Sunday, 22 January 2012 01:15

Emil Kraepelin: Men Of Ideas

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Emil Kraepelin established the basis of modern biological psychiatry; his classifications of psychoses (schizophrenia, delusion, mania and depression) remain intact, today.

EMIL KRAEPELIN

Prior to the nineteenth century many of today's academic disciplines were studied under the rubric of philosophy. The term philosophy was omnibus and stood for knowledge hence even today the terminal degree at Western universities is called doctor of philosophy (doctor of knowledge). In the mid-nineteenth century, psychology, like other disciplines, emerged from philosophy as an independent discipline. Prior to its emergence as an independent discipline psychology was subsumed as that aspect of philosophy that studied human nature.

The word psychology is a compound word combining the Greek words: psyche and logos. Psyche is Greek for Anglo-Saxon mind. Logos is Greek for logic or reason or science. In this sense psychology is the scientific (logical) study of the mind.

What is mind? Mind is metaphoric representation of human tendency to thinking. Thus, psychology is the study of human thinking (and since thinking leads to behavior, the study of human behavior).

Psychology, like philosophy from which it emerged, is an umbrella under which many subjects are studied. There are all kinds of psychologies, including psychology of learning, psychology of teaching, psychology of children or developmental psychology, social psychology, cognitive psychology, experimental psychology, organizational psychology, psychology of business, psychology of diseased minds or psychiatry etc. Psychiatry is the psychological study of disordered thinking.

What is disordered thinking? You first have to ascertain what constitutes ordered thinking before you determine disordered thinking.

What is thinking in the first place? And who does the thinking? We are opening Pandora's Box. Some say that thinking is produced by the specific configuration of atoms in the human brain, that is, thinking is epiphenomenal, is a secondary product of the human body. If thinking is a function of the body it follows that when body dies thinking ceases. Since the self concept, the human personality is a product of thinking if thinking ends with death it follows that the human being ends with the end of his body. This is the position of Huxley's monistic philosophical materialism, the idea that matter determines everything and that man ends with his physical death. This idea seems scientific. Neuroscience is increasingly demonstrating that thinking is a function of the dances of neurons in the brain, neurons themselves following certain biochemical and biophysical determinants (neurotransmitters, ions etc).

Other observers say that man is more than his body. These people, without any shred of empirical evidence, postulate that there is a spiritual element in human beings and that thinking is done by that element. That is to say that an extra material aspect of us thinks through our bodies. Okay. Where is the proof for this hypothesis? As far as science goes there is no proof that there is an aspect of us that transcends our body. Man is part of matter; to understand him you have to study matter, science postulates. In the mid-nineteenth century, a German medical doctor began to study those who society deemed mentally ill. Let it be said that in the past folk simply said that some one was mentally ill and left it at that. Little or no effort was made to understand the nature of mental illness.

The Greeks had a name for mental illness, paranoia. Paranoia means to be besides ones self. To the Greeks a mentally ill person denied his real self and invented a different self and identified with that false self. In effect, the paranoid person is a person who rejected his real self and tries to become a different false self. The paranoid person wears a mask of who he is not.

The term personality is derived from persona, Latin for mask. In other words, the human personality is a mask each of us wears.

Who is hiding behind the mask called human personality? Carl Jung said that a spiritual being covers his true identity with the mask of human personality. Not true, said Emil Kraepelin (1856-1926).

To Kraepelin man is a biological phenomenon; man's thinking is a product of the dynamics of his body. In so far that an individual's thinking is disordered, that person has something wrong with his body (brain).

Kraepelin established the modern psychiatric concept that mental processes, and for our present purposes mental illness is a function of disordered body and not some sort of spiritual issue. This point is very critical for religionists, such as Christians, believe that spirit plays a role in the etiology of mental disorder.

