Unitary psychosis
Encyclopedia
Unitary psychosis refers to the 19th-century belief prevalent in German psychiatry
until the era of Emil Kraepelin
that all forms of psychosis
were surface variations of a single underlying disease process. According to this model, there were no distinct disease entities in psychiatry but only varieties of a single universal madness and the boundaries between these variants were fluid. The prevalence of the concept in Germany during the mid-19th century can be understood in terms of a general resistance to Cartesian dualism and faculty psychology
as expressed in Naturphilosophie
and other Romantic
doctrines that emphasised the unity of body, mind and spirit.
is ultimately derived from the work of the Belgian psychiatrist Joseph Guislain
(1797–1860). In 1833 he published Traité Des Phrénopathies ou Doctrine Nouvelle des Maladies Mentales in which he proposed a complex system of psychiatric classification
encompassing almost a hundred different mental states. He conceptualised this mosaic of symptoms as arising from any of four consecutive stages in mental disease. These were: "(1) exaltation of the brain's activity, (2) aberration of the brain's structures, (3) oppression of the brain's structures, and (4) exhaustion of psychic energy." For Guislain, what he termed phrénalgie, or mental pain, formed the basis of all mental illness where the "psychic reaction" engendered by "worry, annoyance, pain" or other mental "irritants" brought "physical reactions along with it." Mental illness would then unfold along seven successive stages of progressive deterioration, which he detailed as: hyperphrénie (mania
); paraphrénie
(folie); hyperplexie (stupidity); hyperspasmie (epilepsy
); ideosynchysie (hallucinations); analcouthie (confusion
); and noasthénie (dementia
).
or character
and that man was at once composed of both material and spiritual elements. Deriving this belief in part from Naturphilosophie and the influence of anthropology
on German psychiatric concepts, he held that it was this fundamental spiritual
self that was afflicted in madness. For Zeller, both organic and moral (or psychological) causes
combined to produce mental illness. The organic causes of mental illness were, he argued, observable in the physical illnesses that preceded its onset. He reasoned, however, that "cases are rare in which the mental disorder is caused by purely organic problems of the central nervous system". Instead, he held that the psychological pain occasioned by remorse, guilt, poverty and social reversal was the universal causal factor in all forms of mental morbidity. Somatic
and moral factors and the pain attendant on the latter combined variously to produce the four stages of a universal disease: melancholia (the fundamental form of mental disorder which led to the other stages), mania, paranoia and, finally, dementia.
(1817–1868) worked as a medical assistant to Zeller at the Winnental Asylum. While there, he adopted and adapted his senior colleague's model of a unitary psychosis. He did not, however, shares Zeller's conviction regarding the nature of the human soul
or character and its role in madness. A convinced somaticist and commonly considered one of the founders of materialist psychiatry, in the 1845 text which established him as one of the leading scientific psychiatrists of his era, Pathologie and Therapie der psychischen Krankheiten, he conceived of character, or "psychological tonus", as derived from the action of a postulated "psychic reflex action" (psychische Reflexaktion) produced by the stimulus
of the accumulated representations (Vorstellungen) of the individual's life experience. The concept of psychic reflex action was drawn by analogy from the physiological reflex action of the nervous system in response to a stimulus and he argued that both forms of reflex had the same mode of action and obeyed the same physical laws. Mental illnesses occurred, he posited, when the system of psychic reflex action failed to function correctly and were either diminished, leading to melancholia, or accelerated, leading to mania. His belief was that mental illness was a disease of the brain
but that this in turn was caused by psychological
factors. His emphasis on the brain as the central site of mental illness has led to his association with the so-called Somatiker (somaticists) who had argued that the causes of mental illness were entirely physical whereas their opponents, the Psychiker, insisted that mental disorders were the result of psychological perversions, moral failings, or diseases of the soul (Seelenkrankheit). As with Zeller, he postulated that melancholia
constituted the primary form of mental illness which then passed to mania before terminating in dementia. In his 1861 text Mental Pathology and Therapeutics Griesinger proposed a classificatory division of types of mental anomalies between those characterised by emotional
disturbances and those characterised by disturbances in the intellectual and volitional
functions. He argued, based on his observation of cases, that the former condition preceded the latter where disorders of the intellect and will appeared "only as consequences and terminations" of disturbances of the emotions if "the cerebral affliction has not been cured". These two categories thus constituted, for Griesigner, "the different forms [and] the different stages of one morbid process". The general trajectory of this mental pathology tended towards "a constant progressive course, which may even proceed to complete destruction of the mental life". Greisinger maintained his belief in unitary psychosis until the 1860s.
