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Physis does not take leaps, neither does Psyche.

Year: 2007
Type: article
Abstract: Emil Kraepelin did not think dichotomously, but his epigones did. Kraepelin (1) tried to classify mental systematically, bringing a more or less unsystematic period to an end. The classification of the so-called endogenous psychoses in two categories, namely dementia praecox (schizophrenia) and manic-depressive insanity (mood disorders), was one of his attempts to systematization. But Kraepelin warned about dichotomous thinking, especially in one of his most important papers, published in 1920: No experienced psychiatrist will deny that there is an large of cases in which, despite the most careful observation, it seems impossible to arrive at a reliable diagnosis. ...We therefore will have to get used to the fact that the symptoms we have used so far are not sufficient to always reliably distinguish between manic- depressive insanity and schizophrenia, but that there are overlaps based on the origin of these symptoms from given preconditions. (2). It is obvious that Kraepelin described rather than straight entities having impermeable borders. He accepted the idea of an overlap of affective and schizophrenic spectra (3) or a continuum (4), just to use the modern nomenclature. According to Kraepelin, the most important parameters for the distinction between and are the course and the outcome. But even the research carried out by himself and his fellows and pupils showed that there is an alarmingly large number (2) of cases having the course and outcome of the opposite group. Moreover, when observing patients with a longterm course of more than one decade, we realize that schizophrenic, manic, melancholic, schizodepressive, and schizomanic episodes as well as any other psychotic episodes can change into one another (5,6). The clinical research of the last 50 years (3) and the genetic research of the last decades (7,8) make obvious that there is no gap between the two prototypes schizophrenia and mood disorders, but bridges and overlaps. Many efforts have been made to identify the overlaps. And so many concepts have been created, like those of schizoaffective (9), bouffee delirante (10), cycloid psychoses (11,12), atypical psychoses (13), reactive psychoses (14), acute and transient psychotic (6), etc. Irrespective of the reliability and validity of such concepts, all of them reflect clinical realities. A great of patients all over the world suffer from these clinical realities, which are so difficult to classify. Exactly these clinical realities oblige us to think undogmatically and pragmatically. That is what Craddock and Owen do in their paper. They consider the clinical, but also scientific, reality and try to eliminate the nosological nuisance. Their conclusion - that we now have a large body of research data which are inconsistent with the dichotomy and powerful tools allowing us to start to develop a biologically valid framework for classification which is likely to offer much improved clinical utility - is basically correct. But we also have to be aware - which is compatible with Craddock and Owen's conclusions, I think - that even the prototypes cannot be defined biologically and genetically as yet. The biological purity of the prototypes schizophrenia and mood disorders is not clear (15), but the limitations of monolithic categories and of current operational categorical approaches to diagnosis, as demonstrated by Craddock and Owen, are quite evident.
Language: English
Field: Medicine
Open Access status: green
OpenAlex ID: W92791933
FWCI: 0.171
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Cited by: 1
Related to: 10