ORI GIN AL PA PER

Johann Christian August Heinroth (1773–1843):The First Professor of Psychiatry as a Psychotherapist

Holger Steinberg • Hubertus Himmerich

Published online: 2 February 2012� Springer Science+Business Media, LLC 2012

Abstract Heinroth is known as the first professor of psychiatry. His chair was established

200 years ago on the 21st of October 1811. His major importance for the history of

psychotherapy has not yet been acknowledged. Heinroth regarded restriction as well as

activation as fundamental remedies for mental illnesses. Restriction meant making a

voluntary decision to live a life based on religious faith and to abstain from earthly

satisfaction. Within his specific psychotherapeutical module—the ‘‘direct-psychic’’

method—he utilized the patient’s mental powers—mood, mind and will, but also his

spirituality. His therapeutic approach additionally contained elements of cognitive,

behavioral and conversational therapy.

Keywords Johann Christian August Heinroth � Psychotherapy � History of psychiatry �Holistic � Medicine � Romantic psychiatry � History of psychotherapy

Introduction

Until now Johann Christian August Heinroth (17 January 1773–26 October 1843; see

Fig. 1) is best known as the first holder of a chair of psychiatry in Europe, perhaps even in

the world. The chair was established 200 years ago on October 21, 1811, at Leipzig Uni-

versity by command of Frederick August I, King of Saxony (1750–1827) (Steinberg 2004a;

Steinberg 2011). However, this same chair could also be regarded as the first chair of

psychotherapy. Even the official name of it alludes to this: Chair of ‘‘Psychic Therapy’’

(‘‘Psychische Therapie’’). Perhaps that is why Marx also referred to the first Leipzig chair as

a ‘‘Chair of Psychotherapy’’ (Marx 1990, 1991). Furthermore, Heinroth considered himself

H. SteinbergArchives for the History of Psychiatry in Leipzig, Department of Psychiatry and Psychotherapy,University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany

H. Himmerich (&)Department of Psychiatry and Psychotherapy, University of Leipzig, Semmelweisstraße 10,04103 Leipzig, Germanye-mail: Hubertus.Himmerich@medizin.uni-leipzig.de

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J Relig Health (2012) 51:256–268DOI 10.1007/s10943-011-9562-9

and his colleagues to be ‘‘psychic doctors’’ (Heinroth 1818a), by which he meant people

with a strong medical, pedagogical, philosophical, and, last but not least, theological

background. For Heinroth, the doctor had to act according to Christian moral laws when

curing his patients, by which he understood leading them back to a reasonable life by means

of a therapeutical process. Heinroth clearly considered himself as what we nowadays would

call a psychotherapist for within his therapy for him the most successful and long-lasting

method was to exert mental influences. Heinroth was deeply convinced that in a mental

illness, it was the soul that was affected and therefore all treatment had to be directed at it,

hence to be mental in nature. So, despite the increasingly artificial character of this division,

Heinroth was one of the most prominent and radical figures among the so-called psychicists,

that is, those early nineteenth century psychiatrists who followed a mental approach to

psychiatry and regarded mental illnesses as being caused in the soul, in contrast to those

who followed the somatic approach.

Heinroth: His Religiosity and His Work

Heinroth (Steinberg 2005) was born the son of a Leipzig surgeon, according to Heinroth’s

brother-in-law ‘‘a rather strict, serious man who, although taking care to the best of his

endeavors to educate his son decently, always held him at a distance.’’ It was his mother

who ‘‘strived … to compensate for his father’s hardness.’’ ‘‘Educated herself in the tra-

ditions, customs and above all the devoutness of her ancestors,’’ she was ‘‘an archetype of

domestic goodness. Her religiosity coined deeply into the soft mind of her rather active son

… [so that] the 6-year-old boy rather wanted to … preach than to do his homeworks’’

(Querl 1844, 1847; Heinroth 1844). Heinroth himself too admitted that his mother ‘‘made

me pray: Christ’s blood washes us clean from our sins’’ (Heinroth 1827). Against this

background, it is feasible that she had a decisive impact on the foundation of his son’s

Fig. 1 Johann Christian August Heinroth. Lithography by C. Lutherer. Source: UniversitatsbibliothekLeipzig, Sondersammlungen

