Emil Kraepelin

Zdorovye - - ВЕЛИКИЕ МЕДИКИ -

Emil Kraepelin, a giant of medicine, founder of a scientific school, one of the world's leading eminent psychiatrists, had a negative attitude towards psychoanalysis. His ideas improved psychiatric perception as the entire psychiatry of the late nineteenth century and the first quarter of the twentieth century was built basing on his ideas.

Emil Krepelin was born on February 15, 1856. In 1873 he entered the Faculty of Medicine of the University of Wь­rzburg. While being a student, he attended the Wurzburg Psychiatric Clinic daily. In 1878, Krepelin graduated from the University, then he worked as an assistant in psychiatric clinic in Munich and Leipzig, where he was supervised by psychologist Wundt and electrophysiologist Erba, who followed the pieces of advice given by psychiatrist Goodden. Krepelin was fascinated by the theory of Kant Laplace. The first work on psychiatry was performed in 1882. It was a competitive essay on the topic "The impact of acute diseases made on the emergence of mental illness".

Duin the next years, Kerpelin was strongly influenced by Wundt's experimental and psychological research. He published a number of works on the introduction of experimental psychological techniques in a psychiatric clinic to combat alcoholism. In 1883, Krepelin, being an Associate Professor at the University of Leipzig, became aware of Wundt's recognition that his true intention was clinical psychiatry. Wundt defined the circle of psychological interests of 27-year-old Krepelin and the main themes of the works that were carried out under his auspices. Following the proposal of Wundt, Krepelin began to write his "Compendium" on psychiatry that was the first version of his world-famous "Textbook of Psychiatry." This brief grant as a result of subsequent processing turned into a guide where, starting with its fifth edition (1896), Krepelin's nosological concepts developed from. In a while, being convinced that in the first period of his activity he ccontributed too much efforts hoping that the clinical psychiatry is able to meet the needs of experimental psychological method, Kreplyin wrote: "Psychological methods, unfortunately, are still too far from the general methods of research".

Having received the degree of professor in 1886, Krepelin in that same year holds the post of head of the department of psychiatry at the University of Dorpat called Tartu, replacing Emmingaus in this post, whose lectures he listened to in Wь­rzburg. The University was founded in 1802, its predecessor - the Gustavian Academy was founded in 1632. On the basis of the university Krepelin deployed experimental psychological research. Vikentiy Vikentevich Veresayev (1867-1945), a writer and doctor who graduated from the Faculty of Philology of the University of St. Petersburg (1888) and the Medical Faculty of the University of Dorpat in 1894, listened to the lectures of Krepelin, wrote in his

recollections:

"The famous psychiatric professor Emil Krepelin, who was not really aged, thirty-five year old man with a chestnut brown beard and intelligent eye-catching eyes, was particularly prominent at that time. Subsequently, he acquired world-renowned first-class psychiatrist, who had made radical reformations in all clinical psychiatry ...

... They brought a mental patient Krepelin, carefully looking, began to ask questions, and in our eyes, as a highly masterful product, the common overview of this illness began to appear vividly. And the conclusion drawn by the professor concerning the illness was intened for the listeners to be natural and necessary for the resulting outcome of all inquiries of the patient. "

During the Russification of the University, he was forced to leave his place of residence with the famous surgeon Bergman and other scholars. Tsarist Russia was not able to appreciate this man, the teachers of all Russian psychiatrists. In 1891 he founded his school at the ancient Heidelberg University, founded in 1386. Finally, in 1903, he created his school at the University of Munich, founded in 1472.

During the difficult years of World War I Crepelin created the Research Psychiatric Institute in Munich; In 1922, he created a department there and dedicate his time to work. The Munich clinic, led by Krepelin since 1903, was the same place of pilgrimage of doctors as the Salpetrierskaya during the time of Eskorol, and later - in the era of Charcot. On the benches of the audience emerging on the Goethe-StraЯe, the Russians were interspersed with the British and the Japanese, and the doctors of the Scandinavian countries near the inhabitants of Naples and South America. Soon, France, which is fairly proud of its brilliant achievements at the beginning of the nineteenth century, admitted that the German science in the face of Krepelin achieved the highest synthesis of psychiatric knowledge prepared by all the previous course of development of science. As a result, French scholars began to come to the famous "refresher courses" in Munich, where every psychiatrist dreamed of reaching.

Crepelin's merit is the development of a clinic for mental illness and its classification, which was based on the descriptive symptomatology principle prevailing in psychiatry at the end of the XIX century. The basis of its system Krepelin laid the course and outcome of the disease, taking into account the etiological and pathological anatomical data. Emphasizing that the same manifestations can occur in various diseases, Krepelin correctly pointed out that individual symptoms (delusions, hallucinations, etc.) are not the only basis for the division of psychoses. He identified independent nosological units: an early dementia, later named Blailler with schizophrenia and manic-depressive psychosis, and sharply limited the scope of paranoia.

