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 Table of Contents    
BOOK REVIEW  
Year : 2011  |  Volume : 53  |  Issue : 3  |  Page : 281-282
Schizophrenia - A Myth Analysis of the mighty maze of mind - In Kraepelinian Era


Department of Psychiatry, L. T. M. Medical College and General Hospital, Sion, Mumbai, Maharashtra, India

Click here for correspondence address and email

Date of Web Publication29-Oct-2011
 

How to cite this article:
Shah N. Schizophrenia - A Myth Analysis of the mighty maze of mind - In Kraepelinian Era. Indian J Psychiatry 2011;53:281-2

How to cite this URL:
Shah N. Schizophrenia - A Myth Analysis of the mighty maze of mind - In Kraepelinian Era. Indian J Psychiatry [serial online] 2011 [cited 2020 Nov 28];53:281-2. Available from: https://www.indianjpsychiatry.org/text.asp?2011/53/3/281/86828



Authors: K. C. Gurnani

Publisher name and Address: Indian Academy of Clinical Psychiatry,

Department of Psychiatry, S. N. Medical College, Agra, India.

Published in January 2011, first edition

Pages: 420, Price: 1,500/-




"Whenever I have seen people talking about schizophrenia, two things have always struck my mind. First, do we have any laboratory-based diagnostic tool by which we can diagnose it today? Secondly, if we go by the clinical description, we are diagnosing schizophrenia by certain criteria; but even at the very outset of interpreting those criteria, it is a must that those features should not be explainable by other diseases like manic depressive disorder. Are we diagnosing what Kraepelin had advocated or have we come around to the opposite end where we have created a totally different illness?"

This quest has enthused professor Gurnani to review, re-examine and re-evaluate the extensive literature on schizophrenia of the past centuries and look at the formation and transformation of concept of schizophrenia in that Kraepelinian era. Like many others in the field, he has also questioned, on several grounds, the division of cases into dementia praecox and manic depressive insanity by Kraepelin.

In the very first of the 17 chapters of the book, "Understanding the mighty maze of mind", Professor Gurnani has dwelled upon the fallacies of the dichotomy created by Kraepelin. The second chapter "A brief appraisal of schizophrenia" questions the very existence of this disorder with a number of case excerpts. In order to understand where did Kraepelin and others including the psychiatrists of the 20 th century go wrong, he has with due respect criticized the great visionary Kraepelin in the third chapter "A short sketch of Kraepelin". To further shed light on the concept of Kraepelin, the next four chapters (4. Catatonia and Hebephrenia as understood by Kraepelin, 5. Understanding about catatonia before its inclusion under dementia Praecox, 6. Hebephrenia as described by Ewald Hecker, and 7. Some concepts which were overlooked) examine at length the fallacies in the concepts of catatonia and hebephrenia.

Professor Gurnani asserts, "If we are able to find out the fault, we will not repeat the mistakes, but if we are not able to find out the faults, we may make certain new concepts but with a risk that we may commit the same mistakes again. Hence, this fault finding is important". So, the next chapter (8. Understanding about insanity before Kraepelin) is devoted to the concept of "insanity - as it was understood in the nineteenth century". Having examined the concept, Professor Gurnani has analyzed the classification proposed by Kraepelin in the next chapter (9. An analysis of Kraepelin's classificatory system). One of the important scientific concepts which Kraepelin had chosen was the concept of autointoxication which is analyzed in Chapter 10 (Theories of auto-intoxication, fatigue and neurasthenia.
"Kraepelin had not provided any definite clinical features for dementia praecox and which had also contained description of certain vague terms of behaviour, the concepts of Kraepelin started a new line of thinking, in which persons displaying a variation of normal behaviour as well as certain abnormal behaviour which otherwise could have fallen under some minor aberrations of the personality, were being included in this category of schizophrenia; with the result that many normal persons found themselves behind the high walls of those mental asylums for many reasons". Thus, Chapter 11 looks at the impact of Kraepelin's doctrine at the dawn of 20th century.

Alongside the concepts of Kraepelin, there were number of other concepts and doctrines which did not get much attention and ultimately disappeared completely into oblivion. It might be a good idea to learn about those doctrines as well. A little glimpse of the history of psychiatry prior to 19 th century in "The collective unconscious of mental disorders" (Chapter 12) clarifies certain points.
"If we are to understand the psych of Kraepelin, which should have shaped his understanding about insanity, it is important that we take a little glimpse of the situation of those asylums, and also a little of standards of medical curriculum, especially as regards the situation in Germany. Chapters 13, 14 and 15, deliberate on "The social and cultural situations of nineteenth century", "Conditions of mental asylums during the last of nineteenth century" and "Standards of medical curriculum in psychiatry", respectively.

The last two chapters (16. Introduction of Kraepelin to America by Adolf Meyer & August Hoch and 17. The American psychiatry at the dawn of twentieth century) look at how Kraepelin's formulations were accepted widely in America, and that way, the entire world over without much challenge.

Dr. Gurnani states "I don't know if this book is going to be useful to change the way patients are being diagnosed today in psychiatry. I don't know if it is going to make some progress in the field of psychiatry and the science in general. I don't know if this book is going to be recognized even, and I also do not know if it is going to be worth for all those pains which have been endured for this piece of work".

All those who like reading history of psychiatry and would like to know how the concept of schizophrenia was developed by Kraepelin and about its critical evaluation would enjoy reading this book. Dr. Gurnani has drawn our attention to one side of the coin and it is quite natural for the readers, while reading this book, to think about the other side of the coin as well. In a debate on this topic, one may be able to argue with the same conviction and draw attention to a number of points which would justify the existence of disorders called schizophrenia and manic depressive disorder as two separate entities, as suggested by the astute clinician Kraepelin.

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Correspondence Address:
Nilesh Shah
Department of Psychiatry, L. T. M. Medical College and General Hospital, Sion, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


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