978836

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HPY0010.1177/0957154X20978836History of PsychiatryBraun

Article

History of Psychiatry

Karl Leonhard (1904–88) and his

2021, Vol. 32(2) 195­–209
© The Author(s) 2020
Article reuse guidelines:
academic influence through the sagepub.com/journals-permissions
DOI: 10.1177/0957154X20978836
https://doi.org/10.1177/0957154X20978836
‘Erlangen School’ journals.sagepub.com/home/hpy

Birgit Braun
University Hospital Regensburg, Germany

Abstract
The Erlangen University Psychiatric and Mental Clinic was an annexe to the Erlangen Mental Asylum, so
when Leonhard worked there he became acquainted with acute and chronic stages of schizophrenia. This
can be viewed as a decisive impulse for his later differentiated classification of types of schizophrenia. The
suspicion that Leonhard suffered from attention deficit hyperactivity disorder cannot be supported. His
reticence concerning social-psychiatric aspects is analysed in the context of his early professional contact
with the ‘Erlangen system’ of open care and its Nazi perversion. Leonhard’s role in National Socialism is still
uncertain. His unsuccessful attempts to retain the Erlangen Chair of Psychiatry and Mental Illness in 1951 can
be viewed as his first difficulty in the tensions between West Germany and East Germany.

Keywords
Anxiety-happiness psychosis, Erlangen School, history of psychiatry, Karl Leonhard, NS-psychiatry,
schizophrenias

From an early career goal of psychiatry to becoming a professor

Karl Leonhard was born on 21 March 1904 in Edelsfeld near Sulzbach in Bavaria/Upper Palatinate
as the sixth child in the large family (altogether 7 brothers, 4 sisters) of a Protestant pastor. Leonhard
attended the humanistic grammar school (Humanistisches Gymnasium) in Weiden. Having passed
his university entrance qualification, Leonhard began his studies in Erlangen in 1923, where he
took the medical state examination in 1928 after external semesters in Munich and Berlin. In
Berlin, Karl Bonhoeffer (1868–1948) in particular had influenced him: ‘If there was any doubt
before that I would one day be a psychiatrist, the doubt was finally removed by Bonhoeffer’s lec-
ture’ (Leonhard, 1995: 24; see further Leonhard, 1977: 261). Leonhard spent his time as a medical
assistant at the municipal hospital in Nuremberg, mainly in the department of Dr Karl von Rad,
which consisted of about 90 psychiatric and 30 neurological patients (p. 26). During this time,
Leonhard completed his doctorate under Gottfried Ewald (1888–1963) at the Erlangen University
Psychiatric and Mental Clinic. Leonhard then became an assistant doctor under Gustav Specht

Corresponding author:
Birgit Braun, Department of Psychosomatic Medicine, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11,
Regensburg 93053, Germany.
Email: birgit.braun@ukr.de
196 History of Psychiatry 32(2)

(1860–1940), who was the first Ordinarius Professor of Psychiatry in Erlangen since 1903 (Braun
and Kornhuber, 2014d, 2020).
Leonhard’s file in the staff administration archives only preserves the first contract dated 21
June 1929, which states that he was contracted ‘as extracurricular assistant from 01/07/1929 to
01/07/1930’ (UAE: A2/1 No. L61). But in this file, there is a letter from the Directorate of the
Psychiatric Clinic1 dated 30 March 1931 to the Medical Faculty concerning the ‘reappointment of
the post of extracurricular assistant at the Psychiatric and Mental Clinic’. This allows us to trace
the period of Karl Leonhard’s work at the Erlangen University Psychiatric and Mental Clinic: ‘On
30/04/1931, the extracurricular assistant physician Dr. Karl Leonhard is leaving the Psychiatric and
Mental Clinic to fill the position of senior physician assigned to him at the Upper Bavarian Mental
Asylum in Gaberseee.’ However, the reference to the position of senior physician conferred in
Gabersee must be regarded as erroneous: his early publication from Gabersee under the direction
of the senior medical officer Dr Friedrich Utz (1876–1945) refers to Leonhard’s position as ‘assis-
tant doctor of the Mental Asylum’ (Leonhard, 1931: 226).
On 8 June 1931, Leonhard was married in Nuremberg. In the following year, he passed the
examination for the medical state service, and on 1 December 1932 he became senior physician in
Gabersee. His medical colleagues there – according to Leonhard (1995: 32) – displayed no scientific
interest, so ‘the whole asylum was at my disposal for research’. In addition to routine medical work,
he was mainly dedicated to the examination of chronic schizophrenic patients in Gabersee. Since he
‘wanted to get closer to scientific circles again than was possible in Gabersee’ (p. 34), he accepted a
position as senior physician at the Erlangen Mental Asylum, which he ‘already knew well’ due to his
‘previous activity’ at the Erlangen University Psychiatric and Mental Clinic (an annexe to the
Erlangen Mental Asylum). During his time at the Erlangen Mental Asylum, from the beginning of
October to the end of December 1935, Leonhard ‘got to know several chronic schizophrenics’.
On 1 January 1936, Karl Kleist (1879–1960) gave Leonhard a position as senior physician at the
Mental Clinic of the Goethe University and City of Frankfurt (Figure 1). In 1937, Leonhard habili-
tated there with studies performed in Gabersee on ‘the defective-schizophrenic disease pattern’
(Leonhard, 1936). In 1944, Leonhard was promoted to associate professor. However, his desire to
succeed Kleist in Frankfurt in 1950 failed. In 1955, at the age of 50, Leonhard was appointed to the
Chair of Psychiatry and Neurology at the Erfurt Medical Academy in Thuringia/East Germany. From
1957 until his retirement in 1970, he headed the Psychiatric and Mental Clinic at Charité Hospital at
Humboldt University, Berlin/East Germany. Until three days before his death on 23 April 1988, ‘he
was the designer of neurology and psychiatry’, according to Klaus-Jürgen Neumärker (b. 1940)
(2008: 327), who succeeded Leonhard as head of the now independent children’s department of
Charité Hospital. Even as Emeritus Professor, Leonhard visited ‘Charité Hospital daily at quarter to
eight, coming home in the evening at half past five’ (Beckmann, 1998: 119).

