Emil Wilhelm Magnus Georg Kraepelin
Biography of Emil Wilhelm Magnus Georg Kraepelin
Emil Wilhelm Magnus Georg Kraepelin was one of the most influential psychiatrists of his time. His classification system for mental illness influenced subsequent classifications, and his distinctions between schizophrenia and manic-depressive psychosis remain valid today.
Kraepelin studied medicine in Würzburg and Leipzig, where he made the personal acquaintance of Wilhelm Max Wundt (1832-1920). Whilst still a student he decided to become a psychiatrist - Irrenarzt – and was awarded a prize for a work on psychiatry from the University of Würzburg, where he was called upon as assistant to Franz von Rinecker (1811-1883) at the age of 21 years.
After passing the Examina at the University of Würzburg in 1878 he succeeded Aguste-Henri Forel (1848-1931) as assistant to Johann Bernhard Aloys von Gudden (1824-1886) in the Oberbayerische Kreisirrenanstalt in Munich, and worked there for four years. Here he used Wundt’s experimental techniques to study the effects of drugs, alcohol, and fatigue on psychological function, and in 1881 published a study of the influence of infectious diseases on the onset of mental illness.
In 1882 he moved to the newly opened clinic in Leipzig, headed by Paul Emil Flechsig (1847-1929). At the same time he began experimental work in Wundt’s laboratory. This angered Flechsig to such a degree that he was thrown out of Flechsig’s clinic. He was admitted to the Policlinic headed by Wilhelm Erb (1840-1921), however, and thus was able to be habilitated as a Dozent, receiving the venia legendi, in 1883.
In 1883 Kraepelin wrote his Compendium der Psychiatrie in order to improve his financial condition. In this work he first presented his nosology, or classification of disorders. Kraepelin divided mental illnesses into exogenous disorders, which he felt were caused by external conditions and were treatable, and endogenous disorders, which had such biological causes as organic brain damage, metabolic dysfunctions, or hereditary factors, and were thus regarded as incurable.
As Wundt advised him against committing himself fully to psychology, he returned to Gudden, who gave him a position as an assistant in the München Kreisirrenanstalt. In order to be able to marry his seven years older fiancée, Ina Schwabe, with whom he had been engaged since he was fifteen, Kraepelin accepted a position as physician-in-chief at the Irrenanstalt Leubus. This institution is housed in a celebrated ancient Cistercian abbey, situated on the Oder, northwest of Breslau, in the Prussian Province of Silesia. It is still used as a lunatic asylum. The couple had four daughters.
After marrying, in 1885 Kraepelin changed this for a position with the Heil- und Pflegeanstalt in Dresden, and the following year was appointed professor of psychiatry at the University of Dorpat, now Tartu, Estonia, succeeding Hermann Emminghaus (1845-1904). In 1891 he came to the Grossherzoglich Badische Universitäts-Irrenklinik in Heidelberg, succeeding Carl Fürstner (1848-1906), who went as ordinarius to Strassburg. In Heidelberg he established a physiological laboratory in order to attract students to scientific work, and from July 6 was supported in this work by the new assistant physician, Gustav Aschaffenburg (1866-). He collaborated with Franz Nissl (1860-1919) and from 1902 with Alois Alzheimer (1864-1915).
Alzheimer moved with him when Kraepelin in 1904 became professor of clinical psychiatry and head of the psychiatric clinic at the Ludwig-Maximilians-Universität München, succeeding Anton Bumm (1849-1903).
Kraepelin remained in Munich until his retirement in 1922, when he became director of the Deutsche Forschungsanstalt für Psychiatrie, which he had founded in Munich in 1917. He made Munich a world centre of psychiatric research.
Kraepelin went travelling as far as India, Java, the United States of America and Mexico, in order to work in comparative psychiatry. He was planning a sustained journey to Ceylon and India with his pupil Johannes Lange (1891-1938) when he died in 1926. In a letter to his brother Karl, dated January 27, 1905, he wrote: “At the present time I have only one main goal in sight, to make so much money that I will have no problem travelling wherever I want.”