Heinrich Neumann (1814–88). Switching from general medicine to psychiatry in the 1850s, he became the owner of a private psychiatric clinic and from 1874 to 1884 he attained the post of medical director at a university-based clinical ward in the Breslau city hospital (now Wroclaw
in Poland
). He was succeeded by his former medical assistant, Carl Wernicke, a noted neuropsychiatrist. In his Lehrbuch der Psychiatrie (Textbook of Psychiatry) of 1859 he rejected any attempt at psychiatric classification as "artificial". He asserted that, "There is only one type of mental disorder. We call it madness (Irresein). Insanity does not possess different forms but different stages; they are called insanity (Wahnsinn), confusion (Verwirrheit), and dementia (Blödsinn)." Neumann exceeded the position of previous adherents of the unitarian concept by propounding not simply a continuum among diseases but also between disease and health. Thus, he argued that, "sleeplessness, illusions, exaggerated sensitivity ... cause illness, then madness, confusion, and dementia". The proposed mechanism underlying this process was what Neumann termed "metamorphosis" which referred to a disturbance in consciousness
that led to errors in the interpretation of sensations. For Neumann an overabundance of stimulation produced mental irritation and mania. As this depleted mental energy it could then result in hallucinations. The medical historian Eric Engstrom has argued that Neumann's proposal to subsume the entire range of diverse psychiatric symptomatology into the concept of Einheitspsychose had the virtue of flexibility in its capacity to absorb any system of psychiatric classification. Engstom has also noted that the concept supported calls for the early committal to asylums of all potential patients as it did not link the likelihood of remission to disease classification but rather argued for early intervention to prevent the onset of chronic mental disability. Its wider support among asylum-based alienists
(as medical practitioners in mental hospitals were then known) as opposed to academic psychiatrists was due to the fact that it was more applicable to the unhurried tempo of asylum routine where, unlike in university clinics, there was no perceived need for rapid diagnosis
. Equally, medical formation in the asylum setting was focused on protracted clinical observation rather than the formal pedagogy of a standardised university curriculum.
(1829–1899), a German psychiatrist of seminal importance in the development of the modern nosology and a formative influence on the work of Emil Kraepelin
, had taken issue with Neumann's assertion in his 1859 text that mental illness could not be categorised into discrete disease entities. Kahlbaum fashioned a response in 1863 with the publication of his Die Gruppierung der psychischen Krankheiten (The Classification of Psychiatric Diseases). This text delineated four distinct types of mental illness (vesania): vesania acuta, vesania typica, vesania progressiva and vesania catatonica. He asserted that the unitarian position signalled the "end to all diagnosis in the field of psychopathology." For Kahlbaum, Neumann's failure to engage in any attempt at disease classification, his rejection of diagnosis as abstraction and his focus only upon the individual manifestation of mental illness constituted an enterprise without any scientific validity. In the absence of meaningful and acute diagnostic categories in psychiatry Kahlbaum believed that both the development of effective therapeutic practices and the knowledge of mental illness would run stagnant.
as a distinct disease entity in the 1870s. Kraepelin's approach to classification of mental illness was based on longitudinal studies of symptoms, course and outcome. He concluded from his studies that there were only two major forms of serious mental illness: dementia praecox
and manic depression
. This division of the psychoses, currently enshrined in modern classification systems as that between schizophrenia
and bipolar disorder
and referred to as the Kraepelinian dichotomy
, has remained in place for more than a hundred years.
, which straddles the Kraepelinian divide, when delineated as a condition sharing a common causal pathway as both schizophrenia and affective psychosis, shares aspects of the more radical notion of unitary psychosis in regarding the individual psychoses as points on a continuum.
psychosis based partly upon his observation that cyclothymic
patients, or those suffering from affective psychosis
, often sired schizophrenic children. He also held the belief, derived from his clinical experience, that symptoms associated with particular diagnostic categories were fluid and that a patient could, for instance, exhibit signs of mania or depression which might then reappear periodically and subsequently develop delusions and undergo a deterioration in personality. Likewise, symptoms thought to be characteristic of schizophrenia, such as delusions, hallucinations and catatonia
, were, he alleged, also found in depression and mania. Conrad also contested the then established classificatory division between the endogenous
and exogenous
psychoses or, respectively, psychoses of internal or external origin, as whether the disease causing agent was "physical exhaustion or heightened emotion" it "attacked the same structure, physiological mechanism, biological metabolism". Conrad, a proponent of Gestalt psychology
, is typically characterised as having expounded a view of psychosis that is commensurate with the mid-19th century psychiatric concept of unitary psychosis.
