Department of Psychiatry, and Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA, USA.
Psychol Med. 2011 Jun;41(6):1119-26. doi: 10.1017/S0033291710001509.
Emil Kraepelin fundamentally shaped our current psychiatric nosology. Although much has been written about his diagnostic formulations, less is known about his views on the fundamental nature of psychiatric illness and the goals of psychiatric nosology. We focus on his writings from 1896 to 1903 but also review his inaugural lecture in Dorpat in 1887 and his last two papers, published in 1919–1920. Kraepelin hoped for a ‘ natural ’ classification of psychiatric illness but realized that the level of etiologic knowledge required to undergird this effort was not feasible in his own lifetime. This did not stop him, however, from developing a pragmatic approach based on his clinical method of careful description with detailed follow-up, coupled with the available fallible tools of pathological anatomy and, by 1919, genetics and biochemistry. Kraepelin saw psychiatric disorders as multifactorial, arising from the difficult to untangle action and interaction of internal and external causes. He was aware of the problem of defining the boundaries of illness and health but knew this was not unique to psychiatry. Contrary to his stereotype, he was sensitive to the importance of personality factors in psychiatric illness and advocated for their investigation. He also recognized the limitations of his ‘ clinical method' and was especially critical of classifications based on single prominent symptoms. Ultimately, Kraepelin was a skeptical realist when it came to psychiatric nosology. His goal of developing a consistent ‘ natural ’ classification of the major mental disorders has yet to be attained, but his ‘ research agenda' remains central to psychiatry to the present day.
埃米尔·克雷佩林（Emil Kraepelin）从根本上塑造了我们当前的精神病学分类法。尽管已经有很多关于他的诊断公式的论述，但人们对他对精神病本质和精神病学分类学目标的看法知之甚少。我们关注他在 1896 年至 1903 年的著作，但也回顾了他在多尔帕特（Dorpat）的就职演讲以及他在 1919 年至 1920 年发表的最后两篇论文。克雷佩林希望对精神病进行“自然”分类，但他意识到，要支持这种努力所需的病因学知识水平在他有生之年是不可行的。然而，这并没有阻止他根据自己的临床方法，即通过仔细描述并进行详细随访来制定一种实用的方法，再加上可用的易出错的病理解剖学工具，以及到 1919 年的遗传学和生物化学工具。克雷佩林认为精神障碍是多因素的，是由内部和外部原因的难以理清的作用和相互作用引起的。他意识到定义疾病和健康的界限的问题，但他知道这并不是精神病学独有的。与他的刻板印象相反，他对人格因素在精神病中的重要性很敏感，并主张对其进行研究。他还认识到他的“临床方法”的局限性，特别是对基于单个突出症状的分类持批评态度。最终，在精神病学分类学方面，克雷佩林是一个持怀疑态度的现实主义者。他发展一种一致的“自然”分类主要精神障碍的目标尚未实现，但他的“研究议程”至今仍是精神病学的核心。
