339-

Personalia

Klaus Conrad (1905-1961)

DETLEV W. PLOOG*

Klaus Conrad (1905-1961) was an internationally known figure in the field of

neuropsychology and psychopathology. He applied
Gestalt psychology to give a
better understanding of the aphasias, the symptomatic psychoses and incipient
schizophrenia.

Klaus Conrad was born in Reichenberg in Sudetenland’ on 19 June 1905.

His father, Otto, secretary of the Chamber of Commerce in Vienna, was a
Dozent (lecturer) in economics at the Technical University in Vienna and
became an internationally known scholar through his published books. His
mother, Wilhelmine, nee Zwiauer, came from a Viennese family which was
related by marriage to the family of the physiologist Thomas von Brucke.
Conrad’s father’s family, originally from Siebenbtirgen but now living in
Vienna, was related by marriage to the family of the surgeon Thomas
Billroth. The family’s friendship over several generations with the Exners, a
number of whom became well-known scientists, was also an important
element in the environment in which Klaus Conrad grew up. Conrad was
particularly impressed by the research on bees conducted by Karl von Frisch,
whom he called Uncle Karl and whom he saw during his summer vacations
in the now famous Brunnwinkel on Wolfgangsee.3 Influenced by this eminent
scientist, at first Conrad wanted to become a zoologist; the subject of a long

* Originally published as: D. Ploog (1998). ’Klaus Conrad (1905-1961)’. In Hans Schliack and
Hanns Hippius (eds), Nervenärzte. Biographien (Stuttgart: Georg Thieme Verlag), 75-85.
Translated from the German by permission of the publisher. This paper is published in History of
Psychiatry thanks to the great generosity of Mrs Martel Conrad and of Professor emeritus Ploog
himself. The editor is very grateful to both. Address for correspondence: Prof. Dr. med. Dr.
phil.h.c. Detlev Ploog, Max Planck Institute for Psychiatry, Kraepelinstrasse 2, D-80804 Munich,
Germany. E-mail: ploog@mpipsykl.mpg.de

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paper he wroteduring his last year of I

secondary school was ’Die Sorgen den
Insekten fur ihre Nachkommenschaft’
(How insects take care of their
offspring). But equally fascinating to
him, if not more so, were butterflies
and the markings on their wings.
Because there was ’no money’ in
zoology (eine ’brotlose Kunst’), his
avuncular friend advised him to start
off by studying medicine. In the
summer the families from Vienna

spent time together in Litzlberg on

Attersee.’ Conrad often played music
with them, as he did with others
throughout his life. In secondary
school and then as a young university
student he was a sought-after clarinet
player. Later, the cello captivated
him for the rest of his life.
The formal course of Conrad’s life
can be outlined briefly. After gaining
his Abitur for classics at high school, KLAUS CONRAD
he began to study medicine in
Vienna in 1923 and completed his training there in 1929.’ It had already
become clear to him after the first few semesters that he wanted to devote
himself to neurology and psychiatry. Wagner von Jauregg, Pbtzl and
Gerstmann were then teaching in Vienna, and Conrad worked with them as
a volunteer, both as a student and then, after he had completed the state
medical examination, from 1929 to 1931. He does not appear to have had
personal contact with Sigmund Freud, although he later read Freud’s major
works intensively and, for example, held an inspiring lecture series on the
psychopathology of everyday life (Psychopathologie des Alltagslebens) .
In 1924 Conrad spent a semester in Leipzig. At that time he may already
have had his first experience of the holistic approach being promulgated
there (Ganzheitspsychologie) . Excellent caricatures of his university instructors
show his talent for capturing the essence of his subject. A clinical semester in
London as a volunteer in a neurosurgical department established the
foundation for his ongoing connection with the Anglo-Saxon world; later on,
for example, the teachings of Henry Head and Hughlings Jackson had a
strong influence on his scientific thinking.
At that time the economic situation in Austria was desolate. As the result
of an advertisement about a medical position, he went to the city neuro-
psychiatric hospital in Magdeburg, which was headed by Jacobi. Two papers

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written by Conrad during this period already addressed what was to become
the main topic of his scientific work, namely, analysis of neuropsychiatric
syndromes using principles of Gestalt psychology. Starting with the idea that
all psychic activity is based on Gestalt processes, he first formulated some
of the laws governing the ’de differentiation of the Gestalt function’ (Ent-
di,fferen.zierung der Gestaltfwzktion) in a parietal syndrome. His love of neuro-
psychology - in those days called brain pathology (Gehirnpathologie) - probably
developed while he was working with Otto Pbtzl. And his critical paper on
Paul Schilder’s concept of the body image shows the Gestalt approach and
Conrad’s pleasure in questioning existing views and looking for new
approaches.
In February 1933, at very short notice, Conrad decided to go to Paris to
work with Guillain at the Salpetriere and to gain a deeper understanding of
French neurology. Here again, as earlier in London, he had access to another
culture, resulting later in the development of close contacts, especially
through his friendship with Henry Ey.
A stipend from the Rockefeller Foundation, followed by one from the
Notgemeinschaft der Deutschen Wissenschaft (Emergency Fund for German
Science6), enabled the young scientist - who now had a broad training - to
work in Munich from 1934 to 1938 under the direction of Ernst Rudin in
the genealogy department of the Deutsche Forschungsanstalt fur Psychiatrie
(German Institute for Psychiatric Research’), founded by Kraepelin. Here he
almost literally threw himself into his new field of research.

