Isr J Psychiatry - Vol. 54 - No 2 (2017)
Karl Jaspers: The Icon of Modern Psychiatry
Michael A. Schwartz, MD,1 Marcin Moskalewicz, PhD,2 and Osborne P. Wiggins, PhD3
1
2
3
Department of Psychiatry, Texas A&M Health Science Center College of Medicine, Round Rock, Texas, U.S.A.
Faculty of Philosophy, University of Oxford, and the Department of Social Sciences, Poznan University of Medical Sciences, Poznań, Poland
Department of Philosophy, University of Louisville, Louisville, Kentucky, U.S.A.
ABSTRACT
December 2015 and March 2016 issues of the American
Journal of Psychiatry contain a debate focusing on the
legacy of Emil Kraepelin, widely considered one of the
founders if not the iconic founder of modern scientiic
psychiatry. The authors, Eric J. Engstrom and Kenneth S.
Kendler, challenge the so-called neo-Kraepelinian view
of Kraepelin and argue that the true, historical Kraepelin
was far more inclined towards scientiic psychology,
less reductionist and brain-centric, and more skeptical
nosologically than his later followers apparently believe.
Commenting upon this paper, Rael D. Strous, Annete A.
Opler, and Lewis A. Opler do not question these claims
per se, but rather recall and emphasize historical facts
that the paper regretably omited: Kraepelin’s avid
promotion of degeneration theory, eugenics, racism, and
anti-Semitism as well as his mentoring of several of the
most prominent Nazi-collaborating psychiatrists. Strous,
Opler and Opler go on to suggest that it is now time for
psychiatry to unburden itself of any iconic indebtedness
to Kraepelin. The authors of the current paper agree, and
propose to replace Kraepelin with the psychiatrist Karl
Jaspers, MD (1883-1969) as the proper iconic founder
of present-day and future psychiatry. Acknowledging
our debt to Jaspers can usher in a fully humanistic and
scientiic psychiatric practice that can lourish as a
medical discipline that is respectful of and of service
to patients, beneicial for research, multiperspectival
and methodologically pluralistic.
In December 2015 and March 2016 issues of American
Journal of Psychiatry, a debate occurred focusing on the
legacy of Emil Kraepelin (1856-1926), widely considered
one of the founders and, indeed, for many the icon of
modern scientiic psychiatry. In their “Emil Kraepelin:
Icon and Reality” (1), the authors Eric J. Engstrom and
Kenneth S. Kendler challenge the so-called neo-Kraepelinian view of Kraepelin and argue that the true, historical Kraepelin was far more inclined towards scientiic
psychology, less reductionist and brain-centric, and more
skeptical nosologically than his later followers apparently
believe. Subsequently, commenting upon Engstrom’s
and Kendler’s paper, Rael D. Strous, Annette A. Opler
and Lewis A. Opler do not question these claims per se,
but rather recall and emphasize historical facts that the
paper regrettably omitted (2), namely, that Kraepelin
was an avid promoter of degeneration theory, eugenics,
racism and anti-Semitism. Kraepelin made fundamental
contributions to the ideological basis of racial hygiene,
which later resulted in abominable medical practices.
He additionally mentored several of the most prominent
Nazi-collaborating psychiatrists – Robert Gaupp, Paul
Nitsche and Ernst Rudin (2). Strous, Opler and Opler
go on to suggest that it is now time for psychiatry to
unburden itself of any iconic indebtedness to Kraepelin.
In their reply, Engstrom and Kendler do not deny
these uncomfortable facts, but rather underscore that
they go beyond the scope of their article (3). hey also
claim that Kraepelin should not be held accountable
for the actions of his mentees as he was not a direct
proponent of genocidal policies. here is nothing inappropriate – the authors maintain – in discussing some
aspects of Kraepelin work without mentioning those
issues, all the more so since they have been addressed
elsewhere by themselves.
We do agree with Engstrom’s and Kendler’s criticism
of the oversimpliied image of Kraepelin as propagated by
post-psychoanalytic American psychiatry. Kraepelin was
much more than simply a proto-biological, reductionist
psychiatrist, and to claim otherwise deeply distorts the real
historical igure. Nevertheless, we also agree with Strous,
Address for Correspondence: Michael A. Schwartz, MD, 3950 North A.W. Grimes Blvd., Round Rock, Texas 78665, U.S.A
schwartz@medicine.tamhsc.edu
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MiChAEL A. SChWARTz ET AL.