Leonhard’s academic influence through the ‘Erlangen School’

Leonhard’s doctorate under the senior physician Gottfried Ewald has dealt with ‘capillary micro-
scopic examinations of circular and schizophrenic patients and on the relationship of loop length
to certain character structures’ (Leonhard, 1928).
The research approach of capillary microscopic examinations of the fingernail fold was based
on the theory of Walther Jaensch (1889–1950) (HUB UK J 018; see Jaensch, 1929, 1936; Ristau,
2013: 119), according to which the capillaries of the acra (fingernail fold) enable a classification
into certain personality types. Leonhard concluded his work, confident that ‘one will gradually be
able to deduce further character traits from the capillary structure of the skin, the organ that is his-
torically related to the brain’ (Leonhard, 1930a: 38).
Braun 197

In his contribution to the Festschrift for

Gustav Specht, Karl Leonhard described in
great detail the hallucinatory disease pattern
of a post-encephalic patient, N.R. (Leonhard,
1930b), whose case files (APNK 125/30; see
Braun, 2017: 299–302) and personal letters
(APNK 125/30) to Leonhard have been found.2
In this case, Leonhard illustrated the differen-
tiation between organic and endogenous psy-
choses, and his method of meticulously
describing disease symptoms and their locali-
zation is characteristic of his phenomenologi-
cal approach. The extensive study of N.R.
Figure 1.  Photograph of Karl Leonhard (undated); gave Leonhard diagnostic certainty in the
held by Universitätsarchiv Frankfurt am Main (Abt. 854 distinction between organic and endogenous
Nr. 925) and reproduced with permission of UAF. psychoses. As the Erlangen University
Psychiatric and Mental Clinic was attached to
the Erlangen Mental Asylum (Braun, 2020d; Braun and Kornhuber, 2013a, 2013b, 2016),
Leonhard was able to become acquainted with acute and chronic stages of schizophrenia. This
directed his research towards schizophrenia and atypical psychoses (Leonhard, 1934, 1935a,
1935b, 1935c).

Leonhard’s academic development

Most of the information in the following subsections is from archival sources (UAF, Dept. 4 No.
1454 and UAF, Dept. 14, No. 2386).

Post-doctoral research in 1937.  A mere 12 months after his transfer from the Erlangen Mental Asy-
lum to the Mental Clinic of the Goethe University and City of Frankfurt, Leonhard gave a scientific
presentation to the faculty on 14 January 1937 on the topic of ‘exogenous schizophrenia’. On 23
February, the Medical Faculty was authorized by the Imperial and Prussian Minister of Science,
Education and National Education ‘on the basis of §6 of the Imperial Post-Doctoral Research Ordi-
nance of 13/12/1934 - R U I 730’ to ‘award the state doctorate to Dr. med. Karl Leonhard’. He gave
a one-hour demonstration lesson on 24 June, in the presence of the historian and rector Walter
Platzhoff (1881–1969). Although Leonhard’s lecture was not very animated (according to Platzhoff’s
letter of 13 July 1937 to the Imperial and Prussian Minister of Science, Education and National
Education), all listeners had been captivated by the topic: ‘In general, the impression prevailed that
Dr. Leonhard, who in his former position at a mental asylum had lacked practice in lecturing, would
develop into a good lecturer if he continued to teach.’

