General psychiatry and psychotherapy with outpatient clinic

201

202

200

203

204

Address: Calwerstraße 14
72076 Tübingen

Person profile: 07071 29-82311

Fax number: +49 7071 29-4141

History of the clinic

This text was revised and completed in 1996 by M. Leonhardt and M. Bartels, in 2004 by C. Dedner and in 2023 by Univ.- Prof. Dr.med. Dr.scient.pth. Dipl. Psych. Reinhard J. Boerner by the section about Johann Heinrich Ferdinand Autenrieth.

1805The history of Tübingen University Psychiatry begins as early as 1805, when Johann Heinrich Ferdinand Autenrieth (1772-1835) opened his new clinic building in the old Burse on the banks of the Neckar.
At that time, mentally ill people ("lunatics") were still locked up and kept in "madhouses"; there was no medical treatment. The awareness that they were sick people was also only rudimentary.
Autenrieth knew the ideas of a new "psychic medicine" from Johann Christian Reil (1759-1813), with whom he was a friend. He also had several years of experience of his own in treating even the severely mentally ill. In his university clinic with 12 rooms and 15 patients, somatically ill and mentally ill patients were treated together for the first time. At least four single rooms were provided for the latter, depending on the severity of the sick. In fact, however, only 1-2 patients were admitted. Thus, in practice, somatic and mentally ill patients were treated equally in medicine.
For Autenrieth, an individual medical diagnosis and treatment of his patients was fundamental. This should be done with benevolence, but also severity, and should consist of a combination of "physical" and "psychological" means. For patients who were dangerous to themselves or others ("completely raving"), he set up a separate individual room ("palisade room"). He rejected corporal punishment, which was common at the time. In addition to emergency short-term restraints, application of the Autenrieth mask or treatment with the "martyr's ointment", the emphasis was on drug therapy, which he used in accordance with the standards of the time. Here he was well aware of the very limited possibilities of his time. His most famous patient was Friedrich Hölderlin (1770- 1843).
As a general principle of care for acutely mentally ill patients, he recommended the establishment of local small wards instead of creating separate clinics away from the general medical care and the patients' place of residence. Chronically ill patients should - if possible - remain with their families.

Unfortunately, Autenrieth failed in the attempt to implement his concept due to state resistance. The foundation of a university clinic for psychiatry in Tübingen was also repeatedly postponed for financial reasons, despite the capacity problems; this did not succeed until 1897.

In this respect, Autenrieth can be regarded in several respects as a pioneer of humane medical therapy for the mentally ill. Many of his ideas and concepts were far ahead of his time and were not taken up until the psychiatric inquiry of 1975.

Literature:
Boerner, Reinhard J. (2023) Johann Heinrich Ferdinand Autenrieth (1772-1835). A pioneer in the care of the mentally ill. In: Müller Th & Prüter-Schwarte Ch (eds) Series of publications of the German Society for the History of Neurology (DGGN). Königshausen & Neumann, Würzburg. Vol.29, pp.323-350.
1845After a long history that can be traced back to the beginning of the 19th century, the Psychiatric University Hospital in Tübingen was opened in November 1894.
Wilhelm Griesinger (1817-1868) played a significant role in the initiatives that eventually led to the establishment of the hospital. As director of the Medical Clinic in Tübingen, he began lecturing on psychiatry in 1845 after a long break.
1893 till 1901The first director of the newly founded clinic was Ernst Siemerling (1857-1931) from 1893 to 1901. Siemerling devoted himself especially to the pathological-anatomical examination of nervous diseases, the description of clinical pictures and forensic-psychiatric problems.
1901 till 1906After his call to Kiel, Robert Wollenberg (1862-1942) became director of the Nervenklinik from 1901 to 1906. Both he and Siemerling were students of K. F. O. Westphal. Wollenberg became known for his clinical presentations especially on melancholia and hypochondria. In 1906 he followed a call to the University of Strasbourg.
1906 till 1936His successor in Tübingen was Robert Gaupp (1870-1953). He directed the clinic from 1906 to 1936 and was one of the formative figures in German psychiatry. Gaupp had worked in Breslau with Carl Wernicke together with Karl Bonhoeffer and had been with Emil Kraepelin in Heidelberg and Munich. In a lecture in 1902, he had attempted to grasp the limits of psychiatric knowledge, advocating the proposition: Not one cause, but several first create mental illness. As a result of his work as a military hospital physician, he dealt with the problem of traumatic neuroses, which he, in contrast to Oppenheim and other psychiatrists, rejected as consequences of a commotio cerebri and saw in them purely psychogenic disorders. With his decades of observation and description of the illness of the main teacher Wagner, for which he became famous, Gaupp established the dynamic approach in psychiatry by describing personality, experience, and illness in the development of madness.