Opler and Opler that in order to present a true image
of Kraepelin, it is absolutely essential – indeed, it is our
historical moral obligation – to raise the issues having to
do with his problematic side. And once these issues are
raised, it is no longer appropriate to credit Kraepelin with
being the iconic founder of modern psychiatry or with
being someone who – as Engstrom and Kendler maintain
– has still “quite a bit to teach modern psychiatry” (3).
he historical record leaves us with no doubt about
Kraepelin’s views regarding many of his psychiatric
patients, as well as the core congruence of his psychiatric
positions with his politics, world-outlook and well documented views regarding race, ethnicity, religion, sub-culture and degeneration. In his clinical work, Kraepelin was
committed to science and uninterested in psychological
empathy or in the inner life of his patients. But importantly,
in addition, Kraepelin was a political reactionary who
explicitly profered eugenic demands (4). Ater his trip
to Java in 1903, his eugenic views became more explicit
and he started to consider racial hygiene policies as a
solution to the problem of racial degeneration (5). In his
1908 paper “On the question of degeneration,” Kraepelin
associated the growth of civilization with weakening of
resistance, physical vigor and free will as well as with an
increase of mental disorders. At the same time, by putting
his selective focus on somatic facts, he marginalized the
social factors behind other major health problems of his
time, for example, alcoholism and syphilitic infection
(6). Kraepelin became an advocate of the position that
self-domestication of humans underlies degeneration
by replacing natural by artiicial selection – a position
that stemmed from his nosological system, built on the
degeneration paradigm (7). In the eighth edition of his
Textbook on Psychiatry (1909), Kraepelin thus wrote:
“he number of idiots, epileptics, psychopaths, criminals,
prostitutes, and tramps who descend from alcoholic and
syphilitic parents, and who transfer their inferiority to
their ofspring, is incalculable. Of course, the damage will
be balanced in part by their lower viability; however, our
highly developed social welfare has the sad side-efect
that it operates against the natural self-cleansing of our
people” [translated by and cited ater Martin Brüne (7)].
Last but not least, Kraepelin, holding many anti-Semitic
views, was convinced that weak-willed Jews are disposed
towards mental disorders (7, 8).
While it is true that anti-Semitism was not uncommon in the late 19th and early 20th century Europe, and,
in this sense, Kraepelin was “a man of his age,” there
certainly were people who were seeing beyond or above
this historical climate. Furthermore, there is no doubt
that Kraepelin’s enormous scientiic authority helped to
spread these views. We cite here his personal support
for his pupil and later successor at the Kaiser Wilhelm
Institute for Psychiatry, Ernst Rüdin – who later played
an important part in implementing sterilization policies in Germany. It is not without reason that Kraepelin
has been considered an “architect” of Nazi genocidal
policies (8), who, given the overtones of his seminal
“proto-fascistic” views (9), must take some of the credit
for the catastrophic efects of degeneration theory that
would soon follow.
Should these positions marginalize Kraepelin? Some do
acknowledge Kraepelin’s views but claim that to use this
part of his writings and inluence to discredit the scientiic
value of his psychopathology would involve a fall into
the logical fallacy of an argumentum ad hominem. We
strongly disagree. Can the professional writings of a man
have any scientiic value if this man had such a distorted
and biased view of such large numbers of his fellow human
beings? It is, we submit, entirely reasonable to suppose that
Kraepelin’s overall understandings and categorizations
of human beings are distorted and misconceived as well.
Certainly, one clear Kraepelinean legacy, namely, continuing pessimism regarding “the deteriorating course” and
outcome for anyone diagnosed with schizophrenia, has
been refuted by present day studies (10). Nonetheless, bias
and stigma die hard. And furthermore, we need to add –
although it should be obvious – that the fundamental biases
embedded in Kraepelin’s position cannot be dismissed as
irrelevant for a psychiatrist. he core neo-Kraepelinian
legacy seems to reside not only in the DSM-III, but also
in apparent popular acceptance of degeneration theory
of schizophrenia.
herefore, while it is true that Kraepelin should not
be demonized and held personally responsible for the
course of events beyond his inluence, he is certainly
not an appropriate iconic igure for modern psychiatry.
As physicians, we are also responsible for choosing our
professional parental igures wisely. For this reason, we
propose to replace Kraepelin with the psychiatrist Karl
Jaspers, MD (1883-1969), as the proper iconic founder of
present-day and future psychiatry. Despite the inluence of
Sigmund Freud on continental and American psychiatry
in the last century, the psychoanalytic tradition, unlike
the phenomenological one, has not been successful in
convincingly addressing the problem of psychosis, and is
less and less common in the clinical practice. Due to his
limited methodological perspective, Freud, an intellectual
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KARL JASPERS: iCON Of MODERN PSyChiATRy
giant in his own right, cannot fulill the role of a psychiatric icon to the extent that Jaspers can. Acknowledging
our debt to Jaspers can usher in a psychiatric science
and practice that is fully humanistic and scientiic – a
psychiatry that can lourish as a medical discipline that
is respectful of and serves patients, a psychiatry that is
beneicial for research as well as multiperspectival and
methodologically pluralistic.