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theoretical approach to mental illness later. As early as his last school years, Heinroth had a

strong inclination toward ‘‘philosophical and religious speculation’’ (Querl 1847), which

made everyone expect he would study theology. Yet he felt more obliged to tread in his

father’s footsteps and took on medicine at his hometown’s university, graduating with a

doctorate in both medicine and philosophy and the venia legendi (i.e. the right and

capability to teach at a university). For his brother-in-law Heinroth had thus ‘‘mischosen

his profession’’ (Querl 1847). Indeed Heinroth seems to have had difficulties to decide

what was right for him, for he even took on theology at Erlangen. However, he soon

brought his studies to an early end, since he was ‘‘deprived of all supporting means’’ and

after all 32 years of age already (Querl 1847).

Still Heinroth always had a strong theological inclination and hence ‘‘brought theology

into medicine’’ (Mobius 1898), combining both in his psychiatric works. Apart from

Heinroth, Siebenthal identified a large number of ‘‘disciples of theological medicine’’ at his

time, who regarded illness as a religious, ‘‘cathartic’’ reawakening, where the human being

is reassured of his sense of life, in cure subjected to a personal salvation experience, which

reestablishes his agreement with God (Von Siebenthal 1949).

Still it is not possible to allocate Heinroth to a particular religious movement. Nowhere in

his books could the authors find any passage, where he had made a clear theological con-

fession. Neither does his wife nor his brother-in-law, although allowing us insights into

Heinroth’s private life, tell us about the deeper content of his religion apart from the highly

subjective general statements cited above. From all information gathered, Heinroth seems to

not have been an active member of church. Still his ideas show clearly that he shared a deeply

religious, amaterialistic view on man based on natural philosophy and metaphysics. In his

writings, the human being is related to God and appears as the incorporation of ‘‘His ideas and

thoughts,’’ God being ‘‘on Whom we depend and without Whom we are unthinkable’’

(Heinroth 1818b). Both Heinroth’s and his wife’s strict religious and moral, almost ascetic

way of life has been subjected to mock by friends (Querl 1844). In places his writings suggest

that Heinroth was rather pietistic or mysticistic. Yet when some of his contemporaries sup-

ported this notion, he felt viciously impeached and urged to author a monograph to coun-

terattack their approach (Heinroth 1827, 1830). Other passages suggest he followed a rather

puritan approach, the so-called reine Christenlehre (‘‘pure teaching of Christ’’). Indeed

Heinroth shared some basic ideas with a group of intellectuals, theologists and artists of the

decades around 1800 who defined themselves as disciples of this approach. For them nothing

but the Holy Bible itself could feed religiosity and bring salvation. Any church or sect just

strayed from the right way and distorted the original faith by installing an authority-based

institution and subjecting believers to a ministry of rites and formulae. Yet religious belief

was to be an individual, strictly personal, but hence immediate and unbiased experience.

In over 40 years Heinroth authored over 40 large monographs, some of them multi-

volume, as well as academic writings, translations, some journal articles plus four volumes

of his own poems. In the 1950s, psychiatrist Ernest Harms tried to publicize Heinroth in the

US by praising his books in several articles. So he acknowledged (Heinroth 1831) as ‘‘one of

the best, early textbooks on anthropology’’ and his 1834 monograph on lying (Heinroth

1834) as ‘‘the first attempt in criminal psychology.’’ One of his very first writings ever

(Heinroth 1812) constituted a ‘‘psychopathology that proves to be the first dynamic psy-

chiatry ever attempted’’ (Harms 1956). Heinroth’s 40 monographs deal with topics in

various fields, including anthropology, pedagogics, psychology, criminology, forensic

medicine, philosophy, epistemiology. Their majority, however, is about psychiatry, on

which he also wrote the first comprehensive textbook in German-speaking psychiatry,

which appeared in two volumes in 1818 (Heinroth 1818a). Harms acknowledged it as ‘‘the

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first systematic textbook of psychiatry in which an attempt was made to establish an actual

clinical �system� of psychotherapy’’ (Harms 1959). Heinroth also wrote several books,

studies and expert opinions on forensic psychiatry (Richter and Steinberg 2011a, b) and

introduced the term ‘‘psycho-somatic’’ into medical literature (Steinberg 2007).

