Reascending the magic mountain: Thomas Mann's Dr Krokowski and modern psychiatry – psychiatry in history

On a recent trip to Davos, Switzerland, for a forensic psychiatric evaluation, we marvelled at the majestic Schatzalp landscape and recalled the complexities of Thomas Mann's The Magic Mountain (1924).¹ Alongside the eponymous sanatorium-turned-hotel, Mann's bildungsroman was set atop this alpine peak in Switzerland. The book follows Hans Castrop's convalescence and subsequent education about wide-ranging, innovative dialectics that intrigued contemporaneous European medical circles.

Particularly illuminating is the attending psychiatrist, Dr Edhin Krokowski, who instantiates elements of Georg Groddec, Richard von Krafft-Ebing and Sigmund Freud. An ‘idealist of the pathological’, Krokowski considers psychiatric symptoms ‘a disguised manifestation of the power of love’, instead emphasising the inorganic basis of mental disorders, or ‘the bringing of light into the unconscious mind’.¹ Mann ironises such ideas by conveying Krokowski's occultist descent.

For us, the author focused on these concepts precisely because they exemplified state-of-the-art psychiatric thoughts of the time. Sharing similar biographies, Mann and Freud corresponded regularly, but Mann disputed Freudian tenets. Contemplating the Schatzalp today and recalling this fictional physician, we speculated on the hypothetical (and admittedly frivolous) notion of a modern-day Krokowski, and through him, which novel psychiatric ideas Mann would dissect.

With its recent technological developments, Mann may have depicted his archetype as a proponent of biological psychiatry. At one juncture, Castorp reacts to an x-ray of his cousin's heart (cutting-edge technology in this epoch); he was ‘moved’, but experienced ‘uneasy undoubt, as to whether it was really permissible and innocent to stand here [ … ] and gaze’.¹ The protagonist's fascination is tempered by morbid unease, foreshadowing some debates about the contexts in which neuroimaging should be utilised.

Perhaps a contemporary Krokowski may embody principles of social psychiatry? This would depart from his refusal to ‘deduce the perversity of the whole from [ … ] its parts’.¹ One could imagine Mann appraising psychiatric advancements by having Krokowski discuss social determinants. Equally, Mann may have undermined this by symbolising the tension between prevention and treatment previously illustrated by detractors of social psychiatry.

Given its predominance, a contemporary Krokowski could promote the biopsychosocial concept; the eclecticism of this has been criticised as enabling psychiatrists to ‘pick and choose’ their principles of care. Castorp seemingly rejects Krokowski's latter occultism, yet he ultimately disavows his recent insights into rational dialectics by enlisting during the First World War ‘under pressure from the prevailing temper’.¹ Consequently, even today, Mann may still have foregrounded Krokowski's psychodynamic approaches, exploiting the purported flexibility of the biopsychosocial model.

Of course, this represents an arbitrary and light-hearted dialogue on a train ride from Davos; others will undoubtedly (and justifiably) have divergent opinions. Nonetheless, if Mann were writing now, his critical ambivalence may have been piqued by these or other psychiatric concepts, the advantages and disadvantages of which have been extensively debated in scientific literature. Less trivially, the boundlessness of the Schatzalp reminds us how far psychiatry has come since Mann raised his pen, and how much further our discipline can go. The possibilities are as vast as the magic mountain we beheld.