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要旨:
In the last third of the 20th century, the German psychiatrist Emil
Kraepelin (1856-1926) became an icon of postpsychoanalytic medical-model
psychiatry in the United States. His name became synonymous with a
proto-biological, antipsychological, brain-based, and hard-nosed
nosologic approach to psychiatry. This article argues that this
contemporary image of Kraepelin fails to appreciate the historical
contexts in which he worked and misrepresents his own understanding of
his clinical practice and research. A careful rereading and
contextualization of his inaugural lecture on becoming chair of
psychiatry at the University of Tartu (known at the time as the
University of Dorpat) in 1886 and of the numerous editions of his famous
textbook reveals that Kraepelin was, compared with our current view of
him, 1) far more psychologically inclined and stimulated by the exciting
early developments of scientific psychology, 2) considerably less
brain-centric, and 3) nosologically more skeptical and less doctrinaire.
Instead of a quest for a single "true" diagnostic system, his
nosological agenda was expressly pragmatic and tentative: he sought to
sharpen boundaries for didactic reasons and to develop diagnoses that
served critical clinical needs, such as the prediction of illness
course. The historical Kraepelin, who struggled with how to interrelate
brain and mind-based approaches to psychiatric illness, and who
appreciated the strengths and limitations of his clinically based
nosology, still has quite a bit to teach modern psychiatry and can be a
more generative forefather than the icon created by the
neo-Kraepelinians.
