The history of psychiatry has been marked from the very beginning by the “conflict” between leading representatives of the field concerning diagnostic interpretations. For example, Heinroth (1773–1843) identified 48 different diagnoses of mental diseases, while Neumann (1814–1884) in his textbook of psychiatry wrote: “There is only one type of mental disease. We call it insanity.” For a long time there was no agreement on a systematic classification of mental disorders. Using Kahlbaum’s (1828–1899) fundamental idea of clinically oriented research methodology, Kraepelin (1856–1926) finally created a diagnostic-nosological classification system, in which he divided endogenous psychoses into two large groupings: manic-depressive disease and dementia praecox. This dichotomy is based primarily on the different prognoses of the two groups: favorable prognosis in the case of manic-depressive disease and unfavorable prognosis in the case of dementia praecox. Kraepelin defined the term “manic- depressive disease” rather broadly. He also did not see a disease entity in the actual sense, but rather “a group of disorders stemming from a common root, with gradual transitions between the individual types” (Kraepelin 1909). Kraepelin’s paradigm of a dichotomy of endogenous psychoses dominated psychiatric research for decades. With the introduction of the term “schizophrenia” by Bleuler (1857–1939), however, the diagnostic-prognostic dichotomy was lost. Bleuler’s “group of schizophrenia” included both favorable as well as unfavorable psychoses: “… it soon became apparent, however, that many disorders which cannot be distinguished in their psychopathological description from those psychoses which lead to ‘dementia’ have a good prognosis, similar to manic-depressive ‘insanity’. A term had to be created which encompassed illnesses with similar symptomatology, even when they result partly in recovery, partly in deficiency, and partly in ‘dementia’” (Bleuler 1911). The resulting consequences for psychiatric research were summarized resignedly by Gruhle (1880–1958) in 1932: “It is somewhat discouraging to see that the controversies which took place between the years 1800 and 1850 were repeated almost identically from 1900 to 1930; the only difference being that these debates were no longer concerned with insanity as such, but rather with the three endogenous psychoses (idiopathic epilepsy, manic-depressive insanity, schizophrenia) and particularly its primary subject, schizophrenia”.
KeywordsClinical Genetic Unfavorable Prognosis Adoptive Parent Psychiatric Research Idiopathic Epilepsy
Unable to display preview. Download preview PDF.