive of the House of Wittelsbach to study documents on Ludwig's medical history. Results: The documents underlying Gudden's expert opinion which led to Ludwig being deposed would be insufficient for a diagnosis of schizophrenia according to contemporary standards. The autopsy revealed prominent prefrontal brain atrophy. Conclusion: The evidence is compatible with a diagnosis of schizotypal personality and suspected frontotemporal degeneration.

Alzheimer’s disease (AD) has become the model disease for the whole dementia syndrome with predominant memory deficits. Other forms of neurodegenerative dementias – dementia with Lewy bodies (DLB) and frontotemporal degeneration (FTD) – are characterized by different patterns of neuropsychological performance and behavioral disturbances. AD, DLB and FTD affect specific neuronal systems underlying different memory functions. Such differential effects on memory are associated with distinct effects on the perception of time. Concepts of time and their pathological change have not been considered as central issues in dementia research and care. This paper suggests that the altered perception of time in patients with different forms of dementia is largely neglected, and that clinical observations in dementia may improve our understanding of how the past, the present and the future are psychologically connected, a problem which philosophers have addressed repeatedly. I suggest the following two hypotheses: (a) The pathology of different neurodegenerative diseases and their types of memory impairment determine the patients’ concept of time and this is reflected in typical behavioral changes. (b) A better understanding of these pathological conditions may contribute to the psychological and philosophical discussions on the nature of time.

Intellectually challenged heads of state have had a remarkable impact on the course of history and the problem of age-associated impairment in politicians appears to increase with growing life expectancy. Lenin, Paul Deschanel, Woodrow Wilson, Franklin D. Roosevelt, Heinrich Lübke, Urho Kekkonen, Mao tse tung, Ronald Reagan, Pope John Paul II., and Robert Mugabe were still in power while showing signs of cognitive impairment. Margaret Thatcher, Walter Scheel, Helmut Kohl and many others developed dementia after their resignation. Mild cognitive impairment in Paul von Hindenburg and in communist sclerocrats (Andropow, Breshnew, Ceausescu, Honecker, Mielke and others) may have contributed to the rise of Adolf Hitler and the downfall of communist regimes, respectively. Two prototypes of presidential dementia have to be distinguished: the tragic senile King-Lear-form with cognitive deficits and the buffalo- and buffoon-like King-Ubu-type with predominant behavioral disturbances.

Court physicians need to deal with a clientele posing particular personality problems (e. g. rex inutilis) in a difficult environment characterized by specific health issues (morbi aulici) and they may have to avoid serious risks or want to seek great opportunities (medicus politicus). Very few have been successful as King David, a former music therapist without a medical degree, or the dentist and president Gurbanguly Berdimuhamedow. Several became victims of fatal circumstances. Not all could resist temptation of questionable literary fame at the expense of confidentiality. All told, a career close to high profile leaders needs to be considered carefully as risks may outweigh benefits.

Enigmatic disease concepts are notoriously difficult to refute. The history of "trichoma" illustrates the spectacular rise and silent vanishing of an obscure ailment once thought to be responsible for a large proportion of mental disturbances. Dreadlocks (convolutio et contricatio capillorum firmissima) formed the diagnostic sign of a disease called trichoma, plica Polonica (Latin), kottun (Polish), and Weichsel- or Hexenzopf (witch-plate; German). This illness had been prevalent in Poland during the late Middle Ages and Renaissance. Staringelius (1599), rector of the University of Zamosc, was the first Polish physician who wrote about the disease. Schlegel (1806) reviewed the literature of the following 200 years and lists 136 papers, dissertations and monographs from different authors. The number of publications increased steadily until in 1843 Beschorner, director of the first asylum in Poland, published a large population-based study and could not substantiate the disease concept. This led to an immediate cessation of publications on the matter.