Educated in psychiatry in Heidelberg, Karl Jaspers
argued for a “conceptual pluralism” in psychiatry (11).
He emphasized – and this is as true today as it was in his
day – that any single “theory” used in the understanding
and treatment of a patient permitted only a one-sided and
limited perspective on the patient’s problems. In other
words, the one-sided and limited nature of a perspective
entailed that while it pointed the psychiatrist toward some
facts about the patient it also blinded the psychiatrist
regarding others. In order to overcome this blindness and
thereby gain a fuller understanding, the psychiatrist should
draw on other perspectives, also one-sided and limited. To
put it somewhat metaphorically, every perspective both
reveals and conceals aspects of the patient’s condition.
Jaspers’ conceptual pluralism in psychiatry issued from
his commitment to a perspectivalism that entailed the
one-sidedness of any single perspective on the patient.
Following the late 19th century epistemological debate
within the philosophy of science juxtaposing understanding (characteristic of human sciences) with explanation
(characteristic of natural sciences), Jaspers argued for the
coexistence of both in psychiatry. Jaspers thus thought it
useless for any particular school in psychiatry to argue that
their preferred approach was the sole fruitful one. In one of
his early works, Psychology of Worldviews, Jaspers argued
against the absolute character of any kind of doctrine (12).
He was also an advocate of the concept of truth as communication, disclosing itself from multiple points of view.
Truth can never be captured in a dogma and signiicant
parts of the truth are overlooked if practitioners believe
their chosen approach is the exclusive avenue to it. he
very unity of mankind, Jaspers believed, manifests itself
in such a communicative perspectivism.
As a necessary supplement to his methodological
pluralism, Jaspers did preserve a corpus of mental disorders for psychiatrists to investigate, including, of course,
schizophrenia. But what is schizophrenia if not Kraepelin’s
biological and genetic entity? In his masterful and iconic
psychiatric text, General Psychopathology (1913) (13),
Jaspers, while appreciative of Kraepelin’s investigations
of the whole life story of his patients, was highly critical
6
of his nosological ideas (14). He provided an answer
indebted to the great sociologist, Max Weber, and contended that psychopathological categories were unable
to “carve nature at the joints.” Rather they served the
psychiatrist most usefully when they were employed as
heuristic devices that could guide a further, more detailed
investigation. Weber’s “ideal types” served precisely this
purpose. For example, Weber’s ideal type, “the modern
capitalist economy,” provided an overarching concept that
could apply to any modern capitalist economy because
it listed general features of almost all modern capitalist
economies. his concept oriented investigators’ thinking
and allowed them to know which features to look for in
the economies they studied. However, under the guidance
of the ideal type they might oten enough run up against
an important real feature not mentioned by the type.
his might prompt them to ask, “Why not?” Answering
that question might lead the investigator to uncover
something signiicant, even crucial, for the functioning
or dysfunctioning of this particular economy. In the
same manner, for Jaspers, a diagnosis of “schizophrenia”
remains important, but in the sense of an “ideal type”
rather than a “natural kind” or, today, a “reliable entity”
on its way, hopefully, to disclosing such an entity.
In addition to the above, Jaspers’ viewpoints profoundly
serve psychiatry in various other ways. His emphasizing
the role of human sciences and philosophy in psychiatric
practice, in addition to biology, functions as an antidote
to the extreme reductionism according to which mental
illness is nothing more than a brain disease. Moreover, his
commitments to clinical phenomenology, to Weberian
ideal types, and to his philosophy of existence never lose
sight of the patient’s uniqueness. Jaspers’ commitment
to the individual, sufering patient, transcends all the
methodological perspectives and provides a hidden,
moral unity to his approach.
And what of the person, Karl Jaspers, and his own
approach to the looming National Socialist storm in his
native Germany? Here again, Karl Jaspers proves himself
to be entirely diferent from Emil Kraepelin. It is no accident, as Strous et al. report, that Kraepelin’s three students,
Robert Gaupp, Paul Nitsche and Ernst Rudin, played a
far worse part in propounding and putting into deadly
action the eugenics, racism and anti-Semitism conveyed
to them by Kraepelin. It is not our intention to lay the
crimes of National Socialism at the feet of Kraepelin, but
it must be emphasized that it is virtually impossible for
the later German eugenists to pick up Jaspers as an intellectual predecessor and an inspiration for their project.
