EMIL KRAEPELIN’S INAUGURAL LECTURE IN DORPAT: CONTEXTS AND LEGACIES

Abstract

1. Introduction The psychiatrist Emil (1856-1926) is today best known for having distinguished between what we have come to call schizophrenia on the one hand, and manic-depressive illness on the other. This basic dichotomy has been enormously influential in the history of twentieth century psychiatry. Over the past several decades, with the rise of biological psychiatry and--especially in the United States--the displacement of psychoanalytic psychiatry, has become an icon. His legacy has been appropriated by so-called neo-Kraepelinian psychiatrists who have repeatedly evoked his name in support of efforts to strengthen the biomedical model of mental disorders and to reinforce psychiatry's status as a research-based medical specialty within the mental health professions (Mayes and Horowitz 2005, McCarthy and Gerring 1994). Indeed, what some have described as a 'revolutionary' (Compton and Guze 1995, Klerman 1989:31) paradigm shift toward 'biological psychiatry' in the late twentieth century has gone hand-in-hand with recourse to Kraepelin's work. In the words of a former editor of the American Journal of Psychiatry, in moving forward, psychiatric research has found itself returning to the past and coming back full circle to the work of Kraepelin (Andreasen 1997:108). Emil Kraepelin's enormous influence in psychiatry is commonly put down to his clinical methods and nosology. According to advocates and detractors alike, his empirical research techniques and unique powers of observation were decisive factors in the delineation of schizophrenic and manic-depressive forms of mental illness. So it is hardly surprising--and certainly not without justification--that we have come to view him as a grand clinical nosologist. But in the 1880s, was not yet the clinical nosologist that he later became. Rather, a far more apt description of him at that stage in his career would be an experimental psychologist. worked in the famous laboratory of Wilhelm Wundt (1832-1920) in Leipzig, where he conducted psycho-physical experiments on the effects of various pharmacological and other stimulants. And over the course of his entire career, strove to establish the Wundtian psychological experiment as part of psychiatry's diagnostic repertoire. He created laboratories for psychological research at the university clinics he headed in Dorpat, Heidelberg, and Munich, as well as at the German Research Institute in Munich which he founded in 1917. For well over forty years, up to the very end of his career, conducted psychological research and remained convinced of its importance and usefulness in the development of psychiatric science (Kraepelin 1920:359-360, 1983:218). In general, historians of psychiatry have tended to ignore Kraepelin's laboratory research and it has come to be seen as little more than an awkward appendage to his clinical work (Gaupp 1939:68, Birnbaum 1928:42, Gruhle 1929:46, Ackerknecht 1985:78). From the perspective of clinical medicine, never succeeded, as he had hoped, in integrating psychological research into his broader nosological scheme. His enormously influential textbook Psychiatry was all but silent on the relevance of experimental psychology in psychiatric practice. Hence, it is not surprising that it has been largely purged from historical memory, while at the same time his pragmatic taxonomy was readily canonized by clinical psychiatry. My aim in this article is to reflect on Kraepelin's research in experimental psychology and its relationship with his nosology. Much of his early experimental research took place at the University of Dorpat, where from 1886 to 1891 he was a member of the medical faculty and director of the psychiatric clinic. In his inaugural lecture of 1886, he articulated the significance of experimental psychology in his early research agenda (Kraepelin 1887a). 2. Historical contexts: unitary psychosis and neuropsychiatry To fully appreciate the importance of Kraepelin's inaugural lecture, it is worth recalling two especially noteworthy historical contexts. …