Эмиль Краепелин: Өмір және психиатрияға қосқан үлесі

German psychiatrist (1856–1926)

Kraepelin, whose father, Karl Wilhelm, was a former opera singer, music teacher, and later successful story teller, was born in 1856 in Neustrelitz, in the Duchy of Mecklenburg Strelitz in Germany. He was first introduced to biology by his brother Karl, 10 years older and, later, the director of the Zoological Museum of Hamburg.

Kraepelin began his medical studies in 1874 at the University of Leipzig and completed them at the University of Würzburg (1877–78). At Leipzig, he studied neuropathology under Paul Flechsig and experimental psychology with Wilhelm Wundt. Kraepelin would be a disciple of Wundt and had a lifelong interest in experimental psychology based on his theories. While there, Kraepelin wrote a prize winning essay, "The Influence of Acute Illness in the Causation of Mental Disorders". He completed his habilitation thesis at Leipzig;

In 1908, he was elected a member of the Royal Swedish Academy of Sciences. In 1912, at the request of the DVP (Deutscher Verein für Psychiatrie; German Association for Psychiatry), of which he was the head from 1906 to 1920, he began plans to establish a centre for research. Following a large donation from the Jewish German American banker James Loeb, who had at one time been a patient, and promises of support from "patrons of science", the German Institute for Psychiatric Research was founded in 1917 in Munich. Initially housed in existing hospital buildings, it was maintained by further donations from Loeb and his relatives. In 1924 it came under the auspices of the Kaiser Wilhelm Society for the Advancement of Science. The German American Rockefeller family's Rockefeller Foundation made a large donation enabling the development of a new dedicated building for the institute along Kraepelin's guidelines, which was officially opened in 1928. He rejected psychoanalytical theories that posited innate or early sexuality as the cause of mental illness, and he rejected philosophical speculation as unscientific. He focused on collecting clinical data and was particularly interested in neuropathology (e. g., diseased tissue). In the later period of his career, as a convinced champion of social Darwinism, he actively promoted a policy and research agenda in racial hygiene and eugenics. Kraepelin retired from teaching at the age of 66, spending his remaining years establishing the institute. The ninth and final edition of his Textbook was published in 1927, shortly after his death. It comprised four volumes and was ten times larger than the first edition of 1883.

