Kraepelin

Seen as the ‘father of modern psychiatry’ by many in the mental health field, the German psychiatrist Emil Kraepelin (1856-1926) was the first to produce a comprehensive classification system of mental disease. Between 1883 and 1927, his highly popular Lehrbuch der Psychiatrie (textbook of psychiatry) went through nine editions, in the process isolating distinct forms of psychosis including schizophrenia and manic-depression. Though his somatic approach to mental pathology was eventually succeeded by Sigmund Freud’s psychodynamic theory, Kraepelin’s conceptualization of different mental illnesses as discreet pathological entities has been highly influential on the construction of recent editions of the Diagnostic and Statistical Manual and Mental Disorders (DSM).

Modern psychiatry, as represented by Emil Kraepelin (1856-1926), and phenomenology, as developed by Edmund Husserl, began around the same time, namely, during the last decades of the 19th century. Moreover, psychiatry and phenomenology have always shared a common goal: they have both sought detailed descriptions of human experience. This communality of goals has repeatedly led psychiatrists to turn to phenomenology for aid in explicating mental life. For many psychiatrists it has seemed that phenomenology offered a method that could help them better understand and conceptualize the experiences of their patients. As a result, psychiatrists have utilized various phenomenological approaches just as phenomenologists have explored subjects in psychiatry.

The history of this relationship has remained ambiguous, however. Frequently a gap has yawned between the broad theoretical perspectives adapted from phenomenology and the needs of clinical practice. Furthermore, psychiatrists-who are often trained in the biological and natural sciences-may feel disinclined to delve deeply into explorations of the subjective when these explorations appear to them to remain too abstract or metaphysical. And, returning the compliment, phenomenologists have usually exhibited a profound reluctance to ascribe centrality to biological and naturalistic perspectives. In the post-World War II years, impressive progress in empirical research has provided physicians with powerful means for diagnosis and treatment, for example, with psychopharmacology; because psychiatrists are always pragmatists at heart, these new insights have tended to supplant phenomenological insights.

More recently, the relationship has grown more complicated, and these complexities offer hope of a revitalized cross-fertilization between psychiatry and phenomenology. On the one hand, empirical research in psychiatry continues at an even more rapid pace. On the other hand, many physicians and patients are more aware of the gaps, inadequacies, and even untoward consequences of the one-sidedness of these new developments. This has spurred a turn towards holistic medicine, wellness, and environmental medicine that is more congenial to phenomenological views. Moreover, there is a growing recognition that phenomenological and neurobiological perspectives can no longer oppose one another; when properly conceived, each will strengthen the other. We shall first sketch a brief history of the relationships between phenomenology and psychiatry. Subsequently, we shall delineate possible directions that future inquiry might take.

This article examines Emil Kraepelin's notion of comparative psychiatry and relates it to the clinical research he conducted at psychiatric hospitals in SouthEast Asia (1904) and the USA (1925). It argues that his research fits awkwardly within the common historiographic narratives of colonial psychiatry. It also disputes claims that his work can be interpreted meaningfully as the fons et origio of transcultural psychiatry. Instead, it argues that his comparative psychiatry was part of a larger neo-Lamarckian project of clinical epidemiology and was thus primarily a reflection of his own long-standing diagnostic practices and research agendas. However, the hospitals in Java and America exposed the institutional constraints and limitations of those practices and agendas.

** please note: my research was funded by the ARC in the form of a Future Fellowship at USyd.

This study present a collection of examples of verbatim language in dreams, with analyses of how this is altered relative to waking language. Grammar is well-preserved in these dreams while meaningfulness is distorted relative to waking criteria. Novel nouns receive special emphasis as do extra-vocal cues such as voice tone. Dreams with verbatim language tend to be unusually long, vivid, and emotionally salient, though this may be a byproduct differential dream recall affecting both.  The present findings will be compared to past research data on language in dreams, and discussed in relation to what's known about brain areas involved in dreaming and areas involved in different linguistic processes.

For schizophrenia, as well as for many other disorders, there are many approaches (McHugh and Slavney, 1998).Nowadays, it is referred to as a mental disorder. This understanding of schizophrenia implies the presence of a core set, which includes symptoms and signs that we can diagnose as well as a specific etiology. This is the paradigm of the disease, and when it became clear that schizophrenia cannot fully comply with this paradigm, psychiatric problems began. We are going to briefly illuminate that stage in the history of psychiatry and mention the discussions of experts who have sought to resolve the problem of schizophrenia. The bulk of this essay will be devoted to another approach to schizophrenia - anthropological.