One of his lasting achievements in psychiatry was his new approach to and definition of

depression. For the first time ever, he used this term in a psychopathological meaning and

no longer to describe a physiological condition in the brain pressure. By depression

Heinroth understood excessive passivity, be it of the mood, thinking (intellect) or the will,

in contrast to excessive activity, which he referred to as exaltation. In accordance with this

paradigm, Heinroth came to define melancholia as a state of a depressed mood. Further-

more, Heinroth has been acknowledged as the first who clearly understood circular mad-

ness as one clinical entity and not an interchange of two independent clinical pictures,

namely mania and depression (Schmidt-Degenhard 1983). If one looks into his descriptions

in greater detail, one finds that Heinroth clearly acknowledged mixed states of circular

madness, where patients suffered from mania and depression at almost the same time (e.g.

in the morning from the one and in the evening from the other) and that he is furthermore

to be acknowledged as a forefather of schizoaffective disorders (Marneros 2001).

Since there was none, Heinroth never headed a university hospital for psychiatry, but

between 1814 and 1833 he was visiting consultant at Leipzig’s municipal penitentiary and

orphanage, which also housed mentally ill people, though mainly acutely, not chronically ill.

He also used these inmates for clinical demonstrations during his university seminars. At the

age of 71, then being dean of the university’s medical faculty, Heinroth died, presumably of

nephresia.

Restriction and Activation as Psychotherapeutic Tools

Heinroth’s main therapeutic approach was restraint, psychological and physical. ‘‘What is

needed in such cases is restraint, which is in no way cruel or inhumane, but necessary for

the re-education of such patients to the norm of reason’’ (Heinroth 1818a). In another

passage, he explicitly included all kinds of physical restraint: ‘‘being restricted in his

movements he [the patient] benefits from starting to perceive the boundaries that lead his

uncontrolled… imagination and will back to a normal way of life’’ (Heinroth 1825a). In his

‘‘Instructions’’ for future psychiatrists he wrote ‘‘You who have a mission to become

doctors treating the insane: if you want to be our patients’ true friends, do not leave them to

their uncontrolled, mistaken, obsessive way of life, but restrain them in a suitable manner.

In doing so take the best possible care of the patients and show them consideration, but do

not indulge these pathological excesses’’ (Heinroth 1825a).

The basic idea underlying this concept was that the mentally ill person could only

recover, if he renounced all earthly passions and bodily needs and restricted himself to

fulfilling the task given him by God, namely to live a life according to religious faith. The

idea of the patient’s own involvement in his recovery, of therapeutic partnership, corre-

sponded to his belief that activity was the principle of cure (Trenckmann 1988, 2001).

In a first stage, the patient’s will had to be taken from passivity, that is, self-satisfaction

to activity, that is, self-restraint and self-control. Through this transformation, the patient’s

power of reasoning was reactivated with the help of which he was then able to decide for

himself what was ‘‘good’’ and what was ‘‘evil.’’ In the end, his mind would take over

control and decide upon the proper way of living. But Heinroth went even further than that.

Since he was convinced that the ‘‘soul’s mood’’ was a major predisposing factor to mental

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illness, he required treatment to provide an impulse for a fundamental change in the

existing way of life (Heinroth 1825a; Langle 1982). Only then would the treatment have a

long-term, possibly lifelong, effect.

However, when in the course of the treatment the patient has regained his power of rea-

soning, any kind of physical restraint was to be abandoned (Heinroth 1825a; Lidl 1981).

‘‘Sticking to a rule has never done people harm, infringing it, however, has. The extent to which

we exercise our free will, the flame of our life, must be determined by the intellect, the true

protector and guardian of our life’’ (Heinroth 1823). Control was Heinroth’s basic therapeutical

concept. The patient’s will had to be directed, his reasoning adjusted and his mind changed.

Surely that is the basic idea behind some psychotherapeutic treatments, though admittedly not

in that simple archetypical form. In 1965, Annemarie Wettley acknowledged without reser-

vation: ‘‘Control of desires and passions remains the hub of psychotherapy.’’ In her short history

of psychotherapy, she came to the conclusion that Heinroth had made some significant con-

tributions toward the development of this subject (Wettley 1965).

The link between Heinroth’s method of combining restraint with rewards and punish-

ments and present-day psychotherapeutic treatments has been analyzed in several papers.