 

Please recall incidents from the Bible where Jesus allegedly healed the mentally ill by casting evil spirits from them. The implication of Jesus doing so is that mental illness is a product of evil spirits. If it is a product of evil spirits it follows that it is to be healed through exorcism. Before Kraepelin and his cohort entered the healing scene folk tried to heal the mentally ill through religious mumbo jumbo. Catholic Priests waved the cross before the mentally ill trying to cast whatever evil spirit supposedly took hold of his mind. Priests did not have much success in healing the mentally ill.

Unfortunately, Sigmund Freud's purely psychological hypothesis of the etiology of mental illness, the idea that mental illness is caused by pure mental (psycho) dynamics took hold in the land and overshadowed Kraepelin's revolutionary idea that mental illness is caused by biological processes. Freud had his day in the sun but by the end of the twentieth century psychiatry re-embraced Kraepelin. Today, most psychiatrists believe that the state of the brain, biology, is etiological in mental disorder. The treatment of the mentally ill is biological, not psychoanalytic razzamatazz.

Kraepelin pointed out that mental illness is not a spiritual matter but a material one. If mental illness is a function of the body then like any other physical illness it has to be healed through medical intervention. Figure out what is wrong with the brain of the mentally ill, give them medications and you heal them. This is what we do today with the mentally ill. Kraepelin is the father of modern psychiatry, the medical study of mental illness.

Kraepelin not only established modern biological psychiatry he also delineated the nature of mental illness. Today's classifications of the various mental disorders (nosology) are pretty much as Kraepelin methodically classified them in 1899. The American Psychiatric Association's Diagnostic and Statistical Manual (and World Health Organization's ICD) grows in size every time it is revised but despite this growth in volume not an iota of improvement has been made in how Kraepelin defined mental illness. That kind of tells you about the man's influence on his field.

Kraepelin observed that there are two types of psychosis. In the one the individual is excited, euphoric, happy, and feels on top of the world and behaves as if he won millions of dollars in the lotto. He talks a mile a minute and generally exhibits grandiosity in his talks. He may be a poor man but talks as if he is the richest man on planet earth. He may claim to be who he is not; usually, he claims to be a famous person. In premorbid state he probably had admired that famous person and wished that he were him. Let us say that a kid with some musical aspirations wished that he were John Lennon of the Beetles. When he becomes psychotic he believes that he is John Lennon! This type of mental disorder is called mania (a component of what is now called bipolar affective disorder). Kraepelin called it manic-depressive illness because the manic phase alternates with a depressive phase where the individual who hitherto felt happy now feels so sad that he wants to kill himself. (Neuroscience believes that manic-depression is biologic in origin. It hypothesis presence of excess norepinephrine in certain neuro-receptors in mania and deficient serotonin in certain receptors in depression; the medications employed in treating these disorders...Lithium, Depakote, Tegretol... reduce norepinephrine in mania and Zoloft, Paxil, Prozac increase serotonin in depression.)

Kraepelin differentiated between mania and schizophrenia. He called schizophrenia Dementia Praecox because he believed that schizophrenia tended to lead to diminution of mental capabilities; he was wrong for there is no evidence of diminished mental capabilities in schizophrenia (there are many world famous mathematicians and physicists who are schizophrenic). A Swiss psychiatrist, Eugene Blueler, corrected Kraepelin's misnomer and renamed the illness schizophrenia.

In schizophrenia there is thought disorder. This means that the person's thinking are disordered. Even if you are not trained in psychology you can pretty much know when some one is exhibiting thought disorder. Such a person's statements lack logical association. In normalcy when people speak A leads to B and B leads to C; there is logical association in what people say. For example, if I said that I was in London, England when I visited Buckingham Palace and saw the Queen of England drive off in a carriage, what I said makes sense to most people. On the other hand, if I said that I am in San Francisco and saw the Queen of England buying fish at "Frisco's Fisherman's Wharf" the likelihood of that been true is remote. There is no common sense to the second statement.

A psychotic says things that to normal persons do not seem logical. Moreover, what he says lack sequentiality in that a statement leads to a related one? He says two completely unrelated things and does not seem to know that he is conjoining unrelated subjects.