On entend ici réinterroger les spécificités de l'écriture du cas en psychiatrie et en psychanalyse en repartant du grand constat, fait par Freud lui-même, que les « récits de cas » psychanalytiques tenaient plus du « roman » que du « certificat » psychiatrique. Il s'agit de penser cette originalité d'écriture en propre, en ce qu'elle fait cas du sujet, réalisant du même coup le déplacement du centre de gravité en cause dans « l'observation psychiatrique ». Cela permet de dégager a contrario la logique du reproche freudien adressé au regard psychiatrique, régulièrement accusé par Freud d'être frappé d'une sorte d'interdit de voir, dès lors qu'il exclut le conditionnement inconscient du symptôme. Il y aurait là une sorte d'aveuglement médical devant le tableau clinique – la cécité contrastant d'autant avec le voyeurisme animant par définition une clinique du signe. Cela permet finalement d'envisager la posture freudienne devant le tableau clinique, telle que Freud l'a théo-risée au détour de son analyse du « Moïse de Michel-Ange » en convoquant les travaux d'attribution scientifique du célèbre Giovanni Morelli. On souligne alors la portée de l'analogie existant entre cette méthode analytique inédite, et l'attitude proprement psychanalytique devant le tableau clinique. Mots clés Cas ; Kraepelin ; Morelli ; psychiatrie ; sémiologie ; tableau clinique. Summary In this context, we reexamine the specificities of the writing of the case in psychiatry and psychoanalysis , starting from the great observation made by Freud himself that the psychoanalytical « narratives of cases » were more a matter of the « novel » than of the psychiatric « certificate ». It is a matter of thinking about this originality of writing in its own right, in that it makes the case of the subject, thereby realizing the displacement of the center of gravity involved in « psychiatric observation ». This makes it possible to discern a contrario the logic of the Freudian reproach addressed to the psychiatric gaze, regularly accused by Freud of being struck with a sort of forbidden to see, since it excludes the unconscious conditioning of the symptom. There would be a sort of medical blindness in front of the clinical picture – blindness contrasting with voyeurism by definition, a clinic of the sign. This finally allows us to consider the Freudian posture in front of the clinical picture, as Freud has theorized it in the bend of his analysis of the « Moses of

US psychiatric classification arose in the mid 1800’s from a Federal need to collect statistical information about mental disorders. Data, initially collected across mental hospitals, was broadened after WW-II to accommodate outpatient servicemen/veterans. Concurrently, WHO’s 6th Edition of its ICD for the first time included mental disorders, with categories substantially influenced by VA nomenclature. In turn, APsychiatricA in 1952 developed DSM as a variant on ICD-6.  Subsequent revisions were conservative, and DSM-III was to follow ICD-9.

However, far from clinical practice – in courtrooms – a growing US problem called for radical revision.  Primitively conceived psychiatric classification invited trouble. Given “Not guilty by reason of insanity,” the “right diagnosis” could mean the difference between conviction or acquittal. And given Freudian, Jungian, eclectic and biological psychiatrists, the diagnosis often said more about the psychiatrist than the patient. Ennis and Litwack’s 1974 manuscript expresses the dilemma: “Psychiatry and the Presumption of Expertise: Flipping Coins in the Courtroom.”

To resolve this crisis, Hempel’s then preeminent logical empiricist philosophy of science provided an answer, and APA’s DSM-III a methodology for psychiatric classification that persists to today. With valid psychiatric entities “not here yet,” uniform lists of reliable operationalized diagnostic criteria could still delineate reliable disorders.  These entities could be studied and in time achieve validity. Ongoing revolutions in neuroscience and genetics would assure this.

In short – the problem is simple -- reliable entities need never achieve validity. But is there an alternative?

This presentation will argue “yes.” Psychiatric disorders – forms of abnormal psychology -- are real. But the only conceptual coherence is at the methodological level. As complex emergent phenomena, mental disorders can sometimes be typified. And they can be approached variously and in combination as diseases, dimensions, behaviors, life stories, and diversity. The remainder of this presentation will spell out this framework.