Von Economo Neurons and Insular Cortex – The Bridge Between Soma and Psyche. New research suggests a pivotal role of the anterior insular cortex for the integration of somatic sensation and for intuitive decisions in complex situations. Functional magnetic resonance imaging (fMRI) has demonstrated a close coupling between the anterior insular cortex and the anterior cingulate gyrus, the only areas with von Economo-neurons. These large spindle cells are exclusively found in species with complex social lifes (apes, cetaceans). Observations in humans showed decreased numbers of von Economo neurons in patients with frontotemporal dementia, or agenesis of the corpus callosum, conditions with impaired theory of mind and interpersonal behaviour. It almost appears as if spindle cells would reach out from the realm of subconscious gut-feelings into the premises of conscious prefrontal planning.

Der Versuch, die geistige Leistungsfähigkeit – Wachheit, Aufmerksamkeit, Lernen, Erinnerung, Dauerleistung – bei Patienten und vor allem bei gesunden Personen möglichst spürbar und nachhaltig zu optimieren, wird auch als „cognitive enhancement“ (Neuro-Enhancement, Hirndoping etc.) bezeichnet. „Brain boosters“, „cogniceuticals“, Nootropika, Psy- chostimulanzien, „smart drugs“, zerebrale Ergogene, bewusstseinserweiternde Drogen etc. sind keine neuen Themen des 3. Jahrtausends, aber sie werden derzeit aufgrund neuer wissenschaftlicher Erkenntnisse über die Funktion des Gehirns, neuer Substanzen und einer weiter verbreiteten Anwendung wieder vermehrt diskutiert.

For Immanuel Kant (1724-1804) dreams were good, bad and ugly - but not all at once. Before, during and after resolving some of the harder problems of philosophers, he referred to a number of softer issues vexing the minds of ordinary people, such as the meaning (none) and the function (lifesaving) of dreams. As dreams – according to Kant – have no meaning at all, the dream of eternal peace is also likely to fail. Nobody should be seduced by the public displays of spirit seers; persons of melancholic disposition are easy prey for nocturnal chimaera; and lunatics are dreamers in waking: all of which is rather negative. Teleologically however, there must be a purpose to these involuntary, irrational and irritating cerebral activities, and exactly this disturbance of sleep is what keeps us alive, otherwise perfect relaxation (= sleep, slaap, Schlaf, schlaff, schlapp) would cause suffocation, congestion and death. Immanuel Kant himself died after several months of terrible sleep disorders, cognitive deterioration with confusional states and accompanying symptoms characterizing a chimaera of Alzheimer's and Parkinson's disease (nowadays referred to as "dementia with Lewy-bodies").

Conspiracy theories are a most elaborate form of gossip. They have a long tradition and arise preferably during times of drawn out crises, as for example the Corona-pandemic. Hard-wired anxiety, personal powerlessness, palpable socioeconomic consequences, complex causes and insufficient solutions, disconcerting leadership and modern means of communication form fertile ground for conspiracy theories. They are much more than a peculiar marginal phenomenon as they undermine concerted action and distort open discussions, spreading germs and doubts, increasing risks and costs. This paper describes individual, social and communicative mechanisms underlying conspiracy theories and their INCLUSIVE ("we, who know"), CONCLUSIVE (cognitive closure versus inconclusive facts) and EXCLUSIVE effects ("we versus the establishment and the ignorants").

The Department of Psychiatry and Neurology of the German Charles University in Prague was among the leading medical institutions in Central Europe in the early 20th century. In October 1939, Professor Kurt Albrecht, a Berlin neurologist and member of both the NSDAP and the SS, was appointed head of the department. During his tenure, he secured a separate building for the neurological section and held senior academic offices, including dean of the medical faculty, and ultimately, the last rector of the German Charles University. Albrecht's death at the end of the Second World War remains surrounded by uncertainty. Contemporary accounts differ, some attributing it to suicide, and others to his death in armed resistance. While his career is inseparably linked with the Nazi regime, he remains part of the lineage of chiefs of the department, which history forms a broader professional tradition beyond political entanglements. In re-examining the circumstances of his death, we combined established sources with newly identified unpublished archival materials from Prague and Berlin, as well as testimonies of contemporaries from the German University milieu in Prague. These findings contribute to a more nuanced portrait of Albrecht and his era, inviting interpretations that extend beyond narrow national frameworks or the postwar order's perspective.