On the results of Leonhard’s lectureship. In a letter from Kleist to the dean (3 March 1943), he
requested that Leonhard, as the ‘first senior physician’ of his clinic, be given the title of associate
professor: ‘On 23/07/43, he will therefore have been a lecturer for 6 years, and the time seems to
have come to start the preparations for the promotion I have recommended, which will take some
time . . .’.

Classification of schizophrenia.  Kleist emphasized that Leonhard had been able to use the results of his
habilitation thesis in the investigations on special forms of schizophrenia, which Leonhard and other
colleagues had carried out over several years. According to Kleist, Leonhard had been decisively
198 History of Psychiatry 32(2)

involved in the catamnestic follow-up examinations focusing on hereditary biology. Kleist pointed
out, that the elaboration of the hebephrenic forms was still not finished because of the tardiness of
Hans Bodo Gorgaß (1909–93). From 18 June 1941 onwards, the latter was – under the code name
“Dr. Kramer” – responsible for the gas poisoning in the asylum of Hadamar. Gorgaß did not com-
plete his doctorate under Kleist on the topic of catamnestic follow-up examinations of hebephrenic
patients (see further Sandner, 2003: 435; Klee, 2003: 192–193). Kleist continued:

Leonard also re-examined the different heredity of typical and atypical schizophrenia, together with W.
Schulz [sic]³ (from the German Research Institute of Psychiatry in Munich), in a larger group of patients
of Bavarian Mental Homes and confirmed the stronger hereditary burden of the atypical forms compared
with the typical ones; however, some typical types, especially parakinetic catatonia, were also very
strongly affected by heredity.

Affective disorders and the Leonhard cycloid psychoses (LZP).  Kleist mentioned anxious depression
as a further field of Leonhard’s work, and his monograph on involutive and idiopathic anxiety
depression and heredity (Leonhard, 1937) was awarded the Heinrich Lähr (1820–1905) Founda-
tion Prize by the German Society for Psychiatry and Neurology. According to Kleist (letter to the
Dean, 3 March 1943), Leonhard answered ‘the much disputed question about the clinical status
of anxiety-related depression, especially in regression age, to the effect that there are two types of
such disorders’. Leonhard first identified the ‘often periodically active anxiety psychosis (Wer-
nicke)’, which occurs mainly, but not exclusively, during the age of regression (see also Braun,
2019; Braun and Kornhuber, 2015c). Second, Leonhard dealt with the entity of real involutional
psychosis, which occurs only during regression age, possibly only in the climacteric.
In addition, Kleist’s letter emphasized that Leonhard had described ‘delusional diseases related
to anxiety psychoses, in which self-relationships, sensory delusions and thoughts of persecution
join anxious moods, while in the opposite phases of happiness, ecstasies and experiences of inspi-
ration occur’. The here described anxiety-happiness psychosis forms – in addition to confusion
psychosis and motility psychosis – one of the three LZP.

Leonhard’s role as a psychiatrist during the Nazi era

Leonhard’s dissertation was based on one of the controversial hypotheses of the anthropologist,
sports physician and later SS-captain (Hauptsturmführer) Walther Jaensch. This fact may indi-
cate that Leonhard and his supervisor Ewald (as a representative of the Erlangen School4) also
thought that another idea developed by Jaensch was important: the eugenically motivated
‘enhancement of the military- and reproductive force’ of the german nation (Klee, 2003: 281).
In 1937, Leonhard joined the Nationalsozialistische Deutsche Arbeiterpartei (NSDAP). In his
letter of discharge for Leonhard in September 1946, Traugott Riechert (1905–83), who was
head of the Department of Neurosurgery in Freiburg/Breisgau and had worked with Leonhard
at the Kleist Clinic from 1937 to 1939, pointed out that a lack of party membership would have
led to the need to renounce posts as university lecturer and to the impossibility of actively con-
tinuing to work in medical science (HHStA 520/11 Abt: 11187/1). Leonhard was also a member
of the National Socialist Lecturers’ Association during the Nazi era (see Figure 2). Later he
stated that this was inevitable because of his membership of the NSDAP. Leonhard also said
that his medical activity in the H-J (Hitlerjugend: Hitler Youth), for which he was the chief
physician in 1943, automatically had made him a candidate for the National Socialist Medical
Association; but he pointed out that, since he had never made an application, he had not become
a member (UAF, Dept. 4 No. 1454).
Braun 199

In Kleist’s application to the dean for the appointment of Leonhard as associate professor, he
emphasized that Leonhard had, in addition to his work as a senior physician, also headed the
hereditary-biological department of the clinic. The clinic director had been burdened with
Wehrmacht medical duties since the beginning of the war, so Leonhard had frequently represented
him in the Erbgesundheitsobergericht (EGOG, Higher Hereditary Health Court; see: ISG A.51.03
Spezialinventar anonymisiert); it was thus ‘also proven that he fulfils all requirements that are
made of a full professor in our field’ (letter of 3 March 1943, UAF, Dept. 4 No. 1454). According
to Leonhard’s letter on 15 March 1944 to the Plenipotentiary for the Medical and Health Care
System, he had always been politically in agreement with National Socialism, was a member of the
party and a chief physician at the H-J. He emphasized that clinical psychiatric diagnosis should be
promoted primarily through racial examinations (BAB, VBS 307/8200001963). Leonhard did not
mention the practical eugenic relevance of his differentiated diagnostic classification. He stated:

