History and the nature of diagnosis. The example of schizophrenia and Kraepelin’s recant

Abstract

Objective

To examine psychiatry’s cardinal diagnoses as historical concepts that reflect the time and place of their origins not their factual status. Schizophrenia is the exemplar.

Process

Kraepelin on dementia praecox and Bleuler and Schneider on schizophrenias are examined, including Kraepelin’s late unsuccessful attempt to recant his earlier argument.

Conclusion

Diagnoses start as speculative aggregations of phenomena peculiar to their time and place. They have been reified as timeless, universal disease processes. Kraepelin made a late radical recanting of his concept yet schizophrenia became the symbol of 20^th century psychiatry. Diagnoses like schizophrenia are historical artefacts that deserve their place in psychiatry’s history but do not define present problems. They should have been honoured and superseded.