Descriptive Psychopathology: The Signs and Symptoms of ...

31 Chapter 2: A history of psychiatric classificationrisk, introduced the concept of circular insanity (la folie circulaire) in 1854. JulesBaillarger, in a publication a few months later, used the term folie à double forme.These “rare” conditions were conflated by Kraepelin into his manic-depressiveillness concept. 62 Baillarger also recognized the association between melancholia,stupor and what was to become known as catatonia.Classification of mental disorders, however, remained uncertain and differentsystems were espoused across Europe. Johann Christian Heinroth, a Germanpsychiatrist in the early nineteenth century, considered psychological and theologicalderangements to be fundamental to mental illness. Heinroth was more afundamentalist theologian than an objective clinician. 63 But there was no generalagreement on classification, with different versions (all elaborate) or schoolscentered about a prominent psychopathologist. The humoral theory, Galen’sideas about fever and pulse, and theological considerations continued to shapenosologies.The early “lumpers” and the unitary notion of insanityWilhelm Griesinger was influenced by the neurophysiologist Hermann Helmholtz.He considered psychiatry a natural science, not a philosophical or theologicaldiscipline and rejected Heinroth’s theological notions. He sought unity amongpsychiatric syndromes, viewing then as brain diseases. He wrote: “psychiatryand neurology are not merely two closely related fields; they are but one fieldin which one language is spoken and the same laws rule.” 64 Griesinger’s textbookof psychiatry inspired a generation of German neuro-psychiatrists. 65Griesinger took general paresis as a model of a single disease process expressedas several seemingly distinct syndromes. He applied this idea to the mentaldisorders. This unitary psychosis model (Einheitspsychose) came to dominateclassification. Syndromes were considered stages of a single disease rather thandifferent patterns reflecting different diseases. The sufferer passed throughthe stages of melancholia, mania, and amentia (delirium), ending in dementia.Griesinger and his followers were not perturbed by the awareness that whilesome patients experienced different episode types, others with the same presumedunderlying illness experienced one or only a few types. An influencialcontemporary wrote: “There is but one type of mental disturbance and we callit insanity.” 66Because the major syndromes were thought to reflect the same underlyingprocess, there was less need for classification and greater focus on etiology.The return of the splittersHenry Maudsley, a nineteenth-century British alienist, separated psychiatricsyndromes according to presumed faculties of the mind (emotion and intellect)