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{{Short description|German psychiatrist (1856–1926)}} | |||
'''Emil Kraepelin''' (] ]–] ]) was a ] ] 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. | |||
{{Use dmy dates|date=July 2021}} | |||
{{Infobox scientist | |||
| name = Emil Kraepelin | |||
| image = Emil Kraepelin 1926.jpg | |||
| image_size = | |||
| alt = | |||
| caption = Emil Kraepelin in his later years | |||
| birth_date = {{Birth date|df=yes|1856|02|15}} | |||
| birth_place = ], ], ] | |||
| death_date = {{Death date and age|df=yes|1926|10|07|1856|02|15}} | |||
| death_place = ], ], ] | |||
| resting_place = | |||
| resting_place_coordinates = <!-- {{Coord|LAT|LONG|type:landmark|display=inline,title}} --> | |||
| residence = | |||
| citizenship = | |||
| nationality = ] | |||
| fields = ] | |||
| workplaces = ]<br /> ]<br />]<br />] | |||
| alma_mater = ]<br />]<br />(MBBS, 1878)<br />]<br />(Dr. hab. med., 1882) | |||
| thesis_title = The Place of Psychology in Psychiatry | |||
| thesis_url = | |||
| thesis_year = 1882 | |||
| doctoral_advisor = | |||
| academic_advisors = | |||
| doctoral_students = | |||
| notable_students = | |||
| known_for = ], <br />] | |||
| author_abbrev_bot = | |||
| author_abbrev_zoo = | |||
| awards = | |||
| signature = Emil_Kraepelin_signature.JPG | |||
| signature_alt = | |||
| spouse = Ina Marie Marie Wilhelmine Schwabe<ref name="HGL"/> | |||
| children = 2 sons, 6 daughters<ref name="HGL"/> | |||
}} | |||
'''Emil Wilhelm Georg Magnus Kraepelin''' ({{IPAc-en|ˈ|k|r|ɛ|p|əl|ɪ|n}}; {{IPA|de|ˈeːmiːl 'kʁɛːpəliːn|lang}}; 15 February 1856 – 7 October 1926) was a German ]. ]'s Encyclopedia of Psychology identifies him as the founder of modern scientific psychiatry, psychopharmacology and psychiatric genetics. | |||
Kraepelin believed the chief origin of psychiatric ] to be ] and ] malfunction. His theories dominated psychiatry at the start of the 20th century and, despite the later ] influence of ] and his disciples, enjoyed a revival at century's end. While he proclaimed his own high clinical standards of gathering information "by means of expert analysis of individual cases", he also drew on reported observations of officials not trained in psychiatry. | |||
<table align="left"><tr><td>]</tr></td></table> | |||
His textbooks do not contain detailed case histories of individuals but mosaic-like compilations of typical statements and behaviors from patients with a specific diagnosis. He has been described as "a scientific manager" and "a political operator", who developed "a large-scale, clinically oriented, epidemiological research programme".<ref name="Engstrom2007">{{cite journal|last=Engstrom |first=E. J. |title=On the Question of Degeneration' by Emil Kraepelin (1908)1 |journal=] |date=1 September 2007 |volume=18 |issue=3 |pages=389–398 |doi=10.1177/0957154X07079689 |pmid=18175639 |s2cid=46482747 |url=http://134.76.163.171:8080/jspui/bitstream/123456789/10898/1/PEER_stage2_10.1177%252F0957154X07079689.pdf |url-status=dead |archive-url=https://web.archive.org/web/20130526013902/http://134.76.163.171:8080/jspui/bitstream/123456789/10898/1/PEER_stage2_10.1177%252F0957154X07079689.pdf |archive-date=26 May 2013}}.</ref><ref name="Shepherd 174–183">{{cite journal|last=Shepherd|first=M.|title=Two faces of Emil Kraepelin|journal=]|date=1 August 1995|volume=167|issue=2|pages=174–183|doi=10.1192/bjp.167.2.174|pmid=7582666|s2cid=37204909 }}</ref> | |||
In 1886, after only eight years of training, he was appointed to a professorship at the ] (then ''Dorpat'') in what is today ] 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". | |||
== Family and early life == | |||
Drawing on his long term research, and using the criteria of course, outcome and prognosis, he developed the concept of ], 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 a 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, ] and ]. At that time the concept corresponded by and large with ]'s ]. In the sixth edition of the ''Lehrbuch'' in 1899 all three of these clinical types are treated as different expressions of one disease, dementia praecox. | |||
Kraepelin, whose father, Karl Wilhelm, was a former opera singer, music teacher, and later successful story teller,<ref>Peter Barham (2004), ''Forgotten Lunatics of the Great War'' (New Haven: Yale), p. 163 n. 47.</ref> was born in 1856 in ], in the ] in ]. He was first introduced to biology by his brother Karl, 10 years older and, later, the director of the Zoological Museum of Hamburg.<ref>On Kraepelin's early life and family, see Burgmair et al., vol. I, as well as his ''Memoirs'' (Berlin: Springer, 1987).</ref> | |||
==Education and career== | |||
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 ], Kraepelin was confident that it would someday be possible to identify the pathologic basis of each of the major psychiatric disorders. | |||
] | |||
Kraepelin began his medical studies in 1874 at the ] and completed them at the ] (1877–78).<ref name="HGL">Dagmar Drüll, ''Heidelberger Gelehrtenlexikon: 1803–1932'', Springer-Verlag, 2013, p. 149.</ref> At Leipzig, he studied neuropathology under ] and experimental psychology with ]. Kraepelin would be a disciple of Wundt and had a lifelong interest in ] based on his theories. While there, Kraepelin wrote a prize-winning essay, "The Influence of Acute Illness in the Causation of Mental Disorders".<ref name=Alic2001/> | |||
At Würzburg he completed his ''Rigorosum'' (roughly equivalent to a PhD level ], literally "rigorous exam") in March 1878, his '']'' (licensing examination) in July 1878, and his '']'' (his license to practice medicine; roughly equivalent to an ]) on 9 August 1878.<ref name="HGL"/> From August 1878 to 1882,<ref name="HGL"/> he worked with ] at the ]. | |||
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 ]), 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. | |||
Returning to the University of Leipzig in February 1882,<ref name="HGL"/> he worked in ]'s neurology clinic and in Wundt's psychopharmacology laboratory.<ref name=Alic2001> by Margaret Alic, ''Gale Encyclopedia of Psychology'', 2001.</ref> He completed his '']'' thesis - major postdoc publication and process - at Leipzig;<ref name="HGL"/> it was entitled "The Place of Psychology in Psychiatry".<ref name=Alic2001/> On 3 December 1883 he completed his '']'' ("habilitation" at another institution than originally applied for = habilitation recognition procedure) at Munich.<ref name="HGL"/> | |||
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. | |||
Kraepelin's major work, ''Compendium der Psychiatrie: Zum Gebrauche für Studirende und Aerzte'' (''Compendium of Psychiatry: For the Use of Students and Physicians''), was first published in 1883 and was expanded in subsequent multivolume editions to ''Ein Lehrbuch der Psychiatrie'' (''A Textbook: Foundations of Psychiatry and Neuroscience''). In it, he argued that psychiatry was a branch of medical science and should be investigated by observation and experimentation like the other natural sciences. He called for research into the physical causes of mental illness, and started to establish the foundations of the modern classification system for mental disorders. Kraepelin proposed that by studying case histories and identifying specific disorders, the progression of mental illness could be predicted, after taking into account individual differences in personality and patient age at the onset of disease.<ref name=Alic2001/> | |||
He also reported a pattern to the course and outcome of these conditions. Kraepelin believed that ] 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 ], ''dementia praecox'' (the ] 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 ] to correct the misnomer. | |||