The genetics of mental disorders

After only a year, the first in a series of related papers on heredity and
epilepsy appeared, based on studies of 253 sets of twins. Papers then
followed on the progeny of individuals with epilepsy, on the question of
epileptoid psychopathy and on the genetic environment of individuals with
epilepsy and their social class. Conrad quickly became well known. At the
third annual conference of the Gesellschaft deutscher Neurologen und
Psychiater in Munich in September 1937, he was the principal speaker; at
the end of his address on heredity and constitution in epileptics he made a
statement about legislation on eugenics, which for listeners at that time was
very clear and unambiguous, namely, that it must be based solely on
scientific knowledge: ’But knowledge must never be guided by legislation,
otherwise progress would be impossible’ (Die Erkenntnisse aber dürfen sich
niemals nach der Gesetzgebung richten) sonst wäre ein Fortschritt unmöglich).
Conrad’s key research findings - a high concordance rate (86%) in identical
twins with idiopathic epilepsy and a low percentage of affected individuals
with children (only 6-8%) - are, as far as I know, still uncontested.
Meanwhile, under the influence of young National Socialists, the Munich
research institute became increasingly politicized. Jewish researchers had to

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leave the institute. Conrad, who had just completed his postdoctoral dissertation
in Munich and was now eligible for a university teaching position, applied for
a post as senior physician at the university hospital for neuropsychiatry in

Marburg on the river Lahn.

In May 1938 Ernst Kretschmer asked the young Reader to join him as
senior physician at his hospital in Marburg. Two years later and shortly
before being called up to serve as a military physician in Russia, Conrad
quietly completed a comprehensive monograph addressing the problem of
constitution and character from a new angle. Kretschmer’s masterful
description of this subject had fascinated Conrad and stimulated him to
consider the constitutional types as genetically determined products of
diametrically opposed growth tendencies. The book, which was published
by Springer in 1941, was entitled Der Konstitutionstypus als genetisches
Problem.

The Constitutional Type as a Genetic Problem

In Conrad’s constitutional theory, the inherent relationship of certain body
types with certain basic personality structures is based on the principle of the
quantitative gradation of hereditary factors and the hierarchical structure of
genetic effects. Diametrically opposed conservative and propulsive types of
growth, with their associated basic psychic structures, are the result of
different determining steps in the ontogenetic process of progressive
individuation. In Conrad’s theory the growth tendencies are entered into a
system of coordinates, with a leptomorphic-pyknomorphic range of variation
and a hyperplastic-hypoplastic range of variation. In the leptomorphic-
pyknomorphic range of variation, growth tends towards length at the expense
of breadth, and breadth at the expense of length. In metromorphic types
there is balance in growth between length and breadth - these are the classic
body proportions. The hyperplastic-hypoplastic growth tendencies are based
on too much or too little development of tissue; the more extreme types

correspond to Kretschmer’s athletic and asthenic types. In the middle of this

polarity is the metroplastic type. In addition, there are dysplastic types of
growth of endocrine origin (e.g., eunuchoid gigantism and certain types of
obesity). Conrad calls the leptomorphic-pyknomorphic polarity primary
variations of humans and the hyperplastic-hypoplastic polarity secondary
variations. In this way he refers to embryonal development, in which the
primary type begins earlier and therefore has more marked effects, with the
secondary type beginning later ontogenetically and therefore having less
marked effects. The primary and secondary variations refer not only to
somatic processes, however, but also to the associated psychic differentiation.
The pyknomorphic type, with its slower shifts in proportions, is closer to
children (and the feminine body type), whereas the leptomorphic type - with
its greater ’developmental force’ (Entfaltungstemperament) and more rapid

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shifts in proportions through the body shape - changes in the sense of Zeller
and is closer to a pubescent individual than to a child.
The reception of Conrad’s theory of constitutional types was varied. After
its initial publication in 1941 the theory attracted a great deal of attention.
Jaspers discussed the ’excellent work’ (das ausgezeichnete Werk) for ten pages
in the fourth edition of his Allgemeine Psychopathologie (1946)8 and conferred
upon it the status of a ’radical reformation’ (radikale Neugestaltung) of consti-
tutional theory, but in the end concluded that ’in spite of its brilliant nature
the whole theory will sink into oblivion without any consequences’ (das
Ganze trotz seines geistreichell Zuges folgenlos versinken wird). Three decades
later a leading researcher on constitution, Rainer Knuf3mann,9 recognized
that the leptomorphic-pyknomorphic range of variation and the growth
phases as bodily variations during ontogenesis were confirmed by empirical
data. (For me personally, the book was a milestone on the road to a
biologically-oriented psychopathology in which the ’causal connections’ play
a stronger role than the ’meaningful psychic connections’.’° My reading of
the book resulted in a request for a topic for a doctoral dissertation.)
Two decades later Conrad, at the request of Springer-Verlag - and related
to his comprehensive contribution to Psychiatrie der Gegenwart (Current
Psychiatry)&dquo; on the different constitutional theories - wrote a slim second
edition of his 1941 book. In it he evaluated his early work in his own
impartial, unassuming way: ’For much of what the author considered
irrefutable twenty years ago,’ he wrote in the Preface, ’doubts are now noted;
the apodictic certainty no longer exists.’ (Zu vielem, ’Was dem Autor vor 20
3‘ahren unbezweifelbar erschien, werden jetzt Zweifel angemerkt, die apodiktische
Sicherheit besteht nicht mehr. ) But the basic ideas, the genetic-dynamic
approach to the problem of constitution, he still considered fruitful. The
second edition is entitled Der Konstitutionstypus. Theoretische Grundlegung und
praktische Bestimnaung (The Constitutional Type. Theoretical Foundations
and Practical Determination). It was completed in 1961 shortly before his
death.
At the start of the war against the Soviet Union, Conrad was drafted to
serve at the reserve military hospital in Marburg and soon afterwards
marched with his unit from Ukraine into the Caucasus. While there, in
December 1942, he received orders to set up a special hospital for brain
injuries in Marburg. Between 1943 and the end of the war in 1945, 808
soldiers with brain injuries passed through his department, 216 of them with
aphasia. Conrad examined every single patient himself. His careful docu-
mentation in the medical records and with ’diagnostic cards’ (Zdhlkarten,
literally ’counting cards’) enabled a scientific evaluation of these valuable
findings, which was begun even before the war was over. When Marburg was
occupied by the American front-line troops, the whole hospital was taken
over and everyone in it became a prisoner of war, but without any changes