The heredity of this climacteric depression in the narrower sense seems to be low, but my investigations
are not sufficient for this. Anxiety psychoses, on the other hand, both idiopathic and involutional, are,
according to my investigations, so substantially affected that it is not necessary to remove them from the
large group in practical eugenic questions. However, their fundamentally special position should not be
affected by this. (Leonhard, 1938: 515)

In this context, the report of the Higher Regional Court Councilor Dr Grunau, Kiel, which forms
part of the Kleist estate and provides an external assessment of the Kleist-Leonhard classification,
is relevant:

The representative of the presumed hereditary-ill patient has pointed out that the expert opinion of the
University Mental Clinic [Frankfurt] is that the hereditary-ill patient suffers from a paraphrenic psychosis
and is not a genuine schizophrenic. The Higher Hereditary Health Court cannot agree with this expert
opinion in relation to the distinction between paraphrenic psychosis and schizophrenia. According to the
prevailing view in medicine today, which is also supported by the EGOG, paraphrenic psychosis is a type
of schizophrenia. The latter encompasses the paraphrenic psychosis. (HHStA: 1069/ 57/1)

Leonhard’s denazification
The examination board of the medical faculty of the Johann Wolfgang Goethe University in Frankfurt
met on 7 August 1945, with the advocate Dr Flesch attending as chairman and the pharmacologist
Fritz Külz (1887–1949) and the pediatrician Bernhard de Rudder (1894–1962) as assessors. It raised
no objections to retaining Leonhard in office, emphasizing his ‘strictly Protestant family (father,
brother and brother-in-law are pastors), his wife belongs to the confessional church and his children
aged 11 and 7 years have been baptized’ (UAF, Dept. 4 No. 1454).
In his letter (11 August 1946) to the chairman of the Denazification Court in Frankfurt, Leonhard
asked for preferential treatment in the political examination procedure, particularly as he had been
‘shortlisted for the Chair of Psychiatry at the University of Mainz’ (HHStA 520/11 Dept: 11187/1).
He said that the university’s examination board and the main examination board declared him
politically unproblematic. The American military government also recognized him as politically
unproblematic, according to Leonhard’s own information, and approved of him continuing to work
as a university professor. The city of Frankfurt also regarded him as unproblematic and had kept
him in its service, as reported by Leonhard. Leonhard wrote that he had been ‘like all other Pgs
[“ParteiGenosse”, party member] set at the salary of a worker’, but that the city had submitted an
application for his reinstatement into employment. Leonhard stated: ‘According to the provisions
of the law, I am a “follower”, as I have belonged to the party since 1937’. Furthermore, he said:
200 History of Psychiatry 32(2)

Figure 2.  Expert opinion of the National Socialist Lecturers’ Association regarding Leonhard; held by
Universitätsarchiv Frankfurt am Main (Abt. 14 Nr.2386) and reproduced with permission of UAF.
Braun 201

I can present many testimonies that I never actively participated in National Socialist activities, including
testimonies that I spoke out against National Socialism and its institutions. If that is not enough as the
active statement against National Socialism required by law, then I will also submit to the judge who
identified me as a follower. I would be very grateful for a speedy resolution.