Psychiatry
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...
until the era of Emil Kraepelin
Emil Kraepelin
Emil Kraepelin was a German psychiatrist. H.J. Eysenck's Encyclopedia of Psychology identifies him as the founder of modern scientific psychiatry, as well as of psychopharmacology and psychiatric genetics. Kraepelin believed the chief origin of psychiatric disease to be biological and genetic...
that all forms of psychosis
Psychosis
Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...
were surface variations of a single underlying disease process. According to this model, there were no distinct disease entities in psychiatry but only varieties of a single universal madness and the boundaries between these variants were fluid. The prevalence of the concept in Germany during the mid-19th century can be understood in terms of a general resistance to Cartesian dualism and faculty psychology
Faculty psychology
Faculty psychology views the mind as a collection of separate modules or faculties assigned to various mental tasks. The view is explicit in the psychological writings of the medieval scholastic Theologians, such as Thomas Aquinas....
as expressed in Naturphilosophie
Naturphilosophie
Naturphilosophie is a term used in English-language philosophy to identify a current in the philosophical tradition of German idealism, as applied to the study of Nature in the earlier 19th century...
and other Romantic
Romanticism
Romanticism was an artistic, literary and intellectual movement that originated in the second half of the 18th century in Europe, and gained strength in reaction to the Industrial Revolution...
doctrines that emphasised the unity of body, mind and spirit.
Joseph Guislain
The concept of unitary psychosisPsychosis
Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...
is ultimately derived from the work of the Belgian psychiatrist Joseph Guislain
Joseph Guislain
Joseph Guislain was a Belgian physician and a pioneer in psychiatry.-Education:Guislain started his medical studies at Ecole de Médicine and he was one of the first students to the University of Ghent; he graduated as a medical doctor in 1819.-Career:In 1828 Guislain became head of the psychiatric...
(1797–1860). In 1833 he published Traité Des Phrénopathies ou Doctrine Nouvelle des Maladies Mentales in which he proposed a complex system of psychiatric classification
Classification of mental disorders
The classification of mental disorders, also known as psychiatric nosology or taxonomy, is a key aspect of psychiatry and other mental health professions and an important issue for consumers and providers of mental health services...
encompassing almost a hundred different mental states. He conceptualised this mosaic of symptoms as arising from any of four consecutive stages in mental disease. These were: "(1) exaltation of the brain's activity, (2) aberration of the brain's structures, (3) oppression of the brain's structures, and (4) exhaustion of psychic energy." For Guislain, what he termed phrénalgie, or mental pain, formed the basis of all mental illness where the "psychic reaction" engendered by "worry, annoyance, pain" or other mental "irritants" brought "physical reactions along with it." Mental illness would then unfold along seven successive stages of progressive deterioration, which he detailed as: hyperphrénie (mania
Mania
Mania, the presence of which is a criterion for certain psychiatric diagnoses, is a state of abnormally elevated or irritable mood, arousal, and/ or energy levels. In a sense, it is the opposite of depression...
); paraphrénie
Paraphrenia
Paraphrenia is described as a group of psychotic illnesses distinct from paranoia and from schizophrenia.. Paraphrenia as a separate disorder is not included in either ICD 10 or DSM IV and is likely to be classified as atypical psychosis, schizoaffective disorder or delusional disorder using these...
(folie); hyperplexie (stupidity); hyperspasmie (epilepsy
Epilepsy
Epilepsy is a common chronic neurological disorder characterized by seizures. These seizures are transient signs and/or symptoms of abnormal, excessive or hypersynchronous neuronal activity in the brain.About 50 million people worldwide have epilepsy, and nearly two out of every three new cases...