Kraepelin announced that he had found a new way of looking at mental illness, referring to the traditional view as "symptomatic" and to his view as "clinical". This turned out to be his paradigm setting synthesis of the hundreds of mental disorders classified by the 19th century, grouping diseases together based on classification of syndrome—common patterns of symptoms over time—rather than by simple similarity of major symptoms in the manner of his predecessors. Kraepelin described his work in the 5th edition of his textbook as a "decisive step from a symptomatic to a clinical view of insanity. . The importance of external clinical signs has . been subordinated to consideration of the conditions of origin, the course, and the terminus which result from individual disorders. Thus, all purely symptomatic categories have disappeared from the nosology". and
dementia praecox. Drawing on his long term research, and using the criteria of course, outcome and prognosis, he developed the concept of dementia praecox, which he defined as the "sub acute development of a peculiar simple condition of mental weakness occurring at a youthful age". When he first introduced this concept as a diagnostic entity in the fourth German edition of his Lehrbuch der Psychiatrie in 1893, it was placed among the degenerative disorders alongside, but separate from, catatonia and dementia paranoides. At that time, the concept corresponded by and large with Ewald Hecker's hebephrenia. In the sixth edition of the Lehrbuch in 1899 all three of these clinical types are treated as different expressions of one disease, dementia praecox. One of the cardinal principles of his method was the recognition that any given symptom may appear in virtually any one of these disorders; e. g., there is almost no single symptom occurring in dementia praecox which cannot sometimes be found in manic depression. What distinguishes each disease symptomatically (as opposed to the underlying pathology) is not any particular (pathognomonic) symptom or symptoms, but a specific pattern of symptoms. In the absence of a direct physiological or genetic test or marker for each disease, it is only possible to distinguish them by their specific pattern of symptoms. Thus, Kraepelin's system is a method for pattern recognition, not grouping by common symptoms. It has been claimed that Kraepelin also demonstrated specific patterns in the genetics of these disorders and patterns in their course and outcome, but no specific biomarkers have yet been identified. Generally speaking, there tend to be more people with schizophrenia among the relatives of schizophrenic patients than in the general population, while manic depression is more frequent in the relatives of manic depressives. Though, of course, this does not demonstrate genetic linkage, as this might be a socio environmental factor as well. He also reported a pattern to the course and outcome of these conditions. Kraepelin believed that schizophrenia had a deteriorating course in which mental function continuously (although perhaps erratically) declines, while manic depressive patients experienced a course of illness which was intermittent, where patients were relatively symptom free during the intervals which separate acute episodes. This led Kraepelin to name what we now know as schizophrenia, dementia praecox (the dementia part signifying the irreversible mental decline). It later became clear that dementia praecox did not necessarily lead to mental decline and was thus renamed schizophrenia by Eugen Bleuler to correct Kraepelin's misnomer. In addition, as Kraepelin accepted in 1920, "It is becoming increasingly obvious that we cannot satisfactorily distinguish these two diseases"; however, he maintained that "On the one hand we find those patients with irreversible dementia and severe cortical lesions. On the other are those patients whose personality remains intact". Nevertheless, overlap between the diagnoses and neurological abnormalities (when found) have continued, and in fact a diagnostic category of schizoaffective disorder would be brought in to cover the intermediate cases. Kraepelin devoted very few pages to his speculations about the etiology of his two major insanities, dementia praecox and manic depressive insanity. However, from 1896 to his death in 1926 he held to the speculation that these insanities (particularly dementia praecox) would one day probably be found to be caused by a gradual systemic or "whole body" disease process, probably metabolic, which affected many of the organs and nerves in the body but affected the brain in a final, decisive cascade.

In the first through sixth edition of Kraepelin's influential psychiatry textbook, there was a section on moral insanity, which meant then a disorder of the emotions or moral sense without apparent delusions or hallucinations, and which Kraepelin defined as "lack or weakness of those sentiments which counter the ruthless satisfaction of egotism". He attributed this mainly to degeneration. This has been described as a psychiatric redefinition of Cesare Lombroso's theories of the "born criminal", conceptualised as a "moral defect", though Kraepelin stressed it was not yet possible to recognise them by physical characteristics. In fact from 1904 Kraepelin changed the section heading to "The born criminal", moving it from under "Congenital feeble mindedness" to a new chapter on "Psychopathic personalities". They were treated under a theory of degeneration. Four types were distinguished: born criminals (inborn delinquents), pathological liars, querulous persons, and Triebmenschen (persons driven by a basic compulsion, including vagabonds, spendthrifts, and dipsomaniacs). The concept of "psychopathic inferiorities" had been recently popularised in Germany by Julius Ludwig August Koch, who proposed congenital and acquired types. Kraepelin had no evidence or explanation suggesting a congenital cause, and his assumption therefore appears to have been simple "biologism". Others, such as Gustav Aschaffenburg, argued for a varying combination of causes. Kraepelin's assumption of a moral defect rather than a positive drive towards crime has also been questioned, as it implies that the moral sense is somehow inborn and unvarying, yet it was known to vary by time and place, and Kraepelin never considered that the moral sense might just be different. Kurt Schneider criticized Kraepelin's nosology on topics such as Haltlose for appearing to be a list of behaviors that he considered undesirable, rather than medical conditions, though Schneider's alternative version has also been criticised on the same basis. Nevertheless, many essentials of these diagnostic systems were introduced into the diagnostic systems, and remarkable similarities remain in the DSM 5 and ICD 10.

Kraepelin postulated that there is a specific brain or other biological pathology underlying each of the major psychiatric disorders. As a colleague of Alois Alzheimer, he was a co discoverer of Alzheimer's disease, and his laboratory discovered its pathological basis. Kraepelin was confident that it would someday be possible to identify the pathological basis of each of the major psychiatric disorders.