In another letter from Leonhard to the Denazification Court on 5 September 1946, he submitted
evidence that he was not to be classified as a ‘follower’, as he himself had stated on the report form,
but rather to be included in the group of exonerated persons, group 5: ‘I [have] fought against
National Socialism as far as possible without regard to my own person.’
In March 1944, after severe damage to the local Mental Clinic in Frankfurt, the sick had to be
brought to the Eichberg Asylum (see Sandner, 1999), which ‘in the course of the war became known
more and more’ for carrying out ‘treatment according to Nazi methods’ (HHStA 520/11 Dept:
11187/1).5 When Leonhard, representing Kleist, wanted to enforce the care of the sick in Eichberg
Asylum by doctors and nursing staff of the Mental Clinic, he met with resistance from its director
and the director’s superior ‘Mr. Bernodat’ [sic] in Wiesbaden, provincial capital of Hessen. It is
assumed that this refers to Fritz Bernotat (1890–1951), who – as SS colonel (SS-Standartenführer)
and member of the provincial government (Landesrat) as well as Head of the Institutional Department
of the Nassau6 District Association – was significantly involved in the organization and implementa-
tion of the National Socialist ‘euthanasia’ programme.7 Leonhard stated that, after this dispute,
Bernotat finally had rejected him ‘as an anti-Nazi’ and ‘also informed the Frankfurt office of the
Imperial Defence Commissariat (Reichsverteidungskommissariat)’ by telephone. Leonhard said
that he had turned to the Darmstadt8 urban municipality authorities, where he had been ‘more fortu-
nate’ than with the Wiesbaden ones: he had succeeded in ‘creating an alternative site in Goddelau9
for the Mental Clinic and bringing the sick from Eichberg there’.
At a meeting on 6 May 1947, the examination board for cases of ‘followers’ at the University of
Frankfurt consisted of the presiding lawyer Franz Böhm (1895–1977), the physiologist Kurt Felix
(1888–1960), the historian Paul Kirn (1890–1965), the natural scientist Willy Hartner (1905–1981)
and the economist and social scientist Heinz Sauermann (1905–1981), who were deans of the five
faculties; they approved the reinstatement of Leonhard as associate professor and lecturer in
psychiatry and neurology.
In the post-war period, Leonhard was accused of having denounced an employee, so he for-
mally belonged to group 2, ‘Incriminated’, for a period of about three months. On 15 November
1946, the nurse Eva Gleichmann had made a complaint against Leonhard. According to Gleichmann,
there had been a meeting of the Special Court in Frankfurt (chairman: Ldg. [Landgerichts] Rat,
Regional Court Councilor Elldracher), where Leonhard, the hospital matron Anna Buffler, nurses
Hampel and Parlitz and Dr Edda Neele10 also appeared as complainants and witnesses.
Gleichmann said: ‘I had refused to join the Nazi Sisterhood despite repeated requests. Dr. Leonhard
explained to me that my anti-fascist attitude was not acceptable for the National Socialist operation
he was leading. I was then summarily released, arrested and sentenced to 21 months in prison’. A
document dated 16 October 1947 states that Leonhard ‘is to be considered as incriminated pursuant
to Art. 10’, but this was withdrawn on 15 January 1948, because a notice of atonement as ‘follower’
dated 9 November 1946 was already legally binding on 23 November 1946.

Published assessments
According to Karl Leonhard’s son, Volkmar, a treatise by his father dedicated to Ernst Rüdin
(1874–1952) on the ‘hereditary assessment of atypical psychoses’ (Leonhard, 1934) has aroused
suspicion that ‘Karl Leonhard had at least supported National Socialist ideas’ (Leonhard, 1995: 6).
In order to exonerate his father, Volkmar Leonhard referred to a lecture at the General Conference
202 History of Psychiatry 32(2)

of the Society for Psychiatry and Neurology of the German Democratic Republic (GDR) in Leipzig
(7–9 February 1990), in which no ‘indications of a way of thinking rooted in the eugenic thinking
of the National Socialist era’ had been found (p. 7).
Fourteen years later, this statement was interpreted as intention to whitewash Leonhard. On the
occasion of Leonhard’s 100th birthday, a personal ‘exchange of blows’ took place between Hans-
Ulrich Deppe (b. 1939), former Director of the Institute for Medical Sociology in Frankfurt, and
Hans-Joachim Bochnik (1920–2005),11 former Ordinarius Professor of Psychiatry in Frankfurt
(Bochnik, 2004a, 2004b; Deppe, 2004). Recent studies also have shown that the assessment, made
at the time of the German reunification, lacks differentiation.

Current research and further desiderata

Leonhard’s conscientiousness and diligence in preparing expert opinions pursuant to the Nazi Law
for the Prevention of Hereditarily Diseased Offspring (GzVeN: Gesetz zur Verhütung erbkranken
Nachwuchses) is called into question by R.K: On 29 June 1936, Leonhard prepared an expert opin-
ion on this presumed hereditary-ill patient for the Cologne Higher Hereditary Health Court. He had
not seen this patient himself and had based his diagnosis only on reading the files of the EGOG,
the medical histories of the naturopathy department of the Cologne Citizen’s Hospital, of the
Municipal Hospital Cologne-Deutz and of the Provincial Mental Asylum in Bonn, as well as on the
medical history of a nurse from the State Mental Asylum in Untergöltzsch12: ‘Instead, this is a
schizophrenic disorder, the predisposition of which is further demonstrated by her sister’s illness.
The requirements of the Nazi Law for the Prevention of Hereditarily Diseased Offspring have been
met’ (HHStA 1069/57/1).
With regard to Leonhard`s implementation of the GzVeN, doubts about ‘good’ scientific practice
– according to the standards of professional ethics at the time – may hence arise. However, the trans-
fer of Clinic patients from Eichberg to Goddelau initiated by Leonhard could be seen as an active
anti-‘euthanasia’ step, so a field for future research would be a detailed review of all existing archive
material on this relocation from Eichberg to Goddelau. A letter (11 April 1947) from the dean to the
rector regarding the reinstatement of Leonhard, which includes an identical description of the con-
texts of the transfer to Goddelau (UAF, Dept. 4 No. 1454) as an elaborate additional source, cannot
be considered independently (see further Leonhard, 1977: 267). Only by reviewing a sufficiently
large amount of independent source material could one exclude Leonhard from exaggerating the situ-
ational conditions in favour of his ‘anti-euthanasia’ stylization. The intensive source work required
for this, with a consecutive detailed ethical classification of Leonhard’s role as a psychiatrist in the
Nazi era, would go beyond the objectives and scope of this article.

