Emil Kraepelin (February 15, 1856
NeustrelitzNeustrelitz is a town in Mecklenburg-Vorpommern, Germany and is the capital of the district of Mecklenburg-Strelitz. Strelitz is supposed to be an old Slavic word for "shooter" .- History :...
– October 7, 1926
MunichMunich is the capital city of Bavaria, Germany. It is located on the River Isar north of the Bavarian Alps. Munich is the third largest city in Germany, after Berlin and Hamburg...
) was a
GermanGermany , officially the Federal Republic of Germany , is a country in Central Europe. It is bordered to the north by the North Sea, Denmark, and the Baltic Sea; to the east by Poland and the Czech Republic; to the south by Austria and Switzerland; and to the west by France, Luxembourg, Belgium,...
psychiatristA psychiatrist is a physician who specializes in psychiatry and is certified in treating mental disorders. All psychiatrists are trained in diagnostic evaluation and in psychotherapy...
. The
Encyclopedia of Psychology by H. J. Eysenck identifies him as the founder of contemporary scientific
psychiatryPsychiatry is a medical specialty officially devoted to the treatment and study of mental disorders. The term was first coined by the German physician Johann Christian Reil in 1808....
, as well as of
psychopharmacologyPsychopharmacology is the study of drug-induced changes in mood, sensation, thinking, and behavior....
and
psychiatric geneticsPsychiatric genetics, a subfield of behavioral neurogenetics, studies the role of genetics in psychological conditions such as alcoholism, schizophrenia, bipolar disorder, and autism. The basic principle behind psychiatric genetics is that genetic polymorphisms, as indicated by linkage to e.g...
. Kraepelin believed the chief origin of psychiatric
diseaseA disease or medical condition isan abnormal condition of an organism that impairs bodily functions, associated with specific symptoms and signs...
to be
biologicalA biological process is a process of a living organism. Biological processes are made up of any number of chemical reactions or other events that results in a transformation....
and
geneticGenetics, , a discipline of biology, is the science of heredity and variation in living organisms. The fact that living things inherit traits from their parents has been used since prehistoric times to improve crop plants and animals through selective breeding...
malfunction. His theories dominated the field of psychiatry at the start of the twentieth century and, despite the later psychodynamic incursions of
Sigmund FreudSigmund Freud , Sigismund Schlomo Freud , was an Austrian neurologist who founded the psychoanalytic school of psychology...
and his numerous influential disciples, renegade and otherwise, appeared to enjoy something of a revival at the century's end.
Early career
Kraepelin was a student of
Paul FlechsigPaul Emil Flechsig was a German neuroanatomist, psychiatrist and neuropathologist. Born in Zwickau, he spent over fifty years of his medical career at the University of Leipzig. Although Flechsig contributed much in his study of neurological disorders, he is mainly remembered today for his...
at the University of
LeipzigLeipzig is, with a population of 515,459, the largest city in the federal state of Saxony, Germany.-Origins:Leipzig's name is derived from the Slavic word Lipsk, which means "settlement where the lime trees stand"....
. In 1882, after only thirteen years of training, he was appointed to a professorship at the
University of TartuThe University of Tartu is a classical university in the city of Tartu, Estonia. Regarded by many Estonians as the country's "national university", it is the highest-ranked university in Estonia as well as one of the highest-ranked in former Eastern Europe...
(then
Dorpat, see Burgmair Vol IV) in what is today
EstoniaEstonia , officially the Republic of Estonia , is a country in Northern Europe. It is bordered to the north by the Gulf of Finland, to the west by the Baltic Sea, to the south by Latvia , and to the east by the Russian Federation...
and became the director of an eighty-bed
University ClinicThe Tartu University Clinic is a healthcare and medical teaching service in Tartu, Estonia, and a subsidiary of the Tartu University. Its administrative services are located in two buildings on the Puusepa street; its buildings are located throughout the city of Tartu...
. 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". 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
syndromeIn medicine and psychology, the term syndrome refers to the association of several clinically recognizable features, signs , symptoms , phenomena or characteristics that often occur together, so that the presence of one feature alerts the physician to the presence of the others...
s — 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.
Theories & influence
Kraepelin is specifically credited with the classification of what was previously considered to be a unitary concept of
psychosisPsychosis literally means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...
, into two distinct forms:
- manic depression
Bipolar disorder, also known as manic depressive disorder, manic depression or bipolar affective disorder, is a serious mental disorder that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated mood clinically referred to as mania or, if...