being made in the internal structure of the hospital. By then I had completed

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 344

my doctorate, and I had the good fortune to work there under Conrad
during this time.
It was most impressive how patiently, systematically and at the same time
imaginatively he worked with the patients. Time after time he found new
methodological approaches to understanding the laws governing the different
aphasic disorders, the word-finding disturbances and alexia. Through his
professional but very personal approach, he kept the patients’ attention so
well that they never tired of co-operating with him, often for periods of many
months. In other areas of his field, too, especially psychiatry-psychotherapy,
masterful as he in the examination process, he was able to win over the
was

patients help
to him and to share the responsibility. This was the basis of his
success as a clinician. In the treatment of neuroses his efforts were centred on
the reduction of ’egocentricity’ (Ichhaftigkeit), a key concept of Fritz Künkel,
whom he greatly admired. This therapy, based on a partnership, would today
be considered a form of client-centred therapy.
In early 1946, after the oppressive final months of the war and the sad
spring and summer in captivity as a PO«1, his wife and four children were
with him again after a long separation following their evacuation. But, while
playing music with friends, Conrad was suddenly taken away by American
officers and put in the Zuffenhausen camp for war criminals. 12 In September,
after months of unsuccessful attempts, his bright and courageous wife
managed to get him released. The reason for his arrest and internment never
came to light. From this period of many months without any charges or

interrogations, in a state of total uncertainty and despair, there are letters and
poems that bear witness to Conrad’s inner strength and human greatness.

Sonett
Von meinem Fenster seh ich ein Stiick Straj3e
Ein kurzes Stiick, das sich zum Dory verliert.
Auf diesem Wege Groj3 und Klein spaziert.
Lustwandelnd abends zwischen Busch wzd Grase.

.
Sie fiihlen nichts von jenem Ubermaj3e
Der Freiheit, die sie haben, höchster Lust
’

Und keiner ist sich wohl des Glücks bewuJ3t

So hinzugehn - iiber eine StraJ3e.

O daj3 wir niemals es vergessen mögen)

Wenn alles, was ein jeder hier ertrug,
Ihm wieder ferne und verblasst genug.

DaJ3 jedes freie Gehn auf freien Wegen,

Ach, daj3 in Freiheit jeder Atemzug
Ist Gottes immer wieder neuer Segen.

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 345
Sonnet 13
From my window I see a bit of the street .

A short stretch that vanishes towards the village.

On this path people large and small are walking.
Promenading in the evening between bushes and grass.
They feel nothing of the plenitude of
Freedom which they have, the greatest joy
And no one seems aware of his good fortune
So to stroll - along a street.

Oh that we may never forget it,

When everything that each of us endured here
Is again distant and dim enough.

That every unhampered walk on paths of choice,

Oh, that in freedom every breath
Is God’s blessing, new each time.

The tyranny of fate that he experienced in prison left its mark on this
reflective and sensitive man. Nevertheless, as if he had gone away only the
day before, he took up his work again as head of the military hospital and as
a senior physician at the university hospital. In the meantime, Ernst
Kretschmer had gone to Tubingen in 1946, and Werner Villinger was now
head of the university department and the hospital. For Conrad another
fruitful period of scientific work began, and this was to be a central element
for everything that came later.

Structural analyses of cases involving brain pathology

In 1947/48, Conrad published a total of 300 pages on these cases, in six
articles: four in Deutsche Zeitschnft fiir Nervenheilkunde and two in Archiv fiir
Psychiatrie, followed later by four additional contributions. Based on subtle
case studies of different forms of aphasia and diagrams with statistics on the
localization of the brain damage, Conrad showed that the classical system of
brain pathology, with its highly concentrated expression found in Lichtheim’s
scheme, no longer did full justice to the large amount of newly observed data
available. ’The foundation, the notion of a reflex arc that underlies the
classical concept, has become shaky and is in need of revision’, he wrote (Das
Fu71dament, die Vorstellung vom Reflexbogen, das der klassischen Lehre zugrunde
liegt, schwankt und ist revisionsbedürftig). This had been acknowledged in
many valuable papers, but an urgently-needed new model, which would
explain the phenomena better, was lacking. Conrad presented such a model
and referred to the great founder of the classical concept, Carl Wernicke,

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346

who arrived at his theory of mental illness on the basis of observations of

people with aphasia. In this way, as we shall see, Conrad indicated the path
he himself would take in the future.
It is clearly difficult to describe, in the space available, the new, much
more complex fundamental concept which was capable of supporting brain
pathology and, in fact, psychopathology as a whole. But without such an
attempt, which should at the very least stimulate the reader to mine the veins
of gold in the original papers, the essence of Conrad’s way of thinking and
conducting research would be lost.
Two principles are the structural pillars. The first is the principle that
psychic phenomena, which appear to us as wholes or Gestalten, have a
developmental aspect. This means that, underlying every psychic phenomenon,
for example, a perception, a thought, a word, a word-finding disturbance, is
a developmental process. Everything that is present has become. As a model
for this process Conrad chose the then familiar tachistoscopic experiments
of Sander on the microgenesis (Aktualgenese) of Gestalten, whereby the
development of perception goes from the stages of pre-Gestalt ( horgestalt) to
those of the final Gestalt (Endgestalt), a process which usually takes place in a
split second and is not conscious, but which, if it is disturbed, is suitable for
shedding light on psychopathological ways of experiencing. Today, through
recording of event-related potentials in the range 30-500 ms, evidence in
support of this theory is available. The term pre-Gestalt is used for those
forms of perception that lie between the first appearance, the nucleus of an
experience, and its full formation in the final Gestalt. They are in no way
limited to visual or acoustic perceptual Gestalten, but also include movement
Gestalten and processes of speech production, of understanding speech, of
memory and of thought. The question arises: is what we describe as a given
pathological phenomenon merely a consequence of a protracted micro-
genetic process at different stages of the Gestalt formation?
With the introduction of principles of Gestalt theory into psychopathology,
Conrad departed from the then (and to some extent probably still) prevailing
psychology of association, according to which everything psychic results from
complicated mechanisms of association of individual impressions or from
stimulus traces, which the cerebrum, as a mnemonic-associative apparatus,
combines. Any damage in this apparatus must sever numerous connections
and bring certain functions to a standstill, especially if the nodes of
connection (centres) are affected. Conrad countered that it was not the loss
of a function localized at a particular place but rather a change in the process
of mental performance that could be disturbed from a certain location.
These changes in performance had characteristic features that were subject
to laws of Gestalt theory. To discover and describe in detail these laws by
studying different syndromes associated with brain pathology was the goal of
the structural analyses.
The second principle on which Conrad’s psychopathology is based is the