Leonhard in the area of conflict between West-East and East-

West Germany
Leonhard attempted to succeed Heinrich Scheller (1901–72), who held the Chair of Psychiatry
and Mental Illness in Erlangen from 1948 to 1951. Leonhard’s name was the third suggestion on
the list of candidates, dated 9 July 1951. Top of the list was Fritz Eugen Flügel (1897–1973), who
had relocated in 1949 from Halle in East Germany to West Germany. He ‘had to flee to ensure
life and limb because of his political opi­nions’, according to the mayor of Bamberg, Anton
Hergenröder (1910–95), writing from 10 August 1951 to the Bavarian State Ministry for
Education and Culture for the attention of Dr Josef Schwalber (1902–69); Flügel finally was
appointed Head of Psychiatry and Mental Illness in Erlangen (BayHStA MK 72018). Leonhard’s
unsuccessful efforts on this matter can be viewed as his first difficulty in the tensions between
West and East Germany. In 1964, Leonhard tried to succeed Jürg Zutt (1893–1980) as Head of
Braun 203

Psychiatry and Neurology in Frankfurt, but this attempt failed because the construction of the
Berlin Wall in 1961 had invalidated previous agreements from 1955, and Leonhard’s exit from
GDR to the Federal Republic of Germany (FRG) was refused.

Reflections on Karl Leonhard’s 100th birthday – reassessment

Bochnik (2004a: 158) points out the ‘lifelong lack of concentration’ described by Karl Leonhard
on the one hand, and ‘his “scientific hyperactivity”, which has made scientific thinking and pub-
lishing the dominant form of life’ on the other hand. He concludes (pp. 158–9):

that Leonhard also belonged to the large group of people with attention deficit hyperactivity disorder
(ADHD), of whom some fail in life, but others manage outstanding achievements when their other talents
could give content to the urge to act . . . . The family should be asked whether conspicuous ADHD
characteristics are to be found among the ancestors or the descendants.

Bochnik’s suspicion that Karl Leonhard suffered from ADHD can no longer be supported, based
on his own, third-party and family anamnestic data. Leonhard himself reported ‘much sorrow’,
which was caused by his ‘lack of concentration’ (Leonhard, 1995: 144) at school: ‘Through such
careless mistakes, I spoiled some of my examinations, even though the scores remained good,
since I was always finished early and could read very thoroughly through what I had written’ (p.
145). In order to invalidate diagnostic considerations in the direction of so-called ‘Fidgety Phillip
Syndrome’ triggered by his ‘lack of concentration’, Leonhard explained in his autobiography that
schoolchildren with poor concentration are usually assumed to suffer from ‘nervousness, i.e. neu-
rasthenia. But I was not “fidgety” and, in my opinion, not overloaded with work . . . . Today I
attribute . . . [the lack of concentration] to my low blood pressure’ (p. 145). Leonhard’s certificate
of maturity from the Humanistisches Gymnasium Weiden, printed in the Appendix of his autobi-
ography, contains a list of grades – 8 excellent, 2 commendable – and a freely formulated assess-
ment. This does not indicate an attention deficit or a lack of concentration.
The archives of the Augustinus-Gymnasium Weiden (the successor to Humanistisches
Gymnasium), specializing in old and modern languages, contain numerous annual reports concern-
ing the Leonhard school years (AAGW, Jahrgangsberichte 1915/1916, 1918/1919, 1919/1920,
1921/1922). Class reports and Karl Leonhard’s senior class lecture, in which he tried to prove ‘that
one can recognize the character from handwriting’ (Leonhard, 1995: 20), are not preserved. According
to the personal communications of Dr Hildegard Bollmann, the certificates in Karl Leonhard’s estate
(held by the family) never show a drop in performance. Leonhard (1995: 43) wrote:

I don’t get tired of productive scientific work, but can stay with it from early morning to late evening . . . .
On the other hand, I have a low ability to absorb knowledge passively. I get tired quickly and can’t
concentrate enough anymore. I find it difficult to read scientific books to which I cannot contribute with
my own thoughts.

The criteria of abnormally persistent ‘inattention, hyperactivity and agitation’ required by ICD-10
(Dilling and Freyberger, 2010: 310) are not found for Leonhard.