Under Gaupp, after a makeshift preliminary stage in the clinic's construction, the children's department of the Nervenklinik could be opened in 1920, which also experienced its first blossoming under its first director Werner Villinger.
1936 until 1944From 1936 to 1944, Hermann F. Hoffmann (1891-1944), a student of Gaupp, was director of the Nervenklinik. His study of offspring was the first to deal systematically with the descendency of endogenous psychoses. He was concerned with the relationships between hereditary disposition and personality, disposition and life curve, character and environment. He continued Gaupp's dynamic approach and sought the possibility of an understanding psychiatry on a biological basis.
Hoffmann had joined the NSDAP in 1933 and was appointed rector of Tübingen University in 1937. As a "rector in SA uniform," he was one of the university's exposed National Socialists. Contrary to the National Socialist sterilization law, Hoffmann did not see any indication for sterilization in the case of affective psychoses, but in the case of the so-called asocial psychopaths he energetically pleaded for exceeding the legally set framework. As far as is known, the clinic was not involved in the so-called "euthanasia actions" in the Third Reich.
Until 1945After Hoffmann's death, Wilhelm Ederle ran the clinic and the hospital department established in it until 1945. Ederle had brought Sakel's insulin treatment to Tübingen in 1936. Remedial convulsive therapy was introduced, a serological laboratory was established, and neurological activity was more fully developed. The separate X-ray department established before the war now made encephalographic and angiographic neurodiagnostics possible.
1945 till 1946At the end of February 1945, Werner Villinger (1887-1961) temporarily took over the management of the clinic.
He went to Marburg in 1946 and swapped places with Ernst Kretschmer (1888-1964), who had already worked under Gaupp in Tübingen.
1946 till 1960Ernst Kretschmer (1888-1964) was director of the Nervenklinik from 1946 to 1960. He had adopted the dynamic approaches of psychiatry under Gaupp and developed them further in his work on "delusion and manic-depressive symptom complex" and especially in his elaboration of the sensitive relationship delusion.

He introduced the concept of multidimensional diagnostics into psychiatry for the first time. His systematic synthesis of physical constitution theory and character science also made him known to broad sections of the population and opened up new aspects in medicine, psychology and anthropology. In 1921 "Physique and Character" (26th edition 1977) was published, in 1922 "Medical Psychology", in 1923 "Hysteria", in 1929 "Ingenious People" and in 1949 "Psychotherapeutic Studies".
1960 till 1972From 1960 to 1972, Walter Schulte (1910-1972) was head of the mental hospital. He was a student of Hans Berger in Jena, the inventor of the EEG. He had worked in Bethel and was director of the Landesheil- und Krankenanstalt Gütersloh. His experiences there were reflected in his book "Klinik der Anstaltspsychiatrie" (1962). Schulte was the first to discover the antidepressant effect of sleep deprivation and systematically introduced it into depression treatment. He advocated a close connection between neurology and psychiatry and accordingly attached great importance to the presence of two neurological wards within the clinic. In addition to publications from the neuropsychiatric borderline area (e.g. on syncopal seizures, founding of the "Almanach für Neurologie und Psychiatrie"), he dealt with the personal relationship and its effect between doctor and patient, problems of endogenous psychoses - especially melancholia - and gerontopsychiatry. His textbook "Psychiatry", written together with Rainer Tölle, was first published in 1971 and is now already in its 10th edition.