Monika Lidl confirms Heinroth gave an impetus to the formation of psychotherapy and

regards his ideas as ‘‘some form of learning therapy,’’ although not fully comparable to its

modern forms, because Heinroth’s aim was to give patients back their power of self-

determination (freedom of choice), whereas in present-day learning and behavior therapies,

the emphasis of learning lies on relating to the social environment (Lidl 1981). Hilken and

Lewandowski saw similarities to modern behavior therapy where behavior patterns are

learnt anew or are changed (Hilken and Lewandowski 1988). Martin Schrenk pointed out

that Heinroth and others had ideas and applied methods at around 1800 which were not

promoted again until the end of the 1960s. As examples he gave milieu therapy, music and

group psychotherapy (Schrenk 1967), others agreed and added logotherapy to this list or

highlighted the fact that Heinroth determined the kind of therapy each patient was to

receive individually, according to their specific illness and needs (Spoerri 1955; Pauleik-

hoff 1983; Leibbrand 1956; Alexander and Selesnick 1969; Ellenberger 1996). Finally,

reference was also made to Heinroth’s observations on work and occupational therapy.

The main point in Heinroth’s therapeutic approach is that all treatments are aimed at the

pathologically affected or predisposing ‘‘mood of the soul’’. For him there was no use in

simply curing the symptoms of an illness; the patient had to be led to change his misguided

way of living, to acknowledge and fulfill his divine destiny. In this respect, Heinroth’s

therapeutic approach had a strong moral character comparable to William Battie’s

(1704–1776) and Francis Willis’s (1718–1807) theories of ‘‘moral treatment’’ and ‘‘moral

management’’ or to Philippe Pinel’s (1745–1826) ‘‘traitement moral’’ (Trenckmann 1988).

Heinroth even discussed these approaches when laying out his own concept. Therein he

considered the word ‘‘moral’’ as equating to ‘‘humane’’ and called such approaches to

treatment as ‘‘greatly to be praised’’ (Heinroth 1818a). Whatever the wording, however,

Heinroth’s approach had clear moral intentions, as it may be regarded typical for many

intellectuals also committed to the ideals of the enlighteners. He aimed to re-provide his

patients with the power of reasoning and a feeling of personal responsibility, and to enable

them to resist all kinds of guilt-laden temptations—and that is, sin is a clearly moral intent

(Steinberg 2004b, c). Kant called this ‘‘guiding the immature to maturity’’ (Heinroth 1837).

The interchangeability of the terms ‘‘moral’’ in the approaches above and psychisch(‘‘psychic’’ in the old sense or ‘‘mental’’), which prevailed in German psychiatric literature

of the early nineteenth century (Schrenk 1973), is perhaps exemplified by Heinroth, since

his ideas on direct-psychic treatment are clearly moral.

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From the Diagnosis to the Psychotherapeutical Treatment

Before therapy of patients is started, however, ‘‘the first task… is to find out whether or not

the given morbid state really needs help from outside’’ (Heinroth 1818a). Once this initial

diagnosis has been made, ‘‘no special treatment should be attempted, unless the physician

can control the external surroundings, relationships, and influences on the patient.’’ And

finally ‘‘the physician must not apply any specific treatment unless he is the master of the

patient, and this he can only become if he is spiritually superior to him’’ (Heinroth 1818a).

This should be taken literally and does not just mean that the psychiatrist have knowledge

of the therapy that may help the patient recover. Only if these three conditions are fulfilled,

can the doctor draw up a treatment plan. This is done for each patient individually, and this

is one of the distinct features of Heinroth’s therapeutical concept as described in detail in

his well-known ‘‘Textbook of Disturbances of Mental Life’’ of 1818 (Heinroth 1818a).