. 1)
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 347

relationship between object and subject. The commonly held view of the time,
based on the stimulus-response model, that a subject, with the aid of his or
her basic functions of perception, thinking, feeling and will; can understand
the objective world as a primarily independent state or - in the case of
pathology, because of an interruption of this subject-object relationship can
no longer understand - was in his eyes obsolete. Instead of this model, the
idea of a Gestalt-circle-like connection (gestaltkreisartige Verbundenheit) of the
subject with his or her world was introduced. The subject changes with the
objects, and the objects change with the subject; subject and object can be
understood only in their interactive relationship. The achievements of the
organism cannot be understood without the introduction of the subject. Here
Conrad refers to Viktor von Weizsdcker’s theory of the Gestaltkreis.14 He also
takes from it the neurophysiologically-grounded concept of change in
function, which underlies change in performance. Originally Weizsacker was
concerned with the hand that must feel in order to recognize objects and
with the disturbances of stereognosis the subject experiences in disorders of
the posterior funiculus of the spinal cord, which lead to a (neurophysio-
logically definable) change in function - which in turn underlies the change
in performance (inability to recognize objects). Related concepts that have
gained better acceptance in modern sensory physiology are expressed in the
reafference principle (von Holst and Mittelstaedt), in corollary discharge
(Teuber) and most recently in the complex re-entry concept of Edelman. In
the end the modern biologically-oriented schools of the philosophy of
consciousness are united in the new understanding of the subject-object
relationship that Conrad developed in his case analyses of brain pathology
and later used in his research on psychoses.
To understand the change in function that underlies the change in
performance, two additional concepts were necessary, which were taken from
Henry Head’s studies on sensitivity and then applied to psychic processes in
general. These are the epicritic forms of experience, in which the given field
of experience is completely formed, and the protopathic forms of experience,
in which the experiences are of the pre-Gestalt type. Their most important
feature is the blurring of the ’internal structure’ (Binnengliederung) of what is
experienced and the emergence and dominance of the physiognomic qualities of
expression (e.g., grotesque faces in wallpaper).
One has to look carefully at the individual protocols and the long series of
experiments for the different types of aphasia to grasp the force of the
argumentation and to understand that the speech problems in each type of
aphasia are, on the one hand, characteristic for that type of aphasia, but that
underlying these problems are common rules of incorrect formation
processes or, in other words, that the mistakes of people with aphasia are
strongly predetermined. The disturbance is to be sought in the develop-
mental process that leads from the preverbal existence of the thought content
to the verbal form. This developmental process has a temporal course that is

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slowed down by the change in the function of the damaged brain tissue, as
Conrad showed in studies of the duration of excitation and of the refraction
time in the Gestalt change.
The example of a conduction aphasia will be used to illustrate this
disturbed developmental process. This is a typical syndrome of difficulty in
finding words, with literal and verbal paraphasias and a disturbance of the
grammatical structure including expressive and impressive paragrammatisms,
and finally also an impaired ability to repeat words despite retained
comprehension and a relatively good ability to read. The syndrome is
discussed in its component parts. The paragrammatic disorder develops
because, although the motor structures for speech are completely intact, the
microgenesis of developing speech from the preverbal stage is not fully
completed but gets stuck halfway through, and thus the result shows all the
characteristics of the pre-Gestalt. The epicritic, that is, clear grammatical
structuredness of the sentence is lost. Word finding shows the same type of
disturbance; the paraphasic errors show all the characteristics of the absence
of epicritic detail. Because the process is slowed down, the search for a word
can be followed through the individual developmental phases, which are

quite similar to the individual phases of a microgenetic developmental

process. The disturbance of impressive performance corresponds to that of
the expressive performance. The intact grasp of meaning paired with a
disturbed grasp of speech sounds is a typical feature of the protopathic
change in Gestalt in the sense of physiognomization of perception. The
underlying change in function leads to a change in the temporal processes,
with the result that the time from reception of a stimulus until the meaning
is grasped is lengthened. The manifestation is more pronounced with
acoustic performance (which is normally tachistoscopic performance) than
with visual performance. The conduction aphasia (which, according to
Goldstein, would be better termed ’central’ aphasia) is thus the form of
aphasia in which the protopathic change in the Gestalt of speech performance
affects both expressive and impressive performance components; it attacks at
a place in the pre-verbal stage which is before the separation into expressive
and impressive components.
If one studies modern psycholinguistic models of the flow of activation in
speech production, which are based on experiments with event-related
potentials and other registration techniques, one is surprised by the similarity
of the concepts.&dquo; There no longer appears to be any doubt that the ’final
Gestalt’, the articulated word, stands at the end of a process, the duration of
which can be measured. With this approach grammatical processes, too, can
be demonstrated that are not already available in the language apparatus, but
must be generated anew each time, i.e., that must go through a Gestalt
process.
Conrad was decades ahead of his time with his developmental model.
With one exception, all his papers on brain pathology (neuropsychology)