Initially Krapelin was reluctant to undertake histological studies in psychoses, but the studies of Oskar Vogt (1870-1959) and Korbinian Brodmann (1868-1918) on cortical structure and function convinced him to commence in 1905. In 1911 he attached the eponym Alzheimer’s disease to pre-senile dementia. Among his outstanding students were Alfons Maria Jakob (1884-1931), Hugo Spatz (1888-1969) and Robert Bérány (1876-1936).
All through his career Kraepelin continued to refine his classification. In the sixth edition (1899) he first made the distinction between manic-depressive psychosis and dementia praecox, now called schizophrenia. Dementia praecox was Kraepelin’s Latin translation (1896) of the Belgian psychiatrist Francois Morel’s earlier term (1857) demence precoce, “early deterioration of the mind.” He believed that manic-depressive disorders and melancholia (depression) were exogenous and thus treatable, while dementia praecox fell among the endogenous, incurable illnesses, as he believed it to be caused by organic changes in the brain.
Kraepelin also distinguished at least three clinical varieties of dementia praecox: catatonia, in which motor activities are disrupted either excessively active or inhibited; hebephrenia, characterized by inappropriate emotional reactions and behaviour; and paranoia, characterized by delusions of grandeur and persecution.
The concepts embodied in Kraepelin’s classification system did not originate with him, but he was the first to synthesize them into a workable model that could be used to diagnose and treat mental patients. Throughout his career he continued to refine his classification, and was working on the ninth edition of his Psychiatrie: Ein Lehrbuch fur Studierende und Ärtze, now grown into several volumes, when he died.
Kraepelin was a fierce campaigner against smoking and alcohol and investigated the psychiatric effects of alcohol. He published 19 works on the topic. In the psychiatric clinic in Munich alcohol was banned. Instead the patients were offered a lemonade, the so-called Kraepelinsekt. He advocated the establishment of curative institutions for alcoholics, which was not supported by Innenministerium.
The principles of the Kraepelin system are still important to the classification of mental illnesses. After a period with dwindling interest in psychiatric diagnostics, particularly in the U.S., the systematics again has come into focus through a new American system of diagnosis, DSM-III. This has been called a form of neo-Kraepelianism.
Kraepelin had a ten year older brother, Karl (born 1847) with whom he was very close. Karl became a renowned professor of botany.
Outside psychiatry Kraepelin's interests were in the beautiful arts, such as music, theatre, and painting, although he was never a very social person and in his later years had ever less time to devote to these interests. In his leisure time he wrote romantic poetry, many of them mirroring his impressions from travels.
Sacht schweben schon herbei der Dämmerung Schatten;
In dunkles Grau versinkt den Tag.
Ein leises Frösteln lässt das Herz ermatten;
Zum Feierabend ruft der Glocke Schlag.
Schwarz zeichnet sich am silbern dunstgen Himmel
Entlaubter Bäume zackiges Geäst;
Ganz nahe braust der Riesenstadt Getümmel,
Und Lichter flammen strahlend wie zum Fest.
Wie Heimatsehnsucht regt es sich im Herzen;
Ein gastlich Dach zu finden ist mein Ziel !
Froh möcht ich heute mit den Frohen scherzen –
Und schon umfängt mich lärmend das Gewühl.
Ei Donner ist’s, ein Rasseln, Tosen, Schreien;
Fremd stürmt’s und kalt gegen meinem Schritt.
Rings starren feindlich grelle Fensterreihen –
Die Flut umbrandet, packt mich, reisst mich mit !
Als lenkte fremder Wille meiner Glieder,
Als schwände langsam um mich Raum und Zeit –
So senkt mit schwerem Fittich sich hernieder
Auf mich die grauenvolle Einsamkeit.