Leonhard and social psychiatry

In 2013, some records were found in the Rodewisch Clinic (Vogtland, Saxony/East Germany)
about the organization of the ‘International Symposium on Psychiatric Rehabilitation’ in 1963. A
recent publication assumes that the ‘disinterest of Karl Leonhard, [as] Chairman of the Society for
204 History of Psychiatry 32(2)

Psychiatry and Neurology of the GDR, makes it difficult to publish an anthology that would have
secured the lectures of the symposium’ (Steinberg, 2014: 71). This behaviour by Leonhard, which
is described as having ‘far-reaching relevance in the history of psychiatry’ (p. 74), should be seen
in the context of his early professional experiences with the Erlangen system of open care and its
perversion during the National Socialist era.
The Rodewisch reforms saw the social reintegration of the chronically mentally ill persons as a
medical task. They included the demand for occupational therapy and a move away from the
‘safety principle’ towards the ‘welfare principle’, with a ‘dispensary system (especially aftercare)’
with at least one psychiatrist and one full-time psychiatric carer per district. Even if no comparison
was made at that time with the open welfare principle of the 1920s, it can be assumed that, for Karl
Leonhard, the similarities to the ‘Erlangen system’ of open welfare became clear.
During his residency in Erlangen, Leonhard gained insights into the system of open care estab-
lished there from 1914 onwards by the Director of the Mental Asylum, Gustav Kolb (1870–1938):
‘In 1930, in a care area of approximately . . . 3200 square kilometres, 4200 people of the total
770000 residents were in open care. The “Erlangen System” was the largest organization of its kind
in Germany’ (Braun and Kornhuber, 2014a: 401).
In the course of his work as a senior physician at the Erlangen Mental Asylum, Leonhard was
confronted with the decline of the social psychiatric achievement that had once been so progres-
sive. As early as 1934 – that is, in the first year of validity of the Law for the Prevention of
Hereditarily Diseased Offspring – 336 hereditary-ill patients were reported to the public health
officer ‘as urgent’ and about 239 medical records were made available to the Hereditary Health
Court for inspection, as reported by the welfare doctor, Hubert Schuch (b. 1885) (Schuch, 1935).
The misuse of the central index, which had once been carefully compiled by Gustav Kolb, and the
collaboration of medical carers in the enforced sterilizations, as a negative eugenic measure, con-
tinued in the following years.
For example, during Leonhard’s time as senior physician at the Mental Asylum, Schuch sent the
university medical file of the patient S.A. (who was being cared for at home) to the Hereditary
Health Court, with the request for the file to be returned to the Erlangen Mental Asylum (Figure 3).
S.A. could have been personally known to Leonhard from his residency at the Psychiatric and
Mental Clinic.
As an assistant doctor at the Psychiatric and Mental Clinic under Gustav Specht, Leonhard
had benefited from the welfare principle of the associated Mental Asylum under the manage-
ment of Kolb in the sense of an opportunity for long-term observation. On his return as senior
physician from Gabersee to Erlangen, Leonhard experienced not only changed political condi-
tions but also a change of staff. In 1934 Gustav Kolb had been succeeded by Wilhelm Einsle
(1887–1961) and Gustav Specht by Friedrich Meggendorfer (1880–1953) (Braun, 2017: 157,
493; see also Braun, 2020a, 2020b; Braun and Kornhuber, 2014a, 2014b, 2015a; Braun,
Kornhuber and Frewer, 2017).

Final review
Leonhard’s introductory words to his first edition of Aufteilung der endogenen Psychosen have a
haunting character:

If clinical psychiatry becomes difficult, that is only one advantage, because the difficulty of the subject
also leads to a deepening of understanding. It is precisely the ease with which a young psychiatrist today
can make his diagnosis .  .  . that has led to many people no longer learning to see and describe a psychiatric
disease pattern correctly. (Leonhard, 1957: 3)
Braun 205

Figure 3.  Document showing the cooperation of the Erlangen Open Welfare Service with the Hereditary
Health Court concerning S.A.; held by Historische Bestände der Heil- und Pflegeanstalt Erlangen (HPA
7816/8023) in APNK, and reproduced with permission of the Psychiatrische und Psychotherapeutische Klinik
der Friedrich-Alexander-Universität Erlangen-Nürnberg (the successor to the Psychiatric and Mental Clinic).

Apart from the possibility of ‘honing and expanding the psychopathological view’ (Hohl-Radke
2007: 32), the complex Leonhard nosology provides the possibility of differentiated biological-
psychiatric research (Foucher et al., 2020). This approach to research is internationally recognized
(Salvatore et al., 2008). Based on the idea of – unfortunately only – two cases of probable cycloid
psychosis, the Harvard researchers reinforce Leonhard’s view that the psychopharmacological treat-
ment of Leonhard cycloid psychoses differs from the drug strategies used in bipolar-affective disor-
der and schizophrenia (p. 177; see further Orlikov, 2011). In addition to the initiation of further
medical-historical and -ethical studies, this article may also stimulate the attention for Leonhard’s
psychopathological concepts in biological psychiatry.