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 349
were published in German shortly after the war and were therefore hardly
noticed internationally. The one exception of which I am aware and which is
cited occasionally, is a paper published in Brain (1954); in it, the main
questions addressed are those of localization. The analysis of 51 cases of
motor aphasia, 48 of which involved right-handed individuals, showed that
the closer the injury was to the sylvian fissure the more devastating the effect
on speech performance. Neither small injuries localized in Broca’s area

proper nor large areas of destruction at a greater distance led to permanent

speech impairment. Once again, with this finding and the localization of
other types of aphasia, for example, the word-finding disturbance and
amnestic and sensory aphasia, Conrad was ahead of his time.
For Conrad, the immense project on the structural analysis of cases of
brain pathology, completed in barely two years, was a preliminary study for
projects he planned to do later, among them the analysis of dreams based
on Gestalt theory (in which he discussed Freud’s theories extensively),
studies on the symptomatic psychoses, including Korsakoff’s psychosis and,
especially, incipient schizophrenia.
In 1948 a new period began in the life of the Conrad family of six. Conrad
was offered the newly established professorship for psychiatry and neurology
at the International University of Saarland, with a medical school located in
Homburg. In those days this meant that a window to the world opened for
them. The Federal Republic of Germany had not yet been founded. Even
after the currency reform in June 1948 the economic situation was still
di~cult. With very few exceptions, contacts with scientists abroad did not yet
exist. But Saarland, under French administration, was completely integrated
into the West. Because of his prewar acquaintance with French neurology
and psychiatry and thanks to his language skills, Conrad could quickly re-
establish the long-prohibited connection and begin a fruitful exchange of
ideas with clinicians working in neuropsychology, for example Henri H6caen
(Paris) and Oliver Zangwill (Oxford). And this in turn led to publications
because of the symposia of the aphasia researchers, which he helped
establish. Conrad was brilliant in discussion, always amiable and courteous,
but very rigorous in his argumentation. I remember one of the symposia,
held in an old abbey near Oxford with MacDonald Critchley as moderator,
at which the official topic was the function of the parietal lobe but where
there was also a heated discussion about visual agnosia and thus, in fact,
about perceptual disorders. Such debates, some of which were continued in
journals, were also extremely instructive and enlightening for young
researchers. Today, in both spirit and style they seem to have died out.
Through trips within Europe Conrad established new relationships, built
bridges between neurology and psychiatry, gave talks in 1949 at the First
International Congress of Neurology and in 1950 at the First International
Congress of Psychiatry, both in Paris, at a time when the official languages at
congresses were those of the ’Big Four’ Allied Powers only, and long before

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English had become the lingua franca of science. Conrad became an

honorary member of the Paris Neurological Society. In Henry Ey, whose
work first became known to a wide audience in Germany through Fortschritte
der Neurologie und Psychiatrie (then edited by Conrad, Scheid and
Weitbrecht), Conrad found a friend and colleague with the same desire to
trace psychiatric disorders back to an organodynamic foundation that treats
the psychopathological not as an epiphenomenon of organic processes but as
.

psychic structures that change according to a particular pattern. Current

psychopathology, dominated today by surveyors who keep surveying the land
but never dig in it, would probably have been a horror for him.
Conrad’s universal spirit did not allow him to restrict himself to his
specialty. His ongoing concern for his time is shown by his articles and talks,
for example, on the psychopathology of international tensions, on develop-
mental stages of mankind, on modern art, on Jugend und Alter als überindi-
viduelles Problem (Youth and old age as a problem beyond the individual),
and on Das Geistige und das Gehirrz (The mind and the brain). His article Der
zweite Siindetifall - psychiatrische Betrachtungen zur modernen Kunst (The
second fall of man - psychiatric observations on modern art), which
appeared in 1953 in Annales Universitatis Saraviensis, contains a penetrating
analysis of abstract and surrealist painting. The pointed critique of our
culture that appeared in 1961 in the Göttinger Universztdtsreden entitled Die
neurotischen Züge unserer Zeit (The neurotic aspects of our times) was a talk he
was not able to deliver because of his sudden illness. Challenging, original,
sometimes polemical and critical of fashionable views, Conrad expressed his
thoughts in polished language. He even avoided well-worn paths in his
lectures for students, revising them regularly.
In the spring of 1958 Conrad had accepted the position he was offered in
G6ttingen, succeeding Ewald as head of what was then the most modern
Nervenklinik, opened in 1955. As in Homburg, he covered the specialties of
neurology and psychiatry (which would later be separated). He built his first
house; chamber music at home flourished, with all four of his children
participating; hospitality was written large, and his wife was an unparalleled
hostess.
In the autumn of the same year Conrad was offered the position of head of
the psychiatric department at his old hunting ground, the Deutsche
Forschungsanstalt fur Psychiatrie in Munich (now the Max-Planck-Institut
fur Psychiatrie), and was asked to be a consultant on rebuilding the Institute.
Along with him, Richard Jung was to be appointed head of the
neurophysiology department. ’Herr Conrad’, it is reported, ’considers a
future biochemistry department to be the most important one; in his view the
problem of the major psychoses is a biochemical problem.’ (Herr Conrad hiilt
eine zukiinftige biochemische Abteilung fiir die wichtigste; das Problem der groj3en
Psychosen sei ein biochemisches.) In December 1960 the president of the Max-
Planck-Gesellschaft (Max Planck Society), Adolf Butenandt, asked Conrad

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whether he would accept the position as head of the Institute when the
hospital building had been completed, at the latest. Conrad assured him that
’of course’ he would accept the position at that time; he had already been
much involved in the Munich project. But he did ask Butenandt to bear in
mind that it would still be several years before the hospital building was
completed. (And in fact it was more than five years.) ’None of us know’, he
wrote, ’how long we will be able to work, but we certainly know that it will
not be forever.’ Conrad was 55 years old at the time. A few months later he
was dead.
While he was still in Homburg, Conrad had completed what was probably
his most influential work, Die beginnende Schizophrenie (Incipient Schizo-
phrenia). In G6ttingen he began tackling the whole field of the symptomatic
psychoses. He had already done a great deal of work on describing individual
disorders, e.g. chronic tactile hallucinosis, subacute panencephalitis and the
diabetic psychoses; Gestalt analysis of Korsako~’s psychosis has already been
mentioned. But now he tried to present a comprehensive description and
restructuring of this central group of psychopathological disorders.