); ideosynchysie (hallucinations); analcouthie (confusion
Mental confusion
Confusion of a pathological degree usually refers to loss of orientation sometimes accompanied by disordered consciousness and often memory Confusion (from Latin confusĭo, -ōnis, noun of action from confundere "to pour together", also "to confuse") of a pathological degree usually refers to loss...
); and noasthénie (dementia
Dementia
Dementia is a serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging...
).
Ernst Albrecht von Zeller
Guislain's thesis was taken up by the German psychiatrist Ernst Albrecht von Zeller (1804–1877), who translated his text into German in 1837. Zeller was the medical director of a private asylum at Winnenthal in Württemberg. He would become perhaps the figure most associated with the concept of unitary psychosis in German psychiatry. In 1834 he had already declared that the different varieties of mental illness were simply differing stages in a common morbid process and that "in the course of one case all the main forms of mental disorder may occur". His adoption of the concept of unitary madness was predicated on his belief in the unity of the human soulSoul
A soul in certain spiritual, philosophical, and psychological traditions is the incorporeal essence of a person or living thing or object. Many philosophical and spiritual systems teach that humans have souls, and others teach that all living things and even inanimate objects have souls. The...
or character
Character
- Art and entertainment :* Character , an agent in a work of art, including literature, drama, cinema, opera, etc.* Character , a 1997 Dutch film, based on the novel by Dutch author Ferdinand Bordewijk* Character , by Dark Tranquillity...
and that man was at once composed of both material and spiritual elements. Deriving this belief in part from Naturphilosophie and the influence of anthropology
Anthropology
Anthropology is the study of humanity. It has origins in the humanities, the natural sciences, and the social sciences. The term "anthropology" is from the Greek anthrōpos , "man", understood to mean mankind or humanity, and -logia , "discourse" or "study", and was first used in 1501 by German...
on German psychiatric concepts, he held that it was this fundamental spiritual
Spiritual
Spiritual may refer to:*Spirituality, a concern with matters of the spirit*Spiritual , an African American song, usually with a Christian religious text...
self that was afflicted in madness. For Zeller, both organic and moral (or psychological) causes
Causes of mental disorders
The causes of mental disorders are complex, and interact and vary according to the particular disorder and individual. Genetics, early development, drugs, a loss of a family member, disease or injury, neurocognitive and psychological mechanisms, and life experiences, society and culture, can all...
combined to produce mental illness. The organic causes of mental illness were, he argued, observable in the physical illnesses that preceded its onset. He reasoned, however, that "cases are rare in which the mental disorder is caused by purely organic problems of the central nervous system". Instead, he held that the psychological pain occasioned by remorse, guilt, poverty and social reversal was the universal causal factor in all forms of mental morbidity. Somatic
Somatic
The term somatic means 'of the body',, relating to the body. In medicine, somatic illness is bodily, not mental, illness. The term is often used in biology to refer to the cells of the body in contrast to the germ line cells which usually give rise to the gametes...
and moral factors and the pain attendant on the latter combined variously to produce the four stages of a universal disease: melancholia (the fundamental form of mental disorder which led to the other stages), mania, paranoia and, finally, dementia.
Wilhelm Griesinger
For a period of two years from 1840 Wilhelm GriesingerWilhelm Griesinger
Wilhelm Griesinger was a German neurologist and psychiatrist born in Stuttgart. He studied under Johann Lukas Schönlein at the University of Zurich and physiologist François Magendie in Paris....
(1817–1868) worked as a medical assistant to Zeller at the Winnental Asylum. While there, he adopted and adapted his senior colleague's model of a unitary psychosis. He did not, however, shares Zeller's conviction regarding the nature of the human soul
Soul
A soul in certain spiritual, philosophical, and psychological traditions is the incorporeal essence of a person or living thing or object. Many philosophical and spiritual systems teach that humans have souls, and others teach that all living things and even inanimate objects have souls. The...
or character and its role in madness. A convinced somaticist and commonly considered one of the founders of materialist psychiatry, in the 1845 text which established him as one of the leading scientific psychiatrists of his era, Pathologie and Therapie der psychischen Krankheiten, he conceived of character, or "psychological tonus", as derived from the action of a postulated "psychic reflex action" (psychische Reflexaktion) produced by the stimulus
Stimulus (psychology)
In psychology, stimuli are energy patterns which are registered by the senses. In behaviorism and related stimulus–response theories, stimuli constitute the basis for behavior, whereas in perceptual psychology they constitute the basis for perception.In the second half of the 19th century, the...