Acknowledgements
Thanks to Frau Dr Hildegard Bollmann, Frau Dr Barbara Bollmann, Herrn Professor Dr Johannes Kornhuber,
Herrn Dr Hans-Walter Leonhard, Herrn PD Dr Michael Maaser and Herrn Professor Dr Gerald Stöber (1961–
2017). Parts of the study were presented at the EPA-Congress 2015 (Braun and Kornhuber, 2015b) and at the
DGPPN-Kongress 2015 (Braun and Kornhuber 2015d). We thank those who participated in the discussions.

Declaration of conflicting interests

The author has attended the same humanistic grammar school in Weiden as Karl Leonhard. The author is a
psychiatrist, who worked at Psychiatrische und Psychotherapeutische Klinik der Friedrich-Alexander-Universität
Erlangen-Nürnberg from 2011 to 2017. The author is a member of the Wernicke-Kleist-Leonhard Society.

Funding
The author received no financial support for the research, authorship, and/or publication of this article.
206 History of Psychiatry 32(2)

Notes
  1. The Clinic was established in 1903 as ‘Königliche Psychiatrische Klinik’ (Royal Psychiatric Clinic). In
1927 it was renamed as the ‘Psychiatrische und Nervenklinik’ (PNK) (Psychiatric and Mental Clinic). In
this letter dating from 1931, the obsolete heading is: ‘K. Direktion der Psychiatrischen Klinik Erlangen’,
but the ‘K.’ (abbreviation for ‘Königliche’) has been crossed out; see Braun, 2020d.
  2. The letters from N.R. to Leonhard reflect her love delirium, which is also mentioned in Leonhard’s pub-
lished catamnestic information; Leonhard, 1932; Braun, 2020e.
  3. It is assumed that this refers to Willibald Scholz (1889/1899–1971), who headed the Department of
Neuropathology of the German Research Institute of Psychiatry in Munich (Deutsche Forschungsanstalt
für Psychiatrie: Kaiser Wilhelm-Institut, KWI) after the death of Walther Spielmeyer (1879–1935).
From 1945 (November) to 1960 he succeeded Ernst Rüdin as director of this institution, which in
1966 was renamed to Max Planck (1858–1947) Institute of Psychiatry (MPI); https://web.archive.
org/web/20081222120821/http://www.mpipsykl.mpg.de/en/institute/history/index.html (accessed 21
February 2018). Whereas Klee designates 1899 as Scholz’s year of birth, other sources specify the year
number as 1889; Klee, 2003: 557; https://www.deutsche-biographie.de/gnd1022914308.html (accessed
21 February 2018).
  4. Not to be confused with the Erlangen theological school as a movement within the ‘Erweckungstheologie’:
‘An influential school of German Protestant theology that grew out of the corporate efforts of the
Lutheran theological faculty at Erlangen University in the mid-19th century’; https://www.encyclope-
dia.com/religion/encyclopedias-almanacs-transcripts-and-maps/erlangen-school (accessed 25 February
2018).
 5. Concerning ‘Nazi methods’, see also: Braun and Kornhuber, 2013c; Braun and Loew, 2018, 2019.
Regarding the Hessian Asylum Eichberg, see further: https://www.gedenkort-t4.eu/de/historische-
orte/2z5rq-landesheilanstalt-eichberg-vitos-rheingau-klinik-eichberg (accessed 27 February 2018).
  6. The Prussian province Hessen-Nassau existed from 1868–1944 and consisted of the cities Frankfurt,
Kassel and Wiesbaden.
  7. For further information regarding ‘euthanasia’, see: Braun, 2020c; Braun and Kornhuber, 2014c; Braun,
Frewer and Kornhuber, 2015.
  8. Darmstadt is a city in the south of Hessen.
  9. Goddelau is a quarter of Riedstadt, the largest city in the South-Hessian district Groß-Gerau.
10. Edda Neele (1910–2005) was the first German woman to acquire a postdoctoral lecture qualification
for psychiatry. Her habilitation thesis (Neele, 1949) was the first to use the terms ‘unipolar disorder’
and ‘bipolar disorder’ (Shorter, 2012: 5). Influenced by the Swiss theologian Karl Barth (1886–1968),
she – according to an obituary – ‘worked against the National Socialists in the confessional church and
believed in a new, democratic Germany’ (Anon., 2005).
11. Leonhard was not promoted to associate professsor in 1946, as Bochnik states, but earlier, namely in
1944 (Bochnik, 2004: 159; BayHStA MK 72018).
12. The antecessor to the Rodewisch Clinic (see chapter Leonhard and social psychiatry).

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