Emil
Kraepelin (1856-1926)
(From
http://en.wikipedia.org/wiki/Emil_Kraepelin)
Emil
Kraepelin (1856-1926) is
perhaps the most important figure in the
history of
psychiatric classification. He earned a
medical degree in psychiatry and studied under many leading scientists,
including Wilhelm Wundt. As the
director of an 80-bed clinic at the University of Dorpat in Livonia
(now
University of Tartu in Estonia), Kraepelin had occasion to create
detailed histories
of a variety of patients. These records
led to his first breakthrough in psychiatry.
Prior to Kraepelin, the disorders “dementia praecox” (now called
schizophrenia) and manic-depression were viewed as a unitary
concept. Kraepelin separated them and described the
pattern of symptoms and course associated with each disorder. He
determined that manic-depression was
intermittent while dementia praecox was deteriorating.
(Later, it became clear that dementia
praecox was not always associated with mental decline; therefore, it
was
renamed by Eugene Bleuler.) Kraepelin
also co-discovered Alzheimer’s Disease with Alois Alzheimer.
Kraepelin’s contribution to
classification is significant because of its organization.
Although predecessors had grouped diseases
based on similarity of symptoms, Kraepelin used a medical model and
grouped
them based on a pattern of symptoms. He
realized that the same symptom could occur across disorders but that
different
disorders have different patterns of symptoms.
The 6th edition of Lehrbuch der Psychiatrie
(1899)
introduced
16 categories of psychopathology. Its
chapters on dementia praecox and manic-depression made it an instant
classic
and a worldwide favorite as a textbook.
Kraepelin
postulated that diseases
were caused by biological and genetic disorders, and he was confident
that each
would be discovered in time. His ideas
were supported by research documenting brain abnormalities upon autopsy
of
patients with dementia praecox.
Although Kraepelin’s ideas were largely ignored during his
lifetime due
to the popularity of Freud, his legacy may be seen in the most recent
revisions
of the DSM.
Neo-Kraepelinians
versus Anti-Kraepelinians
These two
groups are in constant debate over whether Kraepelin’s views are
appropriate
for psychology today. Here are the
major points of the neo-Kraepelinians and their critics:
Klerman
(1978;
in
Blashfield, 1998) identified 9 tenets of
the neo-Kraepelinian approach:
- Psychiatry is a
branch of medicine.
- Psychiatry should
utilize modern
scientific methodologies and base its practice on scientific knowledge.
- Psychiatry treats
people who are sick
and who require treatment.
- There is a
boundary between the normal
and the sick.
- There are
discrete mental illnesses. They are not
myths, and there are many of them.
- The focus of
psychiatric physicians
should be on the biological aspects of illness.
- There should be
an explicit and
intentional concern with diagnosis and classification.
- Diagnostic
criteria should be
codified, and a legitimate and valued area of research should be to
validate them.
- Statistical
techniques should be used
to improve reliability and validity.
Critics of the
Kraepelinian viewpoint argue that there is an
implicit assumption that psychiatric disorders are similar in nature to
physiological disorders.
www.neocortex.co.uk/oldstuff/essays/clinical/kraeplin.htm offers
5
additional assumptions of this system.
- Assumption 1:
Pathological behavior
can be diagnosed on the basis of symptoms alone.
- Criticism 1:
The presence of
particular symptoms may not be indicative of any one diagnosis. There is a significant amount of symptom
overlap.
- Assumption 2:
Disorders have separate
etiologies.
- Criticism 2:
Patients rarely show
symptoms from only one disorder. Again,
symptom overlap and comorbidities present problems.
- Assumption 3: If
the client fits the
necessary and sufficient conditions, a diagnosis can be made.
- Criticism 3:
What necessary and
sufficient conditions? Most criteria are
heterogeneous and symptoms vary between individuals.
- Assumption 4:
There should be very
little dispute between professionals about a diagnosis.
- Criticism 4:
There are many
subjective decisions, such as the meaning of “interferes with daily
functioning.”
- Assumption 5:
Classification should be
useful in choosing treatment type.
- Criticism 5:
While many treatments
are effective across disorders, none are invariably effective in one
condition. Diagnosis and treatment are not
necessarily linked.