of the accumulated representations (Vorstellungen) of the individual's life experience. The concept of psychic reflex action was drawn by analogy from the physiological reflex action of the nervous system in response to a stimulus and he argued that both forms of reflex had the same mode of action and obeyed the same physical laws. Mental illnesses occurred, he posited, when the system of psychic reflex action failed to function correctly and were either diminished, leading to melancholia, or accelerated, leading to mania. His belief was that mental illness was a disease of the brain
Brain
The brain is the center of the nervous system in all vertebrate and most invertebrate animals—only a few primitive invertebrates such as sponges, jellyfish, sea squirts and starfishes do not have one. It is located in the head, usually close to primary sensory apparatus such as vision, hearing,...
but that this in turn was caused by psychological
Psychology
Psychology is the study of the mind and behavior. Its immediate goal is to understand individuals and groups by both establishing general principles and researching specific cases. For many, the ultimate goal of psychology is to benefit society...
factors. His emphasis on the brain as the central site of mental illness has led to his association with the so-called Somatiker (somaticists) who had argued that the causes of mental illness were entirely physical whereas their opponents, the Psychiker, insisted that mental disorders were the result of psychological perversions, moral failings, or diseases of the soul (Seelenkrankheit). As with Zeller, he postulated that melancholia
Melancholia
Melancholia , also lugubriousness, from the Latin lugere, to mourn; moroseness, from the Latin morosus, self-willed, fastidious habit; wistfulness, from old English wist: intent, or saturnine, , in contemporary usage, is a mood disorder of non-specific depression,...
constituted the primary form of mental illness which then passed to mania before terminating in dementia. In his 1861 text Mental Pathology and Therapeutics Griesinger proposed a classificatory division of types of mental anomalies between those characterised by emotional
Emotion
Emotion is a complex psychophysiological experience of an individual's state of mind as interacting with biochemical and environmental influences. In humans, emotion fundamentally involves "physiological arousal, expressive behaviors, and conscious experience." Emotion is associated with mood,...
disturbances and those characterised by disturbances in the intellectual and volitional
Volition (psychology)
Volition or will is the cognitive process by which an individual decides on and commits to a particular course of action. It is defined as purposive striving, and is one of the primary human psychological functions...
functions. He argued, based on his observation of cases, that the former condition preceded the latter where disorders of the intellect and will appeared "only as consequences and terminations" of disturbances of the emotions if "the cerebral affliction has not been cured". These two categories thus constituted, for Griesigner, "the different forms [and] the different stages of one morbid process". The general trajectory of this mental pathology tended towards "a constant progressive course, which may even proceed to complete destruction of the mental life". Greisinger maintained his belief in unitary psychosis until the 1860s.
Heinrich Neumann
The greatest defender and the most radical proponent of the concept of unitary psychosis in the 19th century was the German psychiatristPsychiatrist
A psychiatrist is a physician who specializes in the diagnosis and treatment of mental disorders. All psychiatrists are trained in diagnostic evaluation and in psychotherapy...
Heinrich Neumann (1814–88). Switching from general medicine to psychiatry in the 1850s, he became the owner of a private psychiatric clinic and from 1874 to 1884 he attained the post of medical director at a university-based clinical ward in the Breslau city hospital (now Wroclaw
Wroclaw
Wrocław , situated on the River Oder , is the main city of southwestern Poland.Wrocław was the historical capital of Silesia and is today the capital of the Lower Silesian Voivodeship. Over the centuries, the city has been part of either Poland, Bohemia, Austria, Prussia, or Germany, but since 1945...
in Poland
Poland
Poland , officially the Republic of Poland , is a country in Central Europe bordered by Germany to the west; the Czech Republic and Slovakia to the south; Ukraine, Belarus and Lithuania to the east; and the Baltic Sea and Kaliningrad Oblast, a Russian exclave, to the north...
). He was succeeded by his former medical assistant, Carl Wernicke, a noted neuropsychiatrist. In his Lehrbuch der Psychiatrie (Textbook of Psychiatry) of 1859 he rejected any attempt at psychiatric classification as "artificial". He asserted that, "There is only one type of mental disorder. We call it madness (Irresein). Insanity does not possess different forms but different stages; they are called insanity (Wahnsinn), confusion (Verwirrheit), and dementia (Blödsinn)." Neumann exceeded the position of previous adherents of the unitarian concept by propounding not simply a continuum among diseases but also between disease and health. Thus, he argued that, "sleeplessness, illusions, exaggerated sensitivity ... cause illness, then madness, confusion, and dementia". The proposed mechanism underlying this process was what Neumann termed "metamorphosis" which referred to a disturbance in consciousness
Consciousness
Consciousness is a term that refers to the relationship between the mind and the world with which it interacts. It has been defined as: subjectivity, awareness, the ability to experience or to feel, wakefulness, having a sense of selfhood, and the executive control system of the mind...
that led to errors in the interpretation of sensations. For Neumann an overabundance of stimulation produced mental irritation and mania. As this depleted mental energy it could then result in hallucinations. The medical historian Eric Engstrom has argued that Neumann's proposal to subsume the entire range of diverse psychiatric symptomatology into the concept of Einheitspsychose had the virtue of flexibility in its capacity to absorb any system of psychiatric classification. Engstom has also noted that the concept supported calls for the early committal to asylums of all potential patients as it did not link the likelihood of remission to disease classification but rather argued for early intervention to prevent the onset of chronic mental disability. Its wider support among asylum-based alienists
Psychiatry
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...
(as medical practitioners in mental hospitals were then known) as opposed to academic psychiatrists was due to the fact that it was more applicable to the unhurried tempo of asylum routine where, unlike in university clinics, there was no perceived need for rapid diagnosis
Diagnosis
Diagnosis is the identification of the nature and cause of anything. Diagnosis is used in many different disciplines with variations in the use of logics, analytics, and experience to determine the cause and effect relationships...
. Equally, medical formation in the asylum setting was focused on protracted clinical observation rather than the formal pedagogy of a standardised university curriculum.
Karl Ludwig Kahlbaum
From the 1860s the concept of unitary psychosis and its advocates came under increasing criticism. Karl Ludwig KahlbaumKarl Ludwig Kahlbaum
Karl Ludwig Kahlbaum was a German psychiatrist. In 1855 he received his medical doctorate at Berlin, and subsequently worked as a physician at the mental asylum in Wehlau. For a period of time he was also a lecturer at the University of Königsberg , and from 1867 was director of the mental...
(1829–1899), a German psychiatrist of seminal importance in the development of the modern nosology and a formative influence on the work of Emil Kraepelin
Emil Kraepelin
Emil Kraepelin was a German psychiatrist. H.J. Eysenck's Encyclopedia of Psychology identifies him as the founder of modern scientific psychiatry, as well as of psychopharmacology and psychiatric genetics. Kraepelin believed the chief origin of psychiatric disease to be biological and genetic...
, had taken issue with Neumann's assertion in his 1859 text that mental illness could not be categorised into discrete disease entities. Kahlbaum fashioned a response in 1863 with the publication of his Die Gruppierung der psychischen Krankheiten (The Classification of Psychiatric Diseases). This text delineated four distinct types of mental illness (vesania): vesania acuta, vesania typica, vesania progressiva and vesania catatonica. He asserted that the unitarian position signalled the "end to all diagnosis in the field of psychopathology." For Kahlbaum, Neumann's failure to engage in any attempt at disease classification, his rejection of diagnosis as abstraction and his focus only upon the individual manifestation of mental illness constituted an enterprise without any scientific validity. In the absence of meaningful and acute diagnostic categories in psychiatry Kahlbaum believed that both the development of effective therapeutic practices and the knowledge of mental illness would run stagnant.
Emil Kraepelin
During his inaugural lecture following his appointment to the chair of psychiatry in Dorpat University in 1887, Kraepelin contended that Zeller's notion of unitary psychosis had led to the calcification of clinical research in Germany until as late as the 1860s. The revival of a more objective clinical approach built upon observation, he contended, had had to await the contribution of researchers such as Ludwig Snell who wrote on monomaniaMonomania
In 19th century psychiatry, monomania is a single pathological preoccupation in an otherwise sound mind. Emotional monomania is that in which the patient is obsessed with only one emotion or several related to it; intellectual monomania is that which is related to only one kind of delirious idea...
as a distinct disease entity in the 1870s. Kraepelin's approach to classification of mental illness was based on longitudinal studies of symptoms, course and outcome. He concluded from his studies that there were only two major forms of serious mental illness: dementia praecox
Dementia praecox
Dementia praecox refers to a chronic, deteriorating psychotic disorder characterized by rapid cognitive disintegration, usually beginning in the late teens or early adulthood. It is a term first used in 1891 in this Latin form by Arnold Pick , a professor of psychiatry at the German branch of...
and manic depression
Bipolar disorder
Bipolar disorder or bipolar affective disorder, historically known as manic–depressive disorder, is a psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood with or without one or...