In 1884, he became senior physician in the Prussian provincial town of ], ], and the following year he was appointed director of the Treatment and Nursing Institute in ]. On 1 July 1886,<ref name="HGL"/> at the age of 30, Kraepelin was named Professor of Psychiatry at the University of ] (today the ]) in what is today Tartu, ] (see Burgmair et al., vol. IV). Four years later, on 5 December 1890,<ref name="HGL"/> he became department head at the ], where he remained until 1904.<ref name=Alic2001/> While at Dorpat he became the director of the 80-bed ], where he began 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". | |||
Kraepelin is credited with the classification of what was previously considered to be a unitary concept of ], into two distinct forms: | |||
* ] (now seen as comprising a range of mood disorders such as Major ] and ]), and | |||
* Dementia praecox, which was later renamed ] by ]. | |||
In 1903, Kraepelin moved to Munich to become Professor of Clinical Psychiatry at the ].<ref>{{cite web | website= LMU Klinikum München |url=https://www.lmu-klinikum.de/psychiatrie-und-psychotherapie/klinik-kompakt/historie/9a5bb39c98bb7489 |title=Klinik für Psychiatrie und Psychotherapie, Historie |access-date=10 June 2021}}</ref> | |||
Kraepelin was also a colleague of ], and co-discoverer with Alzheimer of ]. | |||
In 1908, he was elected a member of the ].{{citation needed|date=March 2013}} | |||
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 ] 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 ] who regarded and treated psychiatric disorders as caused by psychological factors. | |||
In 1912, at the request of the DVP (Deutscher Verein für Psychiatrie; German Association for Psychiatry),<ref>See (1) ] and (2) </ref> of which he was the head from 1906 to 1920, he began plans to establish a centre for research. Following a large donation from the Jewish German-American banker ], who had at one time been a patient, and promises of support from "patrons of science", the ] was founded in 1917 in Munich.<ref>Burgmair, Wolfgang, and Matthias M. Weber. "'Das Geld ist gut angelegt, und du brauchst keine Reue zu haben': James Loeb, ein deutsch-amerikanischer Wissenschaftsmäzen zwischen Kaiserreich und Weimarer Republik." Historische Zeitschrift 277 (2003): 343–378.</ref><ref> Harvard University Press.</ref> Initially housed in existing hospital buildings, it was maintained by further donations from Loeb and his relatives. In 1924 it came under the auspices of the ]. The German-American ]'s ] made a large donation enabling the development of a new dedicated building for the institute along Kraepelin's guidelines, which was officially opened in 1928.<ref name=Alic2001/> | |||
Kraepelin's contribution was largely ignored throughout much of the twentieth century, with the success of Freudian etiological theories. Kraepelin's basic concepts however 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. Kraepelin's great contribution in discovering schizophrenia and manic-depression remains relatively unknown to the general public and his work is little read. This is 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 ]'s ] and the ]'s ] system. | |||
Kraepelin spoke out against the barbarous treatment that was prevalent in the psychiatric asylums of the time, and crusaded against alcohol, ] and the imprisonment rather than treatment of the insane. For the sedation of agitated patients, Kraepelin recommended ].<ref>Hans C. Bangen: ''Geschichte der medikamentösen Therapie der Schizophrenie.'' VWB, Berlin 1992, {{ISBN|3-927408-82-4}}</ref> He rejected psychoanalytical theories that posited innate or early sexuality as the cause of mental illness, and he rejected philosophical speculation as ]. He focused on collecting clinical data and was particularly interested in ] (e.g., diseased tissue).<ref name=Alic2001/> | |||
For a more complete description of the epic social and political battle that gave rise to ] (from an anti-Freudian perspective), see psychiatrist ]'s "The Freudian Fraud". | |||
He also firmly rejected the assumption of natural difference in relation to homosexuality, which he regarded as a vice caused by masturbation. In 1918 he called for "educational discipline" such as those introduced by the Nazi party after 1933: severe punishments for the crime of 'corruption' (seduction), applicable to any act related to sexual gratification. This extended the anti-gay policy of the time, which only punished sexual intercourse between men. These ideas eventually went on to lend legitimacy to Nazi policies that persecuted gay people, allowing the Nazi party to do so under the guise of conforming to scientific opinions. His work legitimized the persecution and inhumane treatment of gay people in Nazi Germany.<ref>{{Cite book |title=Hidden holocaust? Gay and lesbian persecution in Germany 1933–45 |date=1995 |publisher=Cassell |isbn=978-0-304-32956-4 |editor-last=Grau |editor-first=Günter |location=London}}</ref> | |||
In the later period of his career, as a convinced champion of ], he actively promoted a policy and research agenda in ] and ].<ref name=Engstrom2006>{{cite journal|vauthors=Engstrom EJ, Weber MM, Burgmair W |title=Emil Wilhelm Magnus Georg Kraepelin (1856–1926)|journal=]|date=October 2006|volume=163|issue=10|pages=1710|doi=10.1176/appi.ajp.163.10.1710|pmid=17012678}}.</ref> | |||
Kraepelin retired from teaching at the age of 66, spending his remaining years establishing the institute. The ninth and final edition of his ''Textbook'' was published in 1927, shortly after his death. It comprised four volumes and was ten times larger than the first edition of 1883.<ref name=Alic2001/> | |||
In the last years of his life, Kraepelin was preoccupied with ] teachings and was planning to visit Buddhist shrines at the time of his death, according to his daughter, Antonie Schmidt-Kraepelin.<ref>{{Cite book|title=Conceptual Issues in Psychological Medicine|last=Shepherd|first=Michael|publisher=Tavistock/Routledge|year=1990|isbn=978-0415165303|location=London|pages=230}}</ref> | |||
== Theories and classification schemes == | |||
Kraepelin announced that he had found a new way of looking at mental illness, referring to the traditional view as "symptomatic" and to his view as "clinical". This turned out to be his ]-setting synthesis of the hundreds of mental disorders classified by the 19th century, grouping diseases together based on classification of ]—common ''patterns'' of symptoms over time—rather than by simple similarity of major symptoms in the manner of his predecessors. | |||
Kraepelin described his work in the 5th edition of his textbook as a "decisive step from a symptomatic to a clinical view of insanity. . . . The importance of external clinical signs has . . . been subordinated to consideration of the conditions of origin, the course, and the terminus which result from individual disorders. Thus, all purely symptomatic categories have disappeared from the ]".<ref name=decker/> | |||
=== Psychosis and mood === | |||
Kraepelin is specifically credited with the classification of what was previously considered to be a ], into two distinct forms (known as the ]): | |||
* ] (although commonly presented as synonym with bipolar disorder that is inaccurate; manic depressive illness encompasses a broader spectrum of mood disorders such as ] and ],<ref>{{cite journal | vauthors = Teodoro T, Durval R | title = Emil Kraepelin's taxonomic unitary view of manic-depressive insanity in the 21st century: the never-ending diagnostic conundrum of bipolar depression | journal = CNS Spectrums | date = October 2022 | volume = 28 | issue = 4 | pages = 389–390 | pmid = 36210529 | doi = 10.1017/s109285292200102x| s2cid = 252779392 | doi-access = free }}</ref> and | |||