First of all the therapy depends on the kind of illness, whether it is of the exalted type

(excessive activity), the depressive type (excessive passivity) or of a mixed nature

(interchanging between excessive activity and passivity or affecting different mental

capacities). According to the Scot John Brown (1735–1788), every treatment is aimed at

re-establishing the patient’s inner emotional balance. Consequently, hypersthenic (i.e.

exalted) patients require their excitement be calmed, whereas asthenics (i.e. passive,

depressed patients) should be excited. To do so, the patient’s body, as the organ of the soul,

could be exposed to antagonistic influencing, for example, a weak soul lacking in drive

could be cured by producing strengthening, motivating energetic effects on the body (and

vice versa in case of hypersthenia). This idea too was based on Brown’s theory and fell on

fertile ground in Germany—the romanticists too claimed polarity to be the basic principle

in life—and did indeed become a ‘‘focal point of psychiatry’’, and gave it the character of a

natural, in this case a medical science. Heinroth then made polarity ‘‘the basic therapeutical

concept irrespective of all consequences’’ (whether good or bad) (Schott 1990).

For Heinroth hypersthenia and asthenia are basic psychopathological stainings—one

could also say leading symptoms—for his nosology. Following the traditional capabilities

concepts, Heinroth maintained that each or several of the three capabilities of the soul,

namely will, mood and mind (reason) could be either exalted, or depressed, or affected by a

mixture of both exaltation and depression to which he ascribed the traditional mental

illnesses (see Table 1). Besides this general classification and allocation of mental ill-

nesses, Heinroth thought it necessary to take into consideration the specific symptoms, the

course and prognosis of the individual illnesses on the one hand, and the patient’s sex, age,

constitution, temperament, receptibility to stimulation, and personality on the other

(Heinroth 1818a).

In the second part of his textbook, Heinroth drew a distinction between the ‘‘means of

treatment’’ (Heilmittellehre) and the ‘‘stages of treatment’’ (Curlehre).

Table 1 Heinroth’s nosology of basic psychopathological states depending on which psychologicalcapacity is affected as examplified in his 1818 textbook

Psychologicalcapacity

Exaltation(hypersthenia)

Depression(asthenia)

Mixed state(hypersthenia & asthenia)

Mood (temper) Mania Melancholia Mixed disturbances of temper

Mind (reason) Insanity Imbecility Mixed disturbances of mind

Will Madness Abulia (indecision) Mixed disturbances of will

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Psychotherapeutic and Somatic Methods

Heinroth basically differentiated between two approaches, the details of which varied

according to the progress of the treatment. The first approach was the ‘‘direct-psychic’’

method (direct-psychische Methode), which can be regarded as a psychological method

directed at the patient’s soul. The second approach involved several ‘‘indirect-psychic’’

methods that were primarily somatic in nature as they tried to affect the soul by influencing

its organ, the body. Heinroth thought the latter methods merely ‘‘stopgaps’’ (Heinroth

1818a). The ‘‘direct-psychic’’ method was the preferred option, even though Heinroth

could only lay out basic, introductory ‘‘ideas’’ (Heinroth 1818a) as he himself admitted.

‘‘But mental disturbances proper, which result from a morbid soul life, are not of this type,

even if they also affect the somatic organism. The roots of the evil lie deeper, and a more

radical treatment is necessary. In the indirect-psychic method, treatment is mainly directed

at the somatic organism but should in fact be directed, if it were possible at the sick soul

itself. A direct psychic method would be the most decisive, rapid, and effective approach.

It would be the crowning achievement of heurism to discover such a method’’ (Heinroth

1818a).

Since the ‘‘direct-psychic’’ method was still based on hypotheses. It was in fact the

‘‘indirect-psychic’’ ones which Heinroth could lay out in much greater detail. Conse-

quently, their description occupies more space in his textbook (Heinroth 1818a), but this

does not mean that Heinroth preferred somatic methods of treatment (as claimed by Lidl

1981; Kesting 1987; Schmogrow 1967; Schielle 1911). However, he did consider them a

major help—if one condition was fulfilled: ‘‘We do not reject somatic methods, but we

regard them to be negative, for only mental stimuli can have a positive effect on the soul,

and only if somatic means are transferred into mental stimulation can they affect the soul

itself’’ (Heinroth 1825b). Moreover, somatic methods of treatment could help prepare for

the psychotherapeutical process in circumstances when the soul could not be reached

directly, when the body had dominance over the soul and the binding physical forces were

too strong, and no mental stimulus could produce any effect. In this case, dietetic, surgical,

pharmacological or mechanical means of treatment could excite the body or calm it (in

accordance with Brown’s theory) in order to revive the soul and make it receptible to

influences from outside. Furthermore, somatic methods of treatment could awake and assist

the natural healing power of individual organs of the body. They promote secretion and

excretion of poisonous or harmful substances. One should, however, note that in his

description of ‘‘indirect-psychic’’ methods, Heinroth made extensive use of his colleagues’

works and seldom drew conclusions from his own experience. Some passages literally

suggest that their author is not relying on his own first-hand experience here (Lidl 1981;

Kraepelin 1918; Gregor 1921).

