Kraepelin, Emil
Surname:
Kraepelin
First name:
Emil
Era:
19th century
20th century
Field of expertise:
Neurology
Psychiatry
Psychology
Place of birth:
Neustrelitz (DEU)
* 15.02.1856
† 07.10.1926
Biography print

German psychiatrist, pioneer of 20th century somatic psychiatry.

 

Emil Kraepelin (1856-1926) was born on 15 February 1856 in Neustrelitz in the Duchy of Mecklenburg-Strelitz, Germany. His father, an actor, opera singer and music teacher, frequently travelled for business and was said to have had a drinking problem. The parents separated around 1870, and Kraepelin remained with his mother. Throughout his life, he kept close contact with his older brother, Karl, who later became a professor of botany. Kraepelin began his medical studies in 1874. After one year at Leipzig University, he transferred to Würzburg but returned to Leipzig in the spring of 1877 to study under Wilhelm Wundt, who had in the meantime become a professor there (Steinberg 2001: 79). Only shortly thereafter, Franz von Rinecker offered him an assistant position at the mental department of Würzburg’s Juliusspital. Kraepelin, still a student at that time, accepted and returned to Würzburg in July of 1877. He completed his studies there and received his doctoral degree in 1878.

 

Clinical experience

By around 1880, psychiatry had been fully established as a clinical and science-based discipline. The institutional infrastructure was further expanded and, at the same time, a critical and liberal patients’ movement emerged. However, one fundamental theoretical problem still remained to be solved, as Kraepelin himself repeatedly pointed out: how to explain the so-called “functional” disorders that could not be explained by organic illness? Apart from the “unitary” concept of psychosis (Zeller, Griesinger), attributing a broad variety of symptoms to a single underlying disease process, there were explanations drawing on research in brain pathology (Meynert, Wernicke) and the theory of hereditary degeneracy (Morel, Magnan). In 1878, the newly graduated Emil Kraepelin became a ward physician at the Upper Bavarian district asylum in Munich, then directed by Bernhard van Gudden, where he was colleagues with the psychiatrist, writer and later patient Oskar Panizza (cf. Müller 2000). While van Gudden advocated research in brain pathology, Kraepelin rather saw himself as “a psychiatrist with a penchant for psychology” (1983: 82). In 1882, Wilhelm Wundt suggested that he return to Leipzig to work at the University Clinic under Paul Flechsig and in Wundt’s own laboratory. Kraepelin accepted this invitation. Flechsig, however, was highly dissatisfied with his performance and sacked him after only four months, accusing him of neglecting both patients and hygiene (Steinberg 2001: 106 ff.). He gained the formal qualification for professorship (habilitation) and shortly thereafter published his first book, Compendium der Psychiatrie (1883), from which, over the next thirty years, he developed the multi-volume textbook Lehrbuch für Studirende und Aerzte as an authoritative standard reference work. In 1884, he became a senior physician in Leubus, Silesia. This new position finally enabled him to marry his longstanding partner Ina Schwabe, who was seven years his senior. The couple had eight children, four of which died during infancy. His daughter Ina later worked as a physician at her father’s clinic in Munich. In 1885, Kraepelin was appointed director of the mental ward at Dresden municipal hospital.

 

Academic career

In 1886, Kraepelin was named professor of psychiatry at the Imperial Russian University of Dorpat – a German-language university in what is today Tarku, Estonia – where he not only continued his work in experimental psychology but also developed a programme for clinical research. Four years later, in the spring of 1891, he was appointed professor and head of department at Heidelberg University, where he restructured the psychiatric clinic and, together with collaborators such as Gustav Aschaffenburg, Alois Alzheimer, Robert Gaupp and Franz Nissl, set up a psychological laboratory and monitoring rooms for clinical research. He rejected both the unitary concept of psychosis and the sole reference to brain pathologies but still assumed a set of somatically based “disease entities” on the basis of which he sought to develop a theoretically sound new “morphology of disease”. To determine prognoses, and thus substantiate diagnoses, he studied thousands of clinical histories using “counting cards” to compare courses and outcomes (Kraepelin 1897: 842 f.). According to Roelcke (2013: 116; 2003), the data collection was strictly based on the principles of empirical lab science and, consequently, excluded subjective information and psycho-social data. Kraepelin assumed the position of a neutral positivist observer. In demonstrations for his students, he would sometimes prick patients with a needle to test their reactions (1916: 112). Although he claimed that in the course of “psychic treatment”, the physician [or: psychiatrist] should become the patient’s “guide and friend”(1899, I: 323), the concept of comprehension – as developed by Freud, Jaspers or Weber – always remained foreign to him. In 1903, Kraepelin accepted a post as professor of clinical psychiatry at the University of Munich, where he saw greater potential for establishing larger treatment facilities. In the same year, he and his brother Karl travelled to Java (1904a); he was the first to realise the better prognosis for schizophrenia (which he referred to as “dementia praecox”) in the non-industrialised world. He also addressed forensic issues, advocated on behalf of the temperance movement and supported establishing detoxicification facilities.