In the meantime, Krepelin and Blairer paid attention to the sharp initial phases of schizophrenia. In their studies, schizophrenia is generally discussed as the condition of the current disease, its clinic nature (mainly Krepelin), and psychopathology (predominantly Blailler). Giving the description of the symptoms of schizophrenia, Krepelin precedes the remark that "... the most important disorders in the express form are found in the purest form in the final states where the transient phenomena accompanied by the painful process are displaced by long and typical changes in the psychic life." Describing the clinical stage for early dementia, Krepelin estimates the violent pictures of his acute debuts as random and "transitory phenomena." In the following statement he does not pay attention to these phenomena, fixing it on changes "long and typical".

Crepelin's merit is the development of a clinic for mental illness and its classification, which was based on the descriptive symptomatology principle prevailing in psychiatry at the end of the XIX century. Stripping down to the basis of this system Krepelin laid the course and outcome of the disease, taking into account the etiological and pathological anatomical data. Emphasizing that the same manifestations can occur in various diseases, Krepelin correctly pointed out that individual symptoms (delusions, hallucinations, etc.) are not the only basis for the division of mental disorders. He

identified independent nosological units: an early dementia, later named Blailler with schizophrenia and manic-depressive psychosis, and sharply limited in the scope of paranoia.

Eugene Bleiler, professor of psychiatry at the University of Zurich, along with Emile Krepelin paid attention to the matters of early dementia. Blair gained the reputation of a brave man. He publishes his discoveries in no hurry, probing the situation, always documented, never hurting Krepelin and his zealous fans, Krepelin was interested in the form, the type and the category of the disease; Blealer drew attention to the patient's mind. Krepelin emphasized the importance of heredity and the constitution in the emergence of a mental illness and, thus, predestination of psychosis.

The main merit of Krepelin is the development of a classification of mental illness, which is the basis of the present. He is the author of one of the most outstanding textbooks on psychiatry, Clinical Psychiatry, which survived eight life-long editions (1909-1915), which provided an exhaustive classification of mental illnesses. The last, 8th edition of his Textbook, published in 1915, represented something exceptional in its size (3000 pages) and absolutely unbelievable in abundance of material - the invisible achievement of one person in the history of psychiatry. Above we said that at the beginning of his scientific path Krupelin sought to establish all psychiatry in experimental psychology. Over the years, this trend has gradually decayed. In later editions of the Textbook (7th and 8th) psychology occupies an honorable but purely decorative place.

In "Textbook" a lot of space is reserved for absurd actions of schizophrenics. Krepelin describes the patient who wants to smoke: he sees the stomach on the ground and jumps behind him from the second floor. By surprise, some cases have anecdotal character. At the next reception at the dentist, the patient stated that he would be treated only if he put on a gas mask. In another story, the driver of the bus, in the middle of the flight, stopped the car, broke up, hung the socks on the radiator, sat down on the pavement, lit and told the passengers that "he has the right to rest."

Leaving the department in 1922, Krepelin worked at the Munich Psychiatric Institute founded in 1917. Krepelin is a strict empiricist and convinced clinician, a father of modern psychiatric nosology (doctrine of illness). The original nosological concept, which was a bit straightforward and mechanistic, was based on the principle of "the same causes - the same consequences". Nosological forms of the diseases were characterized by the unity of causes, symptoms, course, outcome and, if possible, pathoanatomical substrate. Later he corrected this theory in many aspects. For example, he recognized the importance of age and gender of patients, personal and environmental factors, as well as the possibilities of individual responses to form a clinical picture of psychosis. As a result of this revision, the doctrine of the registers of mental activity, which manifests mental illness, has remained valid for the present. The main achievement of Kruphelin's systematics was the isolation of two forms of endogenous psychoses (manic-depressive psychosis and schizophrenia), differing from each other in terms of symptoms, flow and prognosis. His nosological system has gained a general recognition, despite the strong criticisms.

Even though Krephelin was appreciated for straightforwardness, frankness, simplicity, honesty, he did not like diplomacy and roundabouts. He seemed harsh at the first glance, but he was internally responsive and kind. In the same way, he was in a relationship with the mentally ill partner who loved him, despite his external severity. He was a great master, even an artist, when he talked to a sick person, while he was cramping, sometimes even rough with the sick. He was able to cheat the patient, obtain from him what is necessary for the diagnosis. As a scientist he worked slowly, but thoroughly, without aplomb. He did not like the noise around his name. In old age he remained as vigorous, fresh as he was in his youth, he retained the same love for science and for medical work.

When he was 70, he refused to honor the celebrations that friends and students were planning to organize. At its request, the festival did not take place on that day. He ordered that, after his death, there would be

no loud praises in his address, praise of his personality and his activities; so that only a circle of the people closest to him would have seen his coffin without any noise.

Krepelin died on October 7, 1926, before he managed to edit the 9th edition of his textbook, which expanded to this time to a monumental (volume of more than 3000 pages) manuals.

After Krepelein's death, critical articles appeared. A characteristic article belongs to Ostwald Bumke (Bumke, 1877-1950), a German psychiatrist and neuropathologist, who was invited to take Krepelin to head the department of psychiatry in Munich, who wrote the article "Culture and degeneracy" (1922). Once Bumka said that all the modern psychiatry was on the shoulders of Krepelin that the Krepelin system of mental illnesses (nosological classification) went through a triumphal procession through the whole world, and in a few years he also stated that the Krepelin school had reached the limit of its capabilities and, moreover, that there were almost none of the dogmatists of this school.

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