The ‘‘Direct-Psychic Method’’ and its Religious Implications

According to Heinroth, the ‘‘direct-psychic method’’ usually followed the application of

‘‘indirect-psychic methods’’. The idea behind it was that ‘‘a soul is the force that can most

strongly influence another soul. If an impure soul can corrupt a pure soul, it follows that a

healthy soul, the force of which lies in God, can also make a sick soul healthy’’ (Heinroth

1818a). Moreover, it is not ‘‘the physical and pharmacological means themselves that

overcome the enemy, but the spirit that guides them’’ (Heinroth 1825a). Here Heinroth

clearly emphasized the importance of the doctor’s personality.

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In principle, Heinroth’s idea of a psychological cure was not new. William Battie,

mentioned earlier as the founder of ‘‘moral management’’ and governor of the world-

famous Bedlam Hospital, considered mental guidance of his patients as more important

than, for example, the application of drugs. Pinel and Johann Christian Reil (1759–1813)

too deemed psychological cures of greater significance compared to all other methods of

treatment (Boss 1937; Wettley-Leibbrand 1967). Similar to his predecessors, Heinroth was

not able to overcome the fundamental problem of all psychological treatment, namely that

it could only be applied when the patient still had, or had regained, minimum freedom, that

is, was in basic control of himself (Gerlach 1965). However, it seems that the power

Heinroth ascribed to the will was novel in comparison with his predecessors. As early as in

his 1817 thesis, extensively cited in his textbook of 1 year later, he had laid out his ideas on

cures of mental illness inspired by Christian faith. In this book he, for example, even gave

exact times when and how long treatment should persist and stated that in some cases this

must last for weeks or even months. When describing his ‘‘direct-psychic method,’’ he

repeatedly referred to magnetism, whereby one person’s will was communicated to

another. However, his method was distinct from Franz Anton Mesmer (1734–1815) and the

Marquis de Puysegur’s (Armand-Marie-Jacques de Chastenet, 1751–1825) animal mag-

netism which ultimately was only a ‘‘wild branch of faith’’ (Heinroth 1818a; even more

disparagingly: Heinroth 1821). Heinroth’s own method, however, was incomparably

‘‘more powerful,’’ since it was based on God’s own power and a good, if not divine deed.

Put in simple words, Heinroth suggested that a healthy will could heal a sick one by

exerting a positive influence on it. He called it ‘‘education of the will’’ [Willenserziehung(Schielle 1911)], which, as he saw it, required the ‘‘highest level of skill’’ (Heinroth

1818a). The curative will could only be effective, if it took its power from religious belief:

‘‘This belief is and has a Divine Power… We also maintain that the power of faith is the

actual healing power… able to affect disturbances of the soul directly’’ (Heinroth 1818a).

Consequently, Heinroth seems to be addressing above all his fellow-psychiatrists when he

said: ‘‘So let us believe and we will be able to help’’ (Heinroth 1818a). However, his words

were seldom heeded. In his review of Heinroth’s book Friedrich Gross (1768–1852), a

physician at the Pforzheim asylum and infirmary, fully despised Heinroth’s views and

contented himself by observing: ‘‘The spirit by which the author raises these phantasmata

to a religious height deserves respectful forebearance.’’ Understandingly though he asked

the question: ‘‘Can morality, freedom without which according to the author there is no

health, be communicated from outside by a mere touch? Should it not be earned by one’s

own efforts, the result of one’s own labors and merit?’’ (Gross 1822).

To do Heinroth justice one should, however, point out that in the passages briefly cited

above he described an ideal situation, a generalized thought. Also we can gather that

Heinroth himself had foreseen he would expose himself to widespread ridicule and

compromise his reputation in the eyes of many. To justify himself he quoted God, whom

he served unconditionally and whom he trusted unquestioningly. He also invoked Johann

Wolfgang von Goethe (1749–1832) as a second patron saint and authority who had said

that there was no universal panacea (Heinroth 1818a).