* ]. | |||
Drawing on his long-term research, and using the criteria of course, outcome and ], he developed the concept of ], 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 a 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, ] and ]. At that time, the concept corresponded by and large with ]'s ]. In the sixth edition of the ''Lehrbuch'' in 1899 all three of these clinical types are treated as different expressions of one disease, dementia praecox.<ref>{{cite web|last=Yuhas|first=Daisy|title=Throughout History, Defining Schizophrenia Has Remained a Challenge (Timeline)|date=March 2013 |url=http://www.scientificamerican.com/article.cfm?id=throughout-history-defining-schizophrenia-has-remained-challenge|publisher=Scientific American Mind (March 2013)|access-date=2 March 2013}}.</ref> | |||
One of the cardinal principles of his method was the recognition that any given symptom may appear in virtually any one of these disorders; e.g., there is almost no single symptom occurring in dementia praecox which cannot sometimes be found in manic depression. What distinguishes each disease symptomatically (as opposed to the underlying ]) is not any particular (]) 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. | |||
It has been claimed that Kraepelin also demonstrated specific patterns in the genetics of these disorders and patterns in their course and outcome,<ref>{{cite journal|last1=Ebert|first1=Andreas|title=Emil Kraepelin: A pioneer of scientific understanding of psychiatry and psychopharmacology|journal=Indian Journal of Psychiatry|pmc=2927892|pmid=20838510|doi=10.4103/0019-5545.64591|volume=52|issue=2|pages=191–2|year=2010 |doi-access=free }}</ref> but no specific ] have yet been identified. Generally speaking, there tend to be more people with schizophrenia among the relatives of schizophrenic patients than in the general population, while manic depression is more frequent in the relatives of manic depressives. Though, of course, this does not demonstrate genetic linkage, as this might be a ]-] factor as well. | |||
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 ] part signifying the irreversible mental decline). It later became clear that dementia praecox did not necessarily lead to mental decline and was thus renamed ] by ] to correct Kraepelin's misnomer. | |||
In addition, as Kraepelin accepted in 1920, "It is becoming increasingly obvious that we cannot satisfactorily distinguish these two diseases"; however, he maintained that "On the one hand we find those patients with irreversible dementia and severe cortical lesions. On the other are those patients whose personality remains intact".<ref>{{cite journal |vauthors=Berrios GE, Luque R, Villagran JM| year = 2003 | title = Schizophrenia: a conceptual history | url = http://www.ijpsy.com/volumen3/num2/60/schizophrenia-a-conceptual-history-esquizofrenia-EN.pdf | journal = International Journal of Psychology and Psychological Therapy | volume = 3 | issue = 2| pages = 111–140 }}</ref> Nevertheless, overlap between the diagnoses and neurological abnormalities (when found) have continued, and in fact a diagnostic category of ] would be brought in to cover the intermediate cases. | |||
Kraepelin devoted very few pages to his speculations about the etiology of his two major insanities, dementia praecox and manic-depressive insanity. However, from 1896 to his death in 1926 he held to the speculation that these insanities (particularly dementia praecox) would one day probably be found to be caused by a gradual systemic or "whole body" disease process, probably ], which affected many of the organs and nerves in the body but affected the brain in a final, decisive cascade.<ref>{{cite magazine|last=Noll|first=Richard|title=Whole Body Madness|url=http://www.psychiatrictimes.com/display/article/10168/2104852|magazine=Psychiatric Times|access-date=26 September 2012}}.</ref> | |||
=== Psychopathic personalities === | |||
In the first through sixth edition of Kraepelin's influential psychiatry textbook, there was a section on ], which meant then a disorder of the emotions or moral sense without apparent delusions or hallucinations, and which Kraepelin defined as "lack or weakness of those sentiments which counter the ruthless satisfaction of egotism". He attributed this mainly to degeneration. This has been described as a psychiatric redefinition of ]'s theories of the "born criminal", conceptualised as a "] defect", though Kraepelin stressed it was not yet possible to recognise them by physical characteristics.<ref name=Wetzell2000>] (2000) from p 59 & 146, misc.</ref> | |||
In fact from 1904 Kraepelin changed the section heading to "The born criminal", moving it from under "Congenital feeble-mindedness" to a new chapter on "Psychopathic personalities". They were treated under a theory of degeneration. Four types were distinguished: born criminals (inborn delinquents), ], ] persons, and Triebmenschen (persons driven by a basic compulsion, including ], ], and ]). | |||
The concept of "] inferiorities" had been recently popularised in Germany by ], who proposed congenital and acquired types. Kraepelin had no evidence or explanation suggesting a congenital cause, and his assumption therefore appears to have been simple "]". Others, such as ], argued for a varying combination of causes. Kraepelin's assumption of a moral defect rather than a positive drive towards crime has also been questioned, as it implies that the moral sense is somehow inborn and unvarying, yet it was known to vary by time and place, and Kraepelin never considered that the moral sense might just be different. | |||
] criticized Kraepelin's nosology on topics such as ] for appearing to be a list of behaviors that he considered undesirable, rather than medical conditions, though Schneider's alternative version has also been criticised on the same basis. Nevertheless, many essentials of these diagnostic systems were introduced into the diagnostic systems, and remarkable similarities remain in the DSM-5 and ICD-10.<ref name=Wetzell2000/> The issues would today mainly be considered under the category of ], or in terms of Kraepelin's focus on ]. | |||
Kraepelin had referred to psychopathic conditions (or "states") in his 1896 edition, including compulsive insanity, impulsive insanity, ], and mood disturbances. From 1904, however, he instead termed those "original disease conditions, and introduced the new alternative category of psychopathic personalities. In the eighth edition from 1909 that category would include, in addition to a separate "dissocial" type, the excitable, the unstable, the Triebmenschen driven persons, eccentrics, the liars and swindlers, and the quarrelsome. It has been described as remarkable that Kraepelin now considered mood disturbances to be not part of the same category, but only attenuated (more mild) phases of manic depressive illness; this corresponds to current classification schemes.<ref>Henning Sass & Alan Felthous (2008) Chapter 1: History and Conceptual Development of Psychopathic Disorders in . Edited by Alan Felthous, Henning Sass.</ref> | |||
=== Alzheimer's disease === | |||
Kraepelin postulated that there is a specific brain or other biological pathology underlying each of the major psychiatric disorders.<ref>{{Cite journal |last1=Ebert |first1=Andreas |last2=Bär |first2=Karl-Jürgen |date=2010 |title=Emil Kraepelin: A pioneer of scientific understanding of psychiatry and psychopharmacology |journal=Indian Journal of Psychiatry |volume=52 |issue=2 |pages=191–192 |doi=10.4103/0019-5545.64591 |doi-access=free |issn=0019-5545 |pmc=2927892 |pmid=20838510}}</ref> As a colleague of ], he was a co-discoverer of ], and his laboratory discovered its pathological basis. Kraepelin was confident that it would someday be possible to identify the pathological basis of each of the major psychiatric disorders.{{citation needed|date=March 2013}} | |||