Lemuel Gulliver’s travelogues were published 300 years ago. Gulliver’s fame is well-founded: only a limited number of sailors endured one long sea voyage, while he survived four, experiencing numerous strange and challenging adventures. Some of his encounters raise medical questions or have found their way into medical terminology; others relate to long forgotten diseases or reflect the travel literature and fantastic tales of his era; still others make direct reference to scientific experiments entirely new in those days; and ultimately, all of them question the seemingly obvious values of humanity and medicine.

Mathilde Ludendorff (nee Spiess, widowed von Kemnitz, divorced Kleine) was one of the first women who studied medicine in Imperial Germany. She wrote a feminist doctoral thesis, refuted Sigmund Freud’s psychoanalysis early in her career, detected the fraud of Albert von Schrenck-Notzing’s spiritualist research, became a specialist for nervous and mental diseases after only 17 months of training with Emil Kraepelin, as his—according to her own words—best pupil, treated General Ludendorff’s first wife and soon became his second, developed a Germanic philosophy too radical for Adolf Hitler’s taste, was considered as a primary culprit after a first denazification trial in 1949 and contested the expert opinion of her colleague Professor Georg Stertz about her own mental state. Her books are still in print and her Alliance for God Cognizance (Ludendorff) still exists and is monitored by the National Intelligence Agency.

Richard Semon (1859–1918) was a student of Ernst Haeckel and began his career as a zoologist with work on sea urchins, starfish, chicken and lung fish, which he collected at the Mediterranean Sea and in Australia. After his return to Germany he was forced to leave Jena and the university due to private reasons, and settled in Munich, where Semon devoted most of his time to the more philosophical aspects of biology, developed the theory of “mneme” (1904), which he extended towards the inheritance of acquired characteristics (1912). Semon’s concept of memory reached far beyond the brain and the individual person. In 1918 he took his life, despondent because of a surmised lack of scientific appreciation, the death of his beloved wife, the political turmoil at the end of WWI, and his—the memory researcher’s—suspected loss of memory. Eight years later, the experimental biologist Paul Kammerer (1880–1926) from Vienna, Semon’s must trusted source for the inheritance of acquired characteristics, also shot himself. Serious doubts increasingly overshadowed his work on salamanders and midwife toads. Epigenetics, the nature of memory, the fear of cognitive impairment, depression, the impact of private and political matters on scientific work, suspected scientific errors, fraud and a scientists’ suicides are condensed in Semon’s life and death.

Background: Jonathan Swift (1667–1745) had long been interested in mental disease, which he also (ab)used for satirical purposes. He characterized various forms of madness in 1704, was elected governor of Bedlam in 1714, and in 1731 decided to dedicate his fortune to the founding of a first lunatic asylum in Ireland. Objective: To identify and consider the nature of neuropsychiatric features described in Gulliver’s Travels. Material & methods: Literary works by and biographies of Jonathan Swift were examined together with the pertinent medical and historical specialist literature. Results: Gulliver’s Travels, primarily a political satire, was published 300 years ago. The adventures of the restless naval surgeon Lemuel Gulliver on various remote islands can be understood as a journey into psychosis with characteristic motor, sensory and cognitive features. After his return home an autistic Gulliver refuses contact with his own species, the Yahoo-like humans, including his family and prefers the company of horses. Seamen and lunatic inpatients apparently shared a number of environmental risk factors and features of scorbutic nostalgia. Conclusion: Caution is advised when making a retrospective diagnosis, even with a fictional character like Lemuel Gulliver. If there were no hints at relevant organic causes — primarily hypovitaminoses —,one might suggest that Swift/Gulliver reported a number of characteristic symptoms of schizophrenia long before they were described in the medical literature.