The symptomatic psychoses

Conrad took advantage of the invitation to prepare the chapter ’Die sympto-
matischen Psychosen’ (The symptomatic psychoses) for the handbook
Psychiatrie der Gegenwart (Current Psychiatry), which was published in 1960
(the second edition, 1972, also included his chapter). In it Conrad rued the
fact that, in spite of important advances in the understanding of the mind,
little had been added to Bonhoeffer’s concept of ’exogenous reaction types’.
Conrad proposed that the view of the mind as an association of memory links
be replaced by a model that conceived of it as a whole (Ganzheit), as an
integrated totality which from the start appeared as a ’given’ to subjective
experience (Erlebera) . The method for gaining a better understanding of the
problem of the symptomatic psychoses was to study various aspects of
experiencing: content and components, field structure and dynamics.
Conrad’s method was again Gestalt analysis. In such a phenomenological
perspective we do not find a perceptual function, but only the perceived, and
here the goal is to study the laws governing the perceived, which constitute
the perceptual field. Thus, Conrad describes the change in the Gestalt of the
experiential field as a process that, from the prodromal manifestations of the
psychosis to clouding of consciousness and the delusional phenomena, passes
through characteristic states that can be described in terms of Gestalt
psychology. To this end he uses the model of the control of sleep and
wakefulness (Table 1). From being wide awake to being in deep, dreamless
sleep, there is a broad physiological transition zone, the area with which we
are concerned in some of the psychoses with a physical basis. The only
difference is that instead of the physiological change in the function of sleep

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TABLE 1. The symptomatic psychoses

From Psychiatrie der Gegenwart, Vol. 2 (Berlin: Springer, 1960), 379; translated from the German by
permission of the publisher.

we have apathological change in function resulting from a noxa. But there

are no specific noxious substances that produce specific symptoms.
Accordingly, Conrad describes the obligatory characteristics of the organic
psychoses and the different clinical syndromes in terms of Gestalt theory. He
concludes that there is no psychotic state that cannot also be found in
psychoses with a physical basis. In fact, the current nosology of psychiatry
became a problem for him; and from the perspective of human genetics, too,
he found the sharp differentiation between schizophrenia and cyclothymia, as
if they were completely different types of illness, to be highly questionable.
Finally, let us turn to the publication, also translated into Spanish and
Japanese, which is of most interest to psychiatrists today.

Die beginnende Schizophrenie (Incipient Schizophrenia)

The subtitle of the book is Versuch einer Gestaltanalyse des Wahns (Attempt at
a Gestalt Analysis of Delusion). Conrad saw that psychopathology after

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 353

Jaspers was in a dilemma. Either one tried to ’explain’ psychopathological

phenomena causally by tracing them back to an organic substrate and thus
transforming a psychopathological problem into a physiopathological
problem that was susceptible to medical treatment (’The causal connections
of psychic life’’6), or one attempted to ’understand’ the phenomenon by
tracing it back to some other aspect of the psyche (’Meaningful psychic
connections&dquo;’) and looking for relationships to other aspects of the
individual’s life history, thus transforming the psychopathological problem
into a hermeneutic problem.
Conrad proposed a third approach, the subtle description and analysis of
the psychopathological phenomenon experienced. Here again, the method is
Gestalt analysis. For everything that is experienced has a Gestalt, and the
analysis of given phenomena is always the analysis of forms and config-
urations.
With this in mind, Conrad studied 107 soldiers who during the war, in
1941/42, had suffered a ’fresh episode of schizophrenia’, two-thirds of whom
were between 20 and 31 years old. The fact that all those affected were
soldiers in uniform when the psychosis broke out turned out to be an
advantage, because the effect of being uniformed was that what was
experienced was also ’uniformed’ and this reinforced what was typical of the
illness, and what was typical for the individual became less important. The
aim of the study was to identify the laws governing the phases within an
individual episode of schizophrenia and to replace the past unrelatedness of
schizophrenic symptoms and courses with a structural relationship in which
everything that was happening can be seen in terms of uniform laws
compatible with Gestalt theory.
Conrad called the first phase Trema. It is a strange state that precedes the
delusions. With increasing affective tension (Bodenaffektivität, to use Kurt
Lewin’s term), the individual’s environment gains a strange, never-before-
experienced physiognomic trait. ’It looks coldly and hostilely at the person
experiencing it, as if at someone who has been condemned.’ (Es sieht kalt und
feindselig auf den Erlebenden wie auf einen, fiber den man den Stab gebrochen
hat.) This trema phase can go on for a long time. It is followed by the
apophany phase, the experience of abnormal awareness of meaning and the
sense of being at the centre of what is happening in the world. These types of
experience, which always occur together, form the central feature of
schizophrenic experience. The cause is a severe disturbance of the ability to
change systems of reference. Although all healthy individuals are the centre
of their ’world’, they are still able to see themselves as one among others,
stand next to others or put themselves in someone else’s shoes. In contrast,
people with schizophrenia have in their psychosis lost the possibility of
’changing perspectives’ ( Uberstieg) . They are no longer able to change the
system of reference. Therefore everything is related to them no matter where
they direct their attention.