=== Eugenics === | |||
{{Eugenics sidebar|pre-war academics}} | |||
Upon moving to become Professor of Clinical Psychiatry at the ] in 1903, Kraepelin increasingly wrote on social policy issues. He was a strong and influential proponent of ] and ]. His publications included a focus on ], ], ] and ].<ref name=Engstrom2007>{{cite journal|last=Engstrom |first=E. J. |title=On the Question of Degeneration' by Emil Kraepelin (1908)1 |journal=] |date=1 September 2007 |volume=18 |issue=3 |pages=389–398 |doi=10.1177/0957154X07079689 |pmid=18175639 |s2cid=46482747 |url=http://134.76.163.171:8080/jspui/bitstream/123456789/10898/1/PEER_stage2_10.1177%252F0957154X07079689.pdf |url-status=dead |archive-url=https://web.archive.org/web/20130526013902/http://134.76.163.171:8080/jspui/bitstream/123456789/10898/1/PEER_stage2_10.1177%252F0957154X07079689.pdf |archive-date=26 May 2013}}.</ref> | |||
Kraepelin was convinced that such institutions as the ] and the ], because of their trend to break the processes of ], undermined the Germans' biological "struggle for survival".<ref name=Engstrom2006/> He was concerned to preserve and enhance the German people, the ], in the sense of nation or race. He appears to have held ] concepts of evolution, such that cultural deterioration could be inherited. He was a strong ally and promoter of the work of fellow psychiatrist (and pupil and later successor as director of the clinic) ] to clarify the mechanisms of genetic inheritance as to make a so-called "] genetic ]".<ref name=Engstrom2007/> | |||
Martin Brune has pointed out that Kraepelin and Rüdin also appear to have been ardent advocates of a ] theory, a version of ] which held that modern culture was not allowing people to be weeded out, resulting in more mental disorder and deterioration of the gene pool. Kraepelin saw a number of "symptoms" of this, such as "weakening of viability and resistance, decreasing fertility, proletarianisation, and moral damage due to "penning up people" . He also wrote that "the number of idiots, epileptics, psychopaths, criminals, prostitutes, and tramps who descend from alcoholic and syphilitic parents, and who transfer their inferiority to their offspring, is incalculable". He felt that "the well-known example of the ], with their strong disposition towards nervous and mental disorders, teaches us that their extraordinarily advanced domestication may eventually imprint clear marks on the race". Brune states that Kraepelin's ] system "was, to a great deal, built on the degeneration ]".<ref>{{cite journal|last=Brüne|first=Martin|title=On human self-domestication, psychiatry, and eugenics|journal=Philosophy, Ethics, and Humanities in Medicine|date=1 January 2007|volume=2|issue=1|pages=21|doi=10.1186/1747-5341-2-21|pmid=17919321|pmc=2082022 |doi-access=free }}</ref> | |||
== Influence == | |||
Kraepelin's great contribution in classifying schizophrenia and manic depression remains relatively unknown to the general public, and his work, which had neither the literary quality nor paradigmatic power of Freud's, is little read outside scholarly circles. Kraepelin's contributions were also to a large extent marginalized throughout a good part of the 20th century during the success of Freudian etiological theories. However, his views now dominate many quarters of psychiatric research and academic psychiatry. His fundamental theories on the diagnosis of psychiatric disorders form the basis of the major diagnostic systems in use today, especially the ]'s ] and the ]'s ] system, based on the ] and earlier ] developed by espoused "neo-Kraepelinians", though ] and others in the DSM committees were keen not to include assumptions about causation as Kraepelin had.<ref name=decker>{{cite journal | author = Decker Hannah S | year = 2007| title = How Kraepelinian was Kraepelin? How Kraepelinian are the neo-Kraepelinians?—from Emil Kraepelin to DSM-III | url = http://peer.ccsd.cnrs.fr/docs/00/57/08/96/PDF/PEER_stage2_10.1177%252F0957154X07078976.pdf | journal = History of Psychiatry | volume = 18 | issue = 3 | pages = 337–360 | doi = 10.1177/0957154X07078976 | pmid = 18175636| s2cid = 19754009| url-status = dead | archive-url = https://web.archive.org/web/20131029211818/http://peer.ccsd.cnrs.fr/docs/00/57/08/96/PDF/PEER_stage2_10.1177/0957154X07078976.pdf | archive-date = 29 October 2013}}</ref><ref>{{cite journal | author = Engstrom Eric J., Weber Matthias | year = 2007 | url = http://www.tara.tcd.ie/bitstream/2262/51636/1/PEER_stage2_10.1177%252F0957154X07080819.pdf | title = Making Kraepelin History: A Great Instauration?: Special Issue | journal = History of Psychiatry | volume = 18 | issue = 3 | pages = 267–273 | doi = 10.1177/0957154x07080819 | s2cid = 144482013 | url-status = dead | archive-url = https://web.archive.org/web/20131029215301/http://www.tara.tcd.ie/bitstream/2262/51636/1/PEER_stage2_10.1177/0957154X07080819.pdf | archive-date = 29 October 2013}}</ref> | |||
Kraepelin has been described as a "scientific manager"<ref>Engstrom, Eric J. "Organizing Psychiatric Research in Munich (1903–1925): A Psychiatric Zoon Politicon between State Bureaucracy and American Philanthropy." In International Relations in Psychiatry: Britain, Germany, and the United States through World War II, edited by Volker Roelcke, Paul J. Weindling, and Louise Westwood, 48–66. Rochester: University of Rochester Press, 2010.</ref><ref>{{cite journal|last1=Engstrom|first1=Eric|last2=Weber|first2=Matthias|last3=Burgmair|first3=Wolfgang|title=Psychiatric Governance, völkisch Corporatism, and the German Research Institute for Psychiatry in Munich (1912–1926)|journal=History of Psychiatry|date=2016|volume=27|issue=1/2|pages=38–50, 137–152|doi=10.1177/0957154x15623692|pmid=26823087|s2cid=21375412}}</ref> and political operator, who developed a large-scale, clinically oriented, epidemiological research programme. In this role he took in clinical information from a wide range of sources and networks. Despite proclaiming high clinical standards for himself to gather information "by means of expert analysis of individual cases", he would also draw on the reported observations of officials not trained in psychiatry. The various editions of his textbooks do not contain detailed case histories of individuals, however, but mosaiclike compilations of typical statements and behaviors from patients with a specific diagnosis. | |||
Kraepelin wrote in a ''knapp und klar'' (concise and clear) style that made his books useful tools for physicians. Abridged and clumsy English translations of the sixth and seventh editions of his textbook in 1902 and 1907 (respectively) by Allan Ross Diefendorf (1871–1943), an assistant physician at the Connecticut Hospital for the Insane at Middletown, inadequately conveyed the literary quality of his writings that made them so valuable to practitioners.<ref>{{cite web|last=Noll|first=Richard|title=The Bed Makes Gestures|url=http://www.psychiatrictimes.com/blog/psych-history/content/article/10168/2125478|work=Psychiatric times|access-date=8 February 2013}}.</ref> | |||
Among the doctors trained by Alois Alzheimer and Emil Kraepelin at Munich at the beginning of the 20th century were the Spanish neuropathologists and neuropsychiatrists ] and ], two distinguished disciples of ] and members of the ]. | |||
== Dreaming for psychiatry's sake == | |||
