Arnold Pick

(1851-1924)

Biography  Aphasia

Biography

Arnold Pick was born in a small town in Moravia (Czech Republic) in July 1851. He grew up bilingual; he received his school education in Czech but his parents, who identified with German culture, spoke German to him. After the Gymnasium Pick went to the University of Vienna in 1869. He worked with Meynert, who had also been the teacher of Wernicke and Freud. He received his doctorate at the University of Vienna in 1875. After that he went to Berlin to work in the well-known Charite under Westphal. There he met—among others—Wernicke. After two years of residency as “Sekundararzt” in a psychiatric clinic in north Germany near Oldenburg, Pick accepted a similar position in Prague. There he received the academic title of dozent and with it faculty membership in Psychiatry and Neurology (1878). In 1880 he was appointed director of the psychiatric hospital at Dobrzan. Six years later he was appointed to the chair and the professorship of Psychiatry and Neurology at the German University of Prague ( at the age of 35). He held this position for 35 years, which was not always easy, because of the political animosities between the German and the Czech Universities in Prague. Although he retired in 1921, he continued his active scientific life and published several of his most important papers on aphasia. He died in 1924. During his lifetime Pick contributed 260 articles and 16 books to the fields of neurology and psychiatry, 145 of these after the age of 50.

Aphasia

Pick tried to integrate the contemporary psychological thinking as propounded by Karl Buhler, William James and Wilhelm Wundt in his writings on aphasia. Pick recognized two major areas of interest within the field of the psychology of language. One area concerns the conversion from mental content to spoken expression, the path from thought to speech. A second deals with the path from spoken language to thought, the different stages between hearing and understanding.

Although Pick provided rather detailed description of the different subprocesses involved in both language perception and production, he failed to explain the different aphasic syndromes within this framework. He distinguished several clinical forms of aphasia. On the basis of Wernick’s schema he divided them into (a) motor (frontal) and (b) sensory (temporal) aphasia. He considered the transcortical motor and transcortical sensory aphasia only as stages of recovery from their cortical counterparts (frontal and sensory aphasias) but not as qualitatively different types. Thus the only other established form besides Broca’s and Wernick’s aphasia is total or global aphasia (with lesions in both frontal and temporal areas). Amnestic aphasia may be an additional form of aphasia, which is, however, not explicable in Wernicke’s schema.

Pick concentrated on the two classical aphasias, motor and sensory aphasia. He devoted the whole of his 1913 book to the phenomenon of agrammatic speech disturbances, Die agrammatischen Sprachstorungen. The subtitle indicates that the primary goal of this book is to provide a psychological foundation of the agrammatic deficits. Having laid out a general theory of language production, his explanation of the agrammatic syndromes appears to be only loosely related to it. Pick distinguished motoric and sensoric agrammatism, being associated with, respectively motor and sensory aphasia. Note that this does not mean that agrammatic speech is paralleled by agrammatic comprehension in frontal aphasia—a notion which has been put forward recently by Caramazza and Zurif (1976) and by others—but (rather)it means that there are two different forms of expressive agrammatism; one is called quantitative agrammatism (i.e., agrammatism), the other is referred to as qualitative agrammatism. The latter is synonymous with what Kleist (1916) called paragrammatism. This form is characterized by an incorrect use of auxiliary words, word inflections, and incorrect prefixes and suffixes. The former case is mainly characterized by omission of these elements. He observed that the expressive sensory (temporal) agrammatism (paragrammatism) coincides with paraphasic speech. Any account of these two forms of expressive agrammatism must begin, according to Pick, with the clinical fact of a loss or defective command of the grammatical devices.

The genesis of frontal or motor agrammatism is explained by the principle of economy. Pick started off with the observation that in these patients the word order in simple sentences is mostly preserved. He took this to indicate that these patients are sometimes still able to produce a sentence schema and that the lack of bound and free morphemes has to be explained by speech economy. “The patient attempts to produce the best possible result (a “Notsprache”, which makes him most understandable) with the least expenditure of effort, utilizing the optimal but still automatic application of his linguistic resources”. He assumed that adjustment to a telegraphic style will gradually influence the formulation of the thought. The paragrammatic syndrome, the temporal form of expressive agrammatism brings to bear the fact that the use of grammar is by no means a unified process, but contains many factors which may be affected separately. Pick thought that in paragrammatism the disorder could be attributed to a deficit which precedes the motor function. Frontal agrammatism, in contrast, has to be viewed as a disorder of the motor function itself. The two forms of expressive agrammatism are thus different in nature.

Thus, although Pick provided, for the first time, a psychological model of language production in which the major process levels are already described to explain aphasic deficits, he did not really advance the explanation of agrammatism as compared to earlier descriptions.

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