D’Hippocrate au DSM-5 : vingt-cinq siècles de classifications psychiatriques

Abstract

During the Antiquity, medical classifications opposite phrenitis, acute and feverish, from mania and melancholia, chronic. Hippocrates relies on the theory of “humours”, while the Grecian philosophy separate the psyche in several souls and faculties. Latin lexicon introduces the terms of delusion, insanity, dementia and vesania. Galen develops the concepts of “sympathetic” lesion and of temperament. He localizes the mental faculties in the brain. Across the Arabian medicine (Avicenne), his works are transmitted to scholastic medieval philosophy and to the Renaissance physicians. Fernel and Platter distinguish alienation from amentia. Zacchias separates insania (insanity) from fatuitas and delirium (former phrenitis). During the 17th century, Sydenham relies on empirical description and on clinical observation. He introduces the concept of syndrome. At the 18th century, the symptomatic nosology of Boissier de Sauvages, which takes inspiration from the naturalist Linné, subdivides the classes in orders, “genera” and species. Cullen creates the word neurosis (1769). It constitutes a class of his nosology and of Pinel's “Philosophical nosography” (1798). The 19th century is the golden age of the classifications. For Pinel, mental alienation is subdivided in five species (melancholia, mania with and without delusion, dementia, idiotism). Esquirol divides melancholia in lypemania and monomania. Georget describes the stupidity and separates alienation from acute delirium, either sympathetic, or symptomatic. Griesinger introduces unitary psychosis concept, similar to French unitary alienation. In an opposite way, after 1850, under the influence of Falret's lessons at the Salpêtriere hospital, several autonomous “illnesses” are described, characterized by a specific course, in France and in Germany (Kahlbaum). At the same time, the theory of degeneracy is developed. These works end in Kraepelin's treatise. His classification, at first symptomatic, relies on the course dating from the 5th edition (1896). It articulates in the 6th edition (1899) around manic-depressive illness and dementia praecox, which becomes later schizophrenia (Bleuler, 1911). Freud and Janet classify the neurosis at this time. These entities influence European nosology until the CIM-9 and the DSM-II (1968). The concept of mental “illness” is however criticized at the time of Kraepelin by empiric semiology (Chaslin, 1912) and phenomenology (Jaspers, 1913).They preconize a classification in syndromes and “clinical types”. The development of diagnostic criteria in the USA during the decade 1970 ends on the publication of the DSM-III (1980) and the ICD-10 (1992). The DSM-IV (1994) and the DSM-5 (2013) have corroborated this empiric orientation, in spite of critics on the new categories and on the validity of the field trials.