International Kraepelin Society
International Congress on Schizophrenia Research, 1999
Santa Fe, New Mexico: An Editorial
In the groundbreaking Sixth Edition (1899) of Emil Kraepelin’s “Textbook” of Psychiatry, Kraepelin presents for the first time his criteria for diagnosis and delimitation of the two endogenous psychoses, dementia praecox (now known as “schizophrenia”) and manic-depressive disorder. The centenary of the publication of this work provides a fitting occasion to comment on the current debate over whether schizophrenia and manic depression represent two distinct diseases, varying expressions of a single psychopathological disease process on a continuum, or a range of different disorders.
It was a fundamental tenet of Kraepelin’s thinking that diagnostic formulations stand or fall on the basis of objective empirical validation. Absent any reliable disease markers provided by pathological anatomy or physiology, Kraepelin sought to test the validity of his diagnostic formulations–which were, ultimately, nosological hypotheses– by their ability to accurately predict disease course and outcome. Kraepelin’s decades long follow-up studies of more than a thousand cases confirmed that these two diagnostic groups, dementia praecox and manic depression, each displayed its own characteristic pattern, i.e. the two groups revealed a distinct clinical picture, course and outcome, unfolding and elaborating over time each according to its own fundamental law. Both disorders were observed to be permanent morbid conditions that affected in essentially different ways the mind’s elaborate operations. The simplistic view, too often repeated, that Kraepelin’s dichotomy is based solely upon the presence or absence of a deterioration sorely misses the mark.
Kraepelin’s longitudinal studies not only supported his diagnoses of dementia praecox and manic depression; they provided, as well, empirical validation for his model of mental operations. Applying a well-defined conceptual schema of psychological operations, he distinguished the normal from the psychopathological and differentiated the various forms of mental disorder and disease largely on that basis. It is in significant measure on the basis of this model of mental operations that Kraepelin successfully identified the distinctive patterns of psychopathology that characterized the clinical picture, course and outcome of each different disorder in the absence of any single definitive pathognomonic sign or marker.
This conceptual model of mental operations guided how Kraepelin observed and understood psychopathological signs and symptoms, and determined the significance he attributed to the various clinical phenomena in formulating his system of classification. The fact that one hundred years later, Kraepelin’s classification of the endogenous psychoses still forms the basis of most of the prevailing diagnostic systems attests to the importance of his model for psychiatry and psychology.
Nonetheless, since his death in 1926, Kraepelin’s basic diagnostic principles and his ideas concerning the nature of psychopathology and psychological operations have been ignored even by so-called neo-Kraepelinians. At the same time certain very general features of his approach to biological psychiatry have been appreciated and to a certain extent universally adopted.
Turning to the question of whether schizophrenia and manic-depression represent two diseases or one, it must be asked whether any adequate and reliable data exist to challenge Kraepelin’s differentiation of the two endogenous psychoses. The question is neither rhetorical nor mocking. An adequate test of Kraepelin’s delimitation of dementia praecox and manic-depression requires the faithful replication of Kraepelin’s original criteria and methods for diagnosing these two disorders. Do any of the clinical studies that challenge Kraepelin’s dichotomy adequately replicate his original approach?
One should not look with optimism to the current generation of diagnostic systems such as the “neo-Kraepelinian” DSM-IV, or the ICD-10, whose characteristic symptom requirement for schizophrenia can be satisfied by just a single feature such as bizarre delusions.
Bleuler’s pathognomonic sign approach to diagnosis, which Kraepelin considered empirically untenable and incompatible with his own, deeply penetrates the modern diagnostic systems of the so-called neo-Kraepelinian era. Kraepelin firmly maintained that no single sign or symptom is pathognomonic of either of the endogenous psychoses.
In the introduction to his 6th edition textbook of 1899, Kraepelin guided his readers into the new science of psychiatry with the following statement: “Psychiatry is a young, still developing science, that must, against sharp opposition, gradually achieve the position it deserves according to its scientific and practical importance. There is no doubt that it will achieve this position–for it has at its disposal the same weapons which have served the other branches of medicine so well: clinical observation, the microscope and experimentation.”