The clinic structures further differentiated in the meantime. In January 1972, the day clinic was opened, which had a pilot function in Germany. In 1966, the Clinical Youth Home became independent as the Department of Child and Adolescent Psychiatry under its director Reinhart Lempp, who had worked for Kretschmer. Lempp was concerned with the significance of early childhood brain damage as a vulnerability factor for the development of mental disorders, with the psychoses of childhood and adolescence including their psychotherapy, and with forensic psychiatric issues.
1972 till 1974After Schulte's sudden death, Lempp was acting director of the clinic from 1972 to 1974.
1974 till 1990He handed over the reins to Hans Heimann in 1974. Heimann worked under Jakob Klaesi and Max Müller at the Psychiatric University Hospital in Bern (Waldau) and habilitated in 1953 with the monograph "Die Skopolaminwirkung. Comparative psychopathological-electroencephalographic studies". From 1964 to 1974 he was head of the research department of psychopathology at the Psychiatric University Hospital of Lausanne. In addition to his psychopathological and psychophysiological research, his work extends to areas of psychopharmacology, border areas of psychiatry to philosophy and religion, and questions of research methodology in psychiatry. Influenced by Ludwig Binswanger, the Daseinsanalytische Betrachtung is important to him as a counterweight to the scientific objectivity of neurobiological research. Heimann continued the tradition of the multidimensional approach at the clinic with new accents.

1979 a section for neurophysiology was established in the clinic, headed by Mathias Bartels.

Since 1975, alcoholic patients can be treated in a specialized ward in a six-week program with subsequent outpatient aftercare.
In addition, another addiction ward has existed since 1990, in which qualified detoxification (with motivational therapy) is carried out. This offer was extended in 1997 by a drug detoxification ward.

In order to meet the need for longer-term therapy options for chronically ill patients or patients at risk of chronification, the aftercare clinic was founded in 1975 with 16 places. The aftercare clinic is run by a separate association, but is closely linked to the psychiatric clinic in terms of personnel through a cooperation agreement. It is a medical rehabilitation facility in which mainly younger patients, some of them severely disturbed, are treated within the framework of a multidimensional therapy program.

In 1988, the clinic was given its own section for forensic psychiatry, headed by Klaus Foerster. Foerster's scientific focus is on assessment problems with pension neurotics, diagnosis and quantification of personality disorders, recording of so-called "affective acts" and psychotherapy for offenders.
1990After Heimann's retirement, Gerhard Buchkremer took over the management of the clinic on October 1, 1990. Buchkremer had been assistant and senior physician with Tölle in Münster and had habilitated in 1984 with a thesis on "Relapse prophylaxis in schizophrenic patients". His research also focused on linguistic-analytical studies of communication style in families with schizophrenic patients and therapeutic possibilities of smoking cessation.

Lempp was succeeded by Gunter Klosinski in 1990. Klosinski was senior physician at the Clinical Youth Home until 1986, when he accepted an appointment to the chair of child and adolescent psychiatry in Bern. He is concerned with the significance of sects and youth religions from a child and adolescent psychiatric point of view, in addition to family dynamic problems and questions of a psychotherapeutic approach to children and adolescents differentiated according to age groups.
1995 / 1996In 1995, taking into account new developments, the clinic was renamed University Clinic for Psychiatry and Psychotherapy. Today it consists of the Departments of General Psychiatry and Psychotherapy with Polyclinic, Section of Neurophysiology, Section of Addiction Research, and Child and Adolescent Psychiatry and Psychotherapy with Polyclinic. The Department of General Psychiatry includes ten psychiatric wards (including two protective, "closed" wards, one gerontopsychiatric special ward, two detoxification wards, one specialized psychotherapy ward for patients with alcohol problems, and one specialized psychotherapy ward for patients with alcohol problems).r patients with alcohol problems and one special ward each for depression, eating disorders and schizophrenic psychoses) with a total of 141 beds, the outpatient clinic, an institute outpatient clinic, a day clinic for the elderly and the general day clinic, each with 20 treatment places.

1996 the partial renovation of the clinic was essentially completed. For diagnostic and scientific purposes, the neurophysiology section with EEG, EMG, brain mapping and Doppler sonography, clinical psychology and a clinical chemistry laboratory are of importance. The psychopharmacological and psychophysiological laboratory (with sleep laboratory) serves mainly scientific purposes.

The therapeutic possibilities include, in addition to pharmacotherapy and psychotherapy, movement, occupational and physical therapy. The social service, with currently four employees, assumes an important function in the regulation of social issues and in sociotherapy. Workshops belonging to the clinic (mechanics' workshop, gardening workshop, carpentry workshop) and a sports field can also be used for therapeutic measures.