| Emil Kraepelin
Emil Kraepelin (February 15, 1856- October 7, 1926) was a German
Psychiatrist who attempted to create a synthesis of the hundreds
of mental disorders classified by the 19th century, grouping diseases
together based on classification of common patterns of symptoms,
rather than by simple similarity of major symptoms in the manner
of his predecessors. In fact, it was precisely because of the demonstrated
inadequacy of such methods that Kraepelin developed his new diagnostic
system.
In 1886, after only eight years of training, he was appointed to
a professorship at the University of Tartu (then Dorpat) in what
is today Estonia and became the director of an eighty-bed University
Clinic. There he was able to study and record many clinical histories
in detail and "was led to consider the importance of the course
of the illness with regard to the classification of mental disorders."
Ten years later he announced that he had found a new way of looking
at mental illness. He referred to the traditional view as "symptomatic"
and to his view as "clinical."
Drawing on his long term research, and using the criteria of course,
outcome and prognosis, he developed the concept of dementia praecox,
which he defined as the "sub-acute development of a peculiar
simple condition of mental weakness occurring at a youthful age."
When he first introduced this concept as diagnostic entity in the
fourth German edition of his Lehrbuch der Psychiatrie in 1893, it
was placed among the degenerative disorders alongside, but separate
from, katonia and dementia paranoides. At that time the concept
corresponded by and large with Ewald Hecker's hebephrenia. In the
sixth edition of the Lehrbuch in 1899 all three of these clinical
types are treated but as different expressions of one disease, dementia
praecox.
Kraepelin postulated that there is a specific brain or other biological
pathology underlying each of the major psychiatric disorders. Just
as his laboratory discovered the pathologic basis of what is now
known as Alzheimers disease, Kraepelin was confident that it would
someday be possible to identify the pathologic basis of each of
the major psychiatric disorders.
One of the cardinal principles of his method was the recognition
that any given symptom may appear in virtually any one of these
disorders; i.e. there is virtually no single symptom occurring in
dementia praecox (the name was later changed to "schizophrenia"
by Eugen Bleuler), which cannot sometimes be found in manic-depression.
What distinguishes each disease symptomatically (as opposed to the
underlying pathology) is not any particular (pathognomonic) symptom
or symptoms, but a specific pattern of symptoms. In the absence
of a direct physiological or genetic test or marker for each disease,
it is only possible to distinguish them by their specific pattern
of symptoms. Thus, Kraepelin's system is a method for pattern recognition,
not grouping by common symptoms.
Kraepelin also demonstrated specific patterns in the genetics of
these disorders and specific and characteristic patterns in their
course and outcome. Generally speaking, there tend to be more schizophrenics
among the relatives of schizophrenic patients than in the general
population, while manic-depression is more frequent in the relatives
of manic-depressives.
He also reported a pattern to the course and outcome of these conditions.
Kraepelin believed that schizophrenia had a deteriorating course
in which mental function continuously (although perhaps erratically)
declines, while manic-depressive patients experienced a course of
illness which was intermittent, where patients were relatively symptom-free
during the intervals which separate acute episodes. This led Kraepelin
to name what we now know as schizophrenia, dementia praecox (the
dementia part signifing the irreversible mental decline). It later
became clear that dementia praecox did not necessarily lead to mental
decline and so was renamed by Eugene Bleuler to correct the misnomer.
Kraepelin is credited with the classification of what was previously
considered to be a unitary concept of psychosis, into two distinct
forms:
- Manic Depression (now seen as comprising a range of mood disorders
such as Major Depression and Bipolar Disorder), and
- Dementia praecox, which was later renamed schizophrenia by
Eugene Bleuler.
Kraepelin was also a colleague of Alois Alzheimer, and co-discoverer
with Alzheimer of Alzheimers Disease.
In addition to his distinction between dementia praecox and manic-depression,
Kraepelin should be credited with being the founder of modern scientific
psychiatry, psychopharmacology and psychiatric genetics, according
to the eminent psychologist H. J. Eysenck in his Encyclopedia of
Psychology. Kraepelin postulated that psychiatric diseases are principally
caused by biological and genetic disorders. His psychiatric theories
dominated the field of psychiatry at the beginning of the twentieth
century. He vigorously opposed the approach of Freud who regarded
and treated psychiatric disorders as caused by psychological factors.
Though Kraepelin's contribution was largely ignored through most
of the twentieth century due to the success of Freudian etiological
theories, Kraepelin's basic concepts now dominate psychiatric research
and academic psychiatry, and today the published literature in the
field of psychiatry is overwhelmingly biological and genetic in
its orientation. Largely for political reasons, Kraepelin's great
contribution in discovering schizophrenia and manic-depression remains
relatively unknown to the general public and his work is little
read, despite the recent widespread adoption of his fundamental
theories on the etiology and diagnosis of psychiatric disorders
which form the basis of all major diagnostic systems in use today,
especially the American Psychiatric Association's DSM-IV and the
World Health Organization's ICD system.
For a more complete description of the epic social and political
battle that gave rise to Freudianism (from an anti-Freudian perspective),
see psychiatrist E. Fuller Torrey's "The Freudian Fraud".
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