Naturgemäß hängen LebewesenTom Sawyer an ihrem Leben und an ihrem Wesen. Dem Menschen (homo sapiens) scheint im Wesentlichen das weise Sozialverhalten überlebenswichtig und er sucht sich selbst in anderen besser zu verstehen. Theory of Mind (TOM) ist dieser Versuch sich in die Perspektiven eines anderen Subjekts hineinzuversetzen. Aus diesem tieferen Verständnis entstehen Mitgefühl, Rücksicht, Respekt, aber auch Scham, Verachtung und Hass u. v. a.. TOM beschäftigt ständig einen großen Teil der Zentralnervensystems sozialer Lebewesen. Nach der kindlich-philosophischen Entwicklungsphase folgen Menschen aus rationellen Gründen ihrem emotionalen Grundbedürfnis und gehen ganz selbstverständlich davon aus, dass andere Personen im Wesentlichen ihrem Selbst innerlich ähnlich sind, entsprechend empfinden, denken und sich verhalten. Dies bleibt letztlich eine unbeweisbare Annahme, eine tröstliche Illusion. Rechenmaschinen benötigen Strom und kompetente Wartung, nicht aber Nestwärme. Komplexes Verhalten lässt sich auch ohne fragwürdige Intuitionen allein mithilfe hoher Rechenleistung vorhersagen.

Karl Philipp Moritz edited Gnothi Sauton, the Journal of Empirical Psychology (1783-1793), which stands as the first of numerous psychological and psychiatric periodicals. We evaluated 124 psychiatric or neurological case reports from the journal according to modern diagnostic criteria and present a brief outline of the contributors' and patients' sociodemographic characteristics, selected case reports and the surmised risk factors. A reliable diagnostic reassignment of the well-described cases was feasible; this may indicate that patients retain similar psychiatric disturbances over the centuries. As in the popular literature of the period, examples of' sentimental students' and 'desperate soldiers' represented the most frequently discussed, prototypical high-risk personalities in the Journal, which marked the step from literature to empirical science. The influences of this case material upon contemporary psychiatric writing and thought are reviewed.

Die Theory of Mind (ToM) ist eine au fwendige, zu sammengesetzte Leistung, die auf mehreren kognitiven Voraussetzungen aufbaut. Sie wird in Laborsituationen mit anspruchsvollen Paradigmen untersucht. Diesen Ansprüchen sind ältere Menschen aus u nterschiedlichen Gründen oft nicht mehr gewachsen. Schreiten altersassoziierte Probleme wie Herz-Kreislauf-Krankheiten, Seh- und Hörstörungen fort oder entwickeln sich besondere Hirnerkrankungen wie vaskuläre und neurodegenerative Demenzen (zum Beispiel eine frontotemporale Lobärdegeneration), so fällt es zu nehmend schwer, passende Antworten auf schwierige soziale Fragen finden. Überdies muss ToM regelmässig trainiert werden, u nd d es wird oft durch die »soziale Entsorgung« im Rentenalter vereitelt; dafür wird die altersassoziierte Egozentrizität (AAE) gefördert.

Increasing life expectancy may explain why more elderly candidates appear to be running for office. This raises general questions regarding the specific risks of old age and frailty in demanding political positions. Therefore, I tried to give important contemporary examples of elderly leaders, study the mean age of leading political figures over the last 3 decades and present historical examples of heads of state with age-associated brain diseases and cognitive deficits. I reviewed the literature on mental illness and politics and analyzed the ages of international political leaders in 1990, 2000, 2010 and 2020. Summary: There are several impressive contemporary examples of elderly politicians. The mean age of political leaders has not increased significantly in most parts of the world over the last 3 decades with the exception of the Gulf States and sub-Saharan Africa. Health problems of heads of state in earlier centuries had not been primarily age associated. After 1900, dementia but also mild cognitive and mild behavioral impairment became important issues in politically critical situations, for example international peace negotiations, the rise of Nazi Germany, the breakup of communism, the Arab Spring and others. This paper collects anecdotal evidence of cognitive frailty in ageing politicians; it is not an in-depth analysis of political history. Observations confirm that a very long time in power may obviously increase the risk of age-associated problems; dynamic revolutionary or entrepreneurial idols may be misled to rely on their irreplaceable charisma for too long. However, caution must be exercised against ageism on one side versus silent acquiescence towards leaders with failing mental powers on the other, who may become victims of obscure parties and their decompensating personality disorders. Current news nurture the impression that large and important states are governed by elderly people, and oc- casional reports indicate that there is a number of lesser known countries ruled by rather seasoned leaders.