Upon moving to become Professor of Clinical Psychiatry at the University of Munich in 1903, Kraepelin increasingly wrote on social policy issues. He was a strong and influential proponent of eugenics and racial hygiene. His publications included a focus on alcoholism, crime, degeneration and hysteria. Kraepelin was convinced that such institutions as the education system and the welfare state, because of their trend to break the processes of natural selection, undermined the Germans' biological "struggle for survival".

Kraepelin's great contribution in classifying schizophrenia and manic depression remains relatively unknown to the general public, and his work, which had neither the literary quality nor paradigmatic power of Freud's, is little read outside scholarly circles. Kraepelin's contributions were also to a large extent marginalized throughout a good part of the 20th century during the success of Freudian etiological theories. However, his views now dominate many quarters of psychiatric research and academic psychiatry. His fundamental theories on the diagnosis of psychiatric disorders form the basis of the major diagnostic systems in use today, especially the American Psychiatric Association's DSM IV and the World Health Organization's ICD system, based on the Research Diagnostic Criteria and earlier Feighner Criteria developed by espoused "neo Kraepelinians", though Robert Spitzer and others in the DSM committees were keen not to include assumptions about causation as Kraepelin had. Kraepelin has been described as a "scientific manager" and political operator, who developed a large scale, clinically oriented, epidemiological research programme. In this role he took in clinical information from a wide range of sources and networks. Despite proclaiming high clinical standards for himself to gather information "by means of expert analysis of individual cases", he would also draw on the reported observations of officials not trained in psychiatry. The various editions of his textbooks do not contain detailed case histories of individuals, however, but mosaiclike compilations of typical statements and behaviors from patients with a specific diagnosis. Kraepelin wrote in a knapp und klar (concise and clear) style that made his books useful tools for physicians. Abridged and clumsy English translations of the sixth and seventh editions of his textbook in 1902 and 1907 (respectively) by Allan Ross Diefendorf (1871–1943), an assistant physician at the Connecticut Hospital for the Insane at Middletown, inadequately conveyed the literary quality of his writings that made them so valuable to practitioners. Among the doctors trained by Alois Alzheimer and Emil Kraepelin at Munich at the beginning of the 20th century were the Spanish neuropathologists and neuropsychiatrists Nicolás Achúcarro and Gonzalo Rodríguez Lafora, two distinguished disciples of Santiago Ramón y Cajal and members of the Spanish Neurological School.

In the Heidelberg and early Munich years he edited Psychologische Arbeiten, a journal on experimental psychology. One of his own famous contributions to this journal also appeared in the form of a monograph (105 pp.) entitled Über Sprachstörungen im Traume (On Language Disturbances in Dreams). Kraepelin, on the basis of the dream psychosis analogy, studied for more than 20 years language disorder in dreams in order to study indirectly schizophasia. The dreams Kraepelin collected are mainly his own. They lack extensive comment by the dreamer. In order to study them the full range of biographical knowledge available today on Kraepelin is necessary (see, e. g., Burgmair et al., I IX).

Burgmair, Wolfgang & Eric J. Engstrom & Matthias Weber et al., eds. Emil Kraepelin. 9 vols. Munich: belleville, 2000–2019. Vol. I: Persönliches, Selbstzeugnisse (2000),
Vol. II: Kriminologische und forensische Schriften: Werke und Briefe (2001),
Vol. III: Briefe I, 1868–1886 (2002),
Vol. IV: Kraepelin in Dorpat, 1886–1891 (2003),
Vol. V: Kraepelin in Heidelberg, 1891–1903 (2005),
Vol. VI: Kraepelin in München I: 1903–1914 (2006),
Vol. VII: Kraepelin in München II: 1914–1920 (2009),
Vol. VIII: Kraepelin in München III: 1921–1926 (2013),
Vol. IX: Briefe und Dokumente II: 1876 1926 (2019),