Abstract
The reorganization of psychiatric knowledge at the turn of the twentieth century derived from Emil Kraepelin’s clinical classification of psychoses. Surprisingly, within just few years, Kraepelin’s simple dichotomy between dementia praecox (schizophrenias) and manic-depressive psychosis (bipolar disorders) succeeded in giving psychiatry a new framework that is still used until the present day. Unexpectedly, Kraepelin’s simple clinical scheme based on the dichotomy replaced the significantly more differentiated nosography that dominated psychiatric research in the last three decades of the nineteenth century (Janzarik in Themen und Tendenzen der deutschsprachigen Psychiatrie. Springer, Berlin, 1974). Moreover, although all the components of the future development were already available shortly after 1868, the real course, which led to Kraepelin’s dichotomy, was unpredictable then. This paper explores the ways in which the unpredictability of psychiatric knowledge and the postulate of a rationality underlying psychopathological phenomena interacted in the debates regarding the classification of psychoses. It examines the “natural antagonism” between the practical aspirations of an increasingly specialized medical nosology and unitary conceptions, which, in a psychopathological countermovement, emphasized that no somatic criteria can be specified for the majority of psychic abnormalities and that all nosological distinctions are not binding (Janzarik 1974, 20). In this context, this paper investigates the revival of unitary theories of psychosis in postwar German psychiatry and seeks to understand why the forms of thinking that dominated nineteenth-century psychiatry have proved to be very lasting. Furthermore, this paper emphasizes the perspectivity underlying psychiatric research on psychoses and explores the ways in which writing the history of the schizophrenia concept involves inevitably writing the history of the entire psychiatry.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
In this context, Karl Jaspers emphasizes that Kraepelin’s disease entities should be considered as “ideas” in the Kantian sense cf. (Jaspers 1913, 257ff).
Kraepelin collected under dementia praecox a heterogeneous group of syndromes: catatonia, hebephrenia and primary insanity (or paranoid schizophrenia). Moreover, Kraepelin’s concept of “dementia praecox” was closely associated with his concept of Verbloedungsprozesse, or process of mental deterioration. Under manic-depressive insanity Kraepelin placed simple mania, circular, periodic forms and a few others. Mania might precede or succeed depression; there could be a free interval or none; mania and depression might be present without the other. The facts in common were relapse and recovery and, less clearly defined, affective coloring. Particularly the similarity in outcome suggested a common underlying process cf. (Kraepelin 1989, 16, Notes from the editors).
For details regarding the intense debates on the nature of schizophrenic deterioration cf. (Kronfeld 1930, 332–333).
This broadening of the basic disturbance determined the fact that the resulting schizophrenia concept lacked specificity. In this context, Bleuler and Berze conceived the basic disturbance in schizophrenia as “loosening of associations” (“Assoziationstörung”) and “insufficiency of psychic activity” (“Insuffizienz der psychischen Aktivität”), respectively. Cf. (Bleuler 1911; Berze 1914).
Kahlbaum was the first to emphasize that the form of progression of the total disorders was essentially different from the form of progression of the more partial ones. His reference to the “vesania typica”, which encompassed primary and secondary stages, aimed at showing that the disease processes affecting the psychic life in a considerable way presented a specific form of progression, which was characterized by the succession of different symptom complexes cf. (Kahlbaum 1863, 59–69). These symptom complexes represented different stages of the disease. In contrast to this type of progression, the more partial diseases showed a continuous course in which the character of the alienation remained the same. Moreover, Kahlbaum emphasized that the distinction between partial and total affections was true only with regards to the different symptom complexes. In this connection, it was not necessary that the disease process underlying the partial disorders be different from the one underlying the more total disorders. Alone the consideration of the clinical course of the disease could decide whether the psychiatrist was dealing with a partial or a total mental disorder cf. (Kahlbaum 1863, 150ff). In this context, Kahlbaum was dependent from Griesinger’s conception, according to which the basic forms of psychic diseases, namely, melancholy, mania, insanity (Verruecktheit), and dementia (Bloedsinn), as well as their variants and transitions are different stages of one disease process cf. (Griesinger 1867, 207).
In this context, Janzarik explored the ways in which the nosographic intention hindered considerably the progress in psychiatry during the last three decades of the nineteenth century cf. (Janzarik 1979, 60).
The recent results of cluster studies of syndromes have on the whole reproduced Kraepelin’s groupings cf. for example (Kendler et al. 1998).