(now seen as comprising a range of mood disorders such as recurrent major depressionMajor depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and loss of interest or pleasure in normally enjoyable activities...
and bipolar disorderBipolar disorder, also known as manic depressive disorder, manic depression or bipolar affective disorder, is a serious mental disorder that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated mood clinically referred to as mania or, if...
), and
- dementia praecox
Dementia praecox refers to a chronic, deteriorating psychotic disorder characterized by rapid cognitive disintegration, usually beginning in the late teens or early adulthood. It is a term first used in 1891 in this Latin form by Arnold Pick , a professor of psychiatry at the German branch of...
.
Drawing on his long-term research, and using the criteria of course, outcome and prognosis, he developed the concept of
dementia praecoxDementia praecox refers to a chronic, deteriorating psychotic disorder characterized by rapid cognitive disintegration, usually beginning in the late teens or early adulthood. It is a term first used in 1891 in this Latin form by Arnold Pick , a professor of psychiatry at the German branch 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,
catatoniaCatatonia is a syndrome of psychological and motorological disturbances. Karl Ludwig Kahlbaum first described it in 1874: Die Katatonie oder das Spannungirresein...
and dementia paranoides. At that time, the concept corresponded by and large with
Ewald HeckerEwald Hecker was a German psychiatrist who was an important figure in the early days of modern psychiatry. He is known for research done with his mentor, psychiatrist Karl Ludwig Kahlbaum ....
'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.
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
dementiaDementia is a serious cognitive disorder. It may be static, the result of a unique global brain injury or progressive, resulting in long-term decline in cognitive function due to damage or disease in the body beyond what might be expected from normal aging...
part signifying the irreversible mental decline). It later became clear that dementia praecox did not necessarily lead to mental decline and was thus renamed
schizophreniaSchizophrenia , from the Greek roots skhizein and phrēn, phren- is a psychiatric diagnosis that describes a mental disorder characterized by abnormalities in the perception or expression of reality...
by
Eugen BleulerPaul Eugen Bleuler was a Swiss psychiatrist most notable for his contributions to the understanding of mental illness and coining the term schizophrenia....
to correct Kraepelin's misnomer.
Alzheimer
Kraepelin postulated that there is a specific brain or other biological pathology underlying each of the major psychiatric disorders. As a colleague of
Alois AlzheimerAloysius "Alois" Alzheimer, was a German psychiatrist and neuropathologist and a colleague of Emil Kraepelin...
, and co-discoverer of
Alzheimer's diseaseAlzheimer's disease , also called Alzheimer disease, Senile Dementia of the Alzheimer Type or simply Alzheimer's, is the most common form of dementia. This incurable, degenerative, and terminal disease was first described by German psychiatrist and neuropathologist Alois Alzheimer in 1906 and was...
, it was his laboratory which discovered its pathologic basis. Kraepelin was confident that it would someday be possible to identify the pathologic basis of each of the major psychiatric disorders.
Influence
Kraepelin's great contribution in discovering 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 to a good extent marginalized throughout a good part of the twentieth century, during the success of Freudian etiological theories. However, his views now dominate psychiatric research and academic psychiatry, and today the published literature in the field of psychiatry is overwhelmingly biological in its orientation. His fundamental theories on the etiology and diagnosis of psychiatric disorders form the basis of all major diagnostic systems in use today, especially the
American Psychiatric AssociationThe American Psychiatric Association is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential worldwide. Its some 38,000 members are mainly American but some are international...
's DSM-IV and the
World Health OrganizationThe World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health...
's
ICDThe International Statistical Classification of Diseases and Related Health Problems provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings,...
system. In that sense, not only is Kraepelin's significance historical, but contemporary psychiatric research is also heavily influenced by his work.
Psychology
Kraepelin, being a disciple of Wilhem Wundt, had a life long interest in
experimental psychologyExperimental psychology is a methodological approach rather than a subject and encompasses varied fields within psychology. Experimental psychologists have traditionally conducted research, published articles, and taught classes on neuroscience, developmental psychology, sensation, perception,...
. 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 p.) entitled
Über Sprachstörungen im Traume (on language disturbances in dreams) . Kraepelin, on the basis on the dream-
psychosisPsychosis literally means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...
analogy, studied for more than 20 years
language disorder in dreamsIn 1906 the famous German psychiatrist Emil Kraepelin published a monograph entitled Über Sprachstörungen im Traume . In his psychiatry textbook Kraepelin used the short cut Traumsprache to denote language disturbances occurring 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-VII).
External links
For biographies of Kraepelin see: