Heckers Stephan, Engstrom Eric J, Kendler Kenneth S
Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of History, Humboldt University, Berlin, Germany.
Mol Psychiatry. 2022 Jan;27(1):328-334. doi: 10.1038/s41380-021-01232-9. Epub 2021 Aug 2.
Emil Kraepelin, more than any other individual, has shaped the nature of our psychiatric diagnostic system. Kraepelin published his final contribution to psychiatric nosology as an essay in 1920, which both modified and explicated the conceptual foundation for this approach to diagnosis. This essay was a response to a new generation of psychiatrists, particularly Karl Jaspers, Karl Birnbaum, and Ernst Kretschmer, who each challenged Kraepelin's view that psychiatric disorders represent natural kinds, (i.e., truly distinct entities). They had argued for a structural analysis of psychosis stressing the impact of unique, personal attributes on the causes and clinical presentations of mental diseases. The authors give this text a close reading and conclude that it offers a final nuanced description of Kraepelin's advanced nosologic views and his emerging interest in life history and culture. Kraepelin held fast to his position that psychiatric disorders represented distinct natural kinds, but acknowledged that the distinctions between them were often obscured by personality, life experiences, and/or cultural effects. Kraepelin used several metaphors to illustrate his final views, that of an "organ register" being the most prominent. Psychiatric disorders, he postulated, belong to three registers, each with its own distinct clinical features and putative brain-based mechanisms. Published a century ago, this final synthesis of Kraepelin's views, a capstone to his career, raises central issues about the nature of psychiatric illness and the appropriate goals for psychiatric nosology. They are fertile issues for psychiatric research and practice today.
埃米尔·克雷佩林比其他任何人都更深刻地塑造了我们精神科诊断系统的本质。1920年，克雷佩林以一篇论文的形式发表了他对精神科疾病分类学的最后贡献，该论文既修正又阐释了这种诊断方法的概念基础。这篇论文是对新一代精神科医生的回应，尤其是卡尔·雅斯贝尔斯、卡尔·比尔纳鲍姆和恩斯特·克雷奇默，他们各自都对克雷佩林认为精神障碍代表自然类别（即真正不同的实体）的观点提出了挑战。他们主张对精神病进行结构分析，强调独特的个人特质对精神疾病病因和临床表现的影响。作者对这段文本进行了仔细研读，并得出结论，它对克雷佩林先进的疾病分类学观点以及他对生活史和文化日益增长的兴趣提供了最后的细致入微的描述。克雷佩林坚持他的立场，即精神障碍代表不同的自然类别，但也承认它们之间的区别常常被个性、生活经历和/或文化影响所掩盖。克雷佩林用了几个隐喻来说明他的最终观点，其中“器官登记簿”的隐喻最为突出。他推测，精神障碍属于三个登记簿，每个登记簿都有其独特的临床特征和假定的基于大脑的机制。这篇发表于一个世纪前的克雷佩林观点的最终综合论述，是他职业生涯的巅峰之作，提出了关于精神疾病本质以及精神科疾病分类学恰当目标的核心问题。这些问题在当今精神科研究和实践中仍然具有丰富的探讨价值。