 

Outside of his work, Kraepelin was interested in botany and literature, he wrote poems (1928) and would frequently spend part of the year at Lake Maggiore, where he had a large garden and a library at his disposal. In 1912, he began developing plans for a major research institute. Following donations from bankers and industrialists (Engstrom 2010), the German Institute for Psychiatric Research was founded in 1917 in Munich. Initially associated with the university clinic, it became affiliated with the Kaiser Wilhelm Society for the Advancement of Science in 1924 (today: Max Planck Institute of Psychiatry). Kraepelin became emeritus in 1922. He died from influenza-induced pneumonia in Munich in 1926 at the age of 71.

 

Classification and systematics

Emil Kraepelin ist most credited for restructuring the psychiatric classification systems. Differentiating between psychotic disorders with “endogenous” (non-somatic) and “exogenous” (organic or somatic) causes had already been proposed around 1890 by Paul Möbius. In the sixth edition of his textbook Lehrbuch für Studirende und Aerzte, issued in 1899, Kraepelin also included “psychogenic” disorders, and in a lecture given the same year, he first presented his concept of “dementia praecox” (juvenile or early onset dementia). This term intended to capture chronic courses of illness coinciding with a premature loss of cognitive abilities and distortions of perception, thought, attention and intention (Berrios, Luque & Villagrán 2003). The term “group of schizophrenias”, coined by Eugen Bleuler in 1911, referred to the same kind of disorders (Bernet 2013). In 1899, Kraepelin also introduced the model of “manic depressive” disorders with a favourable prognosis. He also limited the category of “paranoia”, formerly comprising over half of the [psychiatric] patients, down to 3-4 percent (1904, Vol. II: 595 f.). These differentiations are considered groundbreaking in terms of nosology – above all the categorical distinction he made between, in today’s terminology, “schizophrenic” and “bipolar” disorders. In the eighth edition of his textbook (1913, Vol. III: 667 ff.), he grouped “dementia praecox” under “endogenous dementia”, together with “paranoid” disorders and psychotic “paraphrenia”. He thus proposed a classification into five main categories, substantiated with respect to both etiology and prognosis (1916: 298 ff.):

 

    “psychosis due to external physical damage” (e.g., brain injuries, intoxication),

    “psychosis due to internal disease processes” (e.g.. senility, epilepsy, dementia praecox, paraphrenia),

    “psychogenic disorder” (e.g., traumatic neurosis, nervous exhaustion, querulous paranoia),

    “constitutional mental disorder” (e.g., manic depressive disorder, paranoia, hysteria, obsessive-compulsive neurosis),

    “congenital medical condition” (nervousness, psychopathy, oligophrenia).

 

The main features of this categorisation are still reflected in the syndrome-based axis of today’s most significant international classification systems (ICD-10; DSM-5).