The Personality of a Psychiatrist

However, there can be no doubt that according to Heinroth’s ideal the psychiatrist’s

personality had to meet certain standards, the first and most important being to develop a

will totally founded in faith. In fact, every person, but even more so anyone attempting ‘‘to

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cure mental disorders’’ should be keen to ‘‘strengthen the will, purify it, and make it holy.

Thereby he will acquire a force which can achieve what is usually called miracles, and

which is will animated by faith’’ (Heinroth 1818a). The ability to perform such a miracle

was ultimately a necessity in the psychiatrist since only a healthy soul could enable a sick

one to fully recover. According to Heinroth’s model, the power of faith in the psychiatrist

was the essential pre-requisite for the patient’s successful treatment and recovery.

But how then could this curative energy be transferred to the patient? Basically, all

means used in ‘‘direct-psychic’’ treatment were suitable. For this it was essential that the

doctor had spiritual superiority over his patient. The psychiatrist in particular was to be

‘‘like a God to his patients’’—healing them but also bringing them under his will. ‘‘Like a

monarch’’ (Heinroth 1818a), the psychiatrist had to break his patients’ will, which was sick

and confused, and to replace it by his own. ‘‘As with a king, only those are allowed to

approach the doctor whom he deigns to do so; all the others must be kept at bay… he must

not devote himself to his patients unconditionally, without purpose.’’ In another passage,

the doctor was compared to ‘‘a sun surrounded by its dark planets’’ (Heinroth 1825a).

According to Heinroth, his patients have fallen ill by sinning, by falling away from God

and by being selfish. Consequently, the psychiatrist ought to be also morally superior to his

patients. In the guarded asylum surrounded by his immature, outcast satellites, who

depended on him, the mad-doctor seemed ‘‘omnipotent’’ (Fischer 1984) walking around

like a ‘‘helper and savior, as a father and benefactor, as a sympathetic friend, as a friendly

educator and teacher, but also as an examining, judging and punishing guardian of justice,’’

ruling on the one hand with ‘‘mildness and friendliness, gentleness, calmness, patience,

consideration, sympathy, and a measure of condescension, but also (with) earnestness,

firmness, impressive though restrained authority, and the exercise of a just, consistent, firm

discipline. … From the very outset he influences the patient by virtue of his, one may be

permitted to say, holy presence, by the sheer strength of his being, his glance and his will’’

(Heinroth 1818a).

It was this alleged mental, spiritual, and moral superiority, or this power to influence the

will of others, that psychiatrists during the entire nineteenth and early twentieth centuries

based their right to behave like patriarchs, treating their patients like children. By his look

alone, the psychiatrist was transformed into some kind of supernatural being. This look

could be a means to get through to his patients, ‘‘to cause fear and respect at the same

time.’’ Heinroth may have taken this idea directly from William Pargeter (1760–1810)

whose ‘‘way of catching his patients’ eye and holding them and thus attracting them almost

magnetically to himself is quite remarkable and deserves to be imitated… After �having

attracted the patients by his look� in this way he could even make the most stubborn and

resistant of his patients do exactly what he demanded’’ (Heinroth 1818a). Obviously, the

Leipzig professor was an extraordinarily good practitioner of Pargeter’s approach, for even

his widow remarked when speaking about her husband’s way of dealing with his patients:

‘‘He influenced his patients by gentleness, persevering in the search for ways of achieving

his aim, patiently he followed his approach and never became impatient. His voice and his

look had such a remarkable effect on his patients that even the most excited maniac in his

greatest state of excitement calmed down almost instantly as soon as he spoke with him or

fixed him with his eyes’’ (Heinroth 1844).

The physician Wilhelm Ludwig Demme (1801–1878) readily confirmed these ‘‘most

remarkable traits’’ that his friend Heinroth had repeatedly talked to him about. From his

memoirs too we learn how the Leipzig psychotherapist taught himself these and other

methods—by ‘‘pacing the floor with the grace of a patriarch… amusingly adopting an air

of gravitas, taking rhetorical poses, etc.’’ (Heinroth 1844).

