Descriptive Psychopathology: The Signs and Symptoms of ...

49 Chapter 2: A history of psychiatric classification61 Esquirol (1838).62 Falret (1854); Baillarger (1853); also see the translated paper by Sedler and Dessain (1983).63 Shorter (1997), pages 31–2.64 Cited by Zilboorg (1967), page 436.65 Shorter (1997), pages 73–6.66 Neumann (1859), page 167.67 Maudsley (1867).68 Pichot (1983), pages 17–20.69 Thompson (1987) essay by E.H. Hare, pages 53–8.70 Lanczik and Keil (1991).71 Ibid.72 Ibid.73 Ibid.74 Kleist (1914).75 Spitzka (1887/1973).76 Kahlbaum (1863).77 Melancholia was placed in this category, but Kahlbaum used the term dysthymia for it.He also introduced the concept of cyclothymia as a low-grade form of manic-depressiveillness.78 Kraepelin (1913, 1971).79 Kahlbaum used the term Spannungsirresein.80 Robins and Guze (1970).81 Kahlbaum (1874/1973); Kahlbaum’s autopsy material indicates a variety of pathophysiologicprocesses consistent with the modern understanding that catatonia is a syndromeelicited by many conditions.82 Hecker (1871); also see Sedler and Schoelly (1985).83 Kraepelin (1971), pages 3–4.84 Kraepelin (1987), page 59; also see Berrios and Hauser (1988) for a discussion ofKraepelin’s early ideas on classification and disease. Kraepelin’s progression in thinking isalso seen in successive iterations of his textbook. The fifth edition (1896) presented theformulation of the two major disease entities defined by course as well as acute presentation.The fully defined manic-depressive insanity appeared in the sixth edition (1899).The ninth edition (1927) was over six times the length of the first.85 Kraepelin (1987); DSM-IV diagnostic criteria for schizophrenia 85 retain the Kraepelinianimprint. Criterion A for schizophrenia requires the presence of 2 or more of 5 features.Delusions (item 1) and disorganized speech (item 3) represent Kraepelin’s understanding ofa defect in thinking. Negative symptoms (item 5) represent the defect in emotion. Catatonicbehavior (item 4) represents the defect in will. Grossly disorganized behavior (part ofitem 4) reflects the socially inappropriate behaviors and inadequate self-care and selfcontrolobserved in many chronically ill psychiatric patients and are also consistent withKraepelin’s understanding of a defect in will. The examples of hallucinations in criterion A(item 2), however, do not readily fit Kraepelin’s algorithm, as neither he nor Bleulerconsidered these phenomena fundamental to the illness, i.e. pathognomonic.