In the Heidelberg and early Munich years he edited ''Psychologische Arbeiten'', a journal on experimental psychology. One of his own famous contributions to this journal also appeared in the form of a monograph (105 pp.) entitled ''Über Sprachstörungen im Traume'' (''On Language Disturbances in Dreams'').<ref> (1906).</ref> Kraepelin, on the basis of the dream-] analogy, studied for more than 20 years language disorder in dreams in order to study indirectly ]. The dreams Kraepelin collected are mainly his own. They lack extensive comment by the dreamer. In order to study them the full range of biographical knowledge available today on Kraepelin is necessary (see, e.g., Burgmair et al., I-IX). | |||
== Bibliography == | |||
*Kraepelin, E. (1906). ''Über Sprachstörungen im Traume''. Leipzig: Engelmann. ( Online.) | |||
*Kraepelin, E. (1987). ''Memoirs.'' Berlin, Heidelberg, New York: Springer-Verlag. {{ISBN|978-3-642-71926-4}}. | |||
===Collected works=== | |||
*Burgmair, Wolfgang & Eric J. Engstrom & Matthias Weber et al., eds. ''Emil Kraepelin''. 9 vols. Munich: belleville, 2000–2019. | |||
**Vol. I: Persönliches, Selbstzeugnisse (2000), {{ISBN|3-933510-90-2}} | |||
**Vol. II: Kriminologische und forensische Schriften: Werke und Briefe (2001), {{ISBN|3-933510-91-0}} | |||
**Vol. III: Briefe I, 1868–1886 (2002), {{ISBN|3-933510-92-9}} | |||
**Vol. IV: Kraepelin in Dorpat, 1886–1891 (2003), {{ISBN|3-933510-93-7}} | |||
**Vol. V: Kraepelin in Heidelberg, 1891–1903 (2005), {{ISBN|3-933510-94-5}} | |||
**Vol. VI: Kraepelin in München I: 1903–1914 (2006), {{ISBN|3-933510-95-3}} | |||
**Vol. VII: Kraepelin in München II: 1914–1920 (2009), {{ISBN|978-3-933510-96-9}} | |||
**Vol. VIII: Kraepelin in München III: 1921–1926 (2013), {{ISBN|978-3-943157-22-2}} | |||
**Vol. IX: Briefe und Dokumente II: 1876-1926 (2019), {{ISBN|978-3-946875-28-4}} | |||
==See also== | |||
{{Portal|Psychiatry}} | |||
* ] | |||
* ] | |||
* ] | |||
* ] | |||
* ] | |||
* ] | |||
== References == | |||
{{Reflist}} | |||
== Sources == | |||
*Noll, Richard (2011) ''American Madness: The Rise and Fall of Dementia Praecox.'' Cambridge and London: Harvard University Press. {{ISBN?}} | |||
*{{cite journal | author = Briole G | year = 2012 | title = Emil Kraepelin: The Fragility of a Colossal Oeuvre | journal = Hurly-Burly | volume = 8 | pages = 125–147 }} | |||
== External links == | == External links == | ||
* |
* | ||
* | * @ psych.mpg.de | ||
* | |||
* | |||
*{{webarchive |url=https://web.archive.org/web/20191223021720/http://pulse-project.org/node/150 |date=23 December 2019 |title=Octavian Buda, The late works of Emil Kraepelin. Goethe Institute Riga, Latvia, 7th May 2009}} | |||
* {{PM20|FID=pe/010321}} | |||
For biographies of Kraepelin see: | |||
See | |||
* | * | ||
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* Burkhart Brückner, Julian Schwarz: in: . | |||
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for biographies of Kraepelin. | |||
For English translations of Kraepelin's work see: | |||
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{{Bipolar disorder}} | |||
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Latest revision as of 20:34, 10 November 2024
German psychiatrist (1856–1926)
Emil Kraepelin | |
---|---|
Emil Kraepelin in his later years | |
Born | (1856-02-15)15 February 1856 Neustrelitz, Grand Duchy of Mecklenburg-Strelitz, German Confederation |
Died | 7 October 1926(1926-10-07) (aged 70) Munich, Bavaria, Weimar Germany |
Nationality | German |
Alma mater | Leipzig University University of Würzburg (MBBS, 1878) Ludwig Maximilian University of Munich (Dr. hab. med., 1882) |
Known for | Classification of mental disorders, Kraepelinian dichotomy |
Spouse | Ina Marie Marie Wilhelmine Schwabe |
Children | 2 sons, 6 daughters |
Scientific career | |
Fields | Psychiatry |
Institutions | Leipzig University University of Dorpat University of Heidelberg Ludwig Maximilian University of Munich |
Thesis | The Place of Psychology in Psychiatry (1882) |
Signature | |
Emil Wilhelm Georg Magnus Kraepelin (/ˈkrɛpəlɪn/; German: [ˈeːmiːl 'kʁɛːpəliːn]; 15 February 1856 – 7 October 1926) was a German psychiatrist. H. J. Eysenck's Encyclopedia of Psychology identifies him as the founder of modern scientific psychiatry, psychopharmacology and psychiatric genetics.
Kraepelin believed the chief origin of psychiatric disease to be biological and genetic malfunction. His theories dominated psychiatry at the start of the 20th century and, despite the later psychodynamic influence of Sigmund Freud and his disciples, enjoyed a revival at century's end. While he proclaimed his own high clinical standards of gathering information "by means of expert analysis of individual cases", he also drew on reported observations of officials not trained in psychiatry.
His textbooks do not contain detailed case histories of individuals but mosaic-like compilations of typical statements and behaviors from patients with a specific diagnosis. He has been described as "a scientific manager" and "a political operator", who developed "a large-scale, clinically oriented, epidemiological research programme".
Family and early life
Kraepelin, whose father, Karl Wilhelm, was a former opera singer, music teacher, and later successful story teller, was born in 1856 in Neustrelitz, in the Duchy of Mecklenburg-Strelitz in Germany. He was first introduced to biology by his brother Karl, 10 years older and, later, the director of the Zoological Museum of Hamburg.
Education and career
Kraepelin began his medical studies in 1874 at the University of Leipzig and completed them at the University of Würzburg (1877–78). At Leipzig, he studied neuropathology under Paul Flechsig and experimental psychology with Wilhelm Wundt. Kraepelin would be a disciple of Wundt and had a lifelong interest in experimental psychology based on his theories. While there, Kraepelin wrote a prize-winning essay, "The Influence of Acute Illness in the Causation of Mental Disorders".
At Würzburg he completed his Rigorosum (roughly equivalent to a PhD level viva-voce examination, literally "rigorous exam") in March 1878, his Staatsexamen (licensing examination) in July 1878, and his Approbation (his license to practice medicine; roughly equivalent to an MBBS) on 9 August 1878. From August 1878 to 1882, he worked with Bernhard von Gudden at the University of Munich.
Returning to the University of Leipzig in February 1882, he worked in Wilhelm Heinrich Erb's neurology clinic and in Wundt's psychopharmacology laboratory. He completed his habilitation thesis - major postdoc publication and process - at Leipzig; it was entitled "The Place of Psychology in Psychiatry". On 3 December 1883 he completed his umhabilitation ("habilitation" at another institution than originally applied for = habilitation recognition procedure) at Munich.
Kraepelin's major work, Compendium der Psychiatrie: Zum Gebrauche für Studirende und Aerzte (Compendium of Psychiatry: For the Use of Students and Physicians), was first published in 1883 and was expanded in subsequent multivolume editions to Ein Lehrbuch der Psychiatrie (A Textbook: Foundations of Psychiatry and Neuroscience). In it, he argued that psychiatry was a branch of medical science and should be investigated by observation and experimentation like the other natural sciences. He called for research into the physical causes of mental illness, and started to establish the foundations of the modern classification system for mental disorders. Kraepelin proposed that by studying case histories and identifying specific disorders, the progression of mental illness could be predicted, after taking into account individual differences in personality and patient age at the onset of disease.