MiChAEL A. SChWARTz ET AL.
In contradistinction to Kraepelin and the Kraepelinians,
Jaspers was unsparing in his criticism of race theory, which
he understood as a theory of “racial vitality which, ater an
eicient process of artiicial selection has done its work,
will lead to the universalization of a healthy mind and
body so that all will be satisied in a perfected life” (13).
Matthias Bormuth has claimed that, according to Jaspers,
“race theory develops a purely biological philosophy of
history.” his will necessarily lead, in Jaspers’ words, to
“the ruin of human existence” (15). Jaspers’ stance is in
fact the precise opposite of Kraepelin’s support of eugenics,
racism and anti-Semitism. Kurt Salamun has written that
Jaspers’ decisions were, both in his scholarship and in his
life, guided by an “implicit liberal ethos of humanity,” or
“an implicit ethics of virtue” (16).
It should also be noted that Jaspers was married to a
Jewish woman, Gertrude Jaspers, nee Mayer, whom he
loved profoundly. He stayed with her through the entire
Nazi period in Germany despite the eminent danger to
himself as well as to her. Both kept poison on hand in case
they heard the loud knock on the door some night – any
night. Since he was a doctor, Jaspers knew which poisons
were the most eicient, but he nonetheless worried about
his channels for keeping them up to date. It is not the
fact of the potential persecution of Jaspers and his wife
that should partly justify his role of the icon of modern
psychiatry that we advocate, but, among others, his moral
stance and integrity in the face of such persecution.
One of Jaspers’ most prominent students and later close
friend, Hannah Arendt, who was herself Jewish and also
experienced and later famously analyzed the inhumanness
of Nazi and Soviet totalitarianisms, saw in Jaspers the
representation of humanitas in Germany in its darkest
times. his humanitas stemmed not just from Jaspers’
work, but from his person and his deep airmation of
the public realm. Jaspers was for Arendt the true citizen
of the world, and his concept of mankind’s unity based
upon communicative perspectivism was in her opinion
the most appropriate one for our postmodern times (17).
Jaspers himself found the empirical basis for such a unity in
what he called the “axial period,” namely the age between
800 and 200 BC, in which – from China, through India
and Iran, to the West – humankind became conscious
of itself (18). he axial period was supposed to provide
a common framework of mutual understanding for different, oten conlicted nations by pointing towards the
oneness of historical origin of rationality and spirituality
of men. his, in turn, was supposed to help to build peace,
solidarity and unity across human diversity. What a far
cry from biological philosophy of history as implicated in
the ideology of racism. Arendt thus wrote about Jaspers:
“Jaspers’ whole philosophical work (…) was conceived
with the ‘intent toward world citizenship’. If the solidarity
of mankind is to be based on something more solid than
the justiied fear of man’s demonic capabilities, if the new
universal “neighborship” of all countries is to result in
something more promising than a tremendous increase
in mutual hatred and a somewhat universal irritability
of everybody against everybody else, than a process of
mutual understanding and progressing self-clariication on
a gigantic scale must take place. (…). In Jaspers’ opinion
(…) the prerequisite for this mutual understanding would
be the renunciation, not of one’s own tradition and national
past but of the binding authority and universal validity
which tradition and past have always claimed” (17).
Both Arendt and Jaspers argued in favor of a critical
attitude towards the binding authority of the past, including its most prominent historical igures. Rejecting the
authority of tradition as such did not mean renouncing
the past, but critically engaging with its legacy. Acting
against the idea of historical scholarship sine ira et studio,
Arendt warned that ater the horrors of totalitarianisms it is a critical responsibility of historians, as it is of
everybody else, not only to understand and explain the
past but also to judge it, and – if necessary – attempt to
destroy its pernicious aspects (19). he same idea, we
believe, holds true for the iconic igures of our discipline.
Contrary to what Engstrom and Kendler claim (3), we
think that it is absolutely necessary that any discussion
of Kraepelin’s work include those uncomfortable issues
having to do with his engagement in the ideology of
racial hygiene. To focus on just one aspect of the object
of study while neglecting others is appropriate in natural
sciences, but when dealing with signiicant and highly
inluential individuals, it may distort their real image and
impair historical judgment. In other words, we believe in
the moral responsibility of future generations to always
review the complexities of their predecessors’ lives and
choices. And this allows us to see that, in contradistinction to Jaspers, Kraepelin’s views and legacy overshadow
his clinical work. On the other hand, acknowledging our
debt to Jaspers can usher in a psychiatric practice that
is fully scientiic and humanistic – a psychiatry that can
lourish as it serves patients and advances knowledge.
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