. This division of the psychoses, currently enshrined in modern classification systems as that between schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
and bipolar disorder
Bipolar disorder
Bipolar disorder or bipolar affective disorder, historically known as manic–depressive disorder, is a psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood with or without one or...
and referred to as the Kraepelinian dichotomy
Kraepelinian dichotomy
The Kraepelinian dichotomy refers to the division of the major endogenous psychoses into the disease concepts of dementia praecox, which was reformulated as schizophrenia by Eugen Bleuler in 1911, and manic-depressive psychosis, which has now been reconceived as bipolar disorder. This division was...
, has remained in place for more than a hundred years.
20th-century revivals
Variations of the unitary psychosis thesis have been revived occasionally during the 20th century. These have generally taken the form of statistical analyses that purport to demonstrate that the Kraeplinian division is unstable. In the modern era the concept of schizoaffective psychosisSchizoaffective disorder
Schizoaffective disorder is a psychiatric diagnosis that describes a mental disorder characterized by recurring episodes of elevated or depressed mood, or of simultaneously elevated and depressed mood, that alternate with, or occur together with, distortions in perception.Schizoaffective disorder...
, which straddles the Kraepelinian divide, when delineated as a condition sharing a common causal pathway as both schizophrenia and affective psychosis, shares aspects of the more radical notion of unitary psychosis in regarding the individual psychoses as points on a continuum.
Klaus Conrad
Klaus Conrad (1905-1961), a German neuropsychiatrist and a member of the Nazi party from 1940, became convinced that there was only one endogenousEndogenous
Endogenous substances are those that originate from within an organism, tissue, or cell. Endogenous retroviruses are caused by ancient infections of germ cells in humans, mammals and other vertebrates...
psychosis based partly upon his observation that cyclothymic
Cyclothymia
Cyclothymia is a mood and mental disorder in the bipolar spectrum that causes both hypomanic and depressive episodes. It is defined medically within the bipolar spectrum and consists of recurrent disturbances between sudden hypomania and dysthymic episodes. The diagnosis of cyclothymic disorder is...
patients, or those suffering from affective psychosis
Mood disorder
Mood disorder is the term designating a group of diagnoses in the Diagnostic and Statistical Manual of Mental Disorders classification system where a disturbance in the person's mood is hypothesized to be the main underlying feature...
, often sired schizophrenic children. He also held the belief, derived from his clinical experience, that symptoms associated with particular diagnostic categories were fluid and that a patient could, for instance, exhibit signs of mania or depression which might then reappear periodically and subsequently develop delusions and undergo a deterioration in personality. Likewise, symptoms thought to be characteristic of schizophrenia, such as delusions, hallucinations and catatonia
Catatonia
Catatonia is a state of neurogenic motor immobility, and behavioral abnormality manifested by stupor. It was first described in 1874: Die Katatonie oder das Spannungsirresein ....
, were, he alleged, also found in depression and mania. Conrad also contested the then established classificatory division between the endogenous
Endogenous
Endogenous substances are those that originate from within an organism, tissue, or cell. Endogenous retroviruses are caused by ancient infections of germ cells in humans, mammals and other vertebrates...
and exogenous
Exogenous
Exogenous refers to an action or object coming from outside a system. It is the opposite of endogenous, something generated from within the system....
psychoses or, respectively, psychoses of internal or external origin, as whether the disease causing agent was "physical exhaustion or heightened emotion" it "attacked the same structure, physiological mechanism, biological metabolism". Conrad, a proponent of Gestalt psychology
Gestalt psychology
Gestalt psychology or gestaltism is a theory of mind and brain of the Berlin School; the operational principle of gestalt psychology is that the brain is holistic, parallel, and analog, with self-organizing tendencies...
, is typically characterised as having expounded a view of psychosis that is commensurate with the mid-19th century psychiatric concept of unitary psychosis.