In 1884, he became senior physician in the Prussian provincial town of Leubus, Silesia Province, and the following year he was appointed director of the Treatment and Nursing Institute in Dresden. On 1 July 1886, at the age of 30, Kraepelin was named Professor of Psychiatry at the University of Dorpat (today the University of Tartu) in what is today Tartu, Estonia (see Burgmair et al., vol. IV). Four years later, on 5 December 1890, he became department head at the University of Heidelberg, where he remained until 1904. While at Dorpat he became the director of the 80-bed University Clinic, where he began 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".
In 1903, Kraepelin moved to Munich to become Professor of Clinical Psychiatry at the University of Munich.
In 1908, he was elected a member of the Royal Swedish Academy of Sciences.
In 1912, at the request of the DVP (Deutscher Verein für Psychiatrie; German Association for Psychiatry), of which he was the head from 1906 to 1920, he began plans to establish a centre for research. Following a large donation from the Jewish German-American banker James Loeb, who had at one time been a patient, and promises of support from "patrons of science", the German Institute for Psychiatric Research was founded in 1917 in Munich. Initially housed in existing hospital buildings, it was maintained by further donations from Loeb and his relatives. In 1924 it came under the auspices of the Kaiser Wilhelm Society for the Advancement of Science. The German-American Rockefeller family's Rockefeller Foundation made a large donation enabling the development of a new dedicated building for the institute along Kraepelin's guidelines, which was officially opened in 1928.
Kraepelin spoke out against the barbarous treatment that was prevalent in the psychiatric asylums of the time, and crusaded against alcohol, capital punishment and the imprisonment rather than treatment of the insane. For the sedation of agitated patients, Kraepelin recommended potassium bromide. He rejected psychoanalytical theories that posited innate or early sexuality as the cause of mental illness, and he rejected philosophical speculation as unscientific. He focused on collecting clinical data and was particularly interested in neuropathology (e.g., diseased tissue).
He also firmly rejected the assumption of natural difference in relation to homosexuality, which he regarded as a vice caused by masturbation. In 1918 he called for "educational discipline" such as those introduced by the Nazi party after 1933: severe punishments for the crime of 'corruption' (seduction), applicable to any act related to sexual gratification. This extended the anti-gay policy of the time, which only punished sexual intercourse between men. These ideas eventually went on to lend legitimacy to Nazi policies that persecuted gay people, allowing the Nazi party to do so under the guise of conforming to scientific opinions. His work legitimized the persecution and inhumane treatment of gay people in Nazi Germany.
In the later period of his career, as a convinced champion of social Darwinism, he actively promoted a policy and research agenda in racial hygiene and eugenics.
Kraepelin retired from teaching at the age of 66, spending his remaining years establishing the institute. The ninth and final edition of his Textbook was published in 1927, shortly after his death. It comprised four volumes and was ten times larger than the first edition of 1883.
In the last years of his life, Kraepelin was preoccupied with Buddhist teachings and was planning to visit Buddhist shrines at the time of his death, according to his daughter, Antonie Schmidt-Kraepelin.
Theories and classification schemes
Kraepelin announced that he had found a new way of looking at mental illness, referring to the traditional view as "symptomatic" and to his view as "clinical". This turned out to be his paradigm-setting synthesis of the hundreds of mental disorders classified by the 19th century, grouping diseases together based on classification of syndrome—common patterns of symptoms over time—rather than by simple similarity of major symptoms in the manner of his predecessors.
Kraepelin described his work in the 5th edition of his textbook as a "decisive step from a symptomatic to a clinical view of insanity. . . . The importance of external clinical signs has . . . been subordinated to consideration of the conditions of origin, the course, and the terminus which result from individual disorders. Thus, all purely symptomatic categories have disappeared from the nosology".
Psychosis and mood
Kraepelin is specifically credited with the classification of what was previously considered to be a unitary concept of psychosis, into two distinct forms (known as the Kraepelinian dichotomy):
- manic depression (although commonly presented as synonym with bipolar disorder that is inaccurate; manic depressive illness encompasses a broader spectrum of mood disorders such as bipolar disorder and recurrent major depression, and
- dementia praecox.
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 a 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, catatonia 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 as different expressions of one disease, dementia praecox.
One of the cardinal principles of his method was the recognition that any given symptom may appear in virtually any one of these disorders; e.g., there is almost no single symptom occurring in dementia praecox 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.
It has been claimed that Kraepelin also demonstrated specific patterns in the genetics of these disorders and patterns in their course and outcome, but no specific biomarkers have yet been identified. Generally speaking, there tend to be more people with schizophrenia among the relatives of schizophrenic patients than in the general population, while manic depression is more frequent in the relatives of manic depressives. Though, of course, this does not demonstrate genetic linkage, as this might be a socio-environmental factor as well.
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 signifying the irreversible mental decline). It later became clear that dementia praecox did not necessarily lead to mental decline and was thus renamed schizophrenia by Eugen Bleuler to correct Kraepelin's misnomer.
In addition, as Kraepelin accepted in 1920, "It is becoming increasingly obvious that we cannot satisfactorily distinguish these two diseases"; however, he maintained that "On the one hand we find those patients with irreversible dementia and severe cortical lesions. On the other are those patients whose personality remains intact". Nevertheless, overlap between the diagnoses and neurological abnormalities (when found) have continued, and in fact a diagnostic category of schizoaffective disorder would be brought in to cover the intermediate cases.
Kraepelin devoted very few pages to his speculations about the etiology of his two major insanities, dementia praecox and manic-depressive insanity. However, from 1896 to his death in 1926 he held to the speculation that these insanities (particularly dementia praecox) would one day probably be found to be caused by a gradual systemic or "whole body" disease process, probably metabolic, which affected many of the organs and nerves in the body but affected the brain in a final, decisive cascade.
Psychopathic personalities
In the first through sixth edition of Kraepelin's influential psychiatry textbook, there was a section on moral insanity, which meant then a disorder of the emotions or moral sense without apparent delusions or hallucinations, and which Kraepelin defined as "lack or weakness of those sentiments which counter the ruthless satisfaction of egotism". He attributed this mainly to degeneration. This has been described as a psychiatric redefinition of Cesare Lombroso's theories of the "born criminal", conceptualised as a "moral defect", though Kraepelin stressed it was not yet possible to recognise them by physical characteristics.
In fact from 1904 Kraepelin changed the section heading to "The born criminal", moving it from under "Congenital feeble-mindedness" to a new chapter on "Psychopathic personalities". They were treated under a theory of degeneration. Four types were distinguished: born criminals (inborn delinquents), pathological liars, querulous persons, and Triebmenschen (persons driven by a basic compulsion, including vagabonds, spendthrifts, and dipsomaniacs).
The concept of "psychopathic inferiorities" had been recently popularised in Germany by Julius Ludwig August Koch, who proposed congenital and acquired types. Kraepelin had no evidence or explanation suggesting a congenital cause, and his assumption therefore appears to have been simple "biologism". Others, such as Gustav Aschaffenburg, argued for a varying combination of causes. Kraepelin's assumption of a moral defect rather than a positive drive towards crime has also been questioned, as it implies that the moral sense is somehow inborn and unvarying, yet it was known to vary by time and place, and Kraepelin never considered that the moral sense might just be different.
Kurt Schneider criticized Kraepelin's nosology on topics such as Haltlose for appearing to be a list of behaviors that he considered undesirable, rather than medical conditions, though Schneider's alternative version has also been criticised on the same basis. Nevertheless, many essentials of these diagnostic systems were introduced into the diagnostic systems, and remarkable similarities remain in the DSM-5 and ICD-10. The issues would today mainly be considered under the category of personality disorders, or in terms of Kraepelin's focus on psychopathy.
