Criticisms of Kraepelin’s Psychiatric Nosology: 1896–1927

Abstract

Emil Kraepelin's psychiatric nosology, proposed in the 5th and 6th editions of his textbook published in 1896 and 1899, did not quickly gain worldwide acceptance, but was instead met with substantial and sustained criticism. The authors review critiques of Kraepelin's work published in his lifetime by Adolf Meyer, Friedrich Jolly, Eugenio Tanzi, Alfred Hoche, Karl Jaspers, and Willy Hellpach. These critics made six major points. First, Kraepelin's new categories of dementia praecox and manic-depressive insanity were too broad and too heterogeneous. Second, his emphasis on course of illness was misconceived, as the same disease can result in brief episodes or a chronic course. Third, the success of his system was based on the quality of his textbooks and his academic esteem, rather than on empirical findings. Fourth, his focus on symptoms and signs led to neglect of the whole patient and his or her life story. Fifth, Kraepelin's early emphasis on experimental psychology did not bear the expected fruit. Sixth, Kraepelin was committed to the application of the medical disease model. However, because of the many-to-many relationship between brain pathology and psychiatric symptoms, true natural disease entities may not exist in psychiatry. Most of the ongoing debates about Kraepelin's nosology have roots in these earlier discussions and would be enriched by a deeper appreciation of their historical contexts. As authoritative as Kraepelin was, and remains today, his was only one among many voices, and attention to them would be well repaid by a deeper understanding of the fundamental conceptual challenges in our field. [AJP at 175: Remembering Our Past As We Envision Our Future April 1927: In Memoriam: Emil Kraepelin, M.D. Meyer provides an admiring but not uncritical overview of Kraepelin's career and contributions to psychiatry. "It was the unflinchingly psychiatric orientation of the man," he wrote, "that impressed and attracted physicians and students." (Am J Psychiatry 1927; 83:748-755 )].

Genetic and environmental factors of schizophrenia and autism spectrum disorder: insights from twin studies

“…At that time, the idea of urbanization and mental stress as factors that could cause psychosis in young people was widely accepted. However, Kraepelin argued for the involvement of a biological component (Kendler and Engstrom 2018). Eugen Bleuler agreed with Kraepelin's theory but considered hallucinations and delusions to be secondary with conditions resulting from some disruption in the cognitive processing regarded as psychopathologies (Maatz and Hoff 2014).…”

The evolution of Kraepelin's nosological principles

“…These conjectures became a focus of criticism for a number of his detractors 37 . Kraepelin already anticipated such criticism of his strong naturalism in the third edition of the textbook: “The more the forms which have been gained from the different views correspond, the greater the certainty that the latter really represent particular disorders” 7 , p.238 .…”

“…In the end, all validators will converge on natural disease units. This principle – the first and most important one ‐ attracted many critics 37,48 .…”

Diagnostic Issues of Depressive Disorders from Kraepelinian Dualism to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

“…A closer link between generalized anxiety disorder and major depressive disorder rather than other anxiety disorders is described by the specifier "with anxious distress" lowing a rather pragmatic approach, the unipolar depression concept was expanded to major depressive disorder (MDD), potentially influenced by a preference to prescribe antidepressants rather than lithium and neuroleptics, due to side effects. [13][14][15][16] The finding that bipolar and depressive disorders overlap symptomatically and genetically to a degree that is similar to schizophrenia and depressive disorders led to the dichotomization of mood disorders into bipolar disorders and depressive disorders in the DSM-5. [17][18][19] The dichotomization into bipolar disorders and depressive disorders is thus consistent with the deconstruction of the Kraepelinian dualism for psychoses, which denotes the reclassification of schizophrenia and bipolar disorder in terms of a dimensional rather than a categorical approach.…”

“…[17][18][19] The dichotomization into bipolar disorders and depressive disorders is thus consistent with the deconstruction of the Kraepelinian dualism for psychoses, which denotes the reclassification of schizophrenia and bipolar disorder in terms of a dimensional rather than a categorical approach. [13][14][15][16] From the perspective of a paradigm shift from a categorical to a dimensional approach, the dichotomization of mood disorders carries nosological significance, in that MDD is now considered to be a distinctive disease entity parallel to schizophrenia and bipolar disorder. However, the dichotomization into bipolar disorders and depressive disorders is partly inconsistent with the fact that the conversion from depressive disorders to bipolar disorders is one of the most significant conversions to occur in psychiatric taxonomy.…”