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354

Using an example of Gestalt perception,

Conrad demonstrates the ability of healthy
individuals to change their system of reference
constantly. The diagram in Fig. 1 can be seen in
two ways: if we interpret it as two squares that
intersect each other, then the small rhombus in
the middle ’means’ the area common to both of
the large squares; but if we see two angular
Fig. 1. Diagram from Die figures that touch each other at their corners,
beginnende Schizophrenie, p. 48 then the rhombus in the middle ’means’ simply
part of the background. Analogously, the
delusional individual is unable to achieve the
shift from one system of reference to another. The first manifestation of
schizophrenic delusion occurs at the instant when changing perspectives has
become impossible. But it is not just the environment, the exterior space,
that is affected by the apophany; the internal space is also changed by it. Each
’idea’ (Einfalv becomes ’inspiration’ (Eingebung), one’s own thoughts can be
read by anyone, and so forth. The wall separating the world and me becomes
porous. The more advanced the destruction process, the more the general
properties (Wesenseigenschaften) prevail in the perceptual field, with the result
that the perceptual connection begins to weaken. With the severing of the
situational connection, the contact to the affected individual also ceases.
The apocalyptic phase begins. The field of experience is flooded with pictures,
the order in thinking is lost, ’voices’ dominate the internal field. The point of
culmination is catatonia. In the slow consolidation process the individual
goes through the phase of apophany in reverse. As on the way to catatonia, a
brief paranoid phase reappears until the delusions begin to disappear.
Consolidation can go as far as to a ’Copernican change’: the affected
individuals are again able to achieve the ’crossing-over’ process and can
recognize that the change was not in the outside world but rather in themselves.
This would mean that the psychosis was healed. If residual symptoms
remain, Conrad attributes them to the reduction in the energy potential. In
this loss of potential - with different degrees of severity - he sees the specific
(organic) schizophrenic change, the pathological change in function due to a
problem in the brain that underlies schizophrenia in the different phases
described. ’It must be a change in function in those parts of the cerebral
organization through which the human brain is distinguished from the brains
of the highest primates, that is, those parts that are peculiar to humans.’ (Es
muss sich um einen Funktionswandel jener Anteile der cerebralen Organisation

handeln, durch die sich das menschliche von den höchsten Primatengehimen
unterscheidet, die also speziell dem Menschen eigentiitnlich sind.) It is worth
’continuing the search for the pathological substrate of this process’.
Conrad’s phase model, whose far-reaching consequences for psychiatric
nosology cannot be discussed here, was tested by Hambrecht and Hafner’8

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 355
on a representative sample. Their results supported Conrad’s assumption of
a prepsychotic phase (trema) followed regularly by a psychotic-productive
phase (apophany), and they also showed that Conrad’s findings could be
extended to include both sexes and an age range of 12-59 years. But the
strict succession of apophany and apocalypse could not be demonstrated.
For methodological reasons, however, a conclusive statement on this issue
could not yet be made.
One must appreciate the very close relationship between the publications
Strukturanalysen hirnpathologischer Fdlle, Die symptomatischen Psychosen and
Die beginnende Schizophrenie in order to understand that they represent the
development of a reformatory psychopathology that was closely related to
the classical-empirical foundations of our field, but also marked a radical
break with their theoretical prerequisites, namely, with the psychology of the
nineteenth century. Central concepts, such as consciousness, the unconscious,
recent memory and attention take on a new meaning through Gestalt analysis.
Conrad was convinced that the only way to an understanding of the psychosis
problem was that of brain pathology (neuropsychology). With this view, he
led phenomenological psychopathology back to a basis in science and medicine.
Unceasingly active, but at peace with himself and without haste, Conrad
fashioned his life and his work, both in rare accord with each other. His path
in life seemed straight and always headed for the peak. But in early 1961 a
myeloma was discovered, and six weeks before his fifty-sixth birthday he
died, on 5 May 1961.
Klaus Conrad was a remarkable individual both intellectually and as a
person. For those who knew him personally, he was a shining example - as a
clinician, as a researcher and as a human being. The originality of his
thinking, his passion and his wide-ranging thoughts were fascinating, and
they stimulated not only his field of specialization but also related disciplines
in science and the humanities. His courageous analyses of apparently
unshakeable teachings in psychiatry brought changes in the phenomen-
ological psychopathology of his time. The question of what influences he
would have had on psychiatry if he had lived longer is unanswerable. The
only thing that is certain is that he would have been very actively involved in
its further development. For those looking for a model of how clinical work
with patients can be conducted as basic science, an in-depth study of Klaus
Conrad’s work would be rewarding.

Selection of Conrad’s publications

The following are selected from more than one hundred.

Monographs and contributions to handbooks

1939. Erbkreis der Epilepsie. In G. Just (ed.), Handbuch der Erbbiologie des
Menschen, Vol. 5 (Berlin: Springer), 932-1020.