Kraepelin had referred to psychopathic conditions (or "states") in his 1896 edition, including compulsive insanity, impulsive insanity, homosexuality, and mood disturbances. From 1904, however, he instead termed those "original disease conditions, and introduced the new alternative category of psychopathic personalities. In the eighth edition from 1909 that category would include, in addition to a separate "dissocial" type, the excitable, the unstable, the Triebmenschen driven persons, eccentrics, the liars and swindlers, and the quarrelsome. It has been described as remarkable that Kraepelin now considered mood disturbances to be not part of the same category, but only attenuated (more mild) phases of manic depressive illness; this corresponds to current classification schemes.
Alzheimer's disease
Kraepelin postulated that there is a specific brain or other biological pathology underlying each of the major psychiatric disorders. As a colleague of Alois Alzheimer, he was a co-discoverer of Alzheimer's disease, and his laboratory discovered its pathological basis. Kraepelin was confident that it would someday be possible to identify the pathological basis of each of the major psychiatric disorders.
Eugenics
Upon moving to become Professor of Clinical Psychiatry at the University of Munich in 1903, Kraepelin increasingly wrote on social policy issues. He was a strong and influential proponent of eugenics and racial hygiene. His publications included a focus on alcoholism, crime, degeneration and hysteria.
Kraepelin was convinced that such institutions as the education system and the welfare state, because of their trend to break the processes of natural selection, undermined the Germans' biological "struggle for survival". He was concerned to preserve and enhance the German people, the Volk, in the sense of nation or race. He appears to have held Lamarckian concepts of evolution, such that cultural deterioration could be inherited. He was a strong ally and promoter of the work of fellow psychiatrist (and pupil and later successor as director of the clinic) Ernst Rüdin to clarify the mechanisms of genetic inheritance as to make a so-called "empirical genetic prognosis".
Martin Brune has pointed out that Kraepelin and Rüdin also appear to have been ardent advocates of a self-domestication theory, a version of social Darwinism which held that modern culture was not allowing people to be weeded out, resulting in more mental disorder and deterioration of the gene pool. Kraepelin saw a number of "symptoms" of this, such as "weakening of viability and resistance, decreasing fertility, proletarianisation, and moral damage due to "penning up people" . He also wrote that "the number of idiots, epileptics, psychopaths, criminals, prostitutes, and tramps who descend from alcoholic and syphilitic parents, and who transfer their inferiority to their offspring, is incalculable". He felt that "the well-known example of the Jews, with their strong disposition towards nervous and mental disorders, teaches us that their extraordinarily advanced domestication may eventually imprint clear marks on the race". Brune states that Kraepelin's nosological system "was, to a great deal, built on the degeneration paradigm".
Influence
Kraepelin's great contribution in classifying schizophrenia and manic depression remains relatively unknown to the general public, and his work, which had neither the literary quality nor paradigmatic power of Freud's, is little read outside scholarly circles. Kraepelin's contributions were also to a large extent marginalized throughout a good part of the 20th century during the success of Freudian etiological theories. However, his views now dominate many quarters of psychiatric research and academic psychiatry. His fundamental theories on the diagnosis of psychiatric disorders form the basis of the major diagnostic systems in use today, especially the American Psychiatric Association's DSM-IV and the World Health Organization's ICD system, based on the Research Diagnostic Criteria and earlier Feighner Criteria developed by espoused "neo-Kraepelinians", though Robert Spitzer and others in the DSM committees were keen not to include assumptions about causation as Kraepelin had.
Kraepelin has been described as a "scientific manager" and political operator, who developed a large-scale, clinically oriented, epidemiological research programme. In this role he took in clinical information from a wide range of sources and networks. Despite proclaiming high clinical standards for himself to gather information "by means of expert analysis of individual cases", he would also draw on the reported observations of officials not trained in psychiatry. The various editions of his textbooks do not contain detailed case histories of individuals, however, but mosaiclike compilations of typical statements and behaviors from patients with a specific diagnosis.
Kraepelin wrote in a knapp und klar (concise and clear) style that made his books useful tools for physicians. Abridged and clumsy English translations of the sixth and seventh editions of his textbook in 1902 and 1907 (respectively) by Allan Ross Diefendorf (1871–1943), an assistant physician at the Connecticut Hospital for the Insane at Middletown, inadequately conveyed the literary quality of his writings that made them so valuable to practitioners.
Among the doctors trained by Alois Alzheimer and Emil Kraepelin at Munich at the beginning of the 20th century were the Spanish neuropathologists and neuropsychiatrists Nicolás Achúcarro and Gonzalo Rodríguez Lafora, two distinguished disciples of Santiago Ramón y Cajal and members of the Spanish Neurological School.
Dreaming for psychiatry's sake
In the Heidelberg and early Munich years he edited Psychologische Arbeiten, a journal on experimental psychology. One of his own famous contributions to this journal also appeared in the form of a monograph (105 pp.) entitled Über Sprachstörungen im Traume (On Language Disturbances in Dreams). Kraepelin, on the basis of the dream-psychosis analogy, studied for more than 20 years language disorder in dreams in order to study indirectly schizophasia. The dreams Kraepelin collected are mainly his own. They lack extensive comment by the dreamer. In order to study them the full range of biographical knowledge available today on Kraepelin is necessary (see, e.g., Burgmair et al., I-IX).
Bibliography
- Kraepelin, E. (1906). Über Sprachstörungen im Traume. Leipzig: Engelmann. ( Online.)
- Kraepelin, E. (1987). Memoirs. Berlin, Heidelberg, New York: Springer-Verlag. ISBN 978-3-642-71926-4.
Collected works
- Burgmair, Wolfgang & Eric J. Engstrom & Matthias Weber et al., eds. Emil Kraepelin. 9 vols. Munich: belleville, 2000–2019.
- Vol. I: Persönliches, Selbstzeugnisse (2000), ISBN 3-933510-90-2
- Vol. II: Kriminologische und forensische Schriften: Werke und Briefe (2001), ISBN 3-933510-91-0
- Vol. III: Briefe I, 1868–1886 (2002), ISBN 3-933510-92-9
- Vol. IV: Kraepelin in Dorpat, 1886–1891 (2003), ISBN 3-933510-93-7
- Vol. V: Kraepelin in Heidelberg, 1891–1903 (2005), ISBN 3-933510-94-5
- Vol. VI: Kraepelin in München I: 1903–1914 (2006), ISBN 3-933510-95-3
- Vol. VII: Kraepelin in München II: 1914–1920 (2009), ISBN 978-3-933510-96-9
- Vol. VIII: Kraepelin in München III: 1921–1926 (2013), ISBN 978-3-943157-22-2
- Vol. IX: Briefe und Dokumente II: 1876-1926 (2019), ISBN 978-3-946875-28-4
See also
- Kraepelinian dichotomy
- Comparison of bipolar disorder and schizophrenia
- History of bipolar disorder
- History of schizophrenia
- Lunatic asylum
- Psychiatric hospital
References
- ^ Dagmar Drüll, Heidelberger Gelehrtenlexikon: 1803–1932, Springer-Verlag, 2013, p. 149.
- ^ Engstrom, E. J. (1 September 2007). "On the Question of Degeneration' by Emil Kraepelin (1908)1" (PDF). History of Psychiatry. 18 (3): 389–398. doi:10.1177/0957154X07079689. PMID 18175639. S2CID 46482747. Archived from the original (PDF) on 26 May 2013..