During the century that followed, rational and objective study of psychopathology suffered prolonged periods of paralysis: For decades during the 20th century, the requirement that psychiatry and psychology rely upon empirical testing of hypotheses and sound scientific models was suspended. A century after publication of his Textbook, following the advent of the neo-Kraepelinian era, the scientific study of psychopathology is still very much a young discipline. What reasonable justification can be provided to further delay the comprehensive examination and evaluation of Emil Kraepelin’s work in accordance with his own specifications, methods and standards?
Kraepelin Centenary Symposium 1899-1999
XI WORLD CONGRESS OF PSYCHIATRY
SUNDAY AUGUST 8, 1999
Kraepelin’s classification of the major endogenous psychoses forms the cornerstone of modern psychiatric nosology and is an important part of that edifice–scientific psychiatry– which Kraepelin continued to build until his death 27 years later.
Other contributions include:
· Kraepelin pioneered research in psychopharmacology, neuropsychiatry and neuropsychology.
· He designed and created the model for the modern psychiatric research institute, a center for interdisciplinary scientific investigation comprising such specialties as experimental psychopathology, psychiatric genetics, neuropathology, and epidemiology and attracting such gifted scientists as Alzheimer, Nissl and Brodmann.
· A reformer of the modern psychiatric hospital, Kraepelin instituted a policy of ethical and humane treatment for patients.
A Centenary Symposium, entitled “Kraepelin’s Vision for Modern Scientific Psychiatry” was organized by the International Kraepelin Society and funded by the World Psychiatric Association and the XI World Congress of Psychiatry, celebrating the publication of the Sixth Edition of Emil Kraepelin’s Textbook of Psychiatry and Kraepelin’s achievement as the founder of modern scientific psychiatry:
KRAEPELIN’S VISION FOR MODERN SCIENTIFIC PSYCHIATRY
· Chair: Dr. Mark AST Co-Chair: Dr. Judith Jaeger
· Prof. Norman SARTORIUS: Opening remarks
· Prof. Assen JABLENSKY: Kraepelin’s legacy in the era of molecular psychiatry
· Prof. Hagop AKISKAL: Kraepelin’s conception of manic-depression
· Prof. Andreas MARNEROS: Kraepelin’s delineation of the mixed states: Historical and present status
· Dr Matthias M. WEBER, Dr. Wolfgang BURGMAIR &
· Dr. Eric ENGSTROM: Kraepelin and Alzheimer
· Prof. Paul HOFF: Between naturalism and pragmatism – on the theoretical background of Kraepelinian psychiatry
· Dr. Mark AST: Kraepelin’s lost concept of mental operations
We invite all subscribers to provide us with the following information for communicating with other investigators through our website and newsletter:
· Kraepelin-related research being conducted worldwide: We invite communications from investigators conducting empirical or theoretical research on any aspect of Kraepelin’s work, e.g., his diagnostic principles and methods, his clinical observations and experimental studies of manic-depression, dementia praecox (schizophrenia) and other mental disorders or his concepts of psychopathology and mental operations. Information concerning research projects from the areas of psychiatry, psychology and philosophy is welcome. An up to date list of such research projects will facilitate collaboration and the exchange of ideas.
· A bibliography of translations of Kraepelin’s writings and references to his work: The IKS website will maintain an up-to-date online bibliography which will include translations of Kraepelin’s research papers, texts and letters as well as references on or about Kraepelin and his work, both empirical and theoretical. References from the disciplines of psychiatry, psychology and philosophy–both published and unpublished–will be included. We invite our colleagues to inform us about such references so they can be listed in the online bibliography. Where possible, submitted works will be added to IKS online archives.
· Listing of worldwide conferences, meetings, symposia and calls for papers: The website events calendar will include a listing of conferences, meetings, symposia and calls for papers whose topic is related to any aspect of Kraepelin’s work. Please send all pertinent information including type of event, dates, location, event theme or topic, deadline dates for submissions and registration, as well as contact information (contact person, telephone, fax, email address and event website).
· Online archives of Kraepelin’s writings and Kraepelin-related references: The Society website will contain an online archive of all of Kraepelin’s published and unpublished writings in the original German and in translation, where available. Important references directly related to Kraepelin’s work will be included as well.
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International Kraepelin Society
S. W. Eros, MD
International Kraepelin Society
P.O. Box 688
New Hampton, NY 10958-0688
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