Cf. (Kraepelin 1893, 10, Notes from the editors): “Kraepelin traveled clinically with an extraordinarily small baggage of psychological ideas… Nowhere in Kraepelin’s clinical work is his psychological background very obvious.”
In 1927, Arthur Kronfeld devoted a monograph to the study of the interaction between psychology and psychiatry cf. (Kronfeld 1927).
While stressing that the disease concept in psychiatry was a medical one, Schneider emphasized that the postulate of a disease process underlying endogenous psychoses was a working hypothesis: “So, too, we may speak of “diagnosis” in this sphere of purely psychopathologically conceived structures, of “existing state and subsequent course”, though, strictly speaking, this term also only has a place in medicine proper.” (Schneider 1959, 132).
“Actually, in the clinic, where the somatic nature of psychosis is in doubt, there is an easy diagnosis nowadays of more or less typical cyclothymias, but everything else tends to get classed as schizophrenia. All the characteristics which will not fit into the cyclothymic picture are gathered together under this one term. There is nothing to which we can point as a common element in all the clinical pictures that are today christened schizophrenia.” (Schneider 1959, 5).
In this period, phenomenological-anthropological approaches to the endogenous psychoses occupied a central position within psychiatric research. Although their origins can be traced back to the interwar period, these approaches dominated psychopathological research first in the mid-1950s cf. (Glatzel 1974, 576).
Under holistic approaches we understand psychopathological approaches that endeavored to apply holistic psychological theories in the symptom analysis of psychotic disorders. In this context, we refer to the works of Klaus Conrad, Werner Janzarik and Karl Peter Kisker (See bibliography).
In the programmatic introduction of his paper “Strukturanalysen hirnpathologischer Fälle”, Klaus Conrad sketched the conceptual framework of a comprehensive psychopathology. His approach, which he called “Gestaltanalyse”, aimed at elaborating a unitary system, from which the variety of disease forms can be deduced: “Aus einer Vielzahl beziehungslos nebeneinander stehenden Bilder, als welch sich uns die krankhaften Störungsformen auch heute immer noch darstellen, muss ein einheitliches System aufeinander bezogener Formen werden, die durchweg, gleichsam voraussehbar, aus der inneren Strukturgesetzlichkeit dieses Ganzen ableitbar sind.” (Conrad 1947, 350–351).
Of relevance in this connection is Janzarik’s study of the differential typology of delusional phenomena. In this monograph, the author identified four different “dynamic basic-constellations” that enabled him to account for the fact that the two spectra of endogenous psychoses flow into one another, especially in maniform psychoses (Janzarik 1959, 36ff).
Furthermore, the interest in the phenomenological study of the change of experience in schizophrenia should be embedded in the debates regarding the conceptualization methods in psychopathology in the postwar period. In this period, the neutrality in questions of etiology and physiopathology constituted a methodological requirement for the holistic approaches to schizophrenia. However, these approaches emphasized that the phenomenological consideration would be one-sided if it would limit itself to describing phenotypically similar processes without attempting to uncover the dynamic non-equivalence, which is responsible for the nosological ambiguity of such processes (Kisker 1960, 29).
In this connection, it is important to emphasize that, historically, it was the consideration of the dynamic aspect of psychic disorders that enabled Griesinger to integrate the one disease process into the form of progression of mental disorders. This, consequently, opened the way for his foundational thesis of contemporary scientific psychiatry, according to which mental illnesses are diseases of the brain. First at the beginning of the twentieth century, psychiatrists designated this common and widely accepted framework in nineteenth century psychiatry with depreciation as “unitary psychosis”, which became obsolete due to Kraepelin’s new nosological conception cf. (Janzarik 1974, 8).
Shortly before his death, Griesinger departed from the unitary theory, which was based on the idea that the basic forms of psychic illnesses constituted different stages of one disease process. In a paper read in 1867, Griesinger acknowledged the existence of a “primary insanity” (“primäre Verrücktheit”). Furthermore, he underlined the “protogenetic” character of its emergence that he thought was independent from melancholy and mania. However, the revision of Griesinger’s system was not possible due to his premature death in 1868. Furthermore, Griesinger derived the “Primordial-Delirien” (delusions) directly from the cerebral disturbance and not from the emotional ground as he did in his Mental Pathology cf. (Griesinger 1872, 135). This contradictory position that Griesinger adopted in his late psychiatric work was decisive for the further development of psychiatric theories. Among the German psychiatrists, who were altogether dependent upon Griesinger and the contradictions underlying the view he held in 1867, some, like Theodor Meynert and Carl Westphal, were oriented toward his neuropathological program, others, like Heinrich Schüle and Krafft-Ebing followed his clinical intuitions cf. (Janzarik 1979, 52).