- Shepherd, M. (1 August 1995). "Two faces of Emil Kraepelin". The British Journal of Psychiatry. 167 (2): 174–183. doi:10.1192/bjp.167.2.174. PMID 7582666. S2CID 37204909.
- Peter Barham (2004), Forgotten Lunatics of the Great War (New Haven: Yale), p. 163 n. 47.
- On Kraepelin's early life and family, see Burgmair et al., vol. I, as well as his Memoirs (Berlin: Springer, 1987).
- ^ "Kraepelin, Emil (1856–1926)" by Margaret Alic, Gale Encyclopedia of Psychology, 2001.
- "Klinik für Psychiatrie und Psychotherapie, Historie". LMU Klinikum München. Retrieved 10 June 2021.
- See (1) German Society for Psychiatry, Psychotherapy, Psychosomatics and Neurology and (2) History of the DGPPN
- Burgmair, Wolfgang, and Matthias M. Weber. "'Das Geld ist gut angelegt, und du brauchst keine Reue zu haben': James Loeb, ein deutsch-amerikanischer Wissenschaftsmäzen zwischen Kaiserreich und Weimarer Republik." Historische Zeitschrift 277 (2003): 343–378.
- James Loeb Harvard University Press.
- Hans C. Bangen: Geschichte der medikamentösen Therapie der Schizophrenie. VWB, Berlin 1992, ISBN 3-927408-82-4
- Grau, Günter, ed. (1995). Hidden holocaust? Gay and lesbian persecution in Germany 1933–45. London: Cassell. ISBN 978-0-304-32956-4.
- ^ Engstrom EJ, Weber MM, Burgmair W (October 2006). "Emil Wilhelm Magnus Georg Kraepelin (1856–1926)". The American Journal of Psychiatry. 163 (10): 1710. doi:10.1176/appi.ajp.163.10.1710. PMID 17012678..
- Shepherd, Michael (1990). Conceptual Issues in Psychological Medicine. London: Tavistock/Routledge. p. 230. ISBN 978-0415165303.
- ^ Decker Hannah S (2007). "How Kraepelinian was Kraepelin? How Kraepelinian are the neo-Kraepelinians?—from Emil Kraepelin to DSM-III" (PDF). History of Psychiatry. 18 (3): 337–360. doi:10.1177/0957154X07078976. PMID 18175636. S2CID 19754009. Archived from the original (PDF) on 29 October 2013.
- Teodoro T, Durval R (October 2022). "Emil Kraepelin's taxonomic unitary view of manic-depressive insanity in the 21st century: the never-ending diagnostic conundrum of bipolar depression". CNS Spectrums. 28 (4): 389–390. doi:10.1017/s109285292200102x. PMID 36210529. S2CID 252779392.
- Yuhas, Daisy (March 2013). "Throughout History, Defining Schizophrenia Has Remained a Challenge (Timeline)". Scientific American Mind (March 2013). Retrieved 2 March 2013..
- Ebert, Andreas (2010). "Emil Kraepelin: A pioneer of scientific understanding of psychiatry and psychopharmacology". Indian Journal of Psychiatry. 52 (2): 191–2. doi:10.4103/0019-5545.64591. PMC 2927892. PMID 20838510.
- Berrios GE, Luque R, Villagran JM (2003). "Schizophrenia: a conceptual history" (PDF). International Journal of Psychology and Psychological Therapy. 3 (2): 111–140.
- Noll, Richard. "Whole Body Madness". Psychiatric Times. Retrieved 26 September 2012..
- ^ Richard Wetzell (2000) Inventing the criminal: a history of German criminology, 1880–1945 from p 59 & 146, misc.
- Henning Sass & Alan Felthous (2008) Chapter 1: History and Conceptual Development of Psychopathic Disorders in International Handbook on Psychopathic Disorders and the Law. Edited by Alan Felthous, Henning Sass.
- Ebert, Andreas; Bär, Karl-Jürgen (2010). "Emil Kraepelin: A pioneer of scientific understanding of psychiatry and psychopharmacology". Indian Journal of Psychiatry. 52 (2): 191–192. doi:10.4103/0019-5545.64591. ISSN 0019-5545. PMC 2927892. PMID 20838510.
- Brüne, Martin (1 January 2007). "On human self-domestication, psychiatry, and eugenics". Philosophy, Ethics, and Humanities in Medicine. 2 (1): 21. doi:10.1186/1747-5341-2-21. PMC 2082022. PMID 17919321.
- Engstrom Eric J., Weber Matthias (2007). "Making Kraepelin History: A Great Instauration?: Special Issue" (PDF). History of Psychiatry. 18 (3): 267–273. doi:10.1177/0957154x07080819. S2CID 144482013. Archived from the original (PDF) on 29 October 2013.
- Engstrom, Eric J. "Organizing Psychiatric Research in Munich (1903–1925): A Psychiatric Zoon Politicon between State Bureaucracy and American Philanthropy." In International Relations in Psychiatry: Britain, Germany, and the United States through World War II, edited by Volker Roelcke, Paul J. Weindling, and Louise Westwood, 48–66. Rochester: University of Rochester Press, 2010.
- Engstrom, Eric; Weber, Matthias; Burgmair, Wolfgang (2016). "Psychiatric Governance, völkisch Corporatism, and the German Research Institute for Psychiatry in Munich (1912–1926)". History of Psychiatry. 27 (1/2): 38–50, 137–152. doi:10.1177/0957154x15623692. PMID 26823087. S2CID 21375412.
- Noll, Richard. "The Bed Makes Gestures". Psychiatric times. Retrieved 8 February 2013..
- Über Sprachstörungen im Traume (1906).
Sources
- Noll, Richard (2011) American Madness: The Rise and Fall of Dementia Praecox. Cambridge and London: Harvard University Press.
- Briole G (2012). "Emil Kraepelin: The Fragility of a Colossal Oeuvre". Hurly-Burly. 8: 125–147.
External links
- Extensive bibliography of English translations of Kraepelin's works
- Extensive bibliography of works by and about Kraepelin's including those in the original German @ psych.mpg.de
- International Kraepelin Society contact
- Kraepelin's monograph Über Sprachstörungen im Traume
- Octavian Buda, The late works of Emil Kraepelin. Goethe Institute Riga, Latvia, 7th May 2009 at the Wayback Machine (archived 23 December 2019)
- Newspaper clippings about Emil Kraepelin in the 20th Century Press Archives of the ZBW
For biographies of Kraepelin see:
- engstrom.de/KRAEPELINBIOGRAPHY.pdf
- uni-leipzig.de/~psy/eng/kraep-e.html
- Burkhart Brückner, Julian Schwarz: Biography of Emil Wilhelm Georg Magnus Kraepelin in: Biographical Archive of Psychiatry (BIAPSY).
For English translations of Kraepelin's work see:
- On Uprootedness (1921)
- Emil Kraepelin's Clinical Self-Assessment (1920)
- Psychiatric Observations on Contemporary Issues (1919)
- On the Question of Degeneration (1908)
- The Directions of Psychiatric Research (1887)
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History |
- 1856 births
- 1926 deaths
- People from Neustrelitz
- German psychiatrists
- German neuroscientists
- German eugenicists
- Academic staff of the University of Tartu
- German Fatherland Party politicians
- Psychosis
- People from Mecklenburg-Strelitz
- Members of the Royal Swedish Academy of Sciences
- Bipolar disorder researchers
- Leipzig University alumni
- University of Würzburg alumni
- History of psychiatry
- Psychiatry academics
- Antisemitism in Germany