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Discussion

Heinroth’s psychotherapeutic approach smoothed the way to modern psychotherapy, but it

also exhibits elements of a religious and paternalistic thinking. His therapeutic success may

certainly be attributed to his personality as such that also determined his healing approach,

as witnessed by his wife: with gentleness and perseverance he searched for ways to achieve

the patient’s own aim. In modern terms, he made use of elements of cognitive, behavioral

and conversational therapy to accomplish this. Within this complex approach, Heinroth

acknowledged spirituality as a psychotherapeutical dimension. Throughout the therapeutic

process, Heinroth followed a holistic anthropological or anthropocentrical approach, that is

to say he viewed the patient and his illness as an inseparable unity, whereby he followed an

inductive phenomenological approach focusing on the patient as an individual and person.

One of his key propositions made it clear that the patient ‘‘is not a dead, passive something,

but a life in its own right and power, which the doctor should not only strive to recognize,

but to protect and treat with care to its own best and in its way’’ (Heinroth 1818a). Against

this background, the individual psychiatric symptom is reduced to a mere signal of the

diseased ‘‘whole person,’’ which only shows the doctor the way to his patient. In a holistic,

anthropological, or in Heinroth’s terms theo-anthropological system, the individual

symptom as such hence is one mere puzzle piece. In fact it might not even prove necessary

or possible to treat each symptom, because the main concern was to get through to the

patient. Whenever he talks about therapy, Heinroth always refers to the human being or

patient as a ‘‘whole person,’’ as a complex individual, which the doctor needs to understand

to be enabled to choose a suitable and effective therapy. This very holistic idea is based on

the early medical anthropology (Platner 1772) as developed by Ernst Platner (1744–1818)

and his school. As a student of the Leipzig philosopher and physiologist Platner, who

demanded a doctor should be a philosopher also, Heinroth was so to speak a ‘‘philosophical

mad-doctor.’’ This led him to maintain that a merely scientific or even more so a purely

neurobiological-molecular approach, as promoted by present-day psychiatry, could hardly

achieve any cure in mentally ill patients. On the contrary, it would only restrict the doctor

and actually prevent him from really seeing his patient. In German psychiatry, the last

200 years saw phases, in which a more philosophical approach to mental illness, and in

particular the different anthropological concepts, did have an impact on the development of

the discipline as a whole. At some points, they even dominated over the somatic theories.

In present-day psychiatry and neurosciences in general, philosophical or anthropological

ideas are of almost no importance at all and rather conceptionalized as an obstacle for

medical progress. Religious or spiritual aspects are largely neglected, even in anthropo-

logical, holistic psychiatric concepts. Hence, there is hardly any trace of Heinroth’s

approach or ideas left in any of them. Nevertheless, toward the end of the twentieth

century, the possibility of incorporating religion and spirituality into psychotherapy was

discussed, and a biopsychosocial-spiritual disease model was proposed which provides a

framework for integrating spirituality into clinical practice and invites physicians to

consider the spiritual aspects of their patients’ lives (Brown et al. 2012; Plante 2007; King

2000). Moreover, most of the modern psychotherapists seem to be willing to discuss

religion and spirituality with their clients despite several barriers to incorporating religion

and spirituality in psychotherapy (Brown et al. 2012). Heinroth did not view his explicit

paternalism as contradicting his anthropological approach, since for him the mentally ill

person is solely governed by his disease and has hence lost his freedom of decision. For

this reason, the psychiatric doctor must make decisions for him. This also means that a

‘‘guidance from immaturity to maturity,’’ as philosopher Immanuel Kant had put it, that is

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to say bringing patients back to their freedom of will and decision is a key aspect in

Heinroth’s therapeutic approach. Within this guidance, it might even become necessary to

break the patient’s will at times and to replace the ill, restricted, misguided will by the

superior and proper will of the doctor. In any case, it is clear for Heinroth that if the

psychiatrist ‘‘is not the master of his patient, which he can only be through mental and

intellectual superiority,’’ there is no chance he can cure him (Heinroth 1818a). Hence, to be

a good guide for his patients back to their own freedom of choice, the psychiatric doctor

needs to be well educated in medicine, pedagogics, philosophy and theology, following a

Christian-ethical approach in both his thinking and actions.

Acknowledgments The authors thank Dirk Carius (Leipzig) and Graham Evans (London) for help inpreparing this manuscript.

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