The contemporary disagreement concerning the delineation of the schizophrenia concept depends essentially on the lack of consensus regarding the semiotic value of the productive and the residual components, which were assembled in the new designation schizophrenia at the turn of the twentieth century. These two components designated two distinct symptom complexes within the theoretical framework of nineteenth century psychiatry. While the productive component corresponded to the primary affective or dynamic disorders (“Melancholie” and “Manie”), the residual component corresponded to the secondary states cf. (Janzarik 1974, 8).
The reasons for this distinction were closely connected with the striking diversity that the residual states of psychic illnesses offered: “Die Formen, in welchen diese Krankheitszustände, die Ausgänge und Residuen der eigentlichen Krankheit, in der Erscheinung sich darstellen, erhalten durch die Individualität der damit Behafteten ein so verschiedenes und mannigfaltiges Gepräge, dass es außerordentlich schwer ist, sie auf bestimmte Grundformen zurückzuführen, und hierdurch wird, wie ich glaube, die Schwierigkeit einer wissenschaftlichen und naturgemäßen Classification der psychischen Krankheitsformen hauptsächlich herbeigeführt. Der Irrenarzt, welcher die mannigfaltigen, seinen Blicken sich darbietenden Formen zu ordnen und zusammenzustellen sich bemüht, sieht gleichsam ein Chaos vielgestaltiger und wechselnder Formen vor sich liegen, und so lange er die zurückgebliebenen Krankheitszustände, die Residuen der Krankheit, mit der Krankheit selbst vermengt und verwechselt, können seine Classificationsversuche nicht besser gelingen, als ein etwaniger Versuch zur Classificirung der Entzündungen demjenigen gelingen möchte, welcher die nachbleibenden Verhärtungen, Geschwüre und Afterorganisationen als eben so viele Arten der Entzündung zu unterscheiden sich bestrebte.” (Jessen 1838, 632).
References
Balz, Viola. 2010. Zwischen Wirkung und Erfahrung—Eine Geschichte der Psychopharmaka: Neuroleptika in der Bundesrepublik Deutschland, 1950–1980. Bielefeld: Transcript.
Baumeister, Alan A., and Jennifer L. Francis. 2002. Historical development of the dopamine hypothesis of schizophrenia. Journal of the History of the Neurosciences 11(3): 265–277.
Baumeister, Alan A., and Mike F. Hawkins. 2004. The serotonin hypothesis of schizophrenia: A historical case study on the heuristic value of theory. Journal of the History of the Neurosciences 13(3): 277–291.
Baumeister, Alan A., and Mike F. Hawkins. 2005. Continuity and discontinuity in the historical development of modern psychopharmacology. Journal of the History of the Neurosciences 14(3): 199–209.
Baumeister, Alan A. 2013. The chlorpromazine enigma. Journal of the History of the Neurosciences 22(1): 14–29.
Berze, Josef. 1914. Die primäre Insuffizienz der psychischen Aktivität. Leipzig, Wien: Deuticke.
Berze, Josef. 1921. Schizophrenie und psychologische Auffassungen. Allgemeine Zeitschrift fuer Psychiatrie und psychisch-gerichtliche Medizin 77: 58–154.
Berze, Josef, and Hans Walter Gruhle. 1929. Psychologie der Schizophrenie. Berlin: Springer.
Bleuler, Eugen. 1908. Die prognose der dementia praecox (schizophreniegruppe). Allgemeine Zeitschrift für Psychiatrie und Psychisch‐Gerichtliche Medizin 65: 436–464.
Bleuler, Eugen. 1911. Dementia praecox oder Gruppe der Schizophrenien. Leipzig: F. Deuticke.
Bodamer, Joachim. 1944. Wilhelm Griesinger und die Entwicklung der Psychiatrie im 19. Jahrhundert. Ein Beitrag zur Geistesgeschichte der Medizin. Dissertation, Ruprecht-Karls-Universität zu Heidelberg. Not published.
Conrad, Klaus. 1947. Strukturanalysen hirnpathologischer Fälle. Ueber Struktur- und Gestaltwandel. Deutsche Zeitschrift für Nervenheilkunde 158: 344–371.
Conrad, Klaus. 1958. Die beginnende Schizophrenie. Stuttgart: Georg Thieme.