Kraepelin established that psychosis is characterized by the presence of thought disorder (inclusive of hallucinations and delusions). This is still the primary definition of psychosis.

In psychosis hallucinations may occur in one or more of the five senses (auditory, visual, olfactory, tactile etc), there may be thought broadcasting (the psychotic believes that other people can read his mind) and thought insertion (he believes that other people can put ideas into his mind), word salad (speaking in volumes but making little sense), confabulation (making up stories and believing them to be true even though they are palpable lies). The psychotic generally has delusions (that is, believes what is not true as true...recall the manic person who thinks that he is John Lennon when, in fact, he is not, or the paranoid- deluded person who believes that other people are out to get him...persecution complex... that he is godlike in his power...grandiosity...that his spouse or girl friend is cheating on him...delusion of jealousy..., or that a famous man is in love with her...erotomania...or that he is sick when there is no medical evidence for it... somatic type).

Schizophrenia has different types, including disorganized type (this is probably your idea of a mentally ill person, the dirty, filthy guy walking the streets talking to himself and eating from garbage cans), paranoid type (the person who believes that the entire world exists to persecute him and is hiding from other people), undifferentiated type (here the symptoms are not clear enough to differentiate between disorganized and paranoid types), the catatonic type (catatonia is also found in other forms of mental illness and no mental illness; for example, a woman whose only son died in an accident may go into catatonic shock and lay on her bed, not moving, in waxy stupor, not talking, not eating, as if she has checked out of the world), residual type (when medications have stabilized the symptoms of schizophrenia but they are still there in mild forms, for example, a paranoid person who thinks that the world is out to get him, if on medications may know that his suspicion is not quiet true but every once in a while lapses into feeling that the world is closing in on him and panics with fear and flees from people so that they do not kill him).

Kraepelin even understood that in some instances the symptoms of schizophrenia and mania coheres in the same person (what is now called schizoaffective disorder).

Today psychiatry has an array of neuroleptic medications (such as Zyprexa, Risperdal, Geodon, Senequam, Clozapam etc) that work on brain dopamine receptors to reduce the level of dopamine in the brain (schizophrenia is hypothesized to be caused by presence of excess dopamine in the brain). Some neuroscientists and geneticists claim to have identified genetic markers for schizophrenia and mania. What is true is that schizophrenia and mania runs in families (if your parents has it you have fifty percent chance of having it).

I have been around many psychotics to suspect that psychosis is caused by genetic factors; I believe that in the future when genetic science is advanced that through genetic engineering technicians would correct identified problematic gene in psychosis. Until then medications seem the best that we can do; medications suppress the symptoms of psychosis but do not heal it. Unfortunately, many psychotropic medications have terrible side effects hence the need for continued research to come up with less debilitating ones.

Now what do you call a man who single handedly defined the parameters of a new field? You call him a giant of a man. Emil Kraepelin established modern biological psychiatry. He is a giant of a man; he deserves to be known by all people.

• I am inclined to cite references but since these reviews are meant for the general public I will desist from doing so. However, since references seem necessary I will cite one or two.

REFERENCE

Burgmair, Wolfgang; Engstrom, Eric J; Weber, Matthias et al eds. Emil Kraepelin, 7 vols. Munich: Belleville, 2008.

 

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Ozodi Osuji Ph.D

Ozodi Thomas Osuji is from Imo State, Nigeria. He obtained his PhD from UCLA. He taught at a couple of Universities and decided to go back to school and study psychology. Thereafter, he worked in the mental health field and was the Executive Director of two mental health agencies. He subsequently left the mental health environment with the goal of being less influenced by others perspectives, so as to be able to think for himself and synthesize Western, Asian and African perspectives on phenomena. Dr Osuji’s goal is to provide us with a unique perspective, one that is not strictly Western or African but a synthesis of both. Dr Osuji teaches, writes and consults on leadership, management, politics, psychology and religions. Dr Osuji is married and has three children; he lives at Anchorage, Alaska, USA.

He can be reached at: ozodiosuji@gmail.com (907) 310-8176