Criticism and Creative Compensation: Andreas Schönberger, Immanuel Kant et al. In: Sabine Coelsch-Foisner (2023) Kreativität, schöpferischer Wille und (Über)Lebensstrategie. Winter, Heidelberg. Creativity as a survival strategy requires the creative will to succeed in an academic environment. In addition to previous education, originality and the quality of one's own preliminary work, conviction of one's own abilities and flexibility in the choice of topics, activities and places are important prerequisites for success. The spirit of optimism in the age of the Enlightenment and the stormy rise of idealism, the possi- bility of documenting academic achievements and partly self-awarded qualifica- tions in self-financed printed works, and the administrative gaps in the system were enough to annoy Immanuel Kant – at least briefly.

Kant and Medicine - the Philosopher as Anthropologist, Physician and Patient. It remains uncertain whether the student Immanuel Kant (1724-1804) truly wanted to become a physician or only said this in order to please a sponsor. Due to his narrow chest and other typical weaknesses of a scholar he considered himself a hypochondriac and cautiously kept his distance from dangerous illnesses, especially those of the mind. He inspired his students - including Herder, Herz, Lenz and Hoffmann - far less with logic and metaphysics than with exciting findings about far away countries, their alien inhabitants and the health dangers lurking in exotic parts of the world. He called for philosophical treatment of physical illnesses beyond the limited "veterinary" approach of medicine. He claimed the responsibility of the philosophy faculty for forensic questions. Kant developed original ideas about the seat of the soul, which led to the construction of a first model of the brain including functioning synapses. He was unable to overcome reservations about smallpox vaccination because he feared a change in the germ line. He wanted to see "how long the stuff would last" and during his later decades used all the classic dietetics to successfully extend his life. These sex res non-naturales continue to play a significant role in the prevention of widespread diseases today. Then an "electric revolution of the air strata" took its toll on him. Towards the end, his confidants were to look at him like a child, who, however, left posterity an extensive work with deep insights into his thinking, the Opus postumum.

Immanuel Kant (1724-1804) had not been a close friend of Johann Daniel Metzger (1739-1805), the most productive professor at the Medical Faculty of Königsberg and specialist for social and forensic medicine. Kant felt, that many somatic diseases needed philosophical support, while severe mental illness should exclusively and safely be treated with the veterinary procedures of medicine as all rational, sensible interventions were in vain. According to Kant, Metzger's outstanding domain, forensic issues, could only be resolved by philosophy. Metzger used his anonymous obituary on Kant to set several things straight.

John Abercrombie (1780–1844) was considered the most eminent Scottish physician of his time. In his Pathological and Practical Researches on the Diseases of the Brain and Spinal Cord (1836. Edinburgh: John Carfrae and Son, 3rd ed.) he described the cases of 140 patients with cerebral disorders, 48 of whom suffered from language disturbances. Despite the overwhelming clinical and neuropathological evidence of a close association between language disorder and right-sided hemiparesis or diseases of the left hemisphere, and in spite of his great interest in language disorders, he made no attempt to localize the aphasic syndrome to a specific brain area.

Samuel Thomas (von) Soemmerring (1755–1830) war ein umfassend gebildeter und vielseitig interessierter Aufklärer, der sich vor allem als (Neuro-)Anatom anhaltende Berühmtheit ver- diente. Unrühmliche Bedeutung erlangten seine Untersuchung „zur körperlichen Verschiedenheit des Mohren vom Europäer“ und sein Versuch, die menschliche Seele im Liquor cerebrospinalis zu verorten. Weitgehend in Vergessenheit geraten sind seine Ver- dienste um die Gesundheit der Frauen und auch mancher Kna- ben, die ehedem in ein Korsett gezwungen wurden. Kants Kritik an Soemmerrings Organ der Seele (1796) nahm moderne neuro- biologische Konzepte der Neurotransmission vorweg und inspi- rierte Soemmerring zum Bau eines einfachen Nervensystems, dem elektrolytischen Telegrafenapparat.