Conrad, Klaus. 1959. Das Problem der nosologischen Einheit in der Psychiatrie. Nervenarzt 30: 488–494.
Glatzel, Johann. 1974. Die Psychopathologie endogener Psychosen in der Bundesrepublik seit dem Jahre 1945. Fortschritte der Neurologie-Psychiatrie 42: 576–596.
Goldstein, Kurt. 1927. Über Aphasie. Schweizer Archiv fur Neurologie und Psychiatrie 6: 1–68.
Griesinger, Wilhelm. 1867. Mental pathology and therapeutics. London: The New Sydenham Society.
Griesinger, Wilhelm. 1872. Vortrag zur Eröffnung der psychiatrischen Klinik zu Berlin. In Gesammelte Abhandlungen, ed. Wunderlich, C.A., Vol. 1, 127–151. Berlin: Hirschwald.
Janzarik, Werner. 1959. Dynamische Grundkonstellationen in endogenen Psychosen. Berlin: Springer.
Janzarik, Werner. 1974. Themen und Tendenzen der deutschsprachigen Psychiatrie. Berlin: Springer.
Janzarik, Werner. 1978. Wandlungen des Schizophrenibegriffes. Nervenarzt 49: 133–139.
Janzarik, Werner. 1979. Die klinische Psychopathologie zwischen Griesinger und Kraepelin im Querschnitt des Jahres 1878. In Psychopathologie als Grundlagenwissenschaft, ed. Werner Janzarik, 51–61. Stuttgart: Enke.
Jaspers, Karl. 1913. Allgemeine Psychopathologie. Berlin: Springer.
Jessen, Peter Willers. 1838. Aerztliche Erfahrungen in der Irrenanstalt bei Schleswig. Zeitschrift für die Beurtheilung und Heilung der krankhaften Seelenzustände. Drittes Heft: 582–701.
Jung, Carl Gustav. 1907. Über die Psychologie der dementia praecox. Halle: Carl Marhold.
Kahlbaum, Karl Ludwig. 1863. Die Gruppierung der psychischen Krankheiten und die Einteilung der Seelenstörungen. Danzig: A. W. Kafemann.
Kendler, K.S., et al. 1998. The structure of psychosis: latent class analysis of probands from the Roscommon family study. Archives of General Psychiatry 55(6): 492–499.
Kisker, Karl Peter. 1960. Der Erlebniswandel des Schizophrenen. Berlin: Springer.
Kraepelin, Emil. 1893. Psychiatrie, 4th ed. Leipzig: Ambr. Abel.
Kraepelin, Emil. 1989. Dementia praecox and paraphrenia together with manic-depressive insanity and paranoia. Birmingham: The Classics of Medicine Library.
Kronfeld, Arthur. 1927. Die Psychologie in der Psychiatrie. Berlin: Springer.
Kronfeld, Arthur. 1930. Perspektiven der Seelenheilkunde. Leipzig: Georg Thieme.
Missa, Jean-Noël. 2006. Naissance de la psychiatrie biologique: histoire des maladies mentales au XXe siècle. Paris: Presses Universitaires de France.
Pötzl, Otto. 1928. Die Aphasielehre vom Standpunkte der klinischen Psychiatrie. Wien: F. Deuticke.
Schmitt, Wolfram. 1990. Biologismus und psychopathologie: die Heidelberger Schule. In Vom Umgang mit Irren: Beitraege zur Geschichte psychiatrischer Therapeutik, ed. Johann Glatzel, 121–131. Regensburg: Roderer.
Schneider, Kurt. 1959. Clinical psychopathology. New York; London: Grune & Stratton.
Schroeder, Paul. 1920. Die Spielbreite der Symptome beim manisch-depressiven Irresein und bei den Degenerationspsychosen. Berlin: Karger.
Urstein, Maurycy. 1909. Die Dementia Praecox: und ihre Stellung zum manisch-depressiven Irresein. Eine klinische Studie. Berlin, Wien: Urban & Schwarzenberg.
Wilmanns, Karl (ed.). 1932. Handbuch der Geisteskrankheiten, v. 9.5: Die Schizophrenie. Berlin: Springer.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Abu Ghazal, Y. Perspectivity in Psychiatric Research: The Psychopathology of Schizophrenia in Postwar Germany (1955–1961). Medicine Studies 4, 103–111 (2014). https://doi.org/10.1007/s12376-013-0087-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12376-013-0087-2