[Endo-neurotic depression. Necessity and irritation of a diagnostic concept]

Abstract

The traditional system of diagnosis which differentiates clearly between endogenous depression on the one hand and psychogenic depression on the other, results in an dichotomy that limits our thinking and perception. This limitation is an obstacle to an open-minded realisation of the multidimensional cause-effect links underlying depressive syndromes. The historical development is outlined and the descriptive-psychiatrical and psychoanalytical-psychodynamical theoretical aspects are described. There is a definite need for an unequivocal terminology that covers both clinical observations and therapeutic assessments. The term endo-neurotic as a logical development of Weitbrecht's endo-reactive concept represents a verbal diagnostic instrument enabling the characterisation of a typical group among a multitude of "multilayered" depressions. Endogenous and neurotic factors carry the same weight in such depressions, and the phasewise course of the disease does not permit the patient to be classified as purely "somatic" or purely "mental" or "psychological". If endogenous phases having a triggering effect on depression fail to occur during psychotherapy, this may be due to minor penetration by either endogenous or psychogenic factors. A clinical case report shows how intensive psychotherapy of neurotic mechanisms increasingly improves the management of situations that were formerly critical in respect of triggering depressions. The patient feels that this is really so, and the therapist gains confidence that his therapy is progressing in the right direction. Of course such an experience cannot be proven by statistics. This highlights the well-known discrepancy between idiographic and nomothetic methods. Progress could be achieved by "cutting more finely", i. e. by a terminology that is more differentiated and eliminates the compulsion to arrive at a rough diagnosis which disregards the finer gradations of the colours that make up the entire picture. Thus the term endo-neurotic could be useful to define a certain part of the diagnostic spectrum of depression with greater clarity.