 

Science and politics

Kraepelin held explicitly ethno-nationalist (so-called “völkisch”) views, as Kurt Kolle already pointed out in his biographical outline (1956: 177). Michael Sheperd (1995) spoke of Kraepelin’s “two faces” as a scientist and a political reactionary. According to Weber, Burgmaier and Engstrom, his “concern for the ‘mental hygiene’ of the German people also shaped his scientific work” (2006: A 2690; our translation). Initially most likely a follower of Bismarck, he may have leaned towards social democracy during his Leipzig time (Steinberg 2001:19). After the year 1900, Kraepelin increasingly addressed the issue of population policy. Just like Morel before him, he claimed that psychiatric institutions should serve eugenic purposes in preventing “numerous diseased persons from reproducing their worrying properties”, as stated in a lecture on the psychiatric tasks of the state (Die psychiatrischen Aufgaben des Staates, 1900: 17, our translation). In the 1909 edition of his textbook, he warned against a “serious threat to our race” due to the “struggle for existence” in the urbanised industrial society with its “potential impact on the human breed” “if the unquestionable effects of these conditions are reflected in the hereditary properties of large sections of the population” (1909: 198 ff., our translation; cf. Hoff 2008). These statements notwithstanding, Kraepelin took a rather moderate stance on eugenic issues in his scientific writings (compared to, e.g. Auguste Forel).

 

Kraepelin’s political views became more radical during WWI, probably in reaction to the enormous losses of German soldiers and the resulting “völkisch” fears. In 1916, he joined the “Volksausschuß für die rasche Niederkämpfung Englands”, a group that agitated for unrestricted submarine warfare against Britain and largely consisted of ultra-nationalist Pan-Germans. In 1917, he endorsed the call for establishing a Bavarian branch of the far-right German Fatherland Party (Deutsche Vaterlandspartei, DVLP) and also served on the party’s executive committee (Hardy 2013; Engstrom, Burgmair, Weber 2006; Engstrom 1991). The DVLP called for ousting the then Chancellor, Theobald von Bethmann-Hollweg, and strongly pushed for a “Siegfrieden” (“victorious peace”) including large-scale territorial annexations. Kraepelin deemed these political objectives not to go far enough (1983: 192 f.). When the DVLP dissolved in late 1918, he withdrew from politics in disappointment (it should, however, be noted that some of the party’s members later became opponents of National Socialism, like, for example, the prominent journalist Fritz Gerlich).

 

In 1919, his clinic was in charge of assessing the mental state of several of the detained leaders of the Bavarian Soviet Republic. One of them, the writer Ernst Toller, had already been examined by Kraepelin when in custody for his part in the January strikes of 1918; Kraepelin had declared him a “psychopath” but criminally responsible for his actions (cf. Toller 1933: 133 f.; Burgmair, Engstrom, Weber 2009: 174 ff.). In 1919, Toller was assessed by Kraepelin’s protégé Ernst Rüdin, later one of the fathers of Nazi racial hygiene policies. Rüdin had joined the clinic in 1907 and become head of department at the Research Institute in 1918.

 

Reception

Kraepelin’s classification system and his nosological distinction between schizophrenia and bipolar disorders, in particular, became widely accepted in the 1920s. However, the model also attracted criticism. Some, like Jaspers or Freud, took a fundamentally different stance while others disagreed with more specific aspects. Two worth noting are Alfred Hoche, who rejected the construction of “disease entities” in favour of a syndrome-based nosology, and Oswald Bumke, Kraepelin’s successor at Munich University, who argued against the degeneration theory as early as 1912. The search for empirical evidence for “natural disease units”, as initiated by Kraepelin, has remained a key concept in somatic psychiatry, whereas other schools of thought conceptualise mental disorders also from a psycho-social angle. The latter holds not only for psychoanalysis and anthropological psychiatry but also for models rooted in social medicine, sociology, social epidemiology and family theory, which started emerging in the 1950s. Others sought to combine somatic and psychological approaches, such as Adolf Meyer with his “biopsychological” model or Kurt Schneider – initially a follower of Jaspers – who claimed that “endogenous psychoses” have somatic causes.

 

Kraepelin’s influence seems to have lessened during the 1960s. However, the 1970s saw a “neo-Kraepelinian turn” in American psychiatry, the proponents of which sought to revive his key ideas (Klerman 1978; cf. Jablensky 2007; Decker 2007). Today, Kraepelin is considered the most important pioneer of scientific, nomothetic and medically oriented clinical psychiatry in the 20th century. A critical edition of his complete writings has recently been prepared at the Munich-based Max Planck Institute of Psychiatry (Burgmair, Engstrom & Weber 2000-2013; Engstrom, Burgmair & Weber 2017).

