Beiträge zum Problem des symptomatischen Alkoholismus–I. Endogene Psychosen und “Alkoholismus” *

We talk in Jellinek's sense about the disease of alcoholism, but we must regard the word “alcoholism” as a collective clinical conception in which we see: (1) “abnormal” habitual drinkers who drink too much and too often, but need not do so, for they are not dependent upon alcohol; (2) “real” alcoholics who also drink too much and too often because they cannot help it, i.e., because of their alcohol dependence they can be only alcoholics or abstainers; (3) symptomatic drinkers, in whom the everyday or periodic misuse of alcohol functions as a symptom or auto‐correction system of some fundamental psychiatric disorder. These “double” cases can occur together but can change the course of both diseases, sometimes favourably and sometimes unfavourably. We have investigated this problem of symptomatic alcoholism over a period of many years, and have pointed out the importance of the reciprocal action between the abuse of alcohol and schizophrenia. In the case of our 29 schizophrenic drinkers we have observed and described several typical forms of these pathoplastic constellations. We also found, in the history of 100 non‐selected cyclothymics 19 cases of the symptomatic abuse of alcohol, which in the majority of cases led only to a non‐typical or even a typical–i.e., manic or melancholically amalgamate–intoxication, but in 8 cases led to a prolonged bout of habitual or relief drinking. Both these possibilities occurred very often in female cyclothymics. In the pathogenesis of not a few cases the endogenic and endoreactive disturbances of the affectivity can, in addition to the well‐known sociological and psychological factors, play a causative or pathogenetic role. On the other hand, in the coincidence of schizophrenia and alcoholism, pathoplastic intermediate effects occur only from one case to another.