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 356

1941. Der Konstitutionstypus als genetisches Problem (Berlin: Springer).

1951. Contribution for Germany. In G. W. Kisler (ed.), World-tension: The
Psychopathology of International Relations (New York), 87-105.
1958. Die beginnende Schizophrenie. Versuch einer Gestaltanalyse des Wahns
(Stuttgart: Thieme).
1958. Das vierte Zeitalter und die moderne Kunst. In H. Ehrhardt et al.
(eds), Psychiatrie und Gesellschaft (Bern/Stuttgart: Huber), 102-13.
1960. Die symptomatischen Psychosen. In H. W. Gruhle, R. Jung, W.
Mayer-Gross and W. Mfller (eds), Psychiatrie der Gegenwart, Vol. II
(Berlin/Gottingen/Heidelberg: Springer), 369-436; 2nd edn 1972.
1963. Der Konstitutionstypus. Theoretische Grwzdlegung und praktische
Bestimmung, 2nd rev. edn (Berlin: Springer).
1967. Konstitution. In H. W. Gruhle, R. Jung, W. Mayer-Gross and W.
Muller (eds), Psychiatrie der Gegenwart, Vol. I/1 (Berlin/G6ttingen/
Heidelberg: Springer), 70-151.
Publications in journals
1932. Versuch einer psychologischen Analyse des Parietalsyndroms. Monats-
schriftfiir Psychiatrie und Neurologie, 84, 28-97.
1933. Das K6rperschema. Eine kritische Studie und der Versuch einer
Revision. Zeitschrift fiir die gesamte Neurologie und Psychiatrie, 147, 346-69.
1938. Epilepsie. Vererbung und Konstitution. Zeitschrzft fiir die gesamte
Neurologie und Psychiatrie, 161, 280-92.
1939. Der Begriff der Erbanlage und ihre quantitative Stufung. Allgemeine
Zeitschrzft für Psychiatrie, 112, 126-37.
1947/1948. Strukturanalysen hirnpathologischer Fdlle: Part 1, Part 2 in
Deutsche Zeitschrift fiir Nervenheilkunde, lS8 (1947), 344-71, 372-434;
Part 3, Part 4 in Archiv fiir Psychiatrie vereinigt mit Zeitschrift fiir
Neurologie, 179, 180 (1948), 502-67, 54-104; Part 5, Part 6 in
. Deutsche Zeitschrift fiir Nervenheilkunde, 158, IS9 (1948), 132-87,
188-228.
1948. Über differentiale und integrale Gestaltfunktion und den Begriff der
Protopathie. Der Nervenarzt, 19, 315-23.
1949. Das Problem der gest6rten Wortfindung in gestalttheoretischer
Betrachtung. Schweizer Archiv fiir Neurologie und Psychiatrie, 63,
141-92.
1951. Jugend und Alter als uberindividuelles Problem. Studium Generale, 4,
580-7.
1952. Die Gestaltanalyse in der Psychiatrie. Studium Generale, 5, 503-14
[contains list of publications on brain pathology up to 1949].
1953. Über einen Fall von ’Minuten-Geddchtnis’. Beitrag zum Problem des
amnestischen Symptomenkomplexes. Archiv fiir Psychiatrie und
Zeitschrift für Neurologie, 190, 471-502.
1953. Zur Psychopathologie des amnestischen Symptomenkomplexes. Gestalt-

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 357

analyse einer Korsakowschen Psychose. Deutsche Zeitschrift fur Nerven-

heilkunde, 170, 35-60.
1953. Über Erregungsnachdauer und Refraktdrphase im Gestaltwandel
h6herer Leistungen. Analyse eines Syndroms der parieto-occipitalen
Übergangsregion. Archiv fiir Psychiatrie und Nervenk rank heiten, 190,
196-220.
1953. Der zweite Sundenfall. Annales Universitatis Saraviensis, 1/2, 3-20.
1954. New problems of aphasia. Brain, 77, 491-509.
1954. Das Geistige und das Gehirn. Deutsche Universitdts-Zeitung, 5, 6 (8 and
22 March).
1955. Zum Problem der chronischen taktilen Halluzinose. Archiv fur Psychiatrie
und Nervenkrankheiten, 193, 601-6.
1957. Das Unbewuf3te als phdnomenologisches Problem. Fortschritte der
Neurologie, - Psychiatrie, 25, 56-73.
1959. Gestaltanalyse und Daseinsanalytik. Der Nervenarzt, 30, 405-10.
1959. Das Problem der ’nosologischen Einheit’ in der Psychiatrie. Der
Nervenarzt, 30, 488-94.
1960. Die Gestaltanalyse in der psychiatrischen Forschung. Der Nervenarzt,
31, 267-73.

TRANSLATOR’S NOTES
1. Then part of Austria-Hungary, now in the Czech Republic.
2. Then also part of Austria-Hungary, now in Romania.
3. A lake near Salzburg; it became well-known among scientists, especially behavioural scientists,
through von Frisch.
4. A lake near Wolfgangsee.
5. Six years was normal.
6. Now the Deutsche Forschungsgemeinschaft (German Research Foundation).
7. Now the Max-Planck-Institut fur Psychiatrie (Max Planck Institute for Psychiatry).
8. English translation: Karl Jaspers (1963). General Psychopathology (Manchester: Manchester
University Press).
9. Rainer Knußmann (1978). Konstitution, Vererbung und Umwelt. Collegium Anthropologicum,
2, 154-67.
10. Karl Jaspers (1946). Allgemeine Psychopathologie, 4th edn (Berlin: Springer-Verlag).
11. H. W. Gruhle, R. Jung, W. Mayer-Gross and M. Müller (eds) (1960/1967). Psychiatrie der
Gegenwart. Forschung und Praxis, 3 vols (Berlin/Heidelberg/New York: Springer).
12. Near Stuttgart.
13. Translation, without rhymes.
14. Viktor von Weizsäcker (1940). Der Gestaltkreis. Theorie der Einheit von Wahrnehmen und Bewegen
(Leipzig: Thieme).
15. Willem J. M. Levelt (1989). Speaking: From Intention to Articulation (Cambridge, MA: MIT
Press); 5th print 1998.
16. Jaspers, General Psychopathology (
op. cit., Note 8), part 3.
17. Ibid., part 2.
18. Martin Hambrecht and Heinz Häfner (1993). ’Trema, Apophänie, Apokalypse’ - Ist Conrads
Phasenmodell empirisch begründbar?(’Trema, apophany, apocalypse’ - Can Conrad’s phase
model be substantiated empirically?). Fortschritte der Neurologie - Psychiatrie, 61, 418-23.

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