 

Literature

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Bernet, B. (2013): Schizophrenie. Entstehung und Entwicklung eines psychiatrischen Krankheitsbilds um 1900. Zurich: Chronos.

Berrios, G. E., R. Luque, J. Villagrán (2003): Schizophrenia: A Conceptual History. In: International Journal of Psychology and Psychological Therapy 3, (2), S. 111-140.

Bumke, O. (1912): Über nervöse Entartung. Berlin: Springer.

Burgmair, W., E. J. Engstrom, M. Weber (eds.) (2000): Emil Kraepelin. Persönliches, Selbstzeugnisse. Munich: Belleville.

Burgmair, W., E. J. Engstrom, M. Weber (eds.) (2001): Emil Kraepelin. Kriminologische und forensische Schriften. Werke und Briefe. Munich: Belleville.

Burgmair, W., E. J. Engstrom, M. Weber (eds.) (2002): Emil Kraepelin. Briefe I, 1868-1886. Munich: Belleville.

Burgmair, W., E. J. Engstrom, M. Weber (eds.) (2003): Emil Kraepelin. Kraepelin in Dorpat. 1886-1891. Munich: Belleville.

Burgmair, W., E. J. Engstrom, M. Weber (eds.) (2005): Emil Kraepelin. Kraepelin in Heidelberg. 1891-1903. Munich: Belleville.

Burgmair, W., E. J. Engstrom, M. Weber (eds.) (2006): Emil Kraepelin. Kraepelin in München. Teil I. 1903-1914. Munich: Belleville.

Burgmair, W., E. J. Engstrom, M. Weber (eds.) (2009): Emil Kraepelin. Kraepelin in München. Teil II. 1914-1921. Munich: Belleville.

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Engstrom, E. J. (2007): Classic Text No. 71, ‘On the Question of Degeneration’ by Emil Kraepelin (1908). In:History of Psychiatry, 18, (3), pp. 389-404.

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Müller, J. L. (2000): Dr. med. Oskar Panizza: Psychiatrist - antipsychiatrist - patient. The man behind Emil Kraepelin’s case report on ‘paraphrenias’. In: International Journal of Psychiatry in Clinical Practice 4, pp. 335-338.

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Roelcke, V. (2003): Unterwegs zur Psychiatrie als Wissenschaft: Das Projekt einer “Irrenstatistik” und Emil Kraepelins Neuformulierung der psychiatrischen Klassifikation. In: E. J. Engstrom und V. Roelcke (eds.): Psychiatrie im 19. Jahrhundert. Basel: Schwabe, pp. 169-188.

Shepherd, M. (1995): Two Faces of Emil Kraepelin. In: British Journal of Psychiatry 167, (2), pp. 174-183.

Steinberg, H. (2001): Kraepelin in Leipzig. Eine Begegnung von Psychiatrie und Psychologie. Bonn: Psychiatrie-Verlag.

Weber, M. M. (2006): Feindliche Brüder im Geist der Wissenschaft? Zum 150. Geburtstag von Emil Kraepelin und Sigmund Freud. In: Psychotherapie in Psychiatrie, Psychotherapeutischer Medizin und Klinischer Psychologie 11, (2), pp. 142-150.

Wübben, Y. (2009): Ordnen und Erzählen. Emil Kraepelins Beispielgeschichten. In: Zeitschrift für Germanistik. Neue Folge 19, (2), S. 381-395.

Toller, E. (1933): Eine Jugend in Deutschland. Stuttgart: Reclam 2013.

 

Burkhart Brückner, Julian Schwarz

 

Photo: unknown (Munchener Medizinische Wochenschrift (1926) [1])/ Source: Wikimedia / Licence:CC-BY-SA 4.0

 

Referencing format
Burkhart Brückner, Julian Schwarz (2015): Kraepelin, Emil.
In: Biographisches Archiv der Psychiatrie.
URL: biapsy.de/index.php/en/9-biographien-a-z/91-kraepelin-emil-wilhelm-georg-magnus